A Study of Medical Surgical Nurses Leaders' Evidence-Based Practice Attributes: Critical Implications for Practice.

OBJECTIVE: The purpose of this study was to determine medical-surgical nurse leaders' evidence-based practice (EBP) attributes, perceived barriers to EBP, and whether there were differences in leaders' EBP competencies and EBP implementation by demographic and organizational factors. BACKGROUND: Leaders are crucial to the development of cultures that support EBP implementation, but little is known about medical-surgical nurse leaders' capacity to perform this aspect of their role. METHODS: A cross-sectional design using survey methodology was used. The survey contained demographic/work setting questions and 3 instruments to measure EBP beliefs, implementation, and competencies. RESULTS: Senior leaders self-reported higher EBP attributes compared with nurses in other roles; nurses with an MSN or higher reported greater frequency of EBP implementation. A regression revealed that EBP competencies, EBP beliefs, having a DNP degree, and working in an Academy of Medical-Surgical Nurses Premier Recognition In the Specialty of Med-surg unit or a Pathway to Excellence® organization had significant, positive effects on EBP implementation scores ( R2 = 0.37). CONCLUSIONS: Findings demonstrate there is a range of EBP beliefs and competencies, and barriers to EBP among medical-surgical nurse leaders. Because medical-surgical nursing is the largest acute care practice specialty in the United States and many other countries, leaders fully integrating EBP into their practice would be a substantial contribution to advancing EBP in healthcare.

Budgetary investment in evidence-based practice by chief nurses and stronger EBP cultures are associated with less turnover and better patient outcomes.

BACKGROUND: Hospitals and healthcare systems strive to meet benchmarks for the National Database of Nursing Quality Indicator (NDNQI) measures, Centers for Medicare & Medicaid Services (CMS) Core Measures, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) outcome indicators. Prior research indicates that Chief Nursing Officers and Executives (CNOs, CNEs) believe that evidence-based practice (EBP) is important for ensuring the quality of care, but they allocate little funding to its implementation and report it as a low priority in their healthcare system. It is not known how EBP budget investment by chief nurses affects NDNQI, CMS Core Measures, and HCAHPS indicators or key EBP attributes and nurse outcomes. AIMS: This study aimed to generate evidence on the relationships among the budget devoted to EBP by chief nurses and its impact on key patient and nurse outcomes along with EBP attributes. METHODS: A descriptive correlational design was used. An online survey was sent to CNO and CNE members (N = 5026) of various national and regional nurse leader professional organizations across the United States in two recruitment rounds. Data collected included CNO/CNE EBP Beliefs, EBP Implementation, and perceived organizational culture of EBP; organizational culture, structure, personnel, and resources for EBP; percent of budget dedicated to EBP; key performance measures (NDNQI, CMS Core Measures, HCAHPS); nurse satisfaction; nurse turnover; and demographic questions. Descriptive statistics were used to summarize sample characteristics. Kendall's Tau correlation coefficients were calculated among EBP budget, nursing outcome measures, and EBP measures. RESULTS: One hundred and fifteen CNEs/CNOs completed the survey (a 2.3% response rate). The majority (60.9%) allocated <5% of their budget to EBP, with a third investing none. An increase in EBP budget was associated with fewer patient falls and trauma, less nursing turnover, and stronger EBP culture and other positive EBP attributes. A greater number of EBP projects were also associated with better patient outcomes. LINKING EVIDENCE TO ACTION: Chief nurse executives and CNOs allocate very little of their budgets to EBP. When CNEs and CNOs invest more in EBP, patient, nursing, and EBP outcomes improve. System-wide implementation of EBP, which includes appropriate EBP budget allocation, is necessary for improvements in hospital quality indicators and nursing turnover.

Development and Evaluation of the Fuld Institute Evidence-based Implementation and Sustainability Toolkit for Health Care Settings.

Routine implementation and sustainability of evidence-based practices (EBPs) into health care is often the most difficult stage in the change process. Despite major advances in implementation science and quality improvement, a persistent 13- to 15-year research-to-practice gap remains. Nurse leaders may benefit from tools to support implementation that are based on scientific evidence and can be readily integrated into complex health care settings. This article describes development and evaluation of an evidence-based implementation and sustainability toolkit used by health care clinicians seeking to implement EBPs. For this project, implementation science and EBP experts created initial iterations of the toolkit based on Rogers' change theory, the Advancing Research through Close Collaboration (ARCC) model, and phases and strategies from implementation science. Face validity and end-user feedback were obtained after piloting the tool with health care clinicians participating in immersive EBP sessions. The toolkit was then modified, with subsequent content validity and usability evaluations conducted among implementation science experts and health care clinicians. This article presents the newly updated Fuld Institute Evidence-based Implementation and Sustainability Toolkit for health care settings. Nurse leaders seeking to implement EBPs may benefit from an evidence-based toolkit to provide a science-informed approach to implementation and sustainability of practice changes.

Equipping Nurses to Lead Evidence-Based Practice: An Opportunity for Professional Nursing Associations.

OBJECTIVE: The aim of this study was to describe the evidence-based practice (EBP) attributes among California nurse leaders who are members of a professional nursing organization. BACKGROUND: Nurse leaders are pivotal for successful EBP implementation. The Association of California Nurse Leaders' (ACNL) mission to equip nurses to lead self, others, and systems propelled them to conduct a study of members' EBP beliefs, knowledge, competencies, and implementation. METHODS: Evidence-based practice attributes of California nurse leaders were measured using valid and reliable scales via an anonymous, electronic survey. RESULTS: Although ahead in the subjective EBP scales, California nurse leaders' perceptions of organizational EBP culture were comparable with those of a similar national sample. Scores still indicated opportunities for improvement. CONCLUSIONS: Nurse leaders must be prepared to lead EBP in their organizations. Professional organizations such as ACNL have an opportunity to help leaders by conducting research and assessing and meeting their members' learning needs.

A Qualitative Force Field Analysis of Facilitators and Barriers to Evidence-Based Practice in Healthcare Using an Implementation Framework.

Research has identified facilitators and barriers to implementation of evidence-based practices (EBPs). Few studies have evaluated which factors persist among healthcare clinicians with extensive education and training on EBP implementation. Therefore, the purpose of this study was to examine facilitators and barriers to EBP implementation across a national sample of specialty-prepared EBP mentors in healthcare settings. Healthcare clinicians participating in an immersive 5-day EBP knowledge and skill building program were invited to complete a follow-up survey 12 months later to report on implementation experiences. The Consolidated Framework for Implementation Research (CFIR) guided content analysis of responses. A force field analysis using Lewin's change theory was used to assign numerical 'weights' to factors. Eighty-four individuals reported facilitators and barriers to implementation. The majority occurred within the inner setting of the CFIR model. Facilitators were strong leadership engagement (n = 15), positive EBP culture (n = 9), and resources (n = 4). Barriers included lack of resources (n = 21), poor leadership engagement (n = 19), implementation climate (n = 17), lack of relative priority (n = 12), and organizational characteristics (n = 9). Respondents also identified simultaneous facilitators and barriers within the process domain of the CFIR model. The construct of stakeholder engagement was a barrier when absent from the implementation process (n = 23), yet was a strong facilitator when present (n = 23). Implementation in healthcare settings appears most effective when conducted by an interprofessional team with strong leadership, resources, stakeholder engagement, and positive EBP culture. When these same factors are absent, they remain persistent barriers to implementation, even among specialty-trained healthcare clinicians. Supplementary Information: The online version of this article (10.1007/s43477-022-00051-6) contains supplementary material, which is available to authorized users.

EBP education and skills building for leaders: An RCT to promote EBP infrastructure, process and implementation in a comprehensive cancer center.

BACKGROUND: Implementation of evidence-based practice (EBP) in healthcare remains challenging. The influence of leadership has been recognized. However, few randomized trials have tested effects of an educational and skills building intervention for leaders in clinical settings. AIMS: Test effects of an EBP leadership immersion intervention on EBP attributes over time among two cohorts of leaders at a national comprehensive cancer center. METHODS: A stratified, randomized, wait-list group, controlled design was conducted. Participants received the evidence-based intervention one year apart (2020, n = 36; 2021, n = 30) with EBP knowledge, beliefs, competencies, implementation self-efficacy, implementation behaviors, and organizational readiness measured at pre- and post-intervention, and one- and two-year follow-ups. Participants applied learnings to a specific clinical or organization priority topic. RESULTS: Baseline outcomes variables and demographics did not differ between cohorts except for age and years of experience. Both cohorts demonstrated significant changes in EBP attributes (except organizational readiness) post-intervention. Mixed linear modeling revealed group by time effects at 3-months for all EBP attributes except implementation behaviors and organizational readiness after the first intervention, favoring cohort 2020, with retained effects for EBP beliefs and competencies at one year. Following Cohort 2021 intervention, at 12-weeks post-intervention, implementation behaviors were significantly higher for cohort 2021. LINKING EVIDENCE TO ACTION: An intensive EBP intervention can increase healthcare leaders' EBP knowledge and competencies. Aligning EBP projects with organizational priorities is strategic. Follow-up with participants to retain motivation, knowledge and competencies is essential. Future research must demonstrate effects on clinical outcomes.

