Optimizing clinical environments for knowledge translation: strategies for nursing leaders

Using findings from our recent study that found that a context of uncertainty in the work environment hindered nurses' research utilization, we suggest strategies for nurse managers and leaders to optimize clinical environments and support efforts to put research into clinical practice (knowledge translation). Two important sources of uncertainty were the complexity of teamwork and inconsistency in management and leadership styles. To reduce the uncertainty arising from teamwork, we propose (a) clarifying nurses' scopes of practice, (b) increasing knowledge sharing through supporting journal clubs and enhanced computer access and (c) creating safe venues for multidisciplinary dialogue. To reduce uncertainty arising from variations in management and leadership, we propose (a) developing policies that enhance the consistency of leadership and clarify the strategic direction of the management team, (b) clearly communicating those policies to nurses and (c) providing explicit rationales for treatment changes. Small, incremental steps can be taken to realize substantive changes in clinical environments in order to optimize nursing work environments for knowledge translation.