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Nursing unit leaders' influence on the long‐term sustainability of evidence‐based practice improvements
Author(s) -
Fleiszer Andrea R.,
Semenic Sonia E.,
Ritchie Judith A.,
Richer MarieClaire,
Denis JeanLouis
Publication year - 2016
Publication title -
journal of nursing management
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.925
H-Index - 76
eISSN - 1365-2834
pISSN - 0966-0429
DOI - 10.1111/jonm.12320
Subject(s) - sustainability , teamwork , unit (ring theory) , accountability , nursing , best practice , set (abstract data type) , business , process management , psychology , medicine , political science , computer science , ecology , mathematics education , law , biology , programming language
Aim To describe how actions of nursing unit leaders influenced the long‐term sustainability of a best practice guidelines ( BPG ) program on inpatient units. Background Several factors influence the initial implementation of evidence‐based practice improvements in nursing, with leadership recognized as essential. However, there is limited knowledge about enduring change, including how frontline nursing leaders influence the sustainability of practice improvements over the long term. Methods A qualitative descriptive case study included 39 in‐depth interviews, observations, and document reviews. Four embedded nursing unit subcases had differing levels of program sustainability at 7 years (average) following implementation. Results Higher levels of BPG sustainability occurred on units where formal leadership teams used an integrated set of strategies and activities. Two key strategies were maintaining priorities and reinforcing expectations. The coordinated use of six activities (e.g., discussing, evaluating, integrating) promoted the continuation of BPG practices among staff. These leadership processes, fostering exchange and learning, contributed to sustainability‐promoting environments characterized by teamwork and accountability. Conclusions Unit leaders are required to strategically orchestrate several overlapping and synergistic efforts to achieve long‐term sustainability of BPG ‐based practice improvements. Implications As part of managing overall unit performance, unit leaders may influence practice improvement sustainability by aligning vision, strategies, and activities.