When nurses are engaged, they lead, innovate, and inspire. Engaged nurses are passionate about delivering high-quality care, confident in their ability to drive change, and resilient when faced with challenges. Organizations that foster engagement see the rewards: higher retention, lower turnover and improved patient satisfaction (Rivera et al., 2011; Wei et al., 2023). One way to spark engagement is by involving nurses in scholarly work that drives meaningful change.

In this article, we outline the steps of how nurses at Zablocki VA Health Care System were empowered to lead an evidence-based quality improvement (EB-QI) initiative to address a critical practice gap. This project highlights the role of the nursing professional development (NPD) practitioner as a change agent, mentor, learning facilitator, and champion of scientific inquiry.

Cultivate the Spirit of Inquiry

NPD practitioners support the first step in promoting evidence-based practice by being available for and encouraging nurses to ask questions about clinical practice. For us, it began with a simple question from a direct care nurse who felt comfortable asking the NPD practitioner: Is this best practice?

Inpatient medical oncology unit nurses could not identify clear guidelines for performing intermittent bladder irrigation (IBI). They were unable to carry out IBI orders in the absence of a standardized policy or practice resource, resulting in patient care delays, increased patient transfers, and sometimes negative nurse-provider relationships. Recognizing the impact on clinical outcomes, the nurses turned to the NPD practitioner for guidance to understand whether IBI was best practice and to develop their knowledge and skills.

Understand the Problem and Consult Subject Matter Experts

When the NPD practitioner was consulted, she reviewed available evidence-based practice (EBP) guidelines and resources both within our organization and across the enterprise through networking with other NPD practitioners. The NPD practitioner learned that there were no guidelines or policies, nor was there any organizational education or competency management practices in place for IBI. She recognized an opportunity for an EBP project, so she consulted the nurse scientist-EBP coordinator team for additional guidance.

Form the Workgroup

Following preliminary review of resources on IBI, we recognized that implementing best practices would require a collaborative approach. We formed a workgroup composed of five direct care nurses, an NPD practitioner, and an infection preventionist nurse. The group was led by the nurse scientist and facilitated by the EBP coordinator.

The workgroup’s primary goal was to conduct a comprehensive literature review and develop practice recommendations. A secondary, but equally important, goal was to mentor direct care nurses through the EBP process to build capacity for future inquiry. To ensure protected time, the EBP coordinator scheduled eight one-hour meetings in advance, allowing nurse leaders to adjust staffing and enable participants to step away from their regular duties to fully engage in the project.

Engage Nurses in the EBP Process

Guided by the I³ Model for Advancing Quality Patient Centered Care (Hagle et al., 2020), we initiated the EBP process. For many team members this was their first EBP project. Therefore, each meeting consisted of teaching the steps of EBP and then applying them to the project.

The workgroup developed a PICOT question, identified search terms, and conducted a comprehensive literature search across four databases, yielding 191 results. After screening titles and abstracts, 27 articles met the inclusion criteria and were distributed among team members for full structured review. In subsequent meetings, each member presented their assigned article, and we collaboratively engaged in critical appraisal. The nurse scientist facilitated these discussions, providing guidance on levels of evidence, research methodology, and interpretation of outcomes.

Ultimately, we synthesized 12 articles into an evidence table. Based on this synthesis, our team developed five practice recommendations, which were then shared with key parties for review and feedback.

Plan

We utilized the Plan-Do-Study-Act (PDSA) framework to guide our implementation process. After endorsement by key stakeholders and nursing shared governance, we consulted the clinical nurse specialist to translate the evidence into policy. We then developed procedural steps for IBI, a standardized order set for providers, and nursing documentation expectations.

Included in our plan was recruiting 16 nurses from inpatient units to serve as IBI champions. These champions played a critical role both in validating competency of nurses on the procedure and in supporting their peers, leveraging their expertise in clinical workflow to ensure the process was both practical and sustainable.

Do

Given the high-risk, low-volume nature of IBI, we designed learning experiences using multiple modalities to support nurse competence and ensure that educational resources were accessible across all shifts. For visual learners, we created a demonstration video actively involving direct care staff in the filming process. They reviewed the script, visuals, and voiceover to ensure the content was relevant and met learner needs. For kinesthetic learners, we offered low-fidelity simulation sessions to provide hands-on practice.

To promote consistency in skill validation, the NPD practitioner developed an electronic skills checklist to guide IBI champions during return demonstrations. We implemented a train-the-trainer model, beginning with a urology nurse practitioner who validated the competency of two education leads. These leads then validated the remaining unit champions, who in turn validated nurses on their respective units.

