Objective: To examine organizational factors that influence modifications to policies and procedures in Canadian institutions that participated in the pilot implementation and evaluation of six BPGs developed by the Registered Nurses Association of Ontario.

Methods: A secondary analysis was conducted of data collected at six months after BPG implementation in 11 agencies. Response rates ranged from 46% to 94% of randomly selected nurses on a mailed survey and 62% to 100% of nurses, nurse administrators and clinical resource nurses in semi-structured interviews. A total of 316 staff surveys were analyzed using chi-squares and t-tests. As well, content analysis of 104 interviews was conducted.

Findings: A statistically significant relationship (p=0.000) was found between the nurses' perception of modification to policies and procedures and nurses' perception of organizational support. Approximately 75% of the front line staff surveyed perceived that their organization was supportive in facilitating the implementation of BPG. No significant relationship was found between the type of agency - acute care versus others (p=0.149), agency designation as teaching versus non teaching (p=0.876) or nurses' perception of organizational stability (p=0.163) and nurses' perception of modification to policies and procedures.

Implications: Organizational support, in the form of nurses' perceived support by top management, sufficient time and training to learn how to use the BPG, adequate number of qualified staff and sufficient equipment and supplies to implement the BPG, is important and is related to the modification of policies and procedures for evidence-based practice.