January 11, 2018

New study reveals nurses' reported lack of competency in evidence-based practice threatens quality and safety of healthcare

A new survey of United States nurses by The Ohio State University College of Nursing indicates marked deficits in evidence-based practice (EBP) competency. The study’s authors find that these deficits threaten the ability to provide high-quality, safe and cost-effective care.

Published recently in Worldviews in Evidence-Based Nursing, the Ohio State research team’s anonymous online survey of 2,344 nurses working in 19 hospitals and healthcare systems nationwide found that nurses reported they were not yet fully competent in meeting the profession’s 24 EBP competencies.

EBP is a life-long, problem-solving approach to clinical practice that integrates the best evidence from well-designed studies with a patient's preferences and values and a clinician's expertise. Findings from multiple studies have supported that, when patients receive evidence-based care from healthcare providers, healthcare quality, safety and patient outcomes improve and costs decline. EBP also empowers clinicians and leads to higher levels of engagement, teamwork and job satisfaction. However, research has shown that multiple barriers prevent clinicians from consistently implementing EBP, including inadequate knowledge and skills in EBP, barriers in academia that impede how EBP is taught, healthcare cultures that are steeped in tradition (e.g., “that is the way we do it here”), misperceptions about the time it takes to implement EBP, leaders and managers who do not embrace, model and support EBP and lack of EBP mentors available to assist point-of-care providers with evidence-based care. 

Nurses who responded to the survey were asked to report their level of competency for each of the 24 EBP competencies on a scale spanning four categories – “not competent,” “need improvement,” “competent” and “highly competent.” For all but one category, respondents reported falling between the “need improvement” and “competent” levels. Nurses reported themselves as not competent in leading transdisciplinary teams to implement EBP.  

“Our findings concern us greatly because lack of competency in and delivery of EBP threatens the quality and safety of healthcare and hinders our efforts to ensure positive outcomes for patients,” said Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FAANP, FNAP, FAAN, who led the study. Melnyk serves as vice president for health promotion, university chief wellness officer and professor and dean of the College of Nursing at Ohio State. She is also executive director of the Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, which is based at Ohio State.

Other key findings included:

  • Nurses with stronger beliefs in the value of EBP reported higher competency levels.
  • Younger nurses and those with higher levels of education, (i.e., master’s degrees), reported higher EBP competency.
  • EBP competency scores were not significantly different between nurses who worked in Magnet-designated hospitals and non-Magnet facilities.
  • Nurses with higher knowledge of EBP reported greater competency.
  • Nurses who had more mentorship in EBP and worked in cultures that support it reported higher levels of competency. 

“Clearly, educators and healthcare leaders must intensify their efforts to provide the infrastructure, culture and educational resources to ensure that nurses and other health professionals are competent in delivering evidence-based care,” Melnyk said. “Academic programs that prepare nurses and all health professionals should ensure competency in EBP in students by the time of graduation, and healthcare systems should set it as an expectation and ongoing standard for all clinicians.”

Joining Melnyk in designing and conducting the survey were six Ohio State colleagues: Lynn Gallagher-Ford, RN, PhD, DPFNAP, NE-BC, FAAN; Cindy Zellefrow, RN, DNP, LSN, PHNA-BC;  Sharon Tucker, RN, PhD, FAAN; Bindu Thomas, MEd, MS; Loraine T. Sinnott, PhD; and Alai Tan, PhD.


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