1. Peer Review in a Union Environment Jody Charles, MSN, RN Cathy Patton, MA, RN Chris Tarver, MS, RN, CNS January 10, 2013

2. History of Peer Review PRN – union over 30 years Just for RNs, just at ECH 1 st Designation Submittal 2005: Absolute refusal of union to discuss Documentation submitted included communication between CNO and President regarding Peer Review Surveyors met privately with the union during site visit 2

3. History (cont). 2 nd Designation Submittal 2009: On advice of ANCC Consultant, looked at Peer Review in form of direct care nurse feedback Submitted in documentation competency check offs and various audits done by direct care nurses on other direct care nurse’s practice A bit of a stretch 3

4. In prep for 3 rd Submittal 2014 Our CNO, Diana Russell, wanted to elevate peer review Presentation by CNO to Union Board Research on benefits presented Explanation of peer review in a union setting Union strong stance regarding education of all RNs who were going to be asked to give feedback Agreement reached... When leadership committed to educational plan with union input 4

5. Where to Begin? Magnet requirement: “Peer Review at all levels” The beginning work is focused on the Direct Care Nurses 5

6. Start up... Selection Committee Leadership Manager from each campus asked by the CNO Nursing Education Manager “Consultant/Facilitator” Selecting of the Peer Review model/resource We had relationship with Barb Haag-Heitman 6

7. Recruiting Feb 2011: CNO presented to CPC the agreement with PRN and what Peer Review entails Recruiting of direct care nurses “All RN” flier/email & “In Touch” Message Message to: Call Nursing Ed Manager for details Presentation to managers at Nursing Leader Council 7

8. First meeting of committee Sept 2011 1 st meeting Clinical Ladder process comparison to peer review (exemplars) – gave the DCN a point of reference from past practice Distribution of book: Peer Review in Nursing Given task to read the book 8

9. 2 nd Meeting of Group Oct 2011 2 nd Meeting Discussion of pilot unit criteria Discussion of policies and procedures Very important to CNO and union that the nurses developed their process so that they could promote it Direct Care Nurses able to say what they wanted and didn’t want in a process 9

10. 3 rd Meeting – November 2011 Barb Haag-Heitman brought in to meet with committee members in full-day session Agenda included: Developed vision and goals DESC Model Selected Direct Care Nurse co-chairs went around room, and offers made to lead; vote taken Met with managers at conclusion 10

11. ECH Peer Review Committee Vision “Leading the nursing community in promoting the highest standards of patient care through the peer review processes.” 11

12. ECH Peer Review Committee Goals 1.Create sustainable peer review process to promote professional nursing practice at ECH. 2.Increase individual and group accountability for positive patient outcomes. 3.Foster a healthy work environment. 4.Create supportive learning relationships. 12

13. DESC Model (B. Haag-Heitman) Describe Express Suggest (Positive) Consequences Examples... 13

14. Development of Process Details Very important to nurses to have peer review not be included in performance appraisal process Selected pilot unit at each campus Everyone would be expected to participate Change in DCN leadership in Feb 2012 one-on-one conversation with manager facilitator and DCN leader replaced with DCN leader who was former CPC chair 14

15. Spring 2012 Several meetings on education for Committee about DESC model: Allowed members to get feedback from colleagues on the model Education plan discussed and developed 15

16. Summer 2012 Meeting with CNO to review implementation plan in order for CNO to present to union Quarterly plan of a focused competency per quarter based on nursing strategic plan 16

17. Each Quarterly Cycle Early in First month of quarter: competency distributed 1 st - 2 nd month of quarter: complete peer review and turn competency into unit champion; review UPC 3 rd month of quarter: bring to CPC 17

18. Accepted Education Plan Barb Haag-Heitman returned Mandatory for pilot units; open to all DCN 2 hour classes; both campuses Manager of Nursing Education taught four make up sessions 18

19. Unit Binders DCN leaders wanted to create this Resource for each unit, includes: Articles on Peer Review Competency Tools Barb Haag-Heitman’s Powerpoint Vision and Goals of Committee 19

20. First Project Med Admin Competency Related to our Bar Coding Medication Administration initiative HCAHPS data on med communication Barb Haag-Hietman suggested must have pre and post data to show that peer review made a difference Coached us on creating competency with strong focus 20

21. Lessons Learned Selection of Pilot Unit: data difficult to obtain for first project selected for pilot units Need to assess: Does unit have another major project happening? Back up plan for nurses unable to attend mandatory training 21

22. Questions? Jody Charles Jody.Charles@elcaminohospital.org THANK YOU!! 22