Sustaining the gains: moving evidence-based practice forward.

By 2020, the Institute of Medicine (2013) Roundtable on Value & Science-Driven Health Care estimates that 90% of all clinical healthcare decisions will be supported by accurate, timely information and reflect integration of the best evidence available. This objective stands in stark contrast to current estimates that only È15% of practice today is supported by evidence and that between 60% and 90% of attempts to implement evidencebased practice (EBP) fails. Challenges in implementing and sustaining EBP changes mirror the challenges in sustaining quality improvement initiatives or translating these into practice. Simple awareness of EBP initiatives doesn’t translate to sustained clinical implementation. How then do we reconcile practice goals with practice realities? First, plan and organize. As simple as this sounds, we often move aheadVfilled with enthusiasm and energyV without a clear sense of where we are andwhere wewant to be. EBP gurus like Bernadette Melnyk recommend a ‘‘practice pulse-check’’ before moving ahead. Ask staff about their beliefs related to EBP and in what ways they have incorporated EBP into their daily work (Melnyk, Fineout-Overholt, & Mays, 2008). This baseline information allows us to plan. Choose a model I a variety exists; each institution must choose based on ‘‘fit. ’’ No matter which model is used, building a successful EBP infrastructure includes factors such as visible leadership and support, shared governance, education, access to information, mentorship, and feedback of outcomes. Decidewhat successwill look like. Howwill you know you’re making a difference? Are you planning changes to technical work or adaptive work? Technical work examines problemswith known answers; it is skill and knowledge based. Adaptive work examines deeply held beliefs, values, roles, relationships, and approaches to work.Making changes in adaptive work requires change in many places and usually crosses organizational boundaries. Solutions often require new discoveries and experiments and take time. It’s not easy. Link your successes (outcomes) to organizational strategic goals or initiatives. Align rewards and recognition with outcomes; for example, how would EPB changes support an institution’s Pay-for-Performance (P4P) goals? Look at your outcomes at a variety of levelsVvision, goals, inputs, and methods to verify success. Examine the ways in which the existence of EBP initiatives, tools, and resources have made a difference for nursing practice in your organization. Ask whether differences are conceptual or instrumental. Conceptual differences might include better team work or morale, improvements in knowledge and understanding, personal development and growth, and the expressed willingness to continue improving care. Instrumental use could be evident in practice and policy changes. Consider the ways in which implementing EBP contributes to a culture of inquiry that underpins control over our own practice and a healthy work environment. Sound familiar? These are themes woven throughout both the American Nurses Credentialing Center’s Magnet and Pathway to Excellence designations. Nurses are expected to self-regulate, self-determine, and control their practice. ‘‘EBP teams are an essential source of power and control of practice I EBP teams are a bridge between clinical autonomy, making decisions for the benefit of the patient, and the decision-making power of the group’’ (Kramer et al., 2008, p. 540). They are also charged with taking pride in achieving effective outcomes. Finally, sustaining the gains we make in changing practice to reflect evidence is a leadership challenge. Nurses in all roles must hear the call to leadership that helps advance the roles of the profession.