Medical-surgical nurses' EBP beliefs and competencies.

BACKGROUND: The lack of evidence-based practice (EBP) knowledge and inability to implement EBP among nurses is a major barrier to quality nursing care. The literature shows that nurses highly value the use of EBP, however, they lack necessary EBP competencies. Although medical-surgical nurses were included in studies examining cross-sections of the nursing workforce, no studies exist specifically investigating their EBP beliefs and EBP competencies. AIMS: The purpose of this study was to describe medical-surgical nurses' self-reported EBP beliefs and competencies. METHOD: A descriptive, cross-sectional design employing survey methodology was used. RESULTS: A total of 1,709 medical-surgical nurses participated for a response rate of 13%. The findings revealed that medical-surgical nurses had positive beliefs about EBP. However, they rated themselves competent in only 2 EBP competencies of 24. Medical-surgical nurses working in units or organizations that had a special designation such as Academy of Medical-Surgical Nurses Premier Recognition in the Specialty of Med-Surg (AMSN PRISM; p = .001) or Pathway to Excellence (p = .006) reported greater EBP competency scores. Also, nurses educated at the master's level or higher had better EBP competency scores (p < .0001). LINKING EVIDENCE TO ACTION: Medical-surgical nurses need support at the personal and organizational levels to improve their EBP competence and increase uptake of EBP in their practice. Therefore, individual nurses must reflect on their EBP competence level and pursue opportunities to develop these essential attributes. Leaders must also create practice environments where EBP is valued, and barriers to EBP implementation are eliminated. Faculty in prelicensure and graduate programs should integrate EBP into their curricula and assess students' EBP competencies.

Establishment of Nurse Manager Leadership Competencies to Support Clinicians in Evidence-Based Practice.

OBJECTIVE: This 2-part study was conducted to validate nurse manager (NM) leadership competencies that support clinicians in using evidence-based practice (EBP). BACKGROUND: Numerous studies validate the critical need for NM support among clinicians seeking to engage in EBP. METHODS: In phase 1, a Delphi study was conducted to establish the validity of a set of NM leadership competencies that support EBP. In phase 2, descriptive analyses, tests of significance, and reliability coefficients were used to assess reliability. RESULTS: An expert panel achieved consensus on a set of 22 NM leadership competencies that constitute effective support for EBP. Further quantitative analyses demonstrated excellent levels of internal consistency and overall consistent outcomes across time. CONCLUSION: A valid set of 22 NM leadership competencies with evidence of reliability that successfully support clinicians to engage in EBP in clinical settings was established.

Psychometric Properties of the Short Versions of the EBP Beliefs Scale, the EBP Implementation Scale, and the EBP Organizational Culture and Readiness Scale.

BACKGROUND: Evidence-based practice (EBP) is a problem-solving approach to clinical decision making that leads to a higher quality and safety of health care. Three valid and reliable scales that measure EBP attributes, including the EBP Beliefs Scale, the EBP Implementation Scale, and the Organizational Culture and Readiness Scale for System-Wide Integration of EBP, are widely used but require approximately 5 min each to complete. Shorter valid and reliable versions of these scales could offer the benefit of less time for completion, thereby decreasing participant burden. AIM: The aim of this study was to determine the psychometric properties of the three shortened EBP scales, adapted from the longer versions. METHODS: This study used a descriptive survey design with 498 nurses who completed the three original EBP scales along with a shortened version of each scale. Exploratory factor analysis was conducted with principal components extracted to examine the factor structure of each EBP measure for the three shortened EBP scales. Item intercorrelations and the Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) were used to confirm the validity of using factor analysis. Reliability of each scale using Cronbach's α was examined. Convergent validity of the three shortened EBP scales was assessed by correlating each shortened scale with its longer scale. RESULTS: Factor analysis supported the construct validity of each of the three shortened scales, as all item intercorrelations were greater than 0.40, and KMO values were 0.62 to 0.74. The shortened scales Cronbach alphas were 0.81 for the EBP Beliefs Scale, 0.89 for the EBP Implementation Scale, and 0.87 for the EBP Culture and Readiness Scale. The three shortened EBP scales had acceptable convergent validity (r = 0.42-.072) for the correlations between the shortened and longer scales. LINKING EVIDENCE TO ACTION: The three shortened EBP scales, which are valid and reliable, can be used as an alternative to the longer three scales to decrease participant burden when conducting program evaluations, research, or organizational assessments.

Evidence-Based Practice in Oncology Nursing: Oncology Nursing Society Survey Results.

BACKGROUND: Evidence-based practice (EBP) is a clinical decision-making approach that improves quality and outcomes in health care but is not yet standard in clinical settings. OBJECTIVES: The purpose of this study was to determine EBP beliefs, knowledge, implementation strategy self-efficacy, and competencies among a national sample of oncology nurses. METHODS: Oncology nurses completed an online survey of EBP attributes and open-ended questions. Analyses were conducted on data collected from 893 participants from a range of healthcare organizations across a diverse geographic sample of the United States. FINDINGS: Respondents rated themselves competent to question clinical practice to improve quality care. Oncology nurses reported competency to question clinical practice but deficits in EBP knowledge and skills.

Impact of a Formal Educational Skill-Building Program Based on the ARCC Model to Enhance Evidence-Based Practice Competency in Nurse Teams.

BACKGROUND: Implementation of evidence-based practice (EBP) is necessary for healthcare systems to improve quality, safety, patient outcomes, and costs. Yet, EBP competency is lacking in many nurses and clinicians across the country. AIM: The purpose of this initiative was to determine whether nursing teams (Executive Leader, Clinical/Mid-level Leader, and Direct Care Nurse) attending a 5-day EBP continuing education skill-building program (immersion) was an effective strategy to build EBP competence, practice, and culture sustainability over time. The Advancing Research and Clinical Practice Through Close Collaboration Model was used to guide this initiative. METHODS: A project team was assembled, including leaders with EBP expertise from the Air Force Medical Service and The Helene Fuld Health Trust National Institute for EBP in Nursing and Healthcare at The Ohio State University. Five survey instruments were used to evaluate outcomes, including Organizational Culture and Readiness for System-Wide Implementation of Evidence-Based Practice, Evidence-Based Practice Beliefs, Evidence-Based Practice Implementation, and Evidence-Based Practice Competencies, as well as the Knowledge Assessment Questionnaire test. Nursing teams were invited to participate and complete the program with the implementation of EBP projects over the following year. RESULTS: Participants' EBP knowledge, skills, competencies, and beliefs were significantly improved and sustained over 12 months. LINKING EVIDENCE TO ACTION: A team-based EBP skill-building program was an effective strategy for building EBP competence, practice, and culture. This initiative demonstrated that the direct involvement of leadership and infrastructure to support EBP were crucial factors for building and sustaining an EBP culture.

The Impact of the Electronic Health Record on Moving New Evidence-Based Nursing Practices Forward.

BACKGROUND: Anecdotal reports from across the country highlight the fact that nurses are facing major challenges in moving new evidence-based practice (EBP) initiatives into the electronic health record (EHR). PURPOSE: The purpose of this study was to: (a) learn current processes for embedding EBP into EHRs, (b) uncover facilitators and barriers associated with rapid movement of new evidence-based nursing practices into the EHR and (c) identify strategies and processes that have been successfully implemented in healthcare organizations across the nation. METHODS: A qualitative study design was utilized. Purposive sampling was used to recruit nurses from across the country (N = 29). Nine focus group sessions were conducted. Semistructured interview questions were developed. Focus groups were conducted by video and audio conferencing. Using an inductive approach, each transcript was read and initial codes were generated resulting in major themes and subthemes. RESULTS: Five major themes were identified: (a) barriers to advancing EBP secondary to the EHR, (b) organizational structure and governing processes of the EHR, (c) current processes for prioritization of EHR changes, (d) impact on ability of clinicians to implement EBP and (e) wait times and delays. LINKING EVIDENCE TO ACTION: Delays in moving new EBP practice changes into the EHR are significant. These delays are sources of frustration and job dissatisfaction. Our results underscore the importance of a priori planning for anticipated changes and building expected delays into the timeline for EBP projects. Moreover, nurse executives must advocate for greater representation of nursing within informatics technology governance structures and additional resources to hire nurse informaticians.

The Effects of an Intensive Evidence-Based Practice Educational and Skills Building Program on EBP Competency and Attributes.

BACKGROUND AND SIGNIFICANCE: Evidence-based practice (EBP) is a systematic problem-solving approach to the delivery of health care that improves quality and population health outcomes as well as reduces costs and empowers clinicians to fully engage in their role, otherwise known as the quadruple aim in health care. The Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare at The Ohio State University College of Nursing has been offering 5-day EBP immersion programs since 2012. The goal of the program is for the participants to acquire EBP competence (e.g., knowledge, skills, and attitude) and sustain it over time. PURPOSE AND AIMS: The purpose of this study was to evaluate the effects of the 5-day EBP immersion (i.e., an education and skills building program) on EBP attributes and competence over time. METHOD AND DESIGN: A longitudinal pre-experimental study was conducted that gathered data with an anonymous online survey from 400 program attendees who attended 16 5-day immersions between September 2014 and May 2016. Participants completed five valid and reliable instruments at four points over 12 months, including EBP beliefs, implementation, competency, knowledge, and perception of organizational readiness and culture. RESULTS: Findings indicated statistically significant improvements in EBP attributes and competency over time. The results of this study support the hypotheses that EBP competency and attributes can be significantly improved and sustained by attending an intensive 5-day EBP educational and skills building program such as the one described in this study. This study can help leaders and organizations to mitigate many of the traditional barriers to EBP. LINKING EVIDENCE TO ACTION: The results of this study indicate that EBP attributes and competencies can be improved and sustained by attending an intensive 5-day EBP immersion, regardless of clinicians' prior educational preparation.

Antioxidant and Photocatalytic Activity of Aqueous Leaf Extract Mediated Green Synthesis of Silver Nanoparticles Using Passiflora edulis f. flavicarpa.

The purpose of this study is to minimize the negative impacts of synthetic procedures and to develop environmentally benign procedures for the synthesis of metallic nanoparticles. In the present study, Passiflora edulis f. flavicarpa (P. edulis) aqueous leaf extract mediated green synthesis of silver nanoparticles are described. The synthesized silver nanoparticles were characterized by UV-Vis Spectroscopy, Fluorescence Spectroscopy, Fourier Transform Infrared Spectroscopy (FTIR), X-ray diffraction (XRD), Scanning Electron Microscopy (SEM) Transmission Electron Microscopy (TEM) and Cyclic Voltammetry (CV). The silver nanoparticles (AgNPs) showed antibacterial activities against both gram positive (staphylococcus) and gram negative (Escherichia coli) bacteria. The efficacy of the synthesized silver nanoparticles (AgNPs) was demonstrated as catalyst in the photocatalytic degradation of Methyl Orange (MO) and Methylene Blue (MB) dyes which were measured spectrophotometrically. The study revealed that biosynthesized silver nanoparticles using Passiflora. edulis f. flavicarpa, plant extract was found to be very effective as antioxidant agent.

Outcomes From the First Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare Invitational Expert Forum.

BACKGROUND: Even though multiple positive outcomes are the result of evidence-based care, including improvements in healthcare quality, safety, and costs, it is not consistently delivered by clinicians in healthcare systems throughout the world. AIMS: In an attempt to accelerate the implementation of evidence-based practice (EBP) across the United States, an invitational Interprofessional National EBP Forum to determine major priorities for the advancement of EBP was held during the launch of the newly established Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare at The Ohio State University College of Nursing. METHODS: Interprofessional leaders from national organizations and federal agencies across the United States were invited to participate in the Forum. A pre-Forum survey was disseminated to participants to assess their perceptions of the state of EBP and actions necessary to speed the translation of research into real-world clinical settings. RESULTS: Findings from a pre-Forum survey (n = 47) indicated ongoing low implementation of EBP in U.S. healthcare settings. These findings were shared with leaders from 45 organizations and agencies who attended the Forum. Breakout groups on practice, education, implementation science, and policy discussed the findings and responded to a set of standardized questions. High-priority action tactics were identified, including the need for: (a) enhanced reimbursement for EBP, (b) more interprofessional education and skills building in EBP, and (c) leaders to prioritize EBP and fuel it with resources. LINKING EVIDENCE TO ACTION: The delivery of and reimbursement for evidence-based care must become a high national priority. Academic faculty across all healthcare disciplines need to teach EBP, healthcare systems must invest in EBP resources, and payers must attach reimbursement to care that is evidence-based. An action collaborative of the participating organizations has been formed to accelerate EBP across the United States to achieve the quadruple aim in health care.

The First U.S. Study on Nurses' Evidence-Based Practice Competencies Indicates Major Deficits That Threaten Healthcare Quality, Safety, and Patient Outcomes.

BACKGROUND: Tremendous variability in EBP persists throughout the United States even though research supports that implementation of EBP leads to high-quality cost-effective care. Although the first set of EBP competencies for nurses was published in 2014, the state of EBP competency in U.S. nurses is currently unknown. AIMS: The purposes of this study were to: (a) describe the state of EBP competency in nurses across the United States; and (b) determine important factors associated with EBP competency. METHODS: A cross-sectional descriptive study was conducted that gathered data from an anonymous online survey of practicing nurses throughout the U.S. Measures tapped EBP knowledge, beliefs, culture, mentorship, implementation, and reported competency for each of the 13 EBP competencies for practicing nurses and an additional 11 competencies for advanced practice nurses. RESULTS: A total of 2,344 nurses completed the survey from 19 hospitals or healthcare systems. Overall, the nurses reported that they were not yet competent in meeting any of the 24 EBP competencies. Younger nurses and those with higher levels of education reported higher EBP competency (p < .001). The EBP competency scores were not significantly different between nurses in Magnet and non-Magnet designated organizations (p = .28). There were strong positive associations between EBP competency with EBP beliefs (r = .66) and EBP mentorship (r = .69), a moderate positive association between EBP competency and EBP knowledge (r = .43), and a small positive association between EBP competency and culture (r = .29). LINKING EVIDENCE TO ACTION: There is a tremendous need to enhance nurses' skills so that they achieve competency in EBP in order to ensure the highest quality of care and best population health outcomes. Academic programs should ensure competency in EBP in students by the time of graduation and healthcare systems should set it as an expectation and standard for all clinicians.

Evidence-Based Practice and U.S. Healthcare Outcomes: Findings From a National Survey With Nursing Professional Development Practitioners.

Nursing professional development (NPD) practitioners are integral to implementing evidence-based practice (EBP). Research was conducted to describe NPD practitioners' EBP beliefs and competencies, frequency of implementing EBP, and perceptions of organizational culture and readiness for EBP. Relationships among NPD practitioner characteristics and organization outcomes were explored. Findings indicate that NPD practitioners must develop personal competence in EBP, become engaged in shared governance, collaborate with others, and use quality metrics to demonstrate the effectiveness and value of NPD activities.

A Study of Chief Nurse Executives Indicates Low Prioritization of Evidence-Based Practice and Shortcomings in Hospital Performance Metrics Across the United States.

BACKGROUND: Although findings from studies indicate that evidence-based practice (EBP) results in high-quality care, improved patient outcomes, and lower costs, it is not consistently implemented by healthcare systems across the United States and globe. AIMS: The purpose of this study was to describe: (a) the EBP beliefs and level of EBP implementation by chief nurse executives (CNEs), (b) CNEs' perception of their hospitals' EBP organizational culture, (c) CNEs' top priorities, (d) amount of budget invested in EBP, and (e) hospital performance metrics. METHODS: A descriptive survey was conducted. Two-hundred-seventy-six CNEs across the United States participated in the survey. Valid and reliable measures included the EBP Beliefs scale, the EBP Implementation scale, and the Organizational Culture and Readiness scale for EBP. The Centers for Medicare and Medicaid Services Core Measures and the National Database of Nursing Quality Indicators (NDNQI) were also collected. RESULTS: Data from this survey revealed that implementation of EBP in the practices of CNEs and their hospitals is relatively low. More than one-third of the hospitals are not meeting NDNQI performance metrics and almost one-third of the hospitals are above national core measures benchmarks, such as falls and pressure ulcers. LINKING EVIDENCE TO ACTION: Although CNEs believe that EBP results in high-quality care, it is ranked as a low priority with little budget allocation. These findings provide a plausible explanation for shortcomings in key hospital performance metrics. To achieve higher healthcare quality and safety along with decreased costs, CNEs and hospital administrators need to invest in providing resources and an evidence-based culture so that clinicians can routinely implement EBP as the foundation of care.