We piloted the implementation on three acute inpatient units. After one month, based on initial success and feedback, we expanded the project to three additional units and eventually rolled it out across the entire acute inpatient care division.

Study

We monitored several key metrics to evaluate the impact of the implementation, including the number of trained and validated nurses, utilization of the IBI order set by providers, intrafacility transfers, provider-nurse communication, and catheter-associated urinary tract infection (CAUTI) rates. Following the spread of the initiative across the acute inpatient division, 97% of nurses (n = 255) were successfully trained and validated in IBI. Providers utilized the standardized IBI order set 100% of the time, ensuring consistency and adherence to best practices.

Through education, competency management and process improvement, we eliminated preventable intrafacility transfers, ensuring timely care and decreased delay in care. The implementation also strengthened provider-nurse collaboration, fostering improved communication. Most notably, one year after implementation, there were 49 IBI orders completed with zero CAUTI cases, leading to a cost avoidance of approximately $230,006 to $1.46M for the organization based on data from the Agency for Healthcare Research and Quality (2017).

Act

The final step of the PDSA—adapt, adopt, or abandon—focused on evaluating the practice change. We presented outcomes to facility wide nursing shared governance, where the initiative received support and formal endorsement to adopt IBI at other organizational divisions. To ensure sustainment, IBI has been integrated into orientation for all newly hired nurses.

Lessons learned

It can be challenging to sustain nurse engagement in scholarly inquiry. This project engaged 23 nurses in the workgroup managing the EBP-QI process over a one-year period. Our ability to sustain nurse engagement throughout the project can be attributed to three key factors:

Mutual Collaboration

By valuing direct care nurses’ insight and input, keeping the timeline at the forefront, clearly communicating, celebrating the small wins, and recognizing their contributions, we successfully fostered their engagement in the EBP process. Direct care nurses were empowered to participate in the project and were intentionally included in every step. Additionally, nurses in advanced roles brought their expertise to the project to identify best practices and safe operationalization of the new procedure.

Leadership Support

Strong collaboration with nurse managers was essential to continued nurse engagement. We partnered with leaders to ensure that staff had the protected time, space, and resources necessary to meaningfully participate. Regular updates and shared planning allowed nurse managers to serve as accountability partners and advocates for the project.

Mentorship

Mentorship was a critical component, particularly because many participants had no prior experience with EBP-QI. Through structured guidance and support from the nurse scientist, NPD practitioner, and EBP coordinator, nurses gained confidence and competence in applying evidence to practice.

Conclusion

This project exemplifies the NPD throughputs in action—specifically role development, competency management, collaborative partnerships, education, orientation, onboarding, and ongoing competency validation (Harper & Maloney, 2022). The EBP-QI initiative originated from a direct care nurse’s clinical question, highlighting the importance of fostering a spirit of inquiry at the point of care. By encouraging curiosity and critical thinking within our spheres of influence, we can continuously evaluate and refine our practice to ensure alignment with the best available evidence. Moreover, this approach supports the creation of sustainable systems that reduce process variation and promote high-quality, consistent care through structured quality improvement initiatives.

References

Agency for Healthcare Research and Quality. (2017). Estimating the additional hospital inpatient cost and mortality associated with selected hospital-acquired conditions. https://www.ahrq.gov/hai/pfp/haccost2017-results.html

Hagle, M., Dwyer, D., Gettrust, L., Lusk, D., Peterson, K., & Tennies, S. (2020). Development and implementation of a model for research, evidence-based practice, quality improvement, and innovation. Journal of Nursing Care Quality, 35(2), 102–107. https://doi.org/10.1097/NCQ.0000000000000422

Harper, M. & Maloney, P. (2022). Nursing professional development: Scope and standards of practice (4th ed.). Association for Nursing Professional Development.

Rivera, R. R., Fitzpatrick, J. J., & Boyle, S. M. (2011). Closing the RN engagement gap: Which drivers of engagement matter? The Journal of Nursing Administration, 41(6), 265–272. https://doi.org/10.1097/NNA.0b013e31821c476c

Wei, H., Horsley, L., Cao, Y., Haddad, L. M., Hall, K. C., Robinson, R., Powers, M., & Anderson, D. G. (2023). The associations among nurse work engagement, job satisfaction, quality of care, and intent to leave: A national survey in the United States. International Journal of Nursing Sciences, 10(4), 476–484. https://doi.org/10.1016/j.ijnss.2023.09.010