Nurse leaders may believe in the power of evidence-based practices, but more than 50% say EBP is practiced at their organizations "not at all" or "somewhat." The way forward is to quantitatively demonstrate value, says one advocate.
What do Santa Claus and evidence-based practice have in common? Believing in them doesn't mean they exist. If you're scratching your head over this riddle's answer, let me explain. I'll even use evidence on EBP to help make my point.
In 2012, a study published in the Journal of Nursing Administration reported that nurses ranked resistance from nurse leaders and nurse managers as one of the top five barriers to implementing EBP. Now a new study published in Worldviews on Evidence-Based Nursing has found that, while chief nurse executives say they strongly believe EBP results in high-quality care, only 3% of the 276 CNOs and CNEs ranked EBP as a top priority. And 74% reported that they allocated zero to 10% of their annual operating budgets to build and sustain EBP in their organizations.
More than 50% said EBP is practiced at their organizations "not at all" or "somewhat."
"These chief nurses believe in EBP. Their top two priorities are quality and safety," says the author of both studies, Bernadette Melnyk, RN, PhD, CPNP/PMHNP, FAAN, FANP, associate vice president for health promotion, university chief wellness officer, and dean of the College of Nursing at The Ohio State University in Columbus.
"But there's a major disconnect because they don't see evidence-based practice as a direct pathway to get their organizations to high quality and safety. So that's a big problem."
A big problem indeed. Especially when you look at one of Melnyk's other findings—chief nurses reported that more than one-third of their hospitals were not meeting benchmarks for NDNQI measures.
So what is contributing to this disconnect that threatens the quality of patient care? And how can nurse leaders overcome it?
Melnyk and her colleague Mary Nash, RN, PhD, FAAN, FACHE, chief nurse executive, OSU Health System and assistant dean, OSU College of Nursing, spoke with me about the causes and solutions to this EBP paradox.
Getting to Know EBP
When I went to nursing school in the mid-to-late 1990s, EBP wasn't quite yet a "thing." Interest in EBP began to pick-up steam when, in 2003, the IOM set a goal that 90% of healthcare decisions would be evidence-based by 2020.
With 55 being the average age of the chief nurses in Melnyk's study, it's safe to assume that they, like me, weren't exposed to EBP from the beginning of their nursing careers and instead had a course on nursing research.
Even when nurses go back for their master's or doctorate degrees, it's likely they are still being taught how to conduct nursing research versus implementing EBP, Melnyk told me.
"There's so many academic programs throughout the country that are still teaching bachelor's and master's degree students the rigorous process of how to do research instead of teaching them how to do EBP," she says. "The reason for that is because, think about it, the DNP is a relatively new degree. So you've got PhD researchers who are still teaching research all throughout the country who have really never learned EBP."
Melnyk says though almost 70% of the chief nurses in the study had master's degrees, more than 50% said they were not sure how to measure outcomes of the healthcare services they were delivering. Plus, more than half of the study's respondents reported they had not accessed databases for evidence-based guidelines "in the past eight weeks."
This led me to ask Melnyk a question I had originally crossed off my list because I thought it was too basic. What is the difference between EBP and research?
"EBP is a problem-solving approach to the way we deliver healthcare that integrates the best evidence from research studies with a clinician's expertise and a patient's values and preferences. So you're using the evidence that's generated. Research is a scientific process through which you generate new knowledge and new evidence to be used by clinicians," she told me.
"One is the generation of research, new findings, new knowledge— that's research. The other (EBP) is translating the evidence that's generated from research into practice to improve the quality of care in patient outcomes."
Beyond Belief
After uncovering these findings, Melnyk went on to practice—evidence-based practice, if you will—what she preaches. She contacted Pamela Thompson, CEO at the American Organization of Nurse Executives and the two organized a summit of 160 nurse leaders who were members of AONE. The goal was to find out how they could support this group in implementing EBP.
"Do you know what they told us?" Melnyk asks. "'Help us to show CEOs and CFOs in our organizations the return on investment with EBP.' That's what they wanted. You see, in nursing, we traditionally haven't been good at ROI."
Nash says relationships with other C-suite members play an important role in creating a culture that supports EBP.
"I think a barrier is when the chief nurse is not positioned to be a voice in the organization, and the reason I say that is that's where you build the relationships and relationships build trust," she says. "We need to be at the table, and people need to look at nurses as scientists and individuals that have a lot of knowledge about quality and safety rather than just nice to have."
Demonstrating Value
Data and reports that prove EBP is working is another way to show EBP's worth. Showing colleagues numbers that illustrate there has been a decrease in CAUTIs, CLABSIs, or length of stay since an EBP intervention has been implemented, strengthens the argument for EBP.
"You've got to be quantitative. They don't want to hear stuff. They want to see reality," Nash says. "When you take a look at trends and they're all going in the right direction, it's pretty compelling to say that EBP is effective."
And when a chief nurse shows how EBP has moved the organization toward its goals and proven its ROI, it's fair to ask CEOs and CFOs to make a concrete commitment to supporting EBP.
"Take it back to your CEO [and] your CFO and say 'We've saved $500,000 by changing this practice. We want half of that to come back to nursing so we can further fuel our efforts to get everybody up to speed on EBP,'" Melnyk says.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.