Ensuring a Bright Future: 3 Ways Hospital Leaders Can Create a Culture to Support Evidence-Based Practice

by Katie Davis, MS-HSM, BSN, RN

Vizient Clinical Workforce Intelligence Director

I was a newly licensed registered nurse (NLRN) a few months into my first professional role, very excited to be participating in a Nurse Residency Program. The hospital I worked for participated in the Vizient/AACN Nurse Residency Program; and as a part of the program, I was asked to develop an evidence-based practice (EBP) improvement project with my fellow new nurses. After a short discussion, we selected a project that explored the evidence related to the impact of team huddles.  

The case for evidence-based practice was as obvious then as it is now—it ensures that we are using a best evidence-based approach to care that improves patient outcomes and lowers health care costs.

I was reminded of this recently when I had the privilege of attending the 19^th annual conference for the Vizient/AACN Nurse Residency Program, where program participants at Vizient member organizations came together to share best practices. The work presented by our newest nurses shines a bright light on the promising future for these nurses and the nursing profession.

A bright future for EBP in health care

Seven NRP program participants were selected from more than 100 abstract submissions to present their evidence-based practice projects. Their projects highlight a commitment to evidence-based practice as well as the culture and momentum these organizations have created to continue learning, growing and evolving, even amidst a pandemic.

Here’s an overview of these nurse residents’ projects.

• Strengthening the Clinical Nurse Through the Practice of Mindfulness—Claire Judeh and Georgeann Sannino from Thomas Jefferson University Hospital established a daily practice of mindfulness for 26 RNs across three units, providing them with instructions on how to perform the mini-meditation known as the “three-minute breathing space.” The evidence-based practice of mindfulness in the workplace helps alleviate the unfavorable risks of poor job performance and the stressors that hinder self-improvement.
• Is Isolation Injurious—Catalynn Rush, Katelyn Armbruster and Christina Scheck from UC Health Poudre Valley Hospital set out to understand if patients placed on isolation precautions are at greater risk of adverse events and decreased patient satisfaction compared to those that are placed on standard precautions.
• Improving Patients’ Impression of Nursing Care—Ryan Kilgore, Emily Stapleton and Cassie Long from The University of Kansas Health System described the impact of providing individualized, patient-specific care with the goal of ensuring patients feel respected during their stay and improve patients’ experience.
• Workplace Violence and the Effects on Patient Outcomes—David Kwoczala, Allison Jones and Cara Spencer from UC Health were provided with a validated tool to help predict patient violence and assessed if a patient’s elevated violence risk score impacts a nurse’s time and motion data, as well as determine any impact on patient outcomes.
• Why We Choose CHEWS—Allison Charles, Anna Folk, Paige Harrold, Amanda Hess and Aubrey Berrigan from Lehigh Valley Health System described the evidence-based practice project designed to evaluate if the use of the Children’s Hospital Early Warning System (CHEWS) tool with pediatric patients to decrease the time to identification of clinical deterioration and trigger clinicians to expeditiously activate resources to improve patient outcomes.
• Don’t Wait to Palliate: A Neuropalliative Care Trigger Tool Improves Patient/Family Satisfaction in Neuroscience Populations—Marshal Morgan, Jr. and Nina Park from UCLA Health explored the impact of implementation of a standardized palliative care screening tool on palliative care consults.
• Knowledge and Education of Hip-Healthy Swaddling Practices in Neonatal Nurses—Rebecca Patey, Jorji Breeler, Veronica Bianculli, Nayun Lee, Nicole Nguyen and Amanda Price from Lucile Packard Children's Hospital Stanford set out to answer the question: In neonatal nurses, does the use of an educational video on hip dysplasia prevention and swaddling increase knowledge of and intention to use hip-safe swaddling techniques.

Even with all these projects, without the proper support of health care leaders to create a culture that supports evidence-based practice, the insights from these great projects could have died on the vine, resulting in continued adherence to outdated practices and decreasing motivation for a spirit of inquiry among the clinical staff.  The COVID-19 pandemic highlights the urgent need for using the best evidence to approach patient care and staff well-being.

Barriers to EBP culture and how to address them

A quick review of the literature will yield numerous studies and reports that identify the barriers to evidence-based practice. Most barriers fall under the following areas: policies/procedures, education and time. For each of those obstacles, here are ways health care leaders can address them.

• Policies/procedures—A common phrase heard in health care when asked why something is done a certain way, is “we have always done it this way.” This indicates resistance to an evidence-based approach. Solutions to this barrier include aligning potential project lists with the strategic vision of the organization which should emphasize organizational culture and support of EBP. Utilize a review committee comprised of multidisciplinary leadership to determine which projects move forward with organization-wide implementation.
• Education—Memory is fleeting, and practice is continually changing. One study found there was a decrease in knowledge for every year since medical graduation. Provide EBP education to enhance EBP skills. Leverage insights and resources for EBP from academic partners or librarians to support this approach within your organization. The Vizient/AACN Nurse Residency Program offers a comprehensive chapter, and other resources to help organizations disseminate education and best practices for EBP projects for NLRNs.

• Time—A lack of time is often cited as a barrier to EBP. Incorporate EBP into the culture of the organization and build in EBP content into transition to practice or onboarding programs. By weaving EBP into existing programs, meetings and structures within the organization it becomes foundational. Highlighting the value of EBP at the leadership level and making resources such as EBP mentors available are some ways to address this barrier.

The future of the nurses and our profession is bright. With the proper support from health care leaders to create a culture that supports EBP, the next generation of nurses can continue to drive the goal of incorporating the best available evidence into their everyday practice.