Implementation Science in Nursing Practice: Driving Change

Bridging Evidence and Care

As nurses, we're constantly adapting to new evidence-based practices (EBPs) to improve patient care and our working environment. But have you ever wondered why some practices take off while others seem to fizzle out? Or have you ever read about an EBP in a journal that isn't happening in practice in your unit? That's where implementation science comes in!

What Is Implementation Science in Nursing Practice?

Implementation science (IS) is about making sure the best EBPs are used in real-world healthcare settings. It's about finding the best way to care for patients — and making sure those best practices stick! It takes 17 years to move just 14% of evidence into daily practice. IS digs into the system barriers and the context of why EBP is not happening. It is a bridge in the research-practice gap.

Think of it like this: You find a great new handoff report method that improves patient safety. But if no one on your team adopts it (or it disappears after a few weeks), it's not truly effective. IS helps us bridge that gap by studying how we introduce, adopt and sustain changes in practice.

Why IS Matters in Nursing Practice

As direct care nurses and leaders, nurses are at the heart of practice change. Nurses are uniquely positioned to use their insight and perspective on the processes and dynamics of their units to identify barriers and then deploy custom-fit solutions. They also know what works in their unit and are best situated to advocate for unit-specific interventions. Engaging in IS ensures that direct care nurses' voices are heard before a change initiative is deployed.

IS helps us:

• Improve patient outcomes by ensuring EBPs are successful in practice
• Reduce wasted time and resources on initiatives that don't last
• Enhance teamwork and communication when rolling out new practices

IS Strategies in Nursing Practice

1. Understanding Context in Nursing Practice Change

   Before implementing any change, consider the who, what, when, where and why:

   • Who will be affected (nurses, patients, leaders)?
   • What barriers might stand in the way (workload, resistance to change)?
   • What things have worked in the past that might be leveraged in this new change?
   • Where will the change take place (hospital units, clinics, home care settings)?
   • When should the change happen? (Consider what other change initiatives or major disruptions might signal the need to wait.)
   • Why are you proposing this change? (How will you help your unit understand why this change needs to happen; be able to answer "what's in it for me"?)

2. Engaging Stakeholders in IS for Nursing

   Have you ever been frustrated by a top-down change that didn't include your input? Successful implementation happens when nurses, managers, interdisciplinary teams and even patients are involved from the start. Engagement = buy-in and ownership! You want those who are tasked with carrying out the change on a daily basis to believe deeply in the initiative - to take ownership and ensure that barriers are addressed to keep the change going.

   Have you ever worked with a change champion? Yes, you know who we are talking about - that person who is a cheerleader, gets everyone excited about the change, and keeps it at the forefront of everyone's mind. Identifying that person and engaging them early in the change initiative is a classic example of an IS strategy.

3. Frameworks for IS in Nursing Practice

   Instead of trial and error, use a structured approach. Many applicable frameworks can be leveraged to test and refine changes before a full rollout.

   • Consolidated Framework for Implementation Research (CFIR) - This framework helps you identify what things get in the way (barriers) and what things make it easier (facilitators) to implement and sustain the change. This framework helps you take a comprehensive look at the inner setting (things on the unit), outer setting (what patients, families and society bring to the table), individuals (staff nurses, nurse manager, director and other leaders), and the change itself (is it too complicated to be successful?). By doing a comprehensive assessment of these factors, you can more easily identify what is getting in the way and who/what to leverage to make the change happen and be sustainable. If you find the change is too complicated, then you need to find ways to adapt it to work on your unit. By considering all the individuals involved, you can determine who you can lean on to help make the change happen, and who you need to work with to flip them from a barrier to a change champion.
   • Plan-Do-Study-Act (PDSA) - Sometimes we spend months planning and think we need to have every detail figured out before we start. The PDSA framework shows us that we just need to get going. Try a small test of change and learn from it. What one thing can you try today? Try it, learn from it, adapt and try again. These rapid tests of change ensure you are not only making progress, but saving major time and resources as you go. You didn't spend several months building what you think might work and getting a huge budget to find out the initiative was a flop.
   • Organizational Readiness to Change - Getting a change to happen and last requires a solid understanding of where your team and the overall organization are in terms of readiness to embrace the change. You might think it is the most important thing since sliced bread, but if no one else does, it won't stick. By understanding where everyone else is, you can better gauge what, if anything, you need to do first to ensure they are 100% onboard and ready to get to work.
   • Conceptual Model of Implementation - This framework helps you and your team see that when you roll out a change initiative, you need to focus on whether there is an improvement to the targeted patient outcome (i.e., fewer patient falls) and knowing if the strategies to get the change to work (i.e., nurse education, change champion, 30-second call light answer challenge, etc.) actually work. For a change initiative to take off and endure, we have to collect and analyze data that relates to the strategies we try when implementing a change. Otherwise, it's just throwing spaghetti at the wall and hoping it sticks - like driving blind and hoping you get to your destination. We have to know what worked; what did we do that helped the change work?
   • RE-AIM - This framework is all about helping you identify the reach and effectiveness of the change initiative. How well was it adopted? How broadly was it implemented, and is it being sustained? It is a great tool to use when you are planning your change initiative to focus on how you will measure success, and it should be used on an ongoing basis to continually evaluate the initiative.
   • Kotter's Change Model - This model walks you through the eight steps of leading change. You start by creating a sense of urgency to mobilize support, then build a guiding coalition of influential advocates. Remember those change champions? Engage these early adopters to help you craft a strategic vision and clarify direction. From there, enlist stakeholders - those people who are tasked with implementing the change, supporting the change or impacted by the change - to energize broad participation. Next, work to remove the systemic barriers you found when using CFIR - to enable action. Celebrate your short-term wins to build confidence and sustain the acceleration to drive deeper change. Finally, anchor new behaviors into the unit/hospital culture to ensure long-term sustainability.

