The Importance of Evidence-Based Practice in Nursing

What do hand-washing, ACLS protocols, and sterile Foley placement have in common? Each is an evidence-based practice. In nursing, research guides care and helps patients experience the best possible outcomes. But why is evidence-based practice important in nursing, and who determines these standards? Learn more about real-world evidence-based care and examples of non-evidence-based treatments from history.

What Is Evidence-Based Practice?

In nursing, evidence-based practice (EBP) is an approach to clinical decision-making that integrates the best available research, the nurse’s clinical expertise, and the patient’s preferences. Rather than relying on tradition, EBP encourages nurses to use evidence to guide care, improve patient outcomes, and reduce harm. This means constantly questioning whether current practices are supported by the latest research, and being willing to adapt when they’re not.

EBP is both a mindset and a methodology: Staff have to have the mental flexibility to question current practices and the ability to break habits. It requires constant curiosity and a willingness to ask questions. But while it’s not always easy to implement, EBP carries several benefits:

• Improves patient outcomes
• Lowers in healthcare costs
• Standardizes practices promote consistency
• Helps healthcare providers feel more empowered
• Reduces rates of burnout and turnover in healthcare providers
• Reduces complications and claim denials

Who makes decisions regarding EBP standards? Evidence is applied at the institutional level through changes in company policies that reflect research. For example, a hospital director of nursing (DON) might replace a facility-wide cleaning product based on new evidence of efficacy. On individual units, managers and educators might integrate EBP by updating staff on new practices. And individual nurses can promote EBP by staying updated on the latest research in their specialty.

Understanding Levels of Evidence

What do you do when you encounter a new piece of information that could impact your practice? Successful EBP requires analyzing research with a critical eye. Learn more about the levels of evidence in research:

Level 1: The highest-quality evidence. Examples include randomized clinical trials (RCTs), studies that test previously developed criteria, and systematic reviews of RCTs.

Level 2: Moderate-quality evidence. For example, limited studies of patients, systematic reviews with inconsistent results, retrospective studies, or lower-quality RCTs.

Level 3: Lower-quality evidence, including comparative studies using past data, or systematic reviews of level 3 evidence.

Level 4: Low-quality evidence involving case studies, poor standards for references, or analyses that lack sensitivity criteria.

Level 5: Lowest-quality evidence, for example, expert opinion.

Current Examples of Evidence-Based Practice in Nursing

EBP is essential for responsible care. Check out some of the standards that are backed by EBP:

• Pediatric vaccination schedules: Following CDC and WHO immunization guidelines to ensure timely protection against preventable diseases.
• Early mobility programs in the ICU: Evidence shows that early mobilization of critically ill patients improves outcomes and reduces length of stay.
• Safe medication administration: In addition to the 5 medication rights, double-check systems, MAR flags, and barcode medication administration help minimize errors.
• Sepsis protocols: Early recognition and rapid treatment bundles like the Surviving Sepsis Campaign help to standardize care and reduce morbidity and mortality.
• Catheter-associated urinary tract infection (CAUTI) reduction: Following evidence-based catheter insertion and maintenance protocols to reduce infection rates.
• Advanced Cardiac Life Support (ACLS) protocols: This algorithmic approach to resuscitation is based on research and guidelines from the American Heart Association (AHA).

A Short History of Evidence-Based Practice in Nursing

Today’s nursing practice relies on research findings and evidence, but this is a fairly recent development. Before EBP became the foundation of modern healthcare, decisions were driven by habit, tradition, hierarchy, or anecdotal experience. Most professionals would regard many of yesterday’s medical practices as harmful and unethical. See three examples below:

1. Bloodletting: Beginning with the ancient Egyptians and used for over 3,000 years, bloodletting was a treatment for seizures, fevers, pneumonia, and much more. It involved cutting the patient, shedding blood to “balance humors”. While bloodletting is still used in very rare and specific cases, several researchers in the late 1700s showed its lack of efficacy, and it gradually became less common.
2. Lobotomies: A harmful experimental procedure that rose to prominence in the 1950s, a lobotomy was a surgery that aimed to sever connections in the prefrontal cortex of the brain. There was plenty of evidence discrediting lobotomies, and they fell to the wayside with the development of psychotropic medication.
3. Restraints: In psychiatric nursing, using restraints and seclusion on patients was a routine practice until the late 20th century, despite their association with patient injuries and deaths. Today, the use of restraints is much rarer and is generally a last resort after other methods (such as a bed alarm or medications) have failed.

So when did the tide turn towards evidence-guided care? Florence Nightingale, perhaps the most famous nurse in history, was one of the first to use systematic observation and data to improve patient outcomes during the Crimean War. A statistician, Nightingale tracked mortality rates and advocated for sanitation in nursing wards. Still, Nightingale was a complicated figure, and like others of her time, she believed in ideas that lacked evidence, such as the miasma theory.

EBP as we know it today began to take shape in the 1970s, with the promotion of RCTs. One researcher, Archie Cochrane, criticized the lack of evidence behind many common medical interventions and believed that RCTs were the most reliable source of evidence to make healthcare decisions. The term “evidence-based medicine” was popularized in the early 1990s by Dr. David Sackett and colleagues, and nursing quickly adapted the model to its own unique scope and patient-centered focus.

Today, major organizations like the American Nurses Association (ANA), the Institute of Medicine (IOM), and the Agency for Healthcare Research and Quality (AHRQ) formally endorse EBP as the gold standard. Evidence-based practice is integral to nursing education, clinical guidelines, quality improvement initiatives, and bedside care — ensuring that nurses deliver the safest, most effective, and most current care possible.

5 Tips for Using EBP in Nursing Care

If you’re trying to promote EBP in your practice or on your unit, use these practical tips to get started:

1. Stay current with research. Regularly read nursing journals, clinical guidelines, and systematic reviews to ensure your care reflects current best practices. Becoming a member of a professional organization makes it easier to get updates on the latest developments in your specialty.
2. Evaluate evidence critically. Not all research is created equal. Peer-reviewed articles and meta-analyses are generally more trusted than case studies and opinion pieces.
3. Combine evidence with your clinical expertise. Implementing EBP doesn’t mean blindly adopting new practices, but taking them in the context of what you know as a nurse, and what the patient wants.
4. Involve patients in decision-making. Patient-centered care is a core component of EBP. Discuss options, risks, and benefits with patients, and incorporate their values and preferences into care plans.
5. Document and evaluate outcomes. Documenting outcomes allows you to track your adherence to EBP standards, so you can contribute to a culture of continuous improvement.

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