Are Nurses Ready for Evidence-Based Practice?

As the saying goes, you can lead a horse to water but getting them to drink it is another matter. Selected studies by nurses found problems exist in nursing programs and healthcare organizations that may preclude current dissemination methods of information from being effective.

Survey of Nursing Schools in the U.S. Show Lack of Readiness
At the time of survey, many nursing programs indicated that programs mainly focused on computer literacy skills. Competency skills were integrated into the program courses. Few programs checked for information literacy skills. Programs are beginning to check on information literacy skills. Gaps exist between programs on requirements for these skills. Faculty are not skilled in managing information for daily clinical practice. A perceived need exists for these skills. A champion person needs to be identified to promote the skills to faculty. Funding for continuing education of faculty is an issue.

McNeil, B. J. et al. (2005). Nursing informatics knowledge and competencies: A national survey of nursing education programs in the United States. International Journal of Medical Informatics, 74(11-12), 1021 – 1030.

Preference of Peers or Colleagues for Information
In a study of 3,000 registered nurses on perceptions of accessing tools, Pravikoff, Tanner, & Pierce ( 2005) found that clinical nurses sought out peers or colleagues and using the Internet and World Wide Web than using bibliographic databases. Besides little value being placed on research in clinical practice, lack of training in using tools is a problem.
Other individual barriers exist that include: difficulty in understanding research articles, lack of access to the library, lack of search skills, and lack of skills to critique articles. Institutional barriers exist that mainly focused on higher priorities, budgets for information resources and training, and lack of perception for the need of information literate nurses.
One other problem that exists is that the majority of nurses are still trained at the associate degree level. At this level of education, nurses do not receive courses on research in nursing.

Pravikoff, D.S., Tanner, A.B., & Pierce, S.T. (2005). Readiness of U.S. nurses for evidence-based practice. American Journal of Nursing, 105(9), 40 – 51.

Implications for Educators on Evidence-Based Practice
Lack of role modeling by faculty can be a major problem in implementing evidence-based practice. Currently, most clinical faculty members focused on the assessment of skills, time management, and affective behaviors for patient care in nursing students. Factors that inhibit implementation of evidence-based practice with students are: time constraints, lack of appropriate access to information and resources at clinical sites, need for enhancement of research skills particularly information, and lack of clinical organizational support for valuing behaviors needed for evidence-based practice.

The authors suggest that a change agent be utilized to promote the use of evidence-based practice. The clinical nurse educator on the unit would be the ideal person to establish a relationship. Incorporation could possibly take place in post –clinical conferences if facilities are available.

Penz, K. L., & Bassendowski, S. L. (2006). Evidence-based nursing in clinical practice: Implications for nurse educators. The Journal of Continuing Education in Nursing, 37(6), 250 – 254.

Observation and Interviews of Critical Care Nurses
McKnight (2006) further emphasized that on-duty critical care nurses did not seek out information from published resources. With the emphasis on constant assessment and evaluation of the patient, interactions with people on the unit were the main means of acquiring information – patients, nurses, family, physicians, and health care workers. Verbal and written reports were taken and given by the nurses on the various patient issues. The unit secretary was seen as a gatekeeper of information flow on the unit. Patient charts were the main access of information. Technology was not seen as a barrier. Interestingly, the author points out that the physician rarely accessed the information system. Published print information was sought out two times during the fifty hour observation period. Any research that they might seek on a particular problem was completed off duty. The conclusion was that the daily requirements of patient care do not allow time to accessing published information.

McKnight, M. (2006). The information seeking of off-duty critical care nurses: Evidence from participant observation and in-context interviews. Journal of the Medical Library Association, 94(2), 145- 151.


Observations: Healthcare professionals have been directed to implement evidence-based practice (EBP) but currently they lack the tools needed for EBP. Healthcare professionals do not have the time for published information. Current means of disseminating published healht care information is may not be accessible nor valued at work. Peers or collegaues are still the preferred means to acquire information. Access of published resources is not done at work. Nursing schools understand the need to teach students information literacy skills but have limited resources and time constraints. A better means of dissemination might need to occur for practicing nurses to utilize published information at work.