Investigating Evidence-Based Practice Resources

A health system posts a job opening for a clinical nurse specialist (CNS). You update your resume, write a cover letter highlighting your qualifications and experience, fill out the online application, and are thrilled to be invited for an interview. To prepare, you have a colleague role-play the interview. With your thoughts in order, you are ready to ace the interview. But wait, what are you missing? Did you prepare questions to ask the interviewers? When the job duties include implementing evidence-based best practices, there are some essential points you should consider. Implementing evidence-based best practices is a core CNS practice competency. Since the early days of the CNS role, where the competency was labeled “change agent,” implementing practice changes has always been challenging. More recently, evidence-based practice models guide evidence reviews and decision making, and implementation science supports system level assessment and selection of best-fit implementation practices. To take advantage of this emerging area of theoretical and scientifically grounded knowledge, CNSs need a supportive infrastructure with specific resources. Organizations vary in levels of evidence-based practice expertise falling along a spectrum from novice—wanting to start an evidence based practice initiative, to experienced, with expert staff and supportive resources. Whether new or experienced, a CNS considering a new job should use the interview to explore the organization's readiness for and experience with evidence-based practice change initiatives. Here are some points to discuss during the interview to help assess where an organization fits along the evidence-based practicum spectrum. Consider the level of commitment by system-level administrators and directors. How familiar are they with evidence-based practice and implementation science? Have these leaders participated in professional development regarding evidence-based practice? Do administrators routinely engage in evidence-based decision making? For example, are staffing decisions or equipment selection subject to evidence reviews? Are evidence critiques a requirement when creating, updating, or deleting practice policies, procedures, and guidelines? Are the evidence reviews archived along with the older version of the document being updated or deleted? Does the organization subscribe to 1 model or use several models for conducting evidence reviews? Which model(s)? Are unit-based staff nurses actively engaged in evidence-based practices? Is there a professional development program supporting nurses to build evidence-based practice skills and knowledge? What is the level of interprofessional engagement in evidence reviews regarding clinical practice changes? Do nurses participate in decision making as equals and voting members? What drives evidence-based practice changes is, well, evidence! Although these fundamental questions provide insight into an organization's commitment to and experience with implementing evidence-based practice changes, it is critical to assess the staff's access to a comprehensive medical library. Academic medical centers can be expected to have library resources and medical librarians experienced in searching for evidence. Ascertain that nurses have access to the library, that library privileges are not limited to faculty and students, and that the full scope of holdings is available to staff including nurses. Verify that the medical librarians are available to support nurses in searching for evidence. Conducting a comprehensive literature search is the specialty work of librarians. Having inexperienced staff conducting evidence searches is a sure way to miss evidence. And once identified, some evidence may require librarian expertise to procure the documents or articles. Ask about any costs associated with library services. If there is a fee for articles or other services, how are these costs covered? Private and smaller hospitals likely do not have a comprehensive medical library but may be partnered or collaborating with larger libraries for database access, articles, and librarian services. When this is the situation, determine that the nurses have unfettered access to the library, inquire about procedure for obtaining articles, and discuss how any costs are covered. When no library or library partnership exists, use the interview to probe the organization's interest in evidence-based practice and any plans for obtaining library resources. The National Library of Medicine's PubMed citation database is a public website that can be used to access abstracts of journal articles and open access full-text articles. Other full-text articles will be behind a subscription paywall, and a fee will be charged to access the article. Limiting an evidence search to just abstracts and open access articles is inadequate for the purpose of an evidence review. It is best to determine an organization's readiness and expertise along the spectrum before committing to a job. Library access with librarian support is critical for success. It should be established that the library is for all staff, including nurses, without cumbersome permission procedures or restrictions. With tightening budgets, an organization that penny pinches on library access is compromised in moving forward with a robust evidence-based practice initiative. Emphasizing practice based on evidence is a core CNS practice competency. Changing practice using implementation science to foster change and sustainability is the new horizon. Implementing evidence-based practice changes requires access to evidence, and libraries are crucial for a robust evidence review. When considering a CNS job as a new or experienced CNS, it is imperative that the interview process include an in-depth understanding of where on the spectrum an organization sits relative to readiness for evidence-based practice initiatives.