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Reading the article by Russell-Babin and colleagues in the December 2023 issue of AJN made me grateful for all the work that went into developing the nursing implementation science (IS) program at Inova. As a nurse working at this health care system, I’d like to share how I benefited from being in the first cohort of nurses trained and engaged in IS over the last three years.

For the past eight years, I’ve been a clinical coordinator of two different disease-specific programs—first stroke and now sepsis. In these roles, I’ve been engaged in many different quality improvement (QI) projects and have become familiar with the tools and processes used to improve patient care and outcomes.

Towards more comprehensive and systematic evidence-based change.

However, as I was invited to step into the world of IS, I began to realize that a strict QI approach cannot alone bring about all the changes we desire within the complex systems of health care. The fact is that clinicians, even when presented with the best evidence and despite their best intentions, often fail to adopt and sustain best practices. Through the training that my colleagues and I received, we learned that IS offers a more comprehensive and systematic way of integrating best evidence into practice.

Navigating the concepts and terminology of implementation science.

Cohort #1 implementation science team at Inova

But this is easier said than done. As a new student of IS, I was confronted with a lot of interesting but challenging concepts. We learned that IS has process models, determinant frameworks, and evaluation frameworks. Then there were the acronyms (TICD, CFIR, ERIC); the oft-repeated but important names (Flottorp, Proctor, Powell, McNett); and the seemingly simple words with very specific meanings (acceptability, appropriateness, feasibility, fidelity, etc.). It was hard to keep all these ideas straight sometimes.

What helped me navigate the exciting but complicated world of IS were three things:

  • Training – We had a knowledgeable, skilled, and dedicated trainer, Amanda Bettencourt, who spent a total of 24 hours with us over 12 months, explaining the concepts and steps of IS in a way that was easy to understand.
  • Time – Over the last three years, our cohort received not only the 24 hours of training during year one, but a two-day “Putting It All Together” workshop in year two, and finally a two-day “Train the Trainer” session in year three so we could begin teaching it to other nurses and professionals in our health care system. Each time we were basically learning the same ideas, but the repetition solidified our understanding of IS.
  • Teams – Lastly, everyone who was trained had the opportunity to spend two years on a real-world IS project team putting everything we learned into practice. Working on the projects gave us the freedom to experiment with what we learned, to see the success of our work, and even to learn from what didn’t go so well.

The challenge of sustaining change.

Another barrier I still personally face is how easy it is to fall back into the “old ways” of attempting to implement best practices through trial and error. Honestly, in the moment it’s the easier thing to do, but over time it eventually turns into ISLAGIATT – “It seemed like a good idea at the time!” Applying IS principles to an evidence-based practice (EBP) project or a process change takes more time but the payoff is worth it. What we all want for ourselves and our patients is for our work to be meaningful, impactful, and sustained. Not taking a systematic and planned approach using proven principles does a disservice to all our hard work.

To be honest, there is so much more for me to learn about IS. But I’m thankful that the IS program at my health care organization has given me the insight, tools, and experience to approach the work of EBP implementation in a fresh, more purposeful way and that I can begin sharing what I’ve learned with others.

John Lawrence, BSN, RN, NPD-BC, is the Sepsis Coordinator at Inova Mount Vernon Hospital. His work has focused on a variety quality improvement and implementation science initiatives to improve patient outcomes and reduce workplace violence. John chairs the Nursing Research & EBP Council at his hospital and has contributed to research on nurses’ engagement with social drivers of health and the impact of the CMS sepsis early management bundle. In 2023, John was the recipient of the Virginia Nurses Association “40 Under 40” Award.