Be not the first by which the new is tried, nor the last to lay the old aside. - -Alexander Pope

The expectation today in health care is for providers to use scientific evidence to support their clinical decision-making in practice. This is also known as evidence-based practice (EBP). This holds true in the specialty of plastic surgical nursing and is incorporated in the mission of ASPSN. Our mission is to employ education and research to promote practice excellence, nursing leadership, optimal patient safety, and outcomes by using EBP as a foundation of care. To support and meet this mission and promote EBP, ASPSN has prioritized these efforts with the development of a Clinical Practice Committee. This committee will develop evidence-based clinical practice guidelines, position statements, consensus statements, recommendations, and/or protocols for best practices, depending on the specific issue utilizing the best and most current research evidence that can be utilized by plastic surgical and aesthetic nurses in all practice settings. This committee will also address any current issues as they arise and monitor trends in clinical practice that will impact the delivery of optimal care. What is evidence-based practice? Why are we encouraged to utilize it in our daily practice?

EVIDENCE-BASED PRACTICE

Evidence-based practice is the conscientious integration of the best research evidence with clinical expertise and patient values and needs in the delivery of high-quality and cost-effective care. This is much different than conducting research. The goal of EBP is the implementation of generated research for quality cost-effective care to promote positive patient outcomes. This research evidence comes from the conduct and synthesis of numerous high-quality studies in a health-related area. We can no longer rely on tradition and "that's the way we have always done it." I know many of us thought that we were finished with research when we completed our formal education. We are never finished with inquiry and asking the right questions.

BENEFITS OF EBP

There are benefits to utilizing EBP. Evidence-based practice leads to improved outcomes for patients, providers, and agencies. It also establishes best treatment or the gold standard. Evidence-based practice is also an integral part of the Magnet recognition process as well as accreditation requirements. The use of evidence to guide practice in the health care setting also enhances confidence, adaptability, skill development, critical thinking, and decision making because nurses have to constantly evaluate various research that would support and be beneficial in our practices. Evidence-based practice also has been found to lead to higher job satisfaction and better group cohesion and promotes job retention in health care (Saba & McCormick, 2011). In today's climate of doing more in health care with less, EBP reduces cost compared with care that is based on tradition and outdated policies and practices (Saba & McCormick, 2011). Implementation of EBP would better manage available resources because these resources would be used more efficiently and effectively instead of being wasted on processes for determining ways of providing competent patient care. Again, we need to cherish resources and explore means of getting "more bang for the buck." However, in spite of these benefits, implementation of EBP is still met with resistance due to multiple barriers (Melnyk & Fineout-Overholt, 2011).

BARRIERS TO EBP

Some barriers to implementing EBP is nurses' lack research evidence. Historically, nursing research has not focused on providing this evidence but more is currently being done. Many nurses feel that evidence-based guidelines lead to a cookbook approach to nursing care. Standardization of care is becoming a new focus within the health care arena. Another barrier is that using EBP is time consuming. The change may be time consuming, but ultimately the plan would be to better utilize the resource of time, which is becoming more important in today's climate with layoffs and cut backs on staffing. Again, another barrier is the lack of resources to support the implementation of EBP. Some say that there is not enough evidence to support the change. Then generate the evidence. Validate or refute those findings. Just because something is in print does not mean that it is quality research, and the findings are ready to implement into practice. Be critical in your analysis.

One of the most influential barriers to implementation of EBP is the generalized fear nurses have of research. Nurses say they don't understand it, hated the class in school, and didn't know why they even had to take the class. I teach nursing research to undergraduate nursing students. I try and make the class fun, low stress, and encourage answers to nursing problems through the research process and latest evidence. I don't always generate enthusiasm with each and every student but the ones that I do, get it. I hope that this enthusiasm carries them through their profession and they are the ones who have no fear of asking the right questions and seeking the best solution using the most current evidence.

Another barrier to utilizing EBP is research evidence generated on the basis of population data making it difficult to apply in practice to individual patients. Overcoming this barrier requires skill and expertise in synthesizing and analyzing the research evidence for clinical practice. Another barrier is that some nurses believe EBP removes responsibility for individual decision-making. How do we overcome these barriers to implementation?

EBP AND ASPSN

As previously mentioned, the Clinical Practice Committee is utilizing the most current and best evidence for practice in the development of position statements for numerous topics specific to plastic surgical nursing. These position statements will provide the most current evidence to support plastic surgical practice. ASPSN utilized the best available evidence in the development of the certification for CANS. The best evidence was used to support each and every question. The Scientific Sessions Planning Committee also seeks speakers who can present up-to-date information at our Aesthetic Symposium and the National Conference. We anticipate furthering the mission of ASPSN and encourage plastic surgical nurses to utilize EBP. The willingness to change and be open-minded to this change begins with each of us individually. Doing things differently on the basis of the most current evidence and not by the status quo or adopting the attitude of "that's the way I was taught" or "that's the way we have always done it" leads to innovation and leadership. This ultimately will improve the quality and strength of plastic surgical nursing.

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