The State of Evidence-Based Practice in US Nurses: Critical Implications for Nurse Leaders and Educators
Melnyk, Bernadette Mazurek PhD, RN, CPNP/PMHNP, FNAP, FAAN; Fineout-Overholt, Ellen PhD, RN, FNAP, FAAN; Gallagher-Ford, Lynn PhD, RN; Kaplan, Louise PhD, RN, ARNP, FNP-BC, FAANP
Journal of Nursing Administration: September 2012; Volume 42 (9)
Aim: This survey was undertaken to obtain a contemporary assessment of the needs and state of EBP of US nurses. The aims were to;
1. assess the state of EBP as reported by US nurses who are members of the American Nurses Association (ANA),
2. assess the needs of US nurses regarding EBP,
3. determine whether the needs and reported state of EBP differ between master’s degree– and non–master’s degree–prepared nurses, and
4. determine whether the needs and reported state of EBP differ between nurses from Magnet versus non-Magnet institutions.
Methods: A descriptive survey was conducted to assess the needs and current state of EBP implementation in nurses across the United States. The survey was granted exempt status from the institutional review board at the primary author’s university.
- The study indicated that nurses surveyed across the country were ready for and did value EBP.
- The participants reported wanting to gain more knowledge and skills in order to deliver evidence-based care in their institutions.
- Many of the barriers to implementing EBP cited by the participants in this survey were the same ones that have been cited by nurses for over 2 decades, including lack of time, knowledge, mentors, and organizational support. Lack of an organizational culture that supports EBP.
- Additional barriers not frequently cited in previous literature that were noted by this sample of nurses included the lack of available information and evidence to support EBP efforts.
- Resistance toward EBP from work colleagues including physicians and fellow nurses as well as resistance from nurse leaders and managers were reported.
- Resistance to EBP from colleagues/peers was not a new phenomenon, but resistance from nurse leaders and managers was a newly identified barrier that requires attention as their support is critical for point-of-care staff to implement EBP.
Although a recent study found that nurse executives report that they strongly believe in and value EBP, findings indicated that they themselves engaged little in EBP. If nurse executives/leaders are not engaging in EBP, serving as role models, and facilitating evidence-based care, it follows that their staff will not engage in evidence-based care as the behaviors of nurse executives and managers influence staff behaviors.
Nurses need an organizational culture that supports EBP. The results from this survey suggest that Magnet hospitals promote this culture, provide EBP experts and education, facilitate routine implementation of EBP, and recognize nurses for their EBP efforts more so than non-Magnet facilities. However, findings from this survey indicated that nurses in both Magnet and non-Magnet institutions believe in the value of EBP and feel it is important for them to gain more knowledge and skills in EBP as well as to have access to EBP mentors. These findings have important implications for nurse executives, leaders, managers, and educators who are in key positions to build a supportive culture for EBP and to provide the time, educational skills building sessions, and resources necessary for staff nurses to implement evidence-based care.
Findings from this study have important implications for nurse educators. Many members of the faculty in nursing colleges continue to teach EBP in a single course or teach BSN and MSN students the rigorous process of how to do research instead of how to use research to take an evidence-based approach to care. Consequently, graduates continue to leave their educational experience with negative attitudes toward research. Correcting this situation in academia will not be an easy fix; however, recognizing that nursing faculty cannot teach what they themselves do not know is a critical place to begin. Faculty must be equipped with excellent EBP knowledge and skills so that they can teach it to their students as well as integrate EBP throughout entire academic programs in order to produce graduates who are competent in evidence-based care.
Evidence-based practice improves the quality and costs of healthcare along with patient outcomes as well as reduces unnecessary variation of care. Although nurses across the United States believe that EBP results in the best patient outcomes and have a desire to gain more knowledge and skills in EBP, barriers continue to exist in healthcare systems that prevent consistent implementation of evidence-based care. This recent survey reflects the persistence of major barriers in healthcare systems as well as brings forward some new and emerging concerns regarding EBP. The study reinforces the tremendous need for nurse executives/leaders to build organizational cultures that support EBP, implement strategies to enhance nurses’ EBP knowledge and skills, and provide environments where EBP can thrive and be sustained.