Melnyk_Evidence-Based Practice in Nursing & Healthcare, 5e

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

Strengthening EBP Infrastructure Leaders must create and shape an infrastructure that permits a nurse to in uence care deliv ery while maintaining the profession’s legitimacy and legacy. Successful implementation of an EBP model is dependent upon several structural components and processes. For an EBP framework and successful implementation to be sustained over time and become hardwired into an institution’s culture, a staff member, preferably someone at the senior executive level, is needed to support and guide staff. The EBP lead needs to have institutional savviness and knowledge as well as the ability to be nimble and agile. The EBP lead helps staff navigate the complexities of the organizations, associated bureaucracy, and the barriers they will face which can derail or even block implementation. The EBP lead becomes the champion, leading the staff by leveraging their sphere of in uence. The EBP lead needs to also have a command of the model and its intricacies to support staff no matter where they are on the EBP learning curve (i.e., novice, beginner, mentor, or expert). To further support implementation and enculturation, a robust shared governance council structure is critical to provide the foun dation needed to build EBP across the enterprise while hardwiring the tenets of the model. Many times, we look outside our respective organizations for the support needed to fully adopt something new. We often create obstacles that hinder our growth. Having a culture that promotes EBP is hard to nd. Clinicians typically look outside their organizations for the support they need to create a spirit of inquiry that is alive and healthy. Frequently, clinicians do not recognize the tools they need are in front of them. It is often thought that additional human and structural resources are necessary to make such a vision a reality. However, lever aging existing internal and external resources, such as frontline leaders, quality management clinicians, shared governance council leaders, professional development specialists, clinical nurse specialists, council leaders, librarians and library resources, academic partners, and the American Nurses Credentialing Center (ANCC) Magnet designation can provide the momentum needed to augment implementation and ultimate enculturation of a spirit of inquiry. These leaders often have global insight, institutional wisdom, and the tenacity to move EBP forward, hardwiring it into the culture of the organization. Utilization of existing structures will further strengthen the foundation required to propel EBP forward. Tapping into these leaders will ensure organization growth, add value, and ultimately demonstrate ROI. Naturally, they become the early adopters required to propel adoption of EBP. However, this is only possible if the organization’s leaders nurture and support staff on the EBP journey. It is also imperative that leadership tap into the shared governance council structure. A shared governance council structure is typically where unit, divisional, and departmental work gets accomplished. Clinicians from all levels of the organization come together to share ideas, develop innovative programs, make decisions, and strengthen the practice environment. These clinicians are driven, eager to improve patient outcomes, and passionate. As such, they are ready, willing, and best equipped to champion EBP at the unit level. With their passion and enthusiasm, a spirit of inquiry is ignited, and EBP begins to ourish.

Most organizations approach EBP as an entity upon itself. This narrow and siloed approach hinders full enculturation. Leaders must think big and de ne a meaningful strategy to intertwine EBP into the entire healthcare system. To do so takes time and deliberate action with an unobstructed vision forward. Leaders must use the service’s framework to hardwire the principles of EBP into everyday operations. Existing structures and processes, such as job descriptions, annual goals, competencies, policies and procedures, standards of care, curriculum design, quality and safety planning, and career ladder promotions should be used to create a culture that embodies EBP. For example, embedding EBP language into every clinician’s job description sets a foundational requirement holding each clinician accountable for the adoption, promotion, and sustainability of the EBP enterprise. As another example, building EBP requirements into the career advancement ladder ensures clinicians continue to build Copyright © 2022 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.