Adoption and Early Implementation Evaluation of a Heart Failure Nursing Protocol in Veterans Health Clinics

BACKGROUND: The Veterans Health Administration Office of Nursing Services developed an ambulatory care heart failure nursing protocol to standardize outpatient nursing practice and piloted it at 4 medical centers. METHODS: We conducted a cross-sectional evaluation using semi-structured interviews with Likert-scale items to assess early adoption and contextual influences. Interviews were conducted with 39 nursing staff across 4 pilot sites. Data were analyzed using rapid qualitative methods informed by Reach, Effectiveness, Adoption, Implementation, Maintenance and Consolidated Framework for Implementation Research frameworks. RESULTS: Staff described improvements in documentation standardization and communication, and increased confidence in protocol use. Time constraints, workflow integration challenges, and electronic health record barriers limited consistent implementation. Nurse educators were key facilitators. CONCLUSIONS: Early findings suggest the protocol may support standardized outpatient nursing practice. Attention to workflow integration, role clarity, and contextual variation may strengthen broader adoption.