When We Don't Like the Evidence - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

Last week, I attended the 2018 International QSEN (Quality, Safety& Education for Nurses) Forum. This group is committed to the spread of evidence-based practice to improve quality and safety in nursing practice. Dr. Bernadette Melnyk, an international nursing expert on evidence-based practice, spoke about the need to move evidence more quickly into our environments and even our personal health practices.

Currently, the implementation of evidence in practice is a very slow journey often taking two decades. Much of the evidence produced from research never even makes it to the practice arena. Melnyk’s research indicates that a key factor in whether evidence will move into practice is leadership support and the creation of a culture of learning.

As I thought about what Dr. Melnyk found in her research, I realize from my own experience that there is another factor impacting the implementation or even the ability to research new evidence today. That factor is whether the evidence in front of us or that we will potentially find is solving a problem or creating a problem. In our politically charged environment, we often make decisions about evidence because we don’t like the findings and/or they create problems for us.

There is no better example of this than the 12 hour tour which has become the norm in nurse staffing. We have almost two decade of research to indicate that 12 tours (which often extend to 14 hours) lead to issues with quality, safety and patient continuity. In my travels, I have not spoken with one nurse executive who disputes the evidence. Yet it is nursing’s third rail – similar to a politician discussing the reduction of social security benefits. The issue with this evidence is that it creates problems in healthcare environments and does not solve any pressing issues. The 12 hour tour has been part of the employment contract in nursing for more than two decades. Younger nurses know nothing else. If a Chief Nursing Officer were to even raise the issue, he or she might find themselves plunged into a staffing crisis as nurses leave their organizations or they could be opening the door for unionization.

Another good example of evidence that we choose to ignore is the substantial body of organizational management research which suggest that ideal span of control for managers should be no more than 20 direct reports. Our body of nursing administration research indicates that the average nurse manager supervises around 65 FTE direct reports. It is not surprising that these frontline leaders struggle to meet their leadership responsibilities.

In my own work as a researcher and a faculty member guiding research, I have found that leaders in health systems readily embrace work that solves an issue and has a strong return on investment for the organization. But when research is proposed that might point to a problem in an organization that is pressing to solve but not a pain point and involves resources, it is far less likely to be embraced.

There are no easy answers to this problem. But we do need to recognize that we exercise biases as we look at research findings and potential projects. Sometimes the lack of leadership support for implementation is because we think the evidence will cause us problems even if it is the right thing to do.