The impact of Advanced Practice Nurses (APNs) in promoting evidence-based practice among front-line staff - findings from a UK study

Background. Front-line nurses experience considerable challenges implementing evidence into practice at an individual and organisational level (Gerrish et al 2008). Within the UK, APNs are required to act as clinical leaders and change agents to promote evidence-based practice amongst front-line staff. However, little is known about the impact that they have in this aspect of their roles.

This paper will present findings from a study funded by the UK Department of Health.

Aim. To examine the impact of APNs in promoting evidence-based practice amongst frontline staff.
Methods

A collective instrumental case study approach was used (Stake 1995) involving five extended case studies and eighteen short case studies. The purposive sample of twenty-three APNs who formed the 'cases' was selected to include a range of settings, clinical specialities, organisational responsibilities and ways of working.

In-depth interviews were carried out with the APNs and health care professionals with whom they worked. For the extended case studies, non-participant observation and follow-up interviews were also undertaken. Data analysis drew on the principles of the Framework approach (Ritchie and Spencer 1994).

Results. Through a variety of mechanisms including teaching, role modelling, secondments to work with specialist teams, 'trouble shooting' in clinical areas and acting as a repository of knowledge and expertise, the APNs improved the competence, knowledge and skills of frontline staff. The evidence which underpinned these improvements came from a variety of sources including research reports or evidence-based protocols, as well as knowledge of the individual patient, clinical expertise and organisational evidence such as audit.

Conclusions. APNs have a significant impact on the practice of frontline staff and on their ability to deliver care which is based on the best evidence available. This is likely to have a positive effect on patient outcomes and on patient experience.