Clinical Nurse Specialists' Perceptions of Competency and Self-Efficacy in Evidence-Based Practice and Implementation...

Research and demonstration projects have shown that the Clinical Nurse Specialist (CNS) role is uniquely suited to lead implementation of evidence-based clinical practice changes for improved outcomes and reduced costs to healthcare systems. CNS practice competencies closely align with the design, development, and implementation of evidence-based practice change. National data on CNS's knowledge and use of implementation science to guide EBP implementation is lacking.

A CNS professional organization implementation science team and a university evidence-based practice center collaborated on this research to identify self-reported competencies, experiences, and strategies of CNSs when implementing evidence-based practices across healthcare settings.

This cross-sectional observational study used a survey design with a sample of 167 CNS professional organization members. Survey instruments included the Evidence-Based Practice (EBP) Competency Tool, EBP Implementation Strategies Self-Efficacy Scale, and the Implementation Experience Survey to describe aggregate self-reported competencies and experiences with EBP and project implementation.

Demographics revealed most CNSs have no EBP training (54.5%) or implementation science training (74.3%) beyond degree preparation. The mean EBP Competency score was 79.3%. The mean EBP Implementation Strategies Self-Efficacy Scale score was 79.8%. Most participants reported using less than half the survey-identified EBP activities and implementation strategies. Implementation Experience Survey results showed participants rated maintaining EBP change as more difficult and less successful than starting or completing EBP implementation practice change.

CNSs reported confidence with EBP, but the majority are not guided by EBP models. This raises questions about the quality of evidence appraisal and synthesis. Results suggest a disconnect between self-perception of EBP and implementation science competence levels and real-world use of EBP models and implementation science methods. Educational support is needed to improve confidence in advanced EBP and implementation science competencies.