Strategies to Achieve Evidence-Based Practice in Nursing

In the nursing profession, change is a constant. Treatments, diagnostic tests, procedures, and the population served in a given geographic area are always in flux. Changes in nursing practice are prompted by the emergence of new scientific evidence supporting them. Thus, nursing is a career that requires lifelong learning.1 Registered nurses (RNs) need access to the scientific literature to enable their practice to stay current. The use of relevant literature and reliable evidence to support clinical decisions is known as evidence-based practice (EBP).2 Evidence-based practice is associated with improved care quality and patient outcomes, enhanced patient safety, and reduced health care costs.3Failure to incorporate the best available evidence into routine nursing care has economic, legal, and ethical consequences. For example, an RN's lack of awareness of the optimal strategies to prevent a catheter-associated urinary tract infection can lead to additional preventable costs of more than $48 000. Similarly, suboptimal nursing care to prevent hospital-acquired pressure injuries can lead to additional health care costs of as much as $70 000, with stage 4 injuries costing more than $120 000 per case.3 These economic consequences can be accompanied by legal consequences for the RN. According to the American Nurses Association's Code of Ethics,1 RNs are ethically responsible for providing care that is based on relevant scientific information and reliable resources. All RNs need to understand the importance of EBP to minimize unnecessary health care costs and avoid legal and ethical problems.The instability of the nursing workforce is a major obstacle to achieving EBP by all RNs. In 2022, more than 150 000 new RNs entered the profession.4 With current labor shortages expected to increase until 2031,5 these numbers will likely increase annually. The labor shortages are due mainly to the aging of the workforce, with many nurses retiring; attrition related to stress and burnout; and the growth of contract nursing, which can allow for higher pay. It is estimated that approximately 200 000 experienced RNs left the workforce as a result of the COVID-19 pandemic, and more than a quarter of current RNs intend to retire or leave the workforce by 2027.4Younger RNs are making up an increasing proportion of the workforce across the country, elevating the number of inexperienced RNs in all settings. Developing the novice workforce must be a priority, especially given the impact of the COVID-19 pandemic on the quality of nursing programs nationally.6 Although many new RNs entering the workforce learned the importance of EBP in their nursing programs, it can be challenging to apply new research to practice.2 Thus, it is imperative that health care organizations remain committed to EBP and instill a spirit of inquiry in all RNs, whether they are novices or temporary contractors, because all have an impact on patient outcomes and safety as well as health care costs.Developing an inquisitive approach to their practice is the first step toward establishing EBP among RNs.2 In any given clinical situation, questions arise, for new graduates and seasoned experts alike. The answer to the question will determine the clinical action that follows. Ideally, the RN will recognize their lack of knowledge, which will lead them to seek information from available resources. Thus, the RN must be aware of the resources available and how to use them to access the best available evidence. Consulting peers is common and is both practical and time-saving, but unfortunately peer guidance may be based not on the most current guidelines but rather on personal experience.7 Therefore, nurses must take the time to go beyond this readily-available resource.Nursing professional development (NPD) specialists are professionals who use their expertise to influence RN professional competence and growth in a variety of settings to improve population health.8 These specialists have 7 roles: learning facilitator, change agent, mentor, leader, champion for inquiry, advocate for the NPD specialty, and partner for practice transitions. They use quality outcomes and environmental scanning to identify gaps in RN practice, skill, or knowledge and plan continuing professional development (CPD) activities to address them.8Inadequate access to or poor-quality CPD activities not only constitute barriers to enhancing nursing practice but also lower RN job satisfaction and retention.9 The Association for Nursing Professional Development describes certified NPD specialists as individuals who have demonstrated an understanding of how to be a learning facilitator and a champion for inquiry.8 They can plan appropriate and effective CPD activities, communicate the importance of EBP, and teach the foundational skill of locating and appraising relevant research.10 A lack of nurse educators trained in NPD and CPD activities can hinder learning and limit dissemination of knowledge about EBP.9Organizational leaders and managers should incorporate NPD specialists into the initial orientation and training of RNs as well as continuing education plans. But the support should not stop there. Health care leaders themselves must routinely engage in scholarly inquiry regarding their clinical questions as well as CPD activities that emphasize EBP. In so doing, they become role models and demonstrate a spirit of inquiry to new RNs, effectively embedding it within the unit's culture.2,9,11 Establishing a workplace culture that supports scholarly inquiry and seeking the most current research and practice guidelines for all clinical decision-making is necessary to achieve and maintain EBP. These cultural factors are especially influential for new graduate nurses.12Evidence-based practice is associated with improved patient outcomes, enhanced patient safety, and lower health care costs.3 The first step to achieving EBP in the nursing profession is to educate and empower RNs to develop a spirit of inquiry. Nursing professional development specialists are optimally prepared to develop CPD activities that emphasize EBP. Organizational and unit leaders must support and engage in EBP initiatives to foster acceptance of EBP. With the strong combination of qualified specialists and supportive leadership, the goal of EBP can be attained.