Advanced practice nurses are in the best position to advocate for best practices in their own practice environments. Advanced practice nursing is, according to O’Grady (2008), a set of interventions that lead to positive patient outcomes, influence the direct care of patients, manage care for both individual patients and for patient populations, and act as an administrator of healthcare policy that has a direct bearing on positive patient outcomes. The ranks of advanced practice nurses are growing “exponentially,” as the demand in rural, inner city, and other underserved areas continues to increase (p. 2).
Given that information, it is important to understand that healthcare institutions are best served by using defined and accepted best practices in all areas of the institution, including the roles of nursing. Stetler, Ritchie, Rycroft-Malone, Shultz, and Charns (2009) concluded from a study that they conducted that there are some contextual elements that require specific attention if evidence-based practices are to be institutionalized broadly. Contextual factors, which are basically the unique setting and/or personnel oriented factors that influence or mediate the acceptance of and/or implementation of best practices in any specific healthcare setting, however all in how well best practices are institutionalized to the extent that they are no longer external solutions to problems, but form the basis of “how we do things here.”
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These contextual factors are such things as leadership, culture and climate, access to resources, team climate, organizational slack, and organizational support. All of these have a bearing, and an important bearing, on how well evidence-based practice is used and implemented on an institutional level. The authors also suggest the need for a set of receptive contextual factors that are or would be necessary to achieve the institutionalization of evidence-based practice. Leadership, above all, has the greatest potential for influencing the other factors, and ultimately, whether evidence-based practice becomes an institutional part of the way healthcare in that specific setting is managed.
There are specific evidence-based practices for different disciplinary areas of practice, but the above contextual concerns are an important part of all of the different disciplinary areas of practice, and it largely falls on advanced practice nurses, as leaders, to integrate all of the factors and elements into a cohesive organizational commitment to evidence-based practice, thus assuring the likelihood that positive patient outcomes will result, largely irrespective of disciplinary constraints.
