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Worldviews Evid Based Nurs. 2016 Feb;13(1):15-24. doi: 10.1111/wvn.12149.

The Strengths and Challenges of Implementing EBP in Healthcare Systems.

Author information

Director, Nursing Research & Magnet, MedStar Franklin Square Medical Center, Baltimore, MD.
Independent Consultant, Former Director, Nursing Research and Professional Development, MedStar Georgetown University Hospital, Washington, DC.
Assistant Vice President of Special Projects, MedStar Health Corporate Nursing/MedStar Health Research Institute, Hyattsville, MD.
Director, Nursing Education/Staff Development, Medstar Good Samaritan Hospital, Baltimore, MD.
Carol Ann Esche, Clinical Nurse Specialist, Evidence-Based Practice and Nursing Research, MedStar Franklin Square Medical Center, Baltimore, MD.
Nurse Educator, MedStar Union Memorial Hospital, Baltimore, MD.
Critical Care Clinical Nurse Specialist, Holy Cross Hospital, Silver Spring, MD.



Multihospital healthcare system leaders and individual nurses are challenged to integrate standardized evidence-based practices that support continuous performance improvement in their systems.


This study was undertaken to evaluate the strength of and the opportunities for implementing evidence-based nursing practice across a diverse 9-hospital system located in the mid-Atlantic region.


A cross-sectional survey of 6,800 registered nurses (RNs), with a 24% response rate, was conducted to learn about their attitudes, beliefs, and perceptions toward organizational readiness and implementation of EBP.


Although respondents' beliefs about EBP were positive, they reported their ability to implement EBP as extremely low. More than one third (36%) of the respondents worked at two of the system's Magnet designated hospitals. Magnet RNs reported more resources and held more positive beliefs about their hospital's organizational readiness for EBP. Nurses who possess advanced nursing degrees, certification, and who serve in leadership roles were favorable toward EBP. Younger RNs with fewer years in practice were more likely to have positive beliefs toward EBP and embedding it into the organizational culture.


Findings mirror previous research where nurses internationally favor EBP yet struggle with similar barriers for implementation. Strategies to link this evidence to action can be taken at local and global levels. Locally, transformational nurse leaders within each hospital can share the vision for implementing EBP and embrace Magnet principles. At the system level, transformational nurse leaders can collectively allocate resources to create a system-wide online EBP education plan with EBP competencies and tool kit to increase RN exposure to EBP and standardize practice. Globally, promoting free and accessible EBP massive open online courses (MOOC) and sharing best practices online and at international forums such as Magnet conferences will help to lead, educate, and mentor nurses with strategies to systematically increase EBP uptake.


Magnet hospitals; evidence-based practice; evidence-based practice beliefs; healthcare system; hospital system; nursing; organizational culture; organizational readiness; survey; workplace environment

[Indexed for MEDLINE]

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