Evidence-based Practice Fuels Change in Nursing Landscape




Eric Burch, MBA, RN, FACHE, Associate Principal, Clinical Consulting

It’s that time of year again when nurses and health care organizations take time out to celebrate the profession of nursing.

This year’s celebration of National Nurses Week is a special one for me as I mark my 25th year as a nurse. While I am amazed at how far nursing has come over my career, I also see there is much more that we need to accomplish. One area that I have given a lot of thought to recently is how we can empower bedside nurses as clinical leaders and change agents to improve the quality of patient care and improve the bottom line for their hospitals.

Evidence-based practice and health care reform

The “Triple Aim” is what guides our industry’s approach to health care reform today. It also positions us as nurses to impact affordability and access to health care, reduce costs and improve outcomes by shifting the focus towards prevention, wellness and the use of proven interventions aimed at delivering higher quality care. These goals are the concept of patient-centered care coordination that is consistent with our nursing professional standards and the holistic framework of care.

Nurses are expected to contribute to improved clinical outcomes and the reduction of care complications through the knowledge and integration of early clinical interventions at the bedside. I believe promotion of evidence-based practice (EBP) within nursing is essential to achieve these goals. 

Putting evidence-based practice in action

Creating a strategy within organizations to promote and hardwire EBP into their nursing staff is essential for driving positive outcomes for patients. Fostering EBP is not a static or immediate outcome, but a long-term developmental process within organizations. Implementation requires multiple strategies to cultivate a culture of inquiry where nurses generate and answer important questions to guide practice.* 

As a consultant, I get the opportunity to interact with many health care organizations across the country as I assist them in improving their quality outcomes and improving their bottom lines. Before starting these initiatives, it makes sense to first assess the organization’s infrastructure to understand its readiness to implement EBP for their nursing staff. The key components of readiness that I look for are:

  • Leadership - Organizational leadership that is committed to championing EBP strategies, which guide nursing practice and workflow, and use EBP to drive the quality improvement process. This includes providing nurses time to be involved in the EBP process and empowering them to be agents of change.
  • Resources - The willingness and ability to provide their nurses with access to EBP materials through journals, databases and participation in professional practice organizations. 
  • Structure - Shared governance principles in place with practice councils to empower bedside nurses by providing a framework to complete the EBP process and provide strategies for organizationwide planning, communication and implementation.
  • Evaluation - The infrastructure necessary to provide measurement of EBP outcomes to evaluate effectiveness and communicate results throughout the organization.

Organizations that successfully create a culture driven by EBP have an engaged nursing staff that bases their practice on the best available evidence. They also see great improvement in their clinical and operational outcomes. 

I am always excited to see hospitals that implemented nursing-driven protocols based on evidence-based research and love to hear their stories of how they avoided complications and improved patient outcomes. These organizations are creating the best possible environment for their nursing staff — one that promotes personal and professional growth by empowering those at the bedside to directly improve clinical outcomes and reduce the cost of health care.

About the author. A registered nurse with more than 25 years of health care experience, Burch’s key achievements and accomplishments include improvement in pay-for-performance outcomes, improving patient and staff satisfaction, reducing length of stay, and development of successful cost-reduction strategies. In his role at Vizient, he focuses on innovative health care delivery models, clinical quality processes and structures, case management and care coordination, value-based care strategies, and accreditation/regulatory compliance.

*Newhouse, R.P. "Creating Infrastructure Supportive of Evidence-Based Nursing Practice: Leadership Strategies," Worldviews on Evidence-Based Nursing 4(1) (2007):21-29.

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