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Lisbet Proposed Evidence-Based Practice Change


Evidence-based practice allows a nurse or another medical worker to revolve an issue by applying recent studies in the relevant field. One such problem is the decreasing rate of nursing turnover. There are various reasons for it, but all lead to the patients being affected as well. This paper will apply the PICOT Question and the research articles addressing its points to the issue at hand and propose an evidence-based practice change to find the solutions.

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The consequences of understaffing in nursing can be quite severe. According to Griffiths et al. (2019), it may lead to increased death risks among patients, and while hiring nursing care assistants can be beneficial, they don’t seem to be a full alternative to registered nurses. Similar results occurred in another hospital where understaffing was linked to increased length of patient stay (Ramsey et al., 2018). According to the PICOT question, the two main ways to address those consequences are increasing nursing positions and adding more hours to the normal shift of the existing staff. However, simply hiring more nurses is insufficient, as they should also be skillful to impact the negative returns (Twigg et al., 2019). Making the remaining staff work overtime is not the best solution either, as it leads to medical errors, even to a bigger degree than low staffing (Kiymaz & Koç, 2017). Son et al. (2019) also maintain that increasing working hours for nurses is harmful to patients. Therefore, the solution to the issue may involve avoiding overtime and hiring qualified personnel, for instance, registered nurses.

It might not be enough to use only research to suggest evidence-based practice changes. Such elements as the nursing staff’s clinical expertise and the patients’ needs should also be considered (Melnyk & Fineout-Overholt, 2018). Therefore, the following steps after analyzing the evidence would be interviewing the nurses and surveying the patients. For the time being, while the search for qualified specialists is ongoing, making the staff working overtime might be necessary. However, some nurses might also be willing to do so for various reasons, so by interviewing them, the group that can work overtime will be distinguished (Stimpfel et al., 2019). The next step of surveying the patient might occur simultaneously if the problems are evident, or later, sometime after the new work model is implemented. In case there is no significant decrease in the patients’ quality of life with overtime nurses, it could be considered a success and the answer to the PICOT question. Still, other issues may arise in the background and require an immediate resolution.

While the patients’ comfort and well-being are of utmost importance, the nursing staff’s satisfaction with work and performance should also be considered. Even those nurses that volunteered to work overtime might experience difficulties, so it is essential to monitor them by interviewing or surveying. In case their performance declines and affects the patients, it might be necessary to resume searching for new staff. By that time, the financing should be more or less settled, and there might be funds for qualified specialists. Even if the existing staff insists they can manage, what is best for the patients should be the priority. In the end, the evaluation of the proposal’s results can be based on another patient survey after six months following its implementation.


In conclusion, this paper attempted to propose an evidence-based practice change after appraising the research data and drawing the connection between it and the PICOT question. The solution does not seem easy, as hiring qualified personnel and avoiding making the existing staff working overtime might be impossible. However, cooperating with the staff and gathering the patients’ opinion is instrumental in achieving success. The change is based on the initial necessity of making willing nurses work overtime and accruing of funds over time to hire new qualified personnel eventually. Ultimately, the patients will be in charge of determining the initiative’s success.


Griffiths, P., Maruotti, A., Saucedo, A. R., Redfern, O. C., Ball, J. E., Briggs, J., Dall’Ora, C., Schmidt, P. E., & Smith, G. B. (2019). Nurse staffing, nursing assistants and hospital mortality: Retrospective longitudinal cohort study. BMJ Quality & Safety, 28(8), 609-617. Web.

Kiymaz, D., & Koç, Z. (2017). Identification of factors which affect the tendency towards and attitudes of emergency unit nurses to make medical errors. Journal of Clinical Nursