Melnyk_Evidence-Based Practice in Nursing & Healthcare, 5e

352 Unit 3 / Steps 4 and 5: Moving From Evidence to Sustainable Practice Change

improvement. This position can co-lead the EBP council or direct the same work through their “of ce.” Either way, there is a central hub or an established path with structure and form that is fully developed and integrated into the organization’s operations where the best EBP is discovered and delivered. Lack of Clinician Competency in EBP Clinician competence in EBP remains a barrier in the implementation of EBP and EBDM despite identi cation of the opportunity to provide EBP education to the majority of nurses more than a decade ago (Melnyk et al., 2012). In 2018, Melnyk conducted a study of nurses within 19 healthcare systems in the United States and found that nurses overwhelmingly self-reported not being competent in any of the 24 EBP competencies for nurses or advanced practices nurses. The lack of EBP competence exists through each step of the EBP process, starting with the absence of skill sets to ask clinical questions, lack of knowledge and skills for exploring and reviewing literature, and ultimately applying the concepts in practice. This general lack of EBP knowledge begins in academia. The signi cant absence of teach ing EBP in academic programs prior to 2005 has resulted in a massive number of nursing professionals in practice today who never learned EBP. Since 2005 when EBP courses began to be included in nursing programs, a new problem emerged. Many faculty teaching EBP had never learned the steps of EBP and most were already teaching traditional research courses. This led to confusion and the tendency to refer to these two different constructs as interchangeable and has contributed to the persistent teaching of research instead of EBP at the undergraduate level. Although some new graduates may have been fortunate enough to have an EBP course taught by an EBP expert, they are then enrolled in their new graduate nurse residency programs upon hire. Many of these onboarding programs claim to integrate EBP into the curriculum and require participation in the EBP process, but many do not. In addition, those who lead residency programs may not be competent in EBP, resulting in the EBP-capable new graduates becoming disillusioned in EBP at the start of their clinical practice journey. The other traditional onboarding component for new graduates is assignment to a pre ceptor. This is another critical point where the lack of EBP competence can have a profound impact. Breckenridge-Sproat et al. (2015) explained that new graduate nurses are more likely to follow preceptor practices irrespective of recently learning updated evidence-based methods of caring for patients. So, even the best prepared and onboarded new graduate can be derailed from EBP when their unit-based experience begins. In this environment, nurses are less likely to question practice precluding them from developing a spirit of inquiry (Step 0 of EBP). When the spirit of inquiry and the curiosity to wonder is extinguished in the new graduate, the adverse impact can last for an entire individual career and ultimately the discipline of nursing overall.

Recognizing that not all healthcare systems are built with the same organizational struc tures and resources, it is important for those seeking to develop an EBP culture to identify their organization’s intrinsic barriers. As previously discussed, the barriers may range from manager/leader resistance to inadequate administrative support to lack of EBP competency in clinicians and an absence of infrastructure to support EBP implementation and sustainment. These are not the only barriers that may surface in an organization as each organization is unique. Barriers, no matter what they are, must be identi ed and mitigated with individu alized strategies, such as appropriately equipping leaders, funding adequate resources, and developing EBP mentors (among many others). All of this work must start with organizations recognizing their opportunities and leveraging current strengths to embark on the journey of developing an evidence-based enterprise. Copyright © 2022 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.