EVIDENCE-BASED PRACTICE AND THE MAGNET JOURNEY

As many hospitals begin the journey toward Magnet(R) (ANCC, 2008) hospital designation or continue the path toward redesignation, the focus is now front and center on research, evidence-based practice, and quality initiatives to demonstrate improved patient outcomes. In 2008, the American Nurses Credentialing Center (ANCC, 2008) published a new Magnet(R) model supporting Magnet(R) designation, which emphasizes outcomes throughout the five components of transformational leadership: structural empowerment, exemplary professional practice, new knowledge, innovations and improvements, and empirical quality outcomes. The components of new knowledge, innovations and improvements, and empirical outcomes are now more heavily weighted: data are expected to be provided in all sections of the application. Professional development specialists may wonder how it is possible to achieve success with this new emphasis, particularly if resources and expertise are limited. The good news is that many hospitals are demonstrating amazing results with limited resources by exercising creativity to gain clinical nurse engagement in the process of incorporating evidence into practice. Research also can flourish through new ways of partnering.

EARLY STEPS IN THE JOURNEY

It is critical that clinical nurses contribute to building an evidence-based magnet culture. Therefore, an important early step is to work closely with the nursing executive leadership team to carefully budget sufficient funds to provide paid administrative time to facilitate nurse-driven projects and other professional development activities. Many surveys over the years have documented that the barriers to clinical nurses becoming engaged in evidence-based practice and research are primarily related to the need for administrative support and resources, or these activities are unlikely to be initiated or sustained (Brown, Wickline, Ecoff,& Glaser, 2009; Champion & Leach, 1989; Fink, Thompson, & Bonnes, 2005; Funk, Tornquist, & Champagne, 1995; Horsley, Crane, & Bingle, 1978. The professional development specialist can exercise evidence-based practice to support the executive team by providing data to document the level of readiness and knowledge of staff for these activities using a research needs assessment (Witzke et al., 2008). These data can then be used to develop a collaborative, shared leadership evidence-based strategic plan for staff professional development activities. Generating a plan keeps leadership on track and ensures that activities will take place rather than suffering from neglect because of constant and competing work demands. Important activities that serve as early goals for success are deciding upon a model to use for evidence-based practice and research (Reigle et al., 2008), implementing journal clubs (Krugman, 2009), integrating evidence into policies and procedures (Oman, Duran, & Fink, 2008), and initiating performance improvement projects (Institute for Healthcare Improvement, 2010).

PARTNERING TO GAIN EVIDENCE-BASED PRACTICE AND RESEARCH DEVELOPMENT

Whether hospitals are complex and large or small and rural, healthcare institutions have benefited from partnering with academic experts to further the research and evidence-based practice culture. One example of this model is recounted by Jeffers, Robinson, Luxner, and Redding (2008), who reported success using faculty from diverse academic institutions to work with staff development specialists to mentor clinical nurses in evidence-based activities. In another example, Ravert and Merrill (2008) described a comprehensive partnership, with a recommendation to formalize the appointment between academic and hospital institutions to sustain the gains from such relationships. A healthcare system with hospitals located across the country did just that, formalizing a collaborative partnership with two academic entities that have successfully provided support for multisite research studies and quality projects, resulting in improved evidence-based standards of practice as well as quality outcomes, accomplishing this across 20 states (Caspers & Vlasses, 2009).

ADDITIONAL STRATEGIES TO BUILD AN EVIDENCE-BASED PRACTICE CULTURE

Another strategy reported in the literature to advance evidence-based practice on the magnet journey is the development of nursing research fellowships. Turkel, Ferket, Reidinger, and Beatty (2008) established a program in a community hospital, providing protected release time for direct care nurses to spend 12 months developing a research project. Another example of a research fellowship program is described by Latimer and Kimbell (2010), who outlined the curriculum, costs, and examples of proposals developed by nurses participating in a research fellowship program. Gattuso et al. (2007) redesigned a research fellowship program into one that was evidence based, recognizing that a research fellowship was not as pertinent to the work of the clinical nurses in the hospital. Although the settings and the descriptions differ, the theme of these fellowship programs is one of providing opportunities for clinical nurses to receive support and structure to advance their knowledge and skills in using evidence and research in practice.

Yet another supportive structure for healthcare institutions with internal resources is to build into the budget a nurse(s) prepared at the doctoral level to act in the role of a research nurse scientist. This model is ideal to support innovation and new knowledge because these experts are consistent mentors who are integrated into the culture of the organization. This role provides the sustained guidance coupled with the knowledge of the organization and clinical staff to support standardizing evidence-based activities across units and services. How does an organization find a nurse researcher? In one example, two professional development specialists obtained doctoral degrees and then applied their educator expertise to this new role, which is a wonderful blend of experience and professional growth to contribute in new and important ways to the organization.

USING EXEMPLARS TO BUILD THE EVIDENCE-BASED MAGNET JOURNEY

The professional development specialist not only serves as a key member of the team to build an evidence-based culture but also must take this journey in his or her own professional work. Using literature to build an evidence-based staff development environment is critical in advancing your own practice and setting an example for clinical nurses in the institution. One example of such work by Romp and Kiehl (2009) described how the Stetler Model was used to revitalize a preceptor program. A second recent example by Salmon and Edwards (2009) outlines how evidence was used to close a gap in staff knowledge deficits related to a critical clinical situation.

The magnet journey is a cyclic process because as change begins to take place, it stimulates increased use of evidence, building layer upon layer until staff integrate these methods into practice. Improved patient care is the primary outcome, but in the process, a more professional work environment is created for nursing practice. Professional development specialists play a pivotal role in creating this culture by working with staff to teach evidence-based practice, by working on teams to remediate gaps in practice using evidence, and by implementing evidence into their own professional development practice. The magnet journey of using evidence in practice contributes to an environment of excellence for patients, staff, and professional development specialists. The articles cited in this column are but a snapshot of the literature. It is hoped this and other literature will stimulate you on your own transformational journey toward improving professional development outcomes.

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