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How Nurses Can Implement Evidence-Based Practice

By now, most nurses know about the link between evidence-based practice (EBP) and safe, high-quality patient care. Putting EBP into action, however, is another story. Implementation of EBP varies widely among healthcare staff, from novice nurses to seasoned professionals.

However, educational preparation can make a difference. Associate and diploma nursing programs typically focus on developing clinical skills. BSN programs, such as the online RN to BSN at Eastern Michigan University (EMU), build on those skills to prepare nurses at a higher level. This includes an emphasis on EBP as a decision-making approach to care.

What Is Evidence-Based Practice?

There is no single definition of EBP. Lippincott's Why Evidence-Based Practice? defines EBP simply as "the thorough use of current best research-based evidence in making decisions about patient care."

The Institute of Medicine, or IOM, (now the National Academy of Medicine) takes a wider view, defining EBP to mean that "to the greatest extent possible, the decisions that shape the health and health care of Americans — by patients, providers, payers, and policy makers alike — will be grounded on a reliable evidence base, will account appropriately for individual variation in patient needs, and will support the generation of new insights on clinical effectiveness."

If the triple aim in healthcare comes to mind, that is because EBP supports each goal of this framework:

  • Improving the patient experience
  • Improving population health
  • Reducing healthcare costs

The quadruple aim adds a fourth goal — improving the work life of nurses and other healthcare providers, something every RN can get behind. Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN, calls EBP the "secret sauce to enable us to get to that quadruple aim."

What Are Barriers to EBP?

EBP is recognized as a transformational force in healthcare. What keeps EBP from being the standard for clinical decision-making? Workplace culture is part of the problem. As Laura Wallis explains in an American Journal of Nursing article, implementing EBP means getting past "we've always done it this way."

Wallis discusses a survey by Bernadette Mazurek Melnyk and her colleagues that assessed "readiness and willingness" to implement EBP. Only 34.5% of respondents agreed or strongly agreed that their co-workers consistently used EBP. In addition to lack of organizational support, barriers to EBP include:

  • Time limitations
  • Resistance to EBP by work colleagues and nurse leaders/managers
  • Lack of educational opportunities to develop knowledge and skills for EBP
  • Lack of access to knowledgeable mentors, resources and tools for EBP

The survey found that nurses recognize the value of EBP, but they need help adopting it.

What Are Some Implementation Strategies?

EBP is not a new approach. In 2003, the IOM identified EBP as one of five core competencies for providing optimum care. The IOM set a goal that by 2020, 90% of clinical decisions will be supported by EBP.

This goal is still in the works, but the following story shows one strategy that helps: earning a BSN.

Blogging for Nurse.com, Alexander Alvaro Salinas, BSN, RN, shared the experience of being corrected by a seasoned nurse for not aspirating a syringe during an intramuscular injection. Salinas supported his decision with research, explaining that "aspirating intramuscularly is no longer a standard of practice since no evidence supports its practice and it can cause trauma to patients."

BSN graduates are known for their professional-level skills, including in EBP. Coursework in EMU's RN to BSN, for example, emphasizes:

  • Nursing research and the importance of evidence-based nursing practice
  • Ethical issues involved in research
  • Adequacy and application of existing research
  • Critical thinking and actions of EBP in nursing

A study published in The Joint Commission Journal on Quality and Patient Safety backs up the benefits of a BSN to boost EBP implementation. The study compared differences in quality and safety preparedness between associate and bachelor's degree graduates. BSN grads reported being significantly better prepared in 12 of 16 topics, including EBP.

Mentoring helps to build a supportive culture in the nursing workplace. Mentoring is often seen as experienced RNs teaching novice RNs. But as the study suggests, new BSN grads can be a valuable resource for nurses of any age when it comes to EBP.

An Advisory Board "daily briefing" identifies additional strategies for implementing EBP:

  • Modify EBP for available resources. EHR order sets, for example, can promote EBP. A healthcare organization without this capability can achieve similar outcomes with paper checklists.
  • Keep patient-centered goals in mind. For example, shorter hospital stays can reduce the risk of healthcare-associated infections (HAIs). Focusing on "optimizing recovery" instead can reduce the risk of rushing patients out the door.

Building the knowledge to integrate EBP can give RNs confidence that they are providing the best care, even in the most complex situations. In time, the familiar phrase "We've always done it that way" will come to mean providing care that is consistently based on the most current, relevant evidence.

Learn more about EMU's online RN to BSN program.


Sources:

Lippincott Solutions: Why Evidence-Based Practice

NCBI: Institute of Medicine Roundtable on Evidence-Based Medicine

Institute for Healthcare Improvement

Lippincott Solutions: Moving From Triple to Quadruple Aim

American Association of Nurse Practitioners: Why Choose Evidence-Based Practice?

The Journal of Nursing Administration: The State of Evidence-Based Practice in US Nurses

NCBI: The Core Competencies Needed for Health Care Professionals 

Nurse.com: Why Evidence-Based Practice Matters to Students

The Joint Commission Journal on Quality and Patient Safety: Bachelor's Degree Nurse Graduates Report Better Quality and Safety Educational Preparedness Than Associate Degree Graduates

Advisory Board: 4 Ways to Implement Evidence-Based Practice at Your Hospital


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