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  1. Chang, Betty L. DNSc, RN, FAAN
  2. Lee, Jan L. PhD, RN, CS
  3. Pearson, Marjorie L. PhD, MSHS
  4. Kahn, Katherine L. MD
  5. Elliott, Marc N. PhD
  6. Rubenstein, Lisa L. MD, MSPH


The purpose of this article is to determine whether nursing practice, as judged by nurse peer reviewers, varies by type or location of hospital and to assess which aspects of practice tend to be most at variance with nursing theory. This article provides a framework of continued quality assessment and improvement that is based on prior research. Trained nurse peer reviewers carried out structured implicit review, which utilized their professional judgment to evaluate the process of nursing care for patients admitted to acute hospitals with heart failure or cerebrovascular accident. Findings show significant variations in the quality of nursing care and support the continued development of nursing quality assessment and improvement initiatives directed at reducing the gap between nursing theory and practice.