Developing Nursing Agency and Clinical Leadership through Evidence-Based Practice

Purpose: To eliminate healthcare errors, the Institute of Medicine (2001) challenged organizations and providers to adopt evidence based practice (EBP) and to use advanced technology to safely and effectively care for complex patients. Nurse clinicians may lack the educational preparation to initiate an EBP project and may be less familiar with published empirical studies than nurse academics, but may be more likely to recognize a clinically relevant topic that needs to be researched. Creating mutually beneficial academic-clinical partnerships is one way to advance EBP at the bedside and to assure quality and safety in healthcare. 

Methods: The Self-Care Deficit Theory of Nursing posits that encouraging the development of nursing agency (the complex set of learned capabilities for the deliberate action of nursing) helps nurses to be more effective in implementation of nursing care by contributing to the life, health, and well-being of patients. At a small liberal arts university, the concept of nursing agency underpins both the development of academic-clinical partnerships and the creation of future leaders for a global society. Academic-clinical partnerships pair faculty and students from a university with nursing administration and nurses at clinical agencies to complete EBP projects that would be difficult for either side to complete individually. These partnerships not only benefit the nursing agency of students involved in the projects, but increase the nursing agency of clinical partners through implementation of EBP. Two partnerships were developed with clinical agencies which resulted in projects that improved patient care and enhanced nursing agency and leadership skills.

Results: The first partnership was between a small liberal arts university and a regional medical facility. What began as a quality improvement project, rapidly evolved into a research project. Nurses on the pediatric inpatient unit identified that the head to toe assessment frequency for floor status pediatric patients and neonatal intensive care patients was the same. After completing a literature search, no evidence supported specific recommendations for head to toe assessment intervals for hospitalized children. Given the lack of information, the unit manager identified that a pilot study was the most appropriate next step, but did not have the time or resources to complete the project. By partnering with a faculty member at the university, the research was successfully completed. The unit manager provided subject matter expertise while the faculty member provided the research expertise. Under the supervision of nurse faculty, nursing students from the university helped develop the research proposal, complete institutional review board documents, and analyze the data. Nurses from the unit collected data and presented the final project to the hospital’s performance improvement council. The research project exemplified EBP and resulted in a change of the head to toe assessment interval. The results of the study will be submitted to a peer review journal that is read by both academics and clinicians to assure its use at the bedside since a significant delay occurs between dissemination of research and bedside integration.

            The second partnership was the development of an evidence-based presentation on motivational interviewing (MI). A behavioral health educator identified the need for more information on MI which could be used on multiple units, but did not have the time or resources to complete the project. Nursing students researched and constructed a PowerPoint presentation on MI for the staff, and the faculty member presented the information to staff during clinical education days. Using clinical students to construct the presentation and a faculty member to present the information allowed the nursing staff to enhance their MI skills and develop their nursing agency in the care of behavioral health patients. Clinicians have since sought out additional resources on MI and have become clinical leaders in using MI in therapeutic communication.

Conclusion: By using the expertise of academic faculty, clinical agencies benefitted from the partnerships and were able to enhance their use of EBP. Quality improvement and use of best practices is integral in the healthcare settings, but many bedside nurses do not feel adequately prepared to implement EBP projects without guidance. The faculty provided research expertise and additional manpower (nursing students), while the bedside nurses provided the clinically relevant questions. The resulting projects were integral to the development of nursing agency and clinical leadership development of both students and staff nurses.