Editorial

The Evidence-Based Practice Mentor:A Promising Strategy for Implementing andSustaining EBP in Healthcare Systems

F indings from research support the contention thatimplementation of evidence-based care leads to an

improvement in patient outcomes by 28% and thatevidence-based practice (EBP) can reduce the 17-year timegap from the generation of research findings to their trans-lation into clinical practice (Heater et al. 1988; Balas &Boren 2000). Furthermore, clinicians who use research ev-idence in their practices tend to be more satisfied with theirrole (Retsas 2000; Maljanian et al. 2002). Anecdotal reportsfrom nurses support that engaging in EBP renews the pro-fessional spirit of the nurse, a key variable in professionalsatisfaction. Nurses comment that EBP gives them a voiceand allows them to reclaim their authentic self as a “realnurse.” EBP also supports nurses to “become strong patientadvocates, focused on improving the quality of the caregiven to patients” (Strout 2005, p. 39). This enhancementof professional empowerment through EBP is keen, espe-cially given that many countries across the globe are facingsevere nursing shortages that are compromising quality ofcare and patient outcomes. Despite its many benefits, themajority of healthcare providers are not consistently imple-menting evidence-based care (Melnyk & Fineout-Overholt2005). As a result, numerous healthcare organizations andhealth professions colleges (e.g., nursing, medicine, physi-cal therapy) across the globe are accelerating their efforts inthe implementation and teaching of evidence-based prac-tice (EBP).

In the United States, there also is a movement in hos-pitals to attain Magnet status, which is an award given bythe American Nurses’ Credentialing Center (ANCC), anaffiliate of the American Nurses Association. The award isgiven to hospitals that meet established criteria designedto measure the strength and quality of their nursing staff.Key criteria used in the review process for magnet is thatinstitutions engage in research-based nursing practice andthat nurses have high levels of job satisfaction with lowturnover rates. It is widely recognized that evidence-basedpractice is a key mechanism for attaining magnet recog-nition. In order to be re-designated as a magnet hospital,institutions must show sustainability in meeting the estab-lished criteria over time.

Copyright ©2007 Sigma Theta Tau International1545-102X1/07

Both within and outside of healthcare, sustainability isbecoming a frequently used “buzz” word. Sustainability inthe broader sense means an emphasis on promoting andmaintaining a high quality of life for generations to comethrough such factors as clean air, security, and health. Forsustaining a culture of EBP, there must be a mechanism tocontinue and accelerate the implementation of EBP onceit is initiated in a system. Too often, clinicians become ex-cited about learning EBP knowledge and skills. However,that excitement often wanes when faced with day-to-dayresponsibilities and pressures inherent in a stressful health-care role, which is a reason why many healthcare profes-sionals do not consistently deliver evidence-based care. Inorder to sustain EBP in an organization, there must bea key mechanism to assist individuals in consistent im-plementation of EBP, especially when competing prioritiesplace constraints on a healthcare providers’ ability to rou-tinely provide evidence-based care. This key mechanismmay very likely be an EBP mentor, an advanced practicenurse with in-depth knowledge and skills in EBP as well asorganizational change as first proposed in the AdvancingResearch and Clinical practice through close Collabora-tion (ARCC) Model, a conceptual framework for system-wide implementation and sustainability of EBP (Melnyk &Fineout-Overholt 2002).

The first step to system-wide implementation of EBP inthe ARCC model is an organizational assessment of readi-ness for EBP so that the strengths and barriers in a health-care system are identified. Inherent to successful advance-ment of EBP in the system is the key role of an EBP men-tor. Mentorship with direct care nurses on clinical unitsby the EBP mentor is important in strengthening their be-liefs about the value of evidence-based care and their abil-ity to implement it (Melnyk & Fineout-Overholt 2002).Evidence from a recent study also indicates that whennurses’ beliefs/confidence in their ability to implementEBP are stronger, then their EBP implementation is greater(Melnyk et al. 2004). In addition, findings from another re-cent randomized controlled pilot study indicate that nurseswho received mentoring from an ARCC EBP mentor, incomparison to those who received mentoring in physicalassessment skills, had: (1) stronger EBP beliefs/confidence,(2) greater implementation of EBP, and (3) stronger groupcohesion (R.F. Levin, personal communication, 15 October

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2006), which is known to be a predictor of nurse satisfac-tion and turnover rates.

A mentor is defined as a trusted coach or teacher. Men-tors have long been used in nursing and other health profes-sions, but there is a paucity of evidence to link the mentorrole to solid patient and professional practice outcomes.A mentor provides direction, fosters self-confidence, andinstills values in the mentee (Wensel 2006). The mentor–mentee relationship is typically enduring and dynamic asit changes over time to meet the mentee’s needs (Bellack& Morjikian 2005; Wensel 2006). Tobin (2004) describesseven roles of a mentor, including teacher, sponsor, advisor,agent, role model, coach, and confidante.

Some key components of the EBP mentor role as definedin the ARCC model include: (1) assessing the state of readi-ness of an organization to sustain an EBP culture, includingstrengths and limitations; (2) stimulating, facilitating andeducating nursing staff toward a culture of EBP, includ-ing overcoming barriers to best practice; (3) role modelingEBP; (4) working with staff to generate internal evidenceto guide best practice through outcomes management andfacilitating staff involvement in research to generate ex-ternal evidence; (5) using evidence to foster best practice;and (6) collaborating with interdisciplinary professionalsto advance and sustain EBP. These mentors also have ex-cellent strategic planning, implementation, and outcomesevaluation skills so that they can monitor the impact oftheir role and overcome barriers in moving to a culture ofbest practice.

Another EBP mentor model is the Clinical Nurse ScholarModel. In this model, a cadre of staff nurses become pro-ficient in EBP and mentor their peers as well as fosteran environment of continually asking questions (Schultz2005). Clinical scholars are bedside clinicians who chal-lenge nursing practice through inquiry, observation, anal-ysis, and synthesis of internal data and published evi-dence, application of synthesized evidence, and evalua-tion of the subsequent outcomes (Fineout-Overholt et al.2005). Clinical Scholars are role models to others anddisseminate the findings of their projects to team mem-bers and the public. Inherent components of this modelare collaboration, consultation, and mentorship by a doc-torally prepared nurse scientist through every step of theprocess.

Continued testing of these two mentorship modelsthrough rigorous research is necessary so that the relation-ships among the constructs in the models can be empiri-cally supported and it can be determined whether the use ofEBP mentors in healthcare systems not only improves pa-tient outcomes and professional practice in the short-term,but results in sustainable implementation of EBP and a cul-ture of best practice.

Mentoring is more an affair of the heart than the head—it is atwo-way relationship that is based on trust. A mentor wins andsustains the mentee’s trust through constancy (staying the course),reliability (being there when it counts), integrity (honoring com-mitments and promises), and walking the talk. (Tobin 2004,p. 117)

Bernadette Mazurek Melnyk,PhD, RN, CPNP/NPP, FAAN

Dean and Distinguished Foundation Professorin Nursing, Arizona State University College

of Nursing & Healthcare Innovation

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