Deliberate strategies were required to ensure adoption of evidence based practice at MSK, an NCI designated comprehensive cancer center with ANCC Magnet® Designation. MSK Executive leadership partnered with the Helene Fuld Health Trust for Evidence-based Practice with the goal of training all MSK nurses in EBP methodology. The Fuld’s broad experience in education, support and culture change combined with a MSK’s history of commitment to excellence in nursing care created the perfect opportunity to demonstrate success and sustainability. This presentation will include a description of the strategies used and lessons learned in a 2 year collaboration towards reaching our goal.
Methods
MSK leadership contracted with the Fuld to participate in annual week long immersions for cohorts of MSK nurses. The immersions consisted of a standard curriculum provided by Fuld faculty and implementation mentors. The immersions took place at on offsite location nearby the MSK campus to create distance for enhanced learning. The first cohort included 104 nursing leaders from across the Center, including the Chief and deputy Chief Nursing Officers, so as to educate and engage the decision makers. The second cohort included 110 senior staff, APPs, and academic partners as well as previous cohort members to begin skill development as EBP mentors. Participants were assigned to work groups consisting of varied roles and work sites and were delegated to learning tracks: mentor, leader, academic. Inquiry topics were assigned to the first cohort and consisted of significant institutional concerns, selected by executive leadership. The second cohort’s groups chose their own topics, ensuring greater engagement in the ongoing work and outcomes. The groups continued to meet for 15 months with Fuld follow up and boosters every 3 months to provide feedback, direction and support. At the same time, adoption of EBP terms and methods were introduced across the department and incorporated into shared governance bylaws and promotional and staff development processes. Librarians developed resources for writing PICO questions and offered courses on evidence searching and reference management.
Results
Cohort groups presented their 15 month-long work at a peer symposium. Projects included clinical inquiry, PICO questions, synthesis tables, levels of evidence, internal evidence and practice or administrative recommendations. Many of the recommendations had moved ahead to implementation and other groups awaited hospital resources. Whenever appropriate, projects included measurements of clinical outcomes and return on investment. Surveys of knowledge and skill acquisition and attitude about EBP demonstrated significant change from baseline. This presentation will include our experience with multiple examples of cohort project measures, survey results and plans for dissemination of projects and our strategic experience.
Conclusion
Adopting a standardized method for EBP across a large Cancer Center with 3500 nurses at 10 local and regional sites can be accomplished through deliberate strategies. A partnership with the Fuld Trust allowed a committed organization to realize a goal of ensuring that front line nursing practice is always based on evidence. Future plans include ongoing immersions of staff nurses for sustainability, with MSK taking greater ownership for education and mentorship