A National Survey & Forum for Nurse Executives: Leveraging Evidence-Based Practice to Enhance Healthcare Quality, Reliability, Patient Outcomes and Cost Containment
Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAANP, FAAN/ Lynn Gallagher Ford, PhD, RN, DPFNAP, NE-BC/ Michelle Troseth MSN, RN, DPNAP, FAAN/ Kathy Wyngarden, MSN, RN, FNP
Advisory Report; A National Survey & Forum for Nurse Executives; 2014 Elsevier Publishing
The purpose of this descriptive correlational study was to:
1. Describe the EBP beliefs, EBP implementation, and perceived organizational culture of EBP in chief nursing executives
2. Determine the major priorities of nurse executives and the amount of investment in EBP
3. Describe NDNQI, core performance measures, and HCAHPS outcomes in the nurse executives’ organizations
4. Determine the relationships among the study variables.
Method: An email was sent to 5100 chief nursing executives to ask for their anonymous participation in the survey. 1,199 emails were returned for a sample size of 3901. The email provided a link to the survey so their responses could be anonymous. The data was analyzed, conclusions were drawn and recommendations were shared in an Advisory Report.
1. What is the current state of chief nurse executives’ (CNEs) EBP beliefs, EBP implementation, and perceived organizational culture for EBP, and activities that support EBP?
2. What are the major priorities of CNEs and what percent of their budgets do they invest in EBP? What are the relationships among CNEs’ EBP beliefs, EBP implementation, perceived organizational culture for EBP, activities that support EBP, and healthcare system outcomes that include NDNQI, HCAHPS, Core Measures, nurse vacancy rates, BSN rates, certifications, and nursing satisfaction?
Methods: The study was an anonymous online survey of chief nurse executives. The research methodology was a descriptive correlational survey. Participants were provided a cover letter with a description of the study and sent an email inviting them to participate in the online survey.
Sample size, data collection and analysis
Sample size: The sample was 3901 with 327 respondents (8% response rate) and 276 completed surveys (7%).
Measures: The data collected included: (a) demographic questions; (b) three valid and reliable instruments that tapped beliefs about EBP, EBP implementation, and perceived organizational culture of EBP, (c) activities that support EBP (e.g., whether the institution had an EBP and a research council, and the effectiveness of the councils); (d) CNE priorities and budget investment in EBP, and (e) core performance measures, NDNQI measures, and HCAHPS data. Three valid and reliable scales developed by Melnyk and Fineout- Overholt were utilized in this study (Melnyk et al., 2008).
Data Analysis: After data verification and cleaning, descriptive statistics were calculated to assess distributions and examine outliers) and used to describe the sample (e.g., age, education, years of experience, type of medical institution). Bivariate analyses (e.g., contingency table analyses, independent t-tests, correlations, and ANOVA models) were conducted to examine differences by CNO demographic characteristics (e.g., biological sex, age, ethnicity, race, and so on) and institutional characteristics (e.g., size, geographic region, etc.) in the EBP beliefs, implementation, perceived organizational culture for EBP, and EBP activities; and determine relationships among the study variables.
Summary of Findings:
- More than 1/3 of hospitals were not meeting benchmarks for NDNQI performance metrics.
- Almost 1/3 of hospitals were above national benchmarks for core measures (e.g., falls, pressure ulcers).
- Although CNOs believes EBP results in higher quality of care, safety and improved patient outcomes, very little of their budgets were allocated to EBP and EBP was listed as a low priority.
- Although CNOs beliefs in the value of EBP were strong, their own implementation of EBP was relatively low.
- More than 50% of CNOs believed that EBP was practiced in their organization from “not at all” to “somewhat”.
- There were inadequate numbers of EBP mentors in healthcare systems to work on EBP with direct care staff and create EBP cultures/environments that sustain.
- Although CNOs reported top priorities are quality and safety, EBP was rated as a low priority.
Chief Nurse Executive National Forum as a Follow-Up to the Survey
Based on the key findings from the survey and their implications for nursing leadership, the Chief Executive Officer of the American Organization of Nurse Executives (AONE) was contacted to propose a national forum for CNEs at the annual AONE National Conference to share the study’s findings and strategize action tactics for next steps. The AONE Board enthusiastically approved the proposed idea for a forum, which was held on March 12, 2014 in Orlando Florida. The forum was titled: A National Forum for CNEs/ CNOs on Leveraging Evidence-based Practice to Enhance Healthcare Quality, Reliability, Patient Outcomes and Cost Containment.
This forum was attended by over 150 nurse leaders/executives from across the U.S. Major findings from the national survey, implications for nurse leaders, and a framework to leverage the findings were presented by Drs. Bernadette Melnyk and Lynn Gallagher-Ford from The Ohio State University College of Nursing and Michelle Troseth, Chief Professional Practice Officer for Elsevier Clinical Solutions. The presentations were followed by an “Innovation Workout” that engaged the participants in responding to the following questions: Based on the data presented from the survey:
1. How have your perceptions of the need to create organizational cultures and environments that support/promote/ sustain EBP changed?
2. What tactics do you believe nurse leaders must implement to improve and sustain outcomes?
3. What healthcare policy implications does the data impact?
4. What priorities can be moved or aligned on the organizational agenda to allow EBP to become a priority?
5. What solutions will be necessary in order to create organizational cultures and environments that support/ promote/sustain EBP?
6. What do you need, personally, as a nurse leader in order to create an organizational culture and environment that supports/promotes and sustains EBP?
7. What tools would be helpful (toolkit) to you as a nurse leader in order to create an organizational culture and environment that supports/promotes and sustains EBP?
8. What would be the priorities of an AONE sponsored subcommittee to pursue related to these findings and their implications?
9. Who are your key partners within your organization to educate and engage in creating an organizational culture that supports/promotes/sustains EBP?
Innovation Workout Session Participant Feedback
Participants acknowledged that EBP was not an optional initiative or the “difficult to implement endeavor” that some CNEs perceive it to be. EBP needed to be laid as the foundation of care delivered, as it is the pathway to improved outcomes and sustainable quality care. CNEs must understand EBP to be able to model and implement it successfully, demonstrating their commitment to engage front line care providers. Recommendations emerged as priorities for a CNE Action Plan to create/support/promote/sustain a culture of EBP.