Physician buy-in vital to overcoming EBP barriers

Evidence-based practice (EBP) has been the buzzword in my leadership classes and throughout my facility. After reading the article "6 Steps for Transforming Organizational EBP Culture" from the May issue, I was impressed with the integration process that was thoroughly implemented at Elmhurst Hospital Center (EHC). I applaud EHC for taking the time to survey the developmental gaps of its staff nurses. The most common barriers noted for staff nurses were access to literature, ability to interpret research, lack of knowledge regarding EBP, challenging workload, and lack of time.

These are all substantive barriers that can impede the creation of an EBP culture. It's vital that leadership break down these barriers and increase awareness of EBP. They also need to make the necessary changes to engage nurses and inspire them to want to commit to the EBP culture. One important barrier that wasn't addressed in the article is physician buy-in and acceptance of the change. It's imperative for leadership to include physicians in the process of EBP and inform them of the need to be accountable for EBP that's out of the scope of nursing practice.

One example of this is heart failure core measures and best practice. At our facility, nurses have been educated on the criteria for beta-blockers, angiotensin-converting enzyme inhibitors, and device therapy. There are processes in place to remind physicians of the best practice standards, but it's the physician's responsibility to write the prescription or the contraindication. The onus can't solely be on the staff nurse to implement the process. With increased workloads and challenging nurse-patient ratios, nurses already have a full plate.

Higher education should be promoted to improve EBP knowledge among nurses; however, physician acceptance, accountability, and leadership support are vital to overcome barriers. EBP is essential to meet the demands of offering the highest quality of care to improve patient outcomes, and a collaborative team effort is crucial among caregivers and management to achieve this goal.

Consider qualitative as well as numeric data

I was able to read the great editorial you printed in the August 2010 issue regarding nursing management and dashboards. As you know, nurse managers are graded more than ever using many different dashboards, and the pressure to perform can be overwhelming. I think you were spot on when you commented that leaders shouldn't be graded solely on numeric indicators but qualitative data as well. The ability of a nurse manager to create, define, and lead a nursing team toward a unified vision takes much time and well-developed skills. Although immediate results may not be appreciated, leading a team with a great vision will lead to long-term results.