Establishing an environment in which evidence-based practice (EBP) is facilitated to a full extent is challenging for the majority of healthcare organizations. Leadership is seen as an indispensable resource for reaching the goal. However, there is limited knowledge available to show the specific roles and functions that different leadership levels should implement to integrate EBP into the practice of healthcare institutions successfully. Thus, this paper aims to reveal what leaders in different levels of practice and roles do and what actions they take for developing, improving, and sustaining EBP as the norm at a healthcare facility.
Evidence-based practice, in the context of health care, refers to processes and decisions that are made based on scientific evidence in order to make deductive and inductive arguments for decision-making and guidance. When practice does not depend on evidence, it may rely on intuition, tradition, and other methods that have no scientific basis and can lead to varied consequences. In terms of providing care to patients, EBP is essential because it would aim to provide the most effective care that is available up to date. Patients require care that would be instrumental in relieving their health burdens, which explains the need for embedding EBP principles into every setting.
The role of nursing leaders and other higher-standing professionals within the healthcare process should be studied further in the context of contemporary health settings. For example, Bianchi, et al. (2018) mentioned that nurse managers should be more proactive in facilitating and enhancing the use of EBP at healthcare facilities. Both managers and their subordinates are expected to have the required educational preparation and possess the resources and support required for practicing care using evidence (Roussel, Thomas, & Harris, 2015).
It is expected that the facilitators of EBP in the role of nursing leaders would have to have the underlying knowledge and training in order to develop a supportive culture and environment in which EBP would be facilitated (Bianchi et al., 2018). Specific education is needed for addressing the limitations to the integration of the practice and helping leaders understand their roles in developing and supporting the optimum environment.
In order to embed EBP into the everyday processes at healthcare organizations, strategic leadership behaviors are necessary. Strategic behaviors can promote vision-focused and system-oriented thinking, which is imperative for modifying the existing operations at healthcare facilities. In cases when the standard procedures of planning, organizing, and aligning are insufficient, there is a need for the overlap in leaders’ related behaviors, which would represent the strategic vision for EBP processes.
The strategic behaviors of leaders, as suggested by Stetler, Ritchie, Rycroft-Malone, and Charns (2014), are predominantly reflected in the actions of a Tole Model’s Chief Nursing Officer (CNO) and the critical support service director. The professionals in these leadership roles are expected to have an EBP vision, communicate its importance to the care process explicitly and repeatedly. It is imperative to plan for the organization and sustainment of EBP at healthcare facilities, which is why the contribution of a CNO and the key support service direction is crucial.
The development of such a strategic plan consists of a goal-focused set of actions that would change and develop over time, instead of representing a written plan that was developed at a certain point in time and cannot be modified. The key problem associated with EBP development at healthcare facilities is that leaders may create a set of guidelines and ask nurses to follow them. This represents a significant limitation because EBP rules should be developed in accordance with nurses’ needs, their reflections on the process of care, and gaps in care implementation.
The role of EBP leaders is expected to be established and sustained within both normative and cultural expectations that are based on a set of frameworks and documents associated with EBP role requirements, relevant language, journal clubs, and other relevant materials that would support the integration of practice. For instance, EBP language, which would be facilitated by healthcare leaders, refers to the continuous use of terminology in everyday conversations between healthcare professionals. Such terms may include the best evidence, research-based policies, levels of evidence, and others that should be integrated into the healthcare process by relevant professionals in the leadership position.
The terminology refers to the strategic behaviors because it is concerned with increasing the degree of awareness among personnel as well as embedding the considerations of EBP into everyday tasks and processes. Strategic behaviors of leaders within EBP practice are also concerned with increasing the responsiveness to relevant issues. Over time, it is possible for leaders to deliberately establish a context within which EBP components would consistently guide related behaviors by managers and staff (Stetler et al., 2014). For instance, with the help of evidence-based policies, it may be possible to integrate EBP behaviors into varied expectations about the role of the practice within nursing processes.
Apart from strategic behaviors targeted at embedding EBP into the care process, leaders can also implement functional roles. For example, in the role of inspiring and inducing, leaders are expected to motivate and encourage their subordinates to engage in EBP. It is expected to help operationalize key expectations that would have otherwise remained as document-based materials. Leaders, who are deeply involved in relational actions, can “give a spark” to nurses to participate in EBP (Stetler et al., 2014, p. 220). Leaders as expected to strongly urge the staff to engage in a diverse championing of EBP based on the unique needs of patients.
Beyond motivating staff as a core functional behavior, leaders can actively intervene and involve themselves in EBP. This is associated with the personal and hands-on involvement of leaders in EBP activities in order to make them known and visible. Such an approach can help nurses understand that their leaders are directly involved in enhancing the process of care and care about the support of EBP. Leaders’ behaviors can include participating as active members in others’ EBP-related activities, leading organized EBP-related activities, as well as providing tangible support to other members of the process.
To conclude, without appropriate leadership efforts, the establishment of EBP at healthcare facilities may present some challenges. However, there are limitations in research literature concerning the role of leaders in implementing EBP at facilities. According to the recent studies on the topic of EBP integration through leadership, the majority of the studies focus on project-related EBP activities, such as the use of guidelines, and not on making the practice part of the everyday work and the normative behaviors throughout organizations. This limitation must be challenged because leadership could guarantee the integration and oversight of everyday EBP activities.
References
Bianchi, M., Bagnasco, A., Bressan, V., Timmins, F., Rossi, S., & Sasso, L. (2018). A review of the role of nurse leadership in promoting and sustaining evidence‐based practice. Journal of Nursing Management, 26(8), 1–9.
Roussel, L., Thomas, P., & Harris, J. (2015). Management and leadership for nurse administrators (7th ed.). Jones & Bartlett Learning.
Stetler, C. B., Ritchie, J. A., Rycroft-Malone, J., & Charns, M. P. (2014). Leadership for evidence-based practice: strategic and functional behaviors for institutionalizing EBP. Worldviews on Evidence-Based Nursing, 11(4), 219–226.