NASHVILLE – Health care models are shifting rapidly in the current era of reform, and nurse practitioners have an unprecedented opportunity to conduct research and evidence-based practice projects that could reduce costs and improve outcomes for patients.

The United States spends more money on health care than any other Western country in the world, yet ranks 37th in health outcomes, with the average patient only receiving about 55% of the care he or she should get after entering the system, according to Bernadette Melynk, PhD, RN, CPNP, associate vice president for health promotion, dean and professor in the College of Nursing at Ohio State University.

“We really have to put a sense of urgency on what we are doing to improve the state of health care,” she said during the keynote session at the American Association of Nurse Practitioners 2014 meeting. “Practices routed in tradition are often outdated and do not lead to the best patient outcomes.”

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Research indicates that patient outcomes are 28% to 30% better when evidence-based practice recommendations are followed, yet only about 40% to 50% of health care provider’s nationwide report adhering to such guidance.

“Unless you are practicing in a culture that supports its clinicians to practice evidence-based medicine, it is not sustainable,” Melynk said.

In a 2012 survey that involved more than 1,000 nurses, respondents indicated that about one third of colleagues implemented evidence-based practice consistently.

In a second survey involving 276 chief nursing officers and nurse executives, evidence-based practice ranked at the bottom of the priority list; however, participants indicated quality and safety were their top two concerns.

“There is a major disconnect in CNOs. They don’t see evidence-based practice as the path to get them to these outcomes and budget very little money to get their nurses up to speed,” Melynk said.

She suggested a few key strategies to help build cultures and environments that deliver and sustain evidence-based practice.

“Having a vision with specific written goals is an essential element required for a successful change to system-wide evidence-based practice,” Melynk said.

Fostering such organizational commitment should involve hosting orientations, creating clinical ladders that incorporate evidence-based practice competencies, and encouraging a spirit of inquiry in which all health professionals question their current practices.

Another component to achieving this is instituting strong leadership and a cadre of mentors who value and model evidence-based practices and provide the resources needed to sustain them, according to Melynk. Also, build incentives and rewards for achieving specific outcomes and benchmarks.

“When I go into a group, I look for people with a twinkle in their eye a fire in their belly, because if you get enough innovators and early adopters on board, you’ll get the early majority and the culture shift will happen,” she said. “Ask yourself what you’d do in the next three to five years if you knew you couldn’t fail. Dream it, then discover it and deliver it.”


  1. Melynk B. #14.3.010. “Improving Quality of Care, Patient Outcomes & Costs with Evidence-Based Practices: Key Strategies for Success.” Presented at: AANP 2014. June 17-22; Nashville, Tenn.