Introduction

This famous quote by Goethe is so pertinent to evidence-based practice (EBP) given that we have an enormous body of published knowledge from research available, yet so little of it is implemented in healthcare settings. It continues to take years, often decades, to translate findings from research into clinical practice to improve healthcare quality and outcomes. Unfortunately, for much of our scientific body of published research, it is never used.

We have long described the barriers and facilitators to EBP, but healthcare systems and clinicians still face many barriers and “character-builders” in implementing and sustaining evidence-based care. Some of these barriers are decades old, but a new barrier that we recently identified through a national survey with nurses across the country is resistance to EBP by nurse leaders and managers. This barrier is significant because if nurse leaders and managers do not “walk the talk” of EBP and create cultures and environments that support clinicians to implement evidence-based care, it will not happen or sustain. The data from this national nursing survey and the findings from a more recent survey with chief nursing executives and chief nursing officers that revealed low prioritization of EBP and little budgetary investment in it prompted us to conduct a national summit with more than 150 chief nurse leaders. The purpose of this summit was to share the data from these two national studies and obtain the chief nurse leaders’ feedback regarding resources, educational offerings, and tools that could assist them in creating EBP cultures and environments that sustain. The leaders attending the summit said that they needed more knowledge and skills in EBP themselves along with tools to help them support and advance EBP in their institutions. For many years, we also have heard the same request from clinicians for more tools that would help them to implement and sustain EBP. Therefore, we have responded to these requests by developing this book, which provides a practical tool kit for implementing the new EBP competencies in real-world practice settings.

For years, clinicians, leaders, and faculty have struggled with what it means to be competent in EBP. However, there were no research-based EBP competencies for practicing registered nurses (RNs) and advanced practice nurses (APNs) that could set the standard for evidence-based decision-making and care and eliminate the confusion regarding what exactly competency in EBP means. Therefore, we embarked on a journey to develop research-based EBP competencies that could serve as a guide for establishing and assessing EBP competence in RNs and APNs.

In this book, you will read about the vital importance of EBP and learn how the EBP competencies were developed. In addition, this book provides markers of competence for each EBP competency as well as assessment strategies that facilitate implementation of the competencies in real-world clinical settings. The primary goals of this book are to serve as a practical guide for clinicians, leaders, faculty, EBP mentors, and students that will assist them in achieving competency in EBP, facilitate evidence-based decision-making in daily practice, and help sustain evidence-based care as part of a mission to create an EBP enterprise that can accelerate the speed at which research knowledge is translated into real-world settings to improve health outcomes and decrease healthcare costs. Each chapter begins and ends with case scenarios that illustrate exemplars of how the competencies can be actively implemented and assessed in clinical settings.

Numerous hospitals and healthcare systems across the nation and world are trying to build and sustain EBP cultures and environments, yet they struggle with how exactly to accomplish that goal as well as how to know when their institution has “arrived” in EBP. Some institutions believe they have arrived when they have two or three EBP projects underway. Other institutions say they have arrived or excel in evidence-based care when they have purchased an electronic EBP resource. Although these are steps in an EBP journey, an institution has not arrived until EBP is in the DNA of the entire organization and every person who works within it, and also when evidence-based decision-making and evidence-based care are consistently the norm. This book is intended to provide practical advice and ready-to-use resources to help organizations integrate EBP broadly across and deeply into their infrastructure. A widely dispersed and multicomponent strategy is far more likely to move an organization from one that dabbles in EBP occasionally to an organization that is hard-wired for EBP. We have made it standard practice to always ask the following two questions routinely when we are working with clinicians, leaders, faculty, and students:

What will you do in the next 3 to 5 years if you know that you cannot fail?

What is the smallest EBP change that you can make TODAY that will improve the health of the people for whom you care?

We must remember that “nothing happens unless first we dream” (Carl Sandburg). We must dream something before we can do it. Yet in today’s world, so many people lose their dreams because of well-meaning people who talk about all the reasons why something cannot happen instead of how it can happen. We ask everyone we work with to write down their dreams and goals, put a date on them, and place them in an area that is seen every morning and every night. Research has shown that when we write down our dreams and goals and view them every day, we will move faster in accomplishing them. However, the keys to accomplishing dreams are belief in one’s ability to accomplish them and persistent action to make them happen. Therefore, the time to act with a sense of urgency is now! We have so much knowledge available to improve the quality of healthcare and health outcomes, yet we so often do not use it. We must always remember that although changing the way we approach practice is a steep climb, it is a climb that we are obligated as professionals to make. Our patients, families, and communities are depending on us. They expect us to be current and evidence-based in our practice. That is what any of us would hope for and expect from a healthcare team caring for one of our loved ones. This is the dream and the challenge. We hope this book will serve as your guide and assist you in meeting this challenge and seeing your dream for EBP come to fruition.