Ethical Considerations for Nursing Peer Review
Appraising the job performance of nursing peers is a big responsibility. A Senior Nurse Scientist at Cleveland Clinic shares the potential pitfalls and ways to avoid them.
Peer reviews have long been valued in nursing to assess professional performance, with nurses and other caregivers submitting themselves to a panel of peers for appraisal. In 1988, the American Nurses Association (ANA) released peer review guidelines. Healthcare organizations are required to have systematic peer review practices to attain Magnet® designation. There are many benefits of the peer review process; but peer reviews are not without peril.
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“In healthcare organizations, peer reviews are typically used to assure clinicians meet minimum clinical or professional ladder criteria, support ladder progression to the next level and provide a fuller picture of the previous year’s performance during the annual review,” says Sandra L. Siedlecki, PhD, RN, APRN-CNS, FAAN, Senior Nurse Scientist in the Office of Nursing Research and Innovation at Cleveland Clinic. “However, when using a peer review process for job performance assessments, there is a potential for ethical violations.”
In an article on the ethics of peer review in Nursing2015, Siedlecki delved into the possible pitfalls of peer review for appraising professional performance, but the pitfalls also apply to reviewing manuscripts, research proposals and grant submissions. Her assertions still hold true today.
The peer review process should be fair, producing an unbiased evaluation of a person’s performance. Unfortunately, it doesn’t always meet this high standard. “Peer review is meant to improve the process rather than having a single person – your manager – deciding everything,” says Siedlecki. “But it’s not foolproof because we are dealing with people.”
Here are a few problems that may occur:
One of the best ways to ensure that peer reviews for job performance appraisals are fair and unbiased is to educate nurses on the process. “Most nurses have never been taught the basic rules of performing meaningful peer reviews; they don’t understand the ethics involved,” says Siedlecki. There are many articles devoted to the peer review process in publications such as the Journal of Nursing Education and online content provided by the ANA. Numerous organizations also offer continuing education courses on peer review.
In addition, it’s critical to develop pre-established criteria for the review process. “Having set criteria helps maintain fairness and reinforces that it is not acceptable to compare people,” says Siedlecki. “Instead, each person who submits materials should stand alone against the predetermined criteria.”
Finally, although peer reviewers can appraise a person and make recommendations, they should not make the final decision; the peer review is simply one part or aspect of the review process. The final review should be completed by a nurse manager, director or other leader.
Although the peer review process can present challenges, it’s a practice worth committing to, says Siedlecki. “Don’t give up on it! The process provides a good opportunity to experience what it’s like to be peer reviewed and to review others,” she says. “It’s a big responsibility, but an opportunity to grow, too.”