A recent survey of over 1,000 RNs suggests that there are several barriers preventing implementation of evidenced-based practices to improve patient outcomes. One of the primary barriers mentioned was resistance from nursing leadership. Also ranking high on the list were politics and organizational cultures. The cultures that avoid change are certainly damaging to implementation of these standards of care.
There is a disconnect among new graduate nurses and seasoned nurses in understanding the need for evidence-based practice. New grad nurses hear the term “evidence-based practice” and understand that these methods lead to greater patient outcomes, decreased length of stay, and decreased healthcare costs. Well seasoned nurses, whose education did not have a focus on evidence-based practice, tend to brush off the idea of implementing evidence-based practice into their care. They have done it a certain way for so long, who is some young-gun of a nurse to come along and suggest a different way.
But experienced nurses are not resistant to evidence-based practice because they do not want the best for their patients. They are most often part of a organization that is resistant to change. Also, they lack of available education, access to information, and support make it difficult to implement and stick to new processes. It’s also tough when no-one else seems to get one board.
I’ve witnessed many processes that had attempted implementations. Most nurses would attempt a few times to do it the new way. A few nurses would regress to their previous practices, the other nurses would see this and follow suite. There is a great herd mentality in healthcare. There is a greater sense of safety and security in doing what everyone else is doing, and to the nurse it can seem like that is what is best for the patient.
The survey confirm the trend I have myself witnessed. A little more than half of the surveyed stated that their organizations were consistently using evidence-based practice. And only a third said their colleagues consistently used the practices.
Education appears to be the key in evidence-based practice. Those with more education had greater confidence in implementing evidence-based standards of care. However, as referenced above, the long a nurse had been practice, the less he or she was implementing in learning about evidence-based practices.
“This was a distressing finding,” Bernadette Melnyk, RN, PhD, CPNP/PMHNP, FNAP, FANN, the study’s lead author and dean of the College of Nursing and chief wellness officer at Ohio State University, said in a news release. “And it’s a huge problem. The average age of nurses is 47, and they were educated at a time when evidence-based practice was not well integrated into educational programs.
“As a result, many nurses are practicing the way they were taught or steeped in tradition of the healthcare system in which they work. When new graduates who have learned to take an evidence-based approach to care are meeting these nurses in real-world settings, they encounter this prevalence of a ‘this is the way we do it here’ culture.”
If you are interested, the study is titled The State of Evidence-Based Practice in US Nurses: Critical Implications for Nurse Leaders and Educators and appears in the September issue of the Journal of Nursing Administration. The study abstract is available online.
Implementing Evidence-Based Nursing Care
In order to successfully implement evidence-based practice into nursing care, we must ensure that these standards are taught in nursing school. Patients also need to feel empowered to question the nature of their nursing care. They need to be informed about evidence-based practice to understand why care is delivered in a certain manner.
I’ve never been one to accept a method of nursing care as the standard just by taking someone’s word for it. I’ve always wanted facts and evidence to support the nursing care I provided. When I was a new nurse, this created a great challenge for me, as the seasoned nurses expect that I should just bow down and gravel at their mighty years of experience. When I knew what they had told me was in contrast to information I had learn in school, I would question it.
Boy did they hate that.
But I did try to explain that it was not because I did not trust them or think they were not good nurses. I simply could not understand how anyone could just take the “that’s the way it’s always been done” answer as good enough. They could never answer the “yes, I understand how, by why?” question. “Just because” or “This is the real world now” would always be the answer. They would often bully me into keeping quiet. Afterall, they were the experienced nurses. Who was I to question them? The more I attempted, the more lateral violence I experienced.
If only all nurses could appreciate each other for what each of us bring to the table. New grads may be inexperienced in their technical skills, but their knowledge is fresh and they are excited to share it. And “evidence-based practice”, that many of you might think is a crock, is actually pretty cool.
What’s Best for the Patient
If challenge you to ask yourself this question. If you were the patient, would you want the care you received to be based upon the “because this is they way we’ve always done it” answer? Or would you rather evidence and research back up your nursing care?
Evidence-based practice can improve healthcare for all involved. Before you shrug off a new practice, read the research. Confirm or deny if outcomes are approved. And then decide if you think the practice should be implemented.