[The Current State of Integrating Evidence-Based Health Care Competence Into Taiwan's Nursing Clinical Ladder System]

Given the importance of evidence-based health care (EBHC), some hospitals in Taiwan have incorporated this competency into their clinical ladder systems. However, the details regarding how hospitals implement and integrate EBHC across different ladder levels remain insufficiently understood. Inconsistencies between hospitals may affect clinical practice, staff promotion fairness, and the overall effectiveness of EBHC competency development.

This study was designed to explore the current status of the promotion of EBHC in hospitals, how EBHC is being integrated into nursing clinical ladder systems, and the key facilitators and barriers to implementation.

A cross-sectional survey was conducted between January and March 2024. Representatives from 240 member hospitals of the Taiwan Nurses Association completed a self-developed questionnaire. Questions on the survey examined how the targeted hospitals promoted EBHC, how EBHC was being incorporated into the clinical ladder system, related implementation methods, required educational hours, and perceived facilitators and barriers. Data were analyzed using descriptive statistics.

Of the 215 hospitals that responded (response rate = 89.6%), 66.5% reported having promoted EBHC. Of the 183 hospitals that had implemented a clinical ladder system, 68.9% (n = 126) reported incorporating EBHC competencies by requiring evidence-based reports; however, only 24.6% (n = 31) of these applied this requirement at all ladder levels. In addition, only 53.2% of these 183 hospitals required that nurses complete a specific number of EBHC training hours, with these hours varying substantially across institutions. Moreover, EBHC competency requirements and reporting standards were inconsistent between ladder levels. The key facilitators identified included managerial support for EBHC (73.5%), organizational support (69.2%), and regular training (68.4%). The major barriers identified included limited English proficiency among nurses (70.2%) and a lack of qualified mentors (63.7%).

To better integrate EBHC into clinical ladder systems, nursing professional associations should convene expert consensus meetings to define EBHC competencies, develop tiered training standards, and set the assessment methods to be used at each ladder level. Nursing schools should incorporate standardized EBHC core curricula into their programs. In addition, collaboration among professional organizations may facilitate the development of systematic, digital continuing education modules to improve accessibility and support the clinical application of EBHC.