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EBM

A pathway to evidence-based nursing management

Shingler-Nace, Autum MSN, RN, NE-BC; Gonzalez, Judith Zedreck DNP, MPM, NEA-BC

doi: 10.1097/01.NURSE.0000510744.55090.9a
Feature: NEW HORIZONS
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Evidence-based management (EBM) is the use of research evidence by nursing leaders to support decision making and improve processes. This article explores how applying EBM to managerial challenges can improve patient outcomes, nurse satisfaction, working conditions, and leadership.

At the University of Pittsburgh (Pa.), Autum Shingler-Nace is a DNP student and Judith Zedreck Gonzalez is a professor and interim coordinator of the Acute & Tertiary Care department's nursing administration concentration.

The authors have disclosed no financial relationships related to this article.

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ALTHOUGH MODERN REGULATIONS require healthcare organizations to meet more benchmark standards in quality patient care and patient outcomes, current research reveals a gap in healthcare leaders' understanding of how to utilize appropriate evidence to improve inefficiencies in healthcare delivery. The use of evidence-based management (EBM) in nursing hasn't yet been broadly examined, but early research suggests it has the potential to aid nurse managers with tasks such as improving working conditions, decreasing turnover rates, implementing policy, strategic planning, and more.

Through a literature review, this article will explore how applying EBM to focused managerial challenges could improve patient outcomes, nursing satisfaction, and leadership success.1

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Nurse manager applications

EBM is the utilization of various types of research evidence by managerial leaders to support decision making to improve processes and outcomes.2 EBM provides managers with the resources they need to create positive change, such as collective scientific evidence and validated information.

The concept of EBM is a part of the broader evidence-based practice movement, which began in the medical science field in the late 1960s. It's since spread to many other specialized fields, including education, social work, criminal justice, and management.3 Despite the expectation of evidence-based practice in the clinical setting, EBM remains a new concept in nurse management.

Nurse manager utilization of EBM can improve outcomes and potentially decrease turnover rates when used in the hiring process. Studies show that in unstructured face-to-face interviews, hiring managers tend to prefer candidates with qualities that are irrelevant to performance, including likability, characteristics similar to the interviewer, and physical attractiveness. Many other hiring methods are shown to be superior, but are impossible to utilize unless informed by evidence-based research.4

It's essential for healthcare professionals to understand and apply strong research to every aspect of healthcare, not only the clinical domains. Evidence-driven practice in the current healthcare setting is now a vital leadership necessity.5 Utilizing EBM in nursing could provide a new framework for problem solving with clear steps for future nurse leaders to replicate.6

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Literature review

Research is available on EBM, but most published research isn't nursing-specific. EBM research comes primarily from other industries, such as business leadership, entrepreneurship, and human resources. Because evidence-based practice plays such a dominant role in the healthcare field, it's surprising that so little nursing leadership EBM research exists.

Available research suggests managers want to act on the best evidence available. Leaders today follow expertly written and reviewed journals and books, hire consultants, and attend seminars. But many still seem to lack a serious understanding of EBM and its implementation in nursing.

EBM use has advanced the principle that validated information allows leaders to perform at their jobs with higher standards and better outcomes.7 Available information suggests it's widely understood that organizations would perform better if leaders knew and applied the best evidence, but implementation is the real source of difficulty.

The use of EBM may help nursing leaders validate their decisions. Leaders who utilize EBM to support their decision making are more likely to achieve buy-in from other employees within the organization. Research suggests that if leaders encourage and incentivize trial programs, pilot studies, and experimentation, the organization will begin to cultivate its own evidence base.8 Published research shows correlations among positive workplace management initiatives such as transformational leadership, patient-to-nurse ratios, nurse education level, patient-care quality, patient satisfaction, employee health and well-being programs, nurse satisfaction and retention, healthy workplace environments, and healthy patients and personnel.9

What makes a good nurse manager, what tools should be utilized in nurse manager education, and how does a nurse manager effectively accomplish the tasks and challenges placed upon them? Some research shows that nurses perceived as excellent leaders are risk takers, are guided by fundamental philosophies, are strong advocates for nursing, and are supportive of their staff members. Research has also shown that participative managers who encourage and value feedback from all staff members are the most successful. Additionally, leaders who are visible, accessible, and have excellent communication skills had more success than leaders who didn't possess these qualities.

EBM's influence in nursing leadership is exemplified in the trending shift from a transactional autocratic leadership style to a transformational leadership style, which has been shown to provide more efficient outcomes overall in healthcare.9

There is a distribution gap in EBM knowledge. One study highlighted the potential failure of knowledge markets to coordinate knowledge supply with knowledge demand; meaningful research and discoveries need to be distributed to the people who can benefit from them. Knowledge needs to be delivered, not just created.10

More research is needed to determine what makes a successful nurse leader. Nurse leaders will need to explore alternative models for nursing care delivery through evidence-based research to gain support for their decisions and secure their success.

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Future leadership expectations

Organizations don't always invest adequate time or financial interest in research. According to available data, this lack of financial support results from the lack of effectiveness data and inadequate EBM research. Research has suggested that a manager's lack of experience using evidence may be a direct result of insufficient resources to gather, analyze, and assess information needed within an organization.11 The lack of resources and information may cause the manager to instead base decisions on the best interest of one patient, one department, or the personal views of other leaders.

Currently, research finds that expert managers are at liberty to make decisions they find most suitable. The expectation that leaders will use validated research and effectiveness data, although still in its infancy, should be clearly outlined for nurse leaders in the organization's strategic goals; supervision and evaluation should be maintained in all levels of healthcare management.11

The future of nursing success depends on strong nurse leaders. Nurses need to feel secure in their leadership teams and have confidence that their managers are reliable and educated about the best ways to manage situations. Nurse managers need to feel confident in their decision-making skills and problem-solving abilities.

Systematic literature reviews provide the foundation for leadership success because they help nurse leaders discover and critically appraise applicable research from studies in an individual specialty. Leaders who conduct systematic reviews can collect available research relevant to their unique leadership challenges. Utilizing the collected data and research helps them understand the importance of EBM by illustrating proven outcomes and increasing their knowledge and confidence when applying the research to decision-making practices.12

To translate evidence into practice, research needs to be clearly understood, implications for practice need to be clearly defined, and readability needs to be considered. Scholars need to keep the practitioner's education level in mind when developing the structure of abstracts and implications to help managers better appraise relevance and quality of completed research.13 Conversely, the reader needs to recognize the importance of the levels of evidence to select a methodology to follow. Nurse managers need to have a basic understanding of the levels of evidence to complete effective systematic reviews and assist decision making. (See Hierarchy of evidence.)

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Recommendations

Due to increased demands on today's healthcare professionals, EBM isn't utilized to its fullest extent in nursing leadership. Reasons for EBM's underuse include:

  • a lack of EBM research specific to nursing.
  • a lack of nursing leadership understanding about how to access EBM research.
  • lack of knowledge about how to translate evidence into practice.

Organizations need to place greater emphasis on EBM education in nursing. Teaching all management levels the steps and skills to conduct systematic reviews to assist decision-making is one strong approach to this goal.

Nurse leaders will need to collaborate on common goals to expand available research and perform quantitative studies to demonstrate what will and won't contribute to the development of successful nurse leaders in today's healthcare environment.

Literature has demonstrated the level of engagement between management scholars and healthcare leaders is poor, and the academic knowledge available to nursing leadership is extremely fragmented.14 Nurses need more meaningful exchanges on pertinent practical and theoretical issues in management. EBM researchers should focus on further networking and productive research initiated to develop tools for future nurse manager success.14

Finally, aspiring nurse leaders need appropriate education during their academic years through collegiate organizations as well as throughout professional management careers within healthcare institutions. This will help ensure successful decision-making and outcomes for patients and healthcare organizations alike.

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Hierarchy of evidence

Level I: Evidence from a systematic review of meta-analysis of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from well-designed RCTs

Level III: Evidence obtained from well-designed controlled trials without randomization

Level IV: Evidence from well-designed case-control and cohort studies

Level V: Evidence from systematic reviews of descriptive and qualitative studies

Level VI: Evidence from single descriptive or qualitative studies

Level VII: Evidence from the opinion of authorities and/or reports of expert committees

Source: Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice. 3rd ed. Philadelphia, PA: Wolters Kluwer Health; 2015.

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