Let nurses challenge evidence-based practice

Nurse Leader Insider, July 13, 2017

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By Jennifer Thew, RN

Change is good. But it can also be hard.

This is often the case when nursing procedures are updated to align with evidence-based practice. For all the potential EBP has to improve patient care and outcomes, nurses may still dig in their heels and balk at doing things differently than the way they've always been done.

So what's the secret to getting RNs to embrace EBP? Let them challenge it, says Alison Mason, MS, RN, national director, quality informatics, at Englewood, Colorado-based Catholic Health Initiatives.

"What I tell people when I do implementations with them is, if people want to challenge a procedure, I welcome that because that is a way of engaging a nurse and looking at evidence and understanding how leveled evidence works," she says.

Practice Must Align with Evidence

Mason speaks from experience. As part of her role at CHI, she focuses on using evidence-based resources and electronic systems, including those for physicians, nurses, and pharmacists, to affect change and support practice.

Over the years, she has brought number of facilities (CHI operates in 17 states and comprises 104 hospitals; community health-services organizations; accredited nursing colleges; home-health agencies; living communities; and other facilities and services along the care continuum) into the EBP-fold.

"Evidence-based practice was one of our destination metrics that was determined a decade ago," she says. "My goal is to help our facilities align with EBP and to help them analyze data in order to meet metrics that we have set as an organization around quality initiatives."

As one would expect, when new facilities come on board, there can be resistance to doing things differently.

"When you're onboarding somebody new, sometimes they'll say, 'That's not how we do it here.' [But] how you insert a nasogastric tube in Lexington, Kentucky should be same way you do it in Tacoma, Washington," Mason says.

"The expectation is that they will align with the evidence and the [electronic EBP] resource that we use."

EBP Challenges Encourage Critical Thinking

If a nurse takes issue with a standardized procedure, he or she may engage in the challenge process.

"I encourage them to look at it, I encourage them to then go back and, if they want to challenge something there's a form that they have to fill out that is very specific about what it is they have an exception with," Mason explains.

The nurse must provide citations and resources to support the challenge and Mason does an initial review of the challenge.

"If the level of evidence is below the level of evidence used to define the electronic procedure I go back to them and explain that their challenge doesn't have the same rigor of evidence that was used to develop the procedure," she says.

"And I explain, if they still want to carry this forward, the type of evidence they need to find."

This includes explaining the scale CHI uses to determine strength of evidence.

"It's a way of pulling nurses into understanding leveled evidence and how it applies to practice," she says.

Mason also includes the nurse on any communication she has with the vendor regarding the challenge.

"I always copy them if I push this forward to the editor at the vendor for review," she says.

"I copy them so that they're aware that they're being listened to and they're involved in the discussion and the decision."

While it takes time and effort, Mason says encouraging rather than dissuading nurses' challenges to EBP is a positive thing.

"It's challenging sometimes but I think very beneficial for our end users, for our clinicians," she says. "What I have found is that because they see that we're open to pushing their challenges forward if they provide the evidence to support their claim, they really are more accepting then of any kind of changes that may occur."

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