Barriers and facilitators influencing EBP readiness: Building organizational and nurse capacity

Abstract

Background: Organizational supported evidence-based practice (EBP) enables nurses to be change agents and impact patient outcomes. Globally, a multitude of barriers limits EBP implementation, evaluation, and dissemination, which include time constraints, staff, resource access, education, technology, and fiscal support. These barriers and other disenfranchising elements hinder nurses' ability to actualize EBP and change practice within their workplace.Aims: This study describes the EBP readiness, barriers, and facilitators reported by inpatient registered nurses (RNs) employed in a nationwide healthcare system before COVID-19. Methods: The study employed a cross-sectional descriptive survey design using the 2005 Nursing EBP Survey for RN EBP readiness. The setting included 14 hospitals in Southern California. The survey was deployed in November 2016 and closed after 23 weeks. Descriptive statistics analyzed demographics and EBP scores, with inferential statistics for associations between demographics and EBP scores. ANOVA examined differences between EBP scores, service lines, years of employment, and education level. A content approach synthesized open-ended barrier and facilitator questions into seven specific themes. Results: Seven hundred and twenty-four nurses completed the survey. Overall, the scores of inpatient RNs were highest scores for Practice Climate, suggesting the health system fosters a climate conducive to EBP. Scores were lowest for Data Collection and Implementation. Qualitative themes were: (1) Everyone Involved in EBP Implementation, (2) Fear and Resistance to Change, (3) Protected Release Time, (4) Knowing EBP Culture Outside of Current Organization, (5) Organizational Communication and Education, (6) Management and Leadership Support, and (7) Pragmatic Solutions to Facilitate EBP. Fear and Resistance to Change cut across all themes.

Missed nursing care in relation to registered nurses' level of education and self‐reported evidence‐based practice

“…Thus, to decrease MNC in hospitals, managers need to employ and help RNs with higher educational levels to become high EBP users. Our findings, together with previous research (Bianchi et al, 2018; Crawford et al, 2023; Furuki et al, 2023), emphasize that the organizational context (including teamwork), where quality improvement and patient safety are prioritized, is crucial to achieving better patient outcomes.…”

Evidence-Based Practice Implementation

“…Evidence-based practice implementation is less dependent on individual nurse characteristics including education, EBP/research awareness, skills, and practices, with culture having a stronger impact on sustained implementation 1,2 . Challenges and barriers to NL support of EBP include staffing shortages, time limitations, competing work priorities, lack of EBP awareness, and lack of resources including expertise, database access, and capital, and organizational sponsorship 13-15 …”

“…1,2 Challenges and barriers to NL support of EBP include staffing shortages, time limitations, competing work priorities, lack of EBP awareness, and lack of resources including expertise, database access, and capital, and organizational sponsorship. [13][14][15] Magnet designation moved organizations toward nursing excellence by supporting organizational EBP implementation as a scholarly activity, as well as a core requirement for designation. 16 In a precursor to this qualitative study, investigators conducted a quantitative study aimed at describing EBP attributes among Association of California Nurse Leaders (ACNL) members, representing multiple organizations throughout California (CA).…”

Budgetary investment in evidence‐based practice by chief nurses and stronger EBP cultures are associated with less turnover and better patient outcomes

“…Nurse leaders are responsible for ensuring that research findings are integrated into practice and creating a supportive culture and environment with sufficient resources for research, scholarly inquiry, and the generation of knowledge (Caramanica et al, 2022; Crawford et al, 2022; Li et al, 2018; Melnyk & Fineout‐Overholt, 2023). Historically, major barriers to the implementation of EBP in healthcare institutions that have been reported are a lack of EBP knowledge and skills in clinicians, a perception that EBP is time‐intensive, a belief that EBP is burdensome, a lack of a critical mass of EBP mentors, and organizational cultures that do not support EBP (Crawford et al, 2022; Melnyk & Fineout‐Overholt, 2023; Warren et al, 2016). Nurse managers and leader resistance to EBP is also a substantial barrier to the implementation of EBP (Crawford et al, 2022; Li et al, 2018; Melnyk et al, 2012).…”

“…Historically, major barriers to the implementation of EBP in healthcare institutions that have been reported are a lack of EBP knowledge and skills in clinicians, a perception that EBP is time‐intensive, a belief that EBP is burdensome, a lack of a critical mass of EBP mentors, and organizational cultures that do not support EBP (Crawford et al, 2022; Melnyk & Fineout‐Overholt, 2023; Warren et al, 2016). Nurse managers and leader resistance to EBP is also a substantial barrier to the implementation of EBP (Crawford et al, 2022; Li et al, 2018; Melnyk et al, 2012).…”