Nurse Managers' Implementation Leadership and Hospital Nurses' Evidence‐Based Practice: A Multilevel Analysis of the Mediating Effects of Evidence‐Based Practice Beliefs

Evidence-based practice (EBP) is recognized as essential for improving patient outcomes and healthcare quality. Implementation leadership by nurse managers plays a crucial role in promoting EBP in hospital wards. However, the mechanisms by which implementation leadership is related to nurses' EBP activities remain unclear. This research, a secondary analysis of cross-sectional data from three Japanese university hospitals, included 473 nurses from 84 wards. Implementation leadership, EBP beliefs, and EBP behaviors were measured using the Implementation Leadership Scale, EBP Beliefs Scale, and EBP Questionnaire-Japanese version. Multilevel structural equation modeling showed that at the ward level, implementation leadership directly affected staff nurses' EBP behaviors. At the individual level, the relationship between implementation leadership and EBP behaviors was fully mediated by EBP beliefs. The intraclass correlation coefficient was higher for Implementation Leadership Scale scores (0.20) than for EBP Beliefs Scale (0.05) and EBP Questionnaire-Japanese version scores (0.03), indicating that implementation leadership was assessed similarly within wards. However, individual factors primarily affected EBP beliefs and behaviors. These findings suggest the importance of ward-level support and individual belief formation in promoting EBP implementation. Trial Registration: This trail is registered with UMIN000045782.