An Urgent Call to Action for Nurse Leaders to Establish Sustainable Evidence Based Practice Cultures and Implement Evidence Based Interventions to Improve Healthcare Quality.
For the past few decades, findings from research have identified a number of barriers that obstruct the timely translation of research findings into real world practice settings. These long time reported barriers include inadequate evidence based practice (EBP) knowledge and skills of point of care clinicians, cultures, and environments that do not support EBP, lack of access to EBP mentors, lack of appropriate resources and tools, misperceptions of not enough time to engage in EBP, and negative attitudes toward research (Hannes et al. 2007; Melnyk Fineout Overholt, 2015) Another new barrier to EBP recently identified that had not been previously reported in the literature is resistance to EBP by nurse leaders and managers (Melnyk, Fineout Overholt, Gallagher Ford, Kaplan, 2012) Identification of barriers is critical in order to plan, implement, and evaluate interventions to overcome them. However, we now have a large body of evidence on the major barriers to EBP in healthcare systems, yet there is little evidence by comparison on the most effective interventions to facilitate implementation of evidence based care and the role of nurse leaders in overcoming those barriers. Therefore, a call was announced last year for papers to include in a special edition of Worldviews on Evidence Based Nursing that focused on interventions to enhance evidence based care and the role of leaders in enhancing and sustaining EBP. This special edition contains several papers that highlight the persistence of major barriers to advancing evidence based care as well as interventions that were evaluated to enhance EBP among clinicians, leaders, and students. One of the published studies in this edition of Worldviews by Melnyk et al. (2016) reports the results of a survey with 276 chief nurse executives (CNEs) and chief nursing officers (CNOs) that revealed, although beliefs about the value of EBP are high, implementation of EBP in the nurse leaders and point of care clinicians in their hospitals is relatively low. Findings from this survey also revealed that more than one third of the hospitals are not meeting the National Database of Nursing Quality Indicators performance metrics and almost one third of the hospitals are above national core measures benchmarks, such as falls and pressure ulcers. Further, although the CNEs or CNOs in these hospitals said that their top priorities for their hospitals and healthcare systems were quality and safety, EBP was ranked as a low priority and little of their budgets were invested in EBP. In another study by Warren and colleagues featured in this themed issue, they conducted a survey with over 1,500 nurses throughout a nine hospital system in the mid Atlantic region of the United States, and findings once again indicated that EBP beliefs by leaders and clinicians were high, but their ability to implement EBP was extremely low. Younger nurses and those with advanced degrees, certifications, and practicing in Magnet designated facilities were more favorable to EBP and those in Magnet facilities had more EBP resources, which replicates findings from other research (Melnyk et al. 2012) Other research by Warren and colleagues in this issue of Worldviews was undertaken to assess nurse leaders' and clinical registered nurses' (RNs) beliefs to use EBP, perceptions about organizational readiness for EBP, and frequency of implementing EBP following implementation of multifaceted interventions to achieve and maintain Magnet designation. This retrospective descriptive study compared data from two surveys administered 4 years apart at a Magnet designated community hospital. Findings indicated that the multifaceted interventions had a positive impact on clinical RNs' beliefs and readiness for EBP, but not for the nurse leaders. These three above mentioned studies highlight the urgent need to continue to develop and test interventions to assist both nurse leaders and clinicians in overcoming barriers to the consistent implementation of EBP in hospitals and healthcare systems. Educational efforts must be targeted to CNEs and CNOs along with nurse managers so it is understood that EBP is a critical direct pathway to achieving healthcare quality and safety as well as reducing healthcare costs. This understanding is imperative for nursing and other healthcare leaders to invest monetarily in creating cultures and infrastructures to support their staff to consistently implement evidence based care (Melnyk, 2014) For many nurses and other clinicians, EBP requires a change in behavior from "this is the way we do it here" or "this is how we learned it 10 to 20 years ago." Without a culture and environment that support EBP, evidence based
Worldviews on evidence based nursing