Wherever healthcare services are being delivered, there is likely to be a nurse. Registered nurses (RNs) make up the largest segment of all healthcare professions. They also provide the majority of patient care, making them a force for improving the quality of healthcare. Implementing evidence-based practice (EBP) is widely seen as the way to get there.
Earning a Bachelor of Science in Nursing (BSN) can be a game-changer when it comes to employing an evidence-based approach in nursing practice. Associate degree nursing programs typically focus on clinical skills. RN to BSN programs build on that clinical expertise to develop a strong foundation for EBP.
For example, the RN to BSN program at the University of Maine at Fort Kent (UMFK) includes coursework that helps students build EBP competencies. Lack of experience in the research process is a common barrier to use of EBP, and the course Health Related Research addresses this need.
What Is Evidence-Based Practice?
An online search turns up many variations on the definition of "evidence-based practice." One way to understand EBP is to look at what it is not. Nurses are not alone in sometimes making decisions based on a culture of This is how we have always done it. But healthcare is constantly changing, and RNs need to keep their practice current.
This is where EBP comes in. EBP is about inquiry. As Susan B Fowler, PhD, RN, CNRN notes in "How to Conduct an Evidence-Based Practice Investigation, "Nurses who value EBP ask questions, exhibit curiosity, and wonder continually if there's a better way to provide patient care."
In nursing, making the right care decision may mean doing away with how things have always been done. Just think about how salicylates such as aspirin were once routinely recommended to control a child's fever. Based on evidence linking aspirin with Reye's Syndrome, this is no longer standard practice.
The Agency for Healthcare Research and Quality (AHRQ) describes EBP as using the "current best evidence in making decisions about the care of the individual patient."
The Institute of Medicine (IOM) — now the National Academy of Medicine — adds a patient-centered approach: "Evidence-based practice is the integration of best research evidence with clinical expertise and patient values."
This approach to EBP supports the IOM's Aims for Improvement, which include "ensuring that patient values guide clinical decisions."
Why Is EBP Important?
The IOM's 1999 report, To Err Is Human: Building a Safer Health System, found that nearly 100,000 people were dying in any given year as a result of medical errors that occurred in hospitals. "More people were dying from medical errors than from motor vehicle accidents, breast cancer, or AIDS."
The first Quality Chasm report to follow recommended a plan to redesign healthcare. Employing EBP was a key recommendation. The IOM set a goal that by 2020, 90% of clinical decisions would reflect the best available evidence.
The goal of EBP is to standardize care. Care is based on current scientific evidence, regardless of who is providing the care or where it is being delivered. According to Reflections on Nursing Leadership, EBP is a key factor in meeting the Triple Aim in healthcare:
- Improving the patient experience
- Improving the health of populations
- Reducing the cost of healthcare
By empowering RNs in their work, taking an evidence-based approach to nursing practice may also increase job satisfaction.
How Can Earning a BSN Help?
Hospitals are the largest employer of RNs. One reason that more hospitals prefer or require BSN-prepared nurses is that higher levels of education are linked to better patient outcomes. BSN graduates are well-prepared to provide patient-centered care, with an emphasis on EBP.
Research backs up the value of a BSN as preparation for evidence-based care:
- A recent study showed a growing gap in preparedness between BSN and Associate Degree in Nursing (ADN) graduates. BSNs reported being significantly better prepared than ADNs on 12 of 16 quality and safety competencies, including EBP. Notably, the authors concluded that "requiring the BSN for RNs could help safeguard the quality of patient care."
- A study of nurse educators looked at differences between outcomes met in ADN and BSN programs. The study found that only 42 of 109 BSN outcomes were met in ADN programs. The 67 unmet outcomes in associate nursing programs included EBP competencies.
UMFK's RN to BSN program develops essential learning outcomes in EBP. Students learn to apply evidence to clinical decision-making by:
- Identifying and evaluating current evidence
- Considering clinical expertise
- Taking patients' preferences, experience and values into account
Nurses are everywhere healthcare is provided — not just in hospitals, but in nursing homes, primary care clinics, walk-in clinics, private practices, schools, home health care, hospice care, the military installations and more. Based on numbers alone, RNs have an opportunity to take the lead in improving the quality of patient care.
Patient care has always been the nursing profession's priority. As part of their commitment to patients, nurses have an ethical obligation to engage in "evidence-informed practice." Completing an RN to BSN program is an important step in developing the skills, knowledge and confidence RNs need to meet this professional expectation.
Learn more about the University of Maine at Fort Kent's online RN to BSN program.
Sources:NCBI: Bachelor's Degree Nurse Graduates Report Better Quality and Safety Educational Preparedness Than Associate Degree Graduates
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