Registered Nurses' Evidence-Based Practice Revisited: A Longitudinal Study in Mid-Career

Abstract

Background: To improve patient outcomes and patient safety and to reduce costs in health care, the implementation of evidence-based practice (EBP) is crucial.

Aims: To examine the use of the EBP process in Swedish health care. Specifically, to examine whether professional career development (years of experience, years in current position, specialist education, care setting) is associated with RNs' practice of EBP activities and changes in the extent of practicing the EBP process between early and mid-career.

Methods: In this observational longitudinal study, the extent of EBP activities was investigated in three national cohorts of 2,474 RNs. Nurses rated their own EBP levels 11-15 and three years after graduation. Six items measured the respondents' extent of practicing the EBP process. Comparisons of EBP levels between subgroups were tested using unpaired t-tests or one-way ANOVAs.

Results: On average, RNs used the EBP process occasionally every half year. RNs with specialist education reported a higher extent of EBP activities as did RNs who worked in outpatient and home care settings. There was a significant increase in the extent of EBP activities 11 to 13 years after graduation compared to three years after graduation.

Linking evidence to action: The findings raise some central questions for practice: How well equipped are RNs to practice the EBP process? What is needed to facilitate EBP in clinical settings? Building on the findings of this study, managers in clinical practice need to develop supportive organizational structures that facilitate EBP. This study suggests that mid-career RNs increased the extent of practicing the EBP process over time compared to previous reported practice in their first years as RNs. However, the level of EBP activities was low to moderate, and this modest increase took 11 to 13 years to achieve. To enhance the practice of EBP in nursing care, educational and organizational factors need to be considered.

Keywords: evidence-based practice; nursing practice; quantitative methodology; repeated measures; research utilization; survey.