Make Your Leadership Evidence-Based - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

Leadership is both an art and a science

Evidence-based nursing practice is widely recognized as being essential to achieve the best patient outcomes. Yet, rarely do nurse leaders consider that their leadership practice should also be evidence-based. There are numerous opportunities today for nurse leaders to question their own practice and ask some important questions such as: “What is the evidence for my leadership intervention?” or “Am I using strategies here that will lead to the best outcomes for staff and patients?” The use of evidence-based practice helps leaders to make more effective leadership decisions based on research and knowledge instead of traditions, hunches, the advice of colleagues or outdated leadership information.

Evidence-based Nursing Leadership Defined

Building on a definition provided by Sackett, Straus, Richardson, Rosenberg & Hayes, evidence-based nursing leadership can be defined as the conscientious use of current best evidence in making decisions about leadership practices. The following three components should be considered when making leadership decisions or changes that are evidence-based:

1. The Research Evidence

The first component is the research evidence itself. Melynk & Fineout-Overholt provide a useful 7 level hierarchy in how to evaluate evidence with the highest (Level 1) being a systematic review of relevant randomized control studies and the lowest (Level 7) being expert opinion and consensus documents. Few leadership research studies meet the criteria for Level 1, 2 or 3 evidence but many do meet the criteria for Level 5,6 and 7.

2. Leadership Expertise

A second important component to consider in making evidence-based leadership decisions is a critical appraisal of the evidence by experienced leaders based on their leadership expertise. This expertise can only be elicited through frank, open discussions that encourage alternative viewpoints.

3. Staff and Organizational Values and Situational Factors

Finally when evaluating research evidence, it is important for leaders to consider the context of their organizations. What works well in a large academic medical center might not work as well in a small rural hospital. Context matters as does organizational culture, situational factors and values. As an example, many research studies have demonstrated that magnet designated hospitals have better patient outcomes and higher nurse and patient satisfaction. Despite this evidence, a nurse leader may not have the organizational support or resources needed to pursue a magnet journey.

Practical Application of the Evidence

There are many practical applications that can be used in leadership to better ground practices in the evidence. An important example is what nurses look for today in nurse leaders. There is strong evidence to support the use of a transformational nursing leadership style that includes visionary leadership with a focus on developing followers. A transformational style has been found to promote staff engagement, job satisfaction and organizational commitment. It has also been found to inspire staff and can influence attitudes and behavior to create a new culture for nursing practice. The research on the impact of a transformational style has been so compelling that it has been incorporated into the Magnet model.

But What If We Don’t Like the Evidence?

A recurring dilemma in evidence-based nursing leadership is what to do if we have compelling evidence to support a practice but choose not to implement it because of staff values or preferences. The most compelling example of this is the evidence on the 12 hour tour. We know from research that nurses who work 12 hour tours average only 5.5 hours of sleep between tours and are 3X more likely to make errors as opposed to those on 8 hour tours. We also have evidence that the mortality of patients with selected conditions like pneumonia is increased in units/hospitals with 12 or more hour shifts. Patient safety is clearly being compromised but nursing staff prefer the 12 hour tour. Nurse leaders ,while aware of the evidence, want to avoid the conflict that a change would bring.

Current Practices

Do nurse leaders use evidence in their own practices? Recent research published by Melynk, B.M., Fineout-Overholt, E., Gallagher-Ford, L. & Kaplan, L. in the September issue of the Journal of Nursing Administration suggests that many don’t. In their survey of over 1000 ANA members, nurses were asked whether their managers consistently make evidence-based decisions. On a Likert scale of 1 (strongly disagree) to 5 (strongly agree), the mean for magnet hospitals was 3.6 and for non-magnet it was 3.1. These are disappointing findings. To be successful as a nurse leader, you need to continually challenge your assumptions and be willing to look at best scientific evidence available to guide your decision making.

Read to Lead

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Melynk, B.M., Fineout-Overholt, E., Gallagher-Ford, L. & Kaplan, L. (2012). The state of evidence-based practice in US nurses. Journal of Nursing Administration, 9(42), 410-417.

Montgomery, K.L. & Geiger-Brown, J. (2010). Is it time to pull the plug on 12 hour tours: Barriers to change and effective leadership strategies. Journal of Nursing Administration. 4(40), 147-149.

Sackett, Straus, Richardson, Rosenberg & Hayes (2000) Evidence-based medicine: How to practice and teach EBM. London: Churchill Livingston.

Sherman, R.O. (2012). Evidence-Based Effective Nursing Leadership: Check Your Practice. Nursing.com CE Program. Available at http://ce.nurse.com/ce620/evidence-based-effective-nursing-leadership/

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