Learning Objective #1: Identify ways to create an evidence-based culture at the bedside

Learning Objective #2: Identify change agents within an organization

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After the merger of two children's hospitals, one academic based and one community based, it became evident that a common culture needed to be developed that reflected the new mission statement of the organization. The challenge was to find a common culture that the staff at each institution could embrace and unite themselves around. The decision was made to create a culture of evidence-based practice for the newly formed institution, something that neither had fully developed independently in the past. For nursing, the first hurtle was to create the vocabulary and introduce an evidence-based culture at the bedside. A nursing research and outcomes manager was hired and charged with developing classes that introduced evidence-based practice to the nurses at the bedside as well as supporting research efforts at the bedside through development and management of a million dollar fund. The second hurtle within nursing, was to develop a clinical ladder that embraced and promoted an evidence-based culture and challenged the bedside nurse to expand his/her knowledge base while remaining at the bedside. A clinical advancement program was developed as a joint effort between the bedside nurses, educators and management with oversight responsibility through a shared decision making counsel. All promotions are reviewed and approved by this counsel. The final arm of creating an evidence-based culture was to unite the physician and nursing staff. A director for Medical Management and the Center for Pediatric Outcomes and Quality was hired to specifically work on clinical pathways promoting a multidisciplinary approach. The development of clinical pathways is supported through the clinical advancement program.