To maximize the impact of nursing to promote health, improve patient care and increase the value of care, changes to nursing practice must occur (Salmond & Echevarria, 2017). However, the nurses’ experience of engaging in practice change when they are not leading it, has not been adequately explored. There is a gap in the literature exploring the experience and perceptions of hospital nurses who are being asked to change their practice when they are not leading the change themselves. Additionally, studies should explore practice change in a way that aligns with the reality of nurses’ work context where multiple practice changes are co-occurring. This new knowledge can contribute to understanding how to redesign health care systems to facilitate practice change for nurses to align their care with research evidence. Nurses have a pivotal role in implementing practice changes to improve patient outcomes and yet the experience of the daily expectation for practice change has not been adequately captured in the current body of knowledge. Therefore, it is important to hear the voices of nurses who have been asked to change their practice to complement the growing body of implementation science.
Aim: The purpose of this descriptive qualitative study is to examine registered nurses’ (RNs) perception of practice change in the hospital. This study aims to 1) describe nurses’ perception of practice change and 2) describe factors that influence the adoption of practice changes, especially practices that are evidence-based practices (EBPs).
Methods: A descriptive qualitative approach, using inductive content analysis, was used to provide a broad description of practice change (Elo & Kyngas, 2008; Sandelowski, 2000). Eleven direct care inpatient nurses, from one Magnet-designated, Academic Medical Center, were individually interviewed. In this sample of 11 nurses, 63 practice changes were described. This sample worked with adult and pediatric patient populations on units with varying levels of acuity. Years of practice experience ranged from three to greater than 15 years. Two researchers analyzed the data beginning with open-coding, through category development and abstraction.
Findings: Four main categories capture nurses’ descriptions of practice change and what influences them to change their practice. 1) Practice change is a thing. Nurses recognize that practice change exists and describe it as a part of nursing, and yet individual practice changes could be temporal, waxing and waning. Nurse describe a taxonomy of practice changes including differentiating changes by size of change and type of change (clinical versus operational). 2) Practice change happens to nurses. Nurses report being told about practice changes but not involved in practice change. When changes are communicated to nurses, often the why behind the need to change practice is not included. 3) Practice change is work, Nurses describe practice change as a process, one that takes time and includes a process of remembering the new practice and forgetting the old. Nurses also report wishing practice changes made sense and were thought through to align the new practice with the realities of their practice environment. 4) Practice change is meaningful. Nurses place value on and are optimistic about changing practice and can clearly see the link between practice change and how it leads to improved patient outcomes.
Discussion: Nurses clearly experience practice change and are describe it both as something that exists in their practice and as a process that is work. Nurses’ perceptions of what influences them to change their practice aligns, in part, with suggested implementation strategies (Cullen & Adams, 2012). However, unlike the way the available literature describes practice change, as one event occurring in isolation of any other context, the nurses in this study describe practice change occurring at a high frequency and often experience multiple co-occurring practice changes. This study highlights the need to further explore this area of research. The interdependencies of each practice change could be addressed using a systems-approach to improve the uptake of EBPs. These data indicate a need to engage with nurses as valuable resources and key stakeholders to change practice as a means to improve the provision of evidence-based high quality care, to optimize patient outcomes and decrease health care costs. The findings of this study expands current knowledge about nurses role in providing evidence-based care and elevates the need to design practice change for nurses in a way that facilitates the process.