Return on Investment: Demonstrating Value to the Clinician

Purpose: To describe the lived experience of mid-level nursing leaders, both as participants in the learning experience and during transition to the frontline EBP mentor role in years 1 and 2 of the strategic partnership between the Helene Fuld Institute for Evidence-based Practice and the Memorial Sloan Kettering Cancer Center. A second purpose was to describe how the experience of the leadership team, of senior nursing directors, front line nurse leaders, clinical nurse specialists, nursing professional development specialists and other mid-level managers impacted the second cohort of participants.

Methods: The Fuld/MSK partnership along with MSK’s robust shared governance structure, staff development model, Magnet principles, and executive nursing support, allowed the EBP mentors/leaders to play a critical role in the successful implementation of fifteen complex EBP initiatives that were aligned with the organization’s strategic goals. The presentation will highlight and describe several of the EBP initiatives with the focus on the structure and process, program design, and both the predicted and unexpected barriers and challenges that are often associated with organizational changes and a deliberate shift in culture. In addition, facilitating factors, remarkable discoveries, team dynamics, and project results will be shared.

Results: Major evidence-based practice change initiatives were implemented, including: falls mitigation, preceptor program redesign, peer review process implementation, chemotherapy personal protective equipment (PPE) compliance, CLABSI and CAUTI prevention, standardized handoff protocols that cross the continuum of care, chemotherapy extravasations and development of ambulatory and perioperative benchmarks. The presentation will describe how the completed projects which include full proposals and collaboration with nursing business partners to demonstrate return on investment and other related outcomes. An unanticipated benefit of the immersion was the collaboration that led to strengthening and bridging of existing institutional initiatives. Two hundred and twenty attendees were immersed in the 1^st and 2^nd EBP program cohorts. Sixteen 16 EBP mentors were developed in cohort 2 for future EBP programs. Pre and post survey data of participants demonstrated statistically significant, positive changes in all EBP attributes.

Conclusions: Through engagement and enculturation of leaders and mentors this immersion facilitated an EBP movement across the institution. The spirit of inquiry cultivated in nursing leadership has demonstrated impacts wherever care is delivered across a complex organization. This process validated current practice, closed gaps, and amplified standards based on the evidence, challenging traditional approaches such as; “the way we’ve always done it” and “the Memorial way” to an evidence-based decision-making method. The future plan includes immersion of the interdisciplinary team and staff nurses to further augment EBP bench strength across the organization. The impact of this experience on both personal and professional growth as well as the organization’s transformation will be shared.