New-Hire Orientation Peer Review Topic

[bendyprissy]

Am in the process of going through new-hire orientation at a Magnet hospital. Have been an RN for one year. During the Risk Management speech/portion of orientation the CNO comes to speak and states that we (nurses) should not think of Peer Review as a bad thing but should think of it as a good thing because should the patient sue over an adverse event, and the nurse has been through the Peer Review process and found to have done everything a prudent nurse would have done, then it will only help the nurse in court. She stated that every time a nurse does something wrong then she/he is put through the Peer Review process and most of the time the nurse is found to have done what she/he should have done and it is used as a teaching opportunity but on occasion they are made aware of circumstances where they have to alert the BON.

Ok, now even though I have been a nurse for one year, I cannot guarantee I will never make a mistake in my entire nursing career, that is ridiculous. The thought of going through the Peer Review process for every mistake, which could in turn, possibly send me in front of the BON, threatening my license, now has me terrified.

Is it normal for a hospital to do this or is this extreme? My previous hospital was not at all like that, not that they tried to hide anything. What do you all think? Should I be worried? Should I start looking elsewhere seeing as I just got there?

[classicdame, MSN, EdD]

In Texas peer review is mandatory for certain events. In some instances the nurse has to be reported immediately (like injuring a patient on purpose) and in other events the committee meets first, then decides if the report meets BON criteria. Like the CNO said, if something occurs and you are deemed "innocent" then that will be to your advantage. The CNO may be obligated by state law to report. Most do not take the time to explain to nurses however, and I take that as a positive thing. It is like saying , "well, just in case you get sued here is how malpractice insurance works". You may never be sued and you may never have an incident worthy of peer review, but now you have an idea how these two systems work.

[dishes, BSN, RN]

I prefer working in an environment where the risk management process is transparent and standardized. I wouldn't be concerned about working in this environment, I would welcome it, as it seems like it could promote patient safety culture.

[bendyprissy]

You two are probably right and I am probably just concerned with the unfamiliar.

[ptrad]

Peer Review is in place to hopefully protect the RN, promote patient safety and to cut down on errors. However, in my experience, I have found it to be more like being thrown under a bus by my peers. The floor I last worked on tended to report any errors to management before discussing the error w/the nurse. That did not develop good morale on the floor and in fact 7 RN's left in 6 weeks. Management cannot figure out why. :) I want to point out that I worked nights and we often worked with a shortage of nurses and CNA's on this very busy floor, hence, it could be very rushed. We did not take breaks in our 12 h shifts. It was very high acuity. Promises were made, promises were broken.

I believe we need to encourage and uplift one another w/in safe boundaries. It does not mean that we let a patient be injured, or over medicated, but that we help each other out so that those errors can be avoided. A wise instructor reported that most errors occur due to a cumulation of events, not just one event, but that the blame, although from cumulative events, usually is placed on the person closest to that error.

JCO would have a field day on the floor I just left - lights were out in patient rooms due to burned out bulbs, (fall risk), computers w/o ground plugs (the ground had broken off) - electric shock risk, and management had no clue. But management was all about reporting on one another. I was given 5 weeks (3 on the floor & 2 in hospital orientation) to be prepared to take on a full load on this floor - I'm a new grad w/experience in telemetry - this was an intermediate med/surg floor in a new hospital environment. It was not a safe environment and management was not supportive or encouraging, nor did they fulfill orientation needs that were promised. Was the peer report extreme here? Absolutely! It was a blood bath.

I don't think it has to be a negative experience; very dependent on the managment. All the best to you.