   Many frameworks at your disposal. It's OK and a good thing to use more than one framework. Implementing and sustaining change is a complex endeavor, so lean on those frameworks that help you move others to action and make the initiative work!

4. Overcoming Barriers With IS in Nursing

   Change can be difficult, and challenges will come up. Some common barriers for staff and leaders include:

   • Lack of time or staffing
   • Resistance to change
   • Confusion about the new practice

   Overcoming barriers is why using frameworks is so important. Getting past them is all about knowing what the true barrier is (oftentimes, people say time is the issue, but if you dig deeper, it may be something else). Nurse leaders are often too quick to say that education is the barrier - if they only knew better, they'd do better. As a result, we always suggest education for nurses when, in reality, you might have a workflow issue. If workflow is the issue, suggesting education will not solve the problem. By embracing the understanding that there will be roadblocks and working like a sleuth to uncover them, you will become more effective at providing the appropriate support to keep the initiative going and thriving.

5. Sustaining EBP With IS

   Rolling out a new practice is the beginning. You need ongoing support for EBPs to succeed. Sustainability must be considered at the onset of any change project. Using a sustainability assessment tool can help identify areas of strength and weakness; then you can proactively plan interventions. Strategies such as peer mentorship, data tracking and leadership reinforcement can help make changes last. It is also essential to understand that achieving sustainability means the initiative must change and adapt over time to meet the changing environment. Remember Darwin's theory? Look around you in nature; animals, insects, plants and humans must adapt to survive. The same is true for your change initiative. If you try to keep the same processes that were put into place at the beginning of the change, the initiative will lose relevance, become dated and inefficient, and end. Change leaders understand that their initiatives must adapt over time to be sustainable. Luckily, IS understands this as well, and there is a tool to monitor adaptation too.

IS in Nursing Practice: Real-World Examples

IS is a game-changer for nurses who want to improve patient care. Through AACN Clinical Scene Investigator (CSI) Academy, nurses are turning evidence-based ideas into practice, ensuring their changes improve outcomes at the bedside. Direct care nurses have improved their work environments and improved patient outcomes.

A team from Stony Brook University Hospital in New York decreased the incidence of medical device-related pressure injuries by 60% and non-device-related pressure injuries by 61% by using IS tenets and frameworks. These outcomes ultimately saved the hospital an estimated annual impact of $500,457.

A team from University Health in Cleveland decreased nurse turnover rates by 72% while decreasing the need for agency contracts by focusing on meaningful recognition. They increased their Healthy Work Environment Assessment Tool scores in all categories and saved the hospital $708,346 in nurse staffing costs.

The best part? IS amplifies nurses' voices, making sure their insights and frontline experiences shape meaningful, lasting change. When nurses lead with IS, everyone benefits — patients, families, teams and the entire healthcare system.

IS in Nursing Practice: Key Takeaways

IS isn't just for researchers — it's a practical, hands-on approach to help nurses turn knowledge into action. By understanding how to introduce and sustain changes effectively, we can improve patient care and make our work more efficient and rewarding.

So, the next time you hear about a new best practice, think further than "does this work?" and ask, "How can we make this work for the long run?" You are now an implementation scientist in action!

What challenges could you solve with implementation science? Tell us in the comments!