How CNOs Can Build Support for Evidence-based Practice

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Written by Jennifer Thew, RN for Health Leaders Media

When I saw the results from a recent study on nurse executives’ prioritization of evidence-based practice, I was shocked. Only 3% of the CNOs surveyed ranked evidence-based practice as a top priority. How was that possible?

EBP has become such a buzzword in the nursing profession that I assumed it would be at, or at least near, the top of every CNO’s priority list. Plus, its implementation is part of the criteria for achieving the American Nurses Credentialing Center’s much coveted Magnet Designation.

Mary Nash, RN, PhD, FAAN, FACHE, chief nurse executive at The Ohio State University Health System and assistant dean at The Ohio State University College of Nursing in Columbus, had a similar reaction to the findings. “I’ve been a nurse exec for 32 years,” she told me. “I was really surprised.”

But perhaps the results shouldn’t have been such a surprise to either of us.

As I mentioned in last week’s column, many nurses went to school before EBP was part of the curriculum and therefore, have not been steeped in its concepts and processes for their entire careers.

Not being an “EBP-native,” however, isn’t an excuse for not getting up to speed on EBP. 

“We have got to educate the chief nurses, the nursing directors, and the nurse managers [in EBP],” says the study’s author Bernadette, Melynk, 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.

“We’ve got to equip them with skills in EBP so they can build a culture and an environment that makes EBP the easy choice for people to make at the bedside.”

A Common Thread

The first step in developing a culture that embraces EBP is to set clear priorities. Nash recommends using the strategic planning process to identify about four areas on which to focus.

“We have an annual strategic planning process and a five-year strategic plan,” she says. “We look at four major areas:

    1. Quality and safety
    2. Nurse engagement
    3. Patient experience and
    4. Cost-effective care delivery

Once these areas have been defined, it’s time to bring EBP into the picture. “Rather than thinking about [EBP] as a separate component, we think about it as woven into all of our four priorities,” Nash says. “It’s a thread that’s woven across all those dimensions.”

Take the health system’s top priority of quality and safety, for example. Preventing and reducing central-line acquired bloodstream infections is a common quality and safety goal across the U.S. healthcare system. Evidence on ways to achieve this goal (Nash specifically mentions the use of disinfecting port protector caps) should be assessed and implemented.

“You think about each one of those quadrants,” she says. “You think about what’s wrong, where the evidence is, and what you can do that may be a best practice for improving.”

To garner support for EBP among his or her C-Suite colleagues, a CNO must produce data regarding an intervention’s outcomes. Back to the previous example, Nash says using reports to show that CLABSI rates declined after using an \ evidence-based protocol, and tying that decrease to cost savings from shorter length of stay or lower complication rates, would be vital in getting other executives to support the culture change.

“They don’t want to hear stuff. They want to see reality,” she says. “When you take a look at trends and they’re all going in the right direction, it’s pretty compelling. Then you can say, ‘We really need to do this and here’s what the ROI is.’”

Investing in Infrastructure

While it’s necessary to achieve an organization’s goals and outcomes, creating a culture that values EBP is not instantaneous. It can, in fact, takes years of hard work.

Mary Nash, RN, PhD, FAAN, FACHE“You think, ‘That’s great I’ll just weave it into my strategic plan and that will be that,’” Nash says. “But it doesn’t come overnight. We made a decision about four-and-a-half years ago that we were going to have an infrastructure that supported EBP.”

That meant creating a full-time position for a director of evidence-based practice to ensure that policies and procedures at all of OSU’s five hospitals were evidence-based.

“After four-and-a-half years of having this role and having an EBP council, the staff now talk in terms of EBP,” says Nash of the investment. “She’ll be on the unit and they’ll say, ‘Well, the latest evidence says…” It really is enculturated where people feel compelled to make sure the patient gets the very latest and best care.”

Sending staff through an EBP immersion program has also helped promote use of EBP among nurses. Nash says that when nurses recognize a problem or see an opportunity to improve care, they look for evidence to help develop a solution.

She told me about a nurse on the heart failure unit who recognized patients were falling at consistent times during the day. It turned out the falls were tied to the times patients received their Lasix dosages. The nurse took the initiative to independently create an EBP poster to share with her peers.

“When there’s a problem on the unit, [the nurses] do a lit search, and they come up with a solution,” Nash proudly says. “It’s really neat to see. In all my years, I have not seen as much of a culture for EBP as we have here.”