Comprehensive Peer Review: Exploring the Impact on Nurse Engagement


Lower levels of work engagement are associated with higher turnover intent (Memon et al., 2016), and nursing turnover has both financial and quality implications. The cost of replacing one nurse ranges from $37,700 to $58,400 for nurses that require advanced skills and training (Nursing Solutions, 2016). Reduced experience at the bedside may mean fewer nurses are in the workforce who have astute assessment skills, can think critically, and have an intuitive understanding of the most important patient needs. This doctoral project sought to study the impact of in-person structured peer feedback sessions on work engagement as measured by the employee version of the Work Engagement Scale developed by Schaufeli et al (2002). The tool measures nurses’ connection to the work they do every day through three constructs: vigor, dedication, and absorption.


Baseline scale responses and additional information about nurse’s level of experience, background, and participation in professional development activities. Nurses were gathered in small groups of two to three during a normally scheduled shift. Participants received a brief 15-minute overview module on the concept of peer review, the need for specific feedback, as well as strategies for giving and receiving actionable feedback with positive intent immediately as part of the first peer dyad session. At each dyad session, participants were provided with a peer reflection tool and were asked to thoughtfully consider their partner’s clinical practice and provide feedback using the IDEA message methodology. Each nurse had the opportunity to participate in two peer dyad sessions before engagement levels were reassessed with the Shaufeli tool.


For the Vigor subscale, illustrated in Figure 3, the median score pre-intervention was 22 (n=26) and the post peer feedback sessions the median score was 23 (n=26), a 4.4% increase. For the Dedication sub-scale, illustrated in Figure 4 below, the median score was 20 for both pre-intervention and post-intervention groups. For the Absorption sub-scale, the pre-implementation median was 18, and the post-implementation median was 19, a 5.5% increase. Changes in the median score was not statistically significant for any of the subscales.


This doctoral project was not able to answer the question of how implementing in-person feedback sessions consistent with the ANA recommendations impacts work engagement. Work engagement is a complicated metric with multiple variables that contribute to the overall result. In a natural system, it is difficult to analyze the results without considering other system influences. The results of this project can be used to help others design and implement a project. Assurance of dedicated time, and allowing for a longer duration of implementation before evaluating the impact of behavioral change may be beneficial. A deeper understanding of skills that could allow staff to improve work engagement and increases the desire for experienced nurses to stay engaged in frontline nursing is of critical importance to hospitals interested in delivering high-quality care. Further study of how interventions impact staff engagement is essential in helping to stabilize turnover in our increasingly valuable bedside leaders.