Statement Of Purpose: Evidence Based Practice

My name is Tammy and I have been Registered Nurse for nearly 20 years now. I have worked in a variety of settings and have carried many titles. For the past 10 years or so, I have primarily been a hemodialysis nurse and I’ve embraced the love I have for this specialty. I recently entered the RN to BSN program at The Ohio State University. I am learning about Evidence Based Practice, or EBP for short, which is a fairly new concept for me. I work in a relatively small environment for an extremely large healthcare company. I work in an outpatient hemodialysis clinic where we provide approximately 250 hemodialysis treatments per week to about 100 patients. My company is an international company with nearly 3,000 clinics in the US and abroad serving
over 200,000 patients every day. We also contract with thousands of hospitals to provide inpatient dialysis services for acutely ill individuals. My clinic as 22 full time employees plus one part time employee: myself along with 4 other RNs, 12 patient care technicians, and one each of a nurse manager, social worker, dietician, secretary, maintenance technician. We also have a nurse educator whom we share with several other clinics. Additionally, there are 4 regular physicians who practice at the clinic, though they are generally only present for about 2 hours each per week.
As I previously mentioned, EBP is a relatively new concept for me, one in which I have not formally utilized to shape my practice as a nurse.
EBP is not a part of the daily work environment at my clinic. Our EBP score was a mere six, indicating an urgent need for EBP consultation. We received points for clinical inquiry (Q2), access to scholarly resources (Q8), and incorporation of evidence into daily practice (Q15-18). Some other strengths the clinic enjoys are support from upper level management and supervision (within the confines of corporate policies and procedures) as well as our medical director and physicians. Both entities are supportive of initiatives that encourage positive outcomes. In addition, financial support and resources, though not unlimited, are not stringent. Finally, I feel like, although I would love to have more one on one time with each patient, my clinic is very fortunate to have adequate staffing rations that enable us to provide safe and efficient patient care on most
days.
To be perfectly honest, at first glance I don’t see a lot of barriers to implementing EBP within my little clinic.
The most impactful challenge the clinic faces is resistance to change. In previous experiences, this team resists change when the impact is not easily realized or they are not “shown truths that influence their feelings” (Melnyk, 2015). One factor that has contributed to this spiraling effect is inadequate or ineffective mentoring and teaching. EBP is not clearly stated in my company or clinic mission, however it is indeed implied by the desire to provide the very best possible care and be leaders in the delivery of healthcare. Finally, we have essentially no resources, such as an EBP mentor or leader, point of care EBP, and EBP councils or competencies that are specific to EBP. The team with which I work essentially is just not cognizant of EBP as a concept in driving healthcare decisions. The closest ever get to utilizing EBP is in our quality improvement projects that are state mandated and federally regulated. The biggest obstacle my organization is likely to face during the incorporation of EBP will simply be introducing this new way of thinking and acting to our
team.
A lack of significant barriers to EBP implementation opens the door to a vast amount of opportunity. I am blessed to be part of a tremendous team and have been witness to and participated a numerous quality improvement projects at my center. As I read the assigned textbook chapter this week, I was pleasantly surprised at how “on point” the Stages of Team Development with Associated Characteristics is. I was also impressed with Kotter and Cohen’s Model of Change; I have observed my own team transition through most, if not all, of the identified steps. Interestingly, I recently completed a continuing education course that focused on identifying personality traits of patients and honing in on their strengths as a technique to motivate them toward making better health choices. I can easily envision utilizing this knowledge to foster change within a healthcare delivery team as well. Despite having previously identified resistance to change as a challenge, the team easily embraces positive change when it is easy to see how that change will improve patient care and satisfaction. I am looking forward to learning more about EBP and discussing the topic further with my supervisor, the clinic manager.

References
Melnyk, Bernadette Mazurek, and Ellen Fineout-Overholt. Evidence-based practice in nursing & healthcare: a guide to best practice. Philadelphia: Wolters Kluwer Health, 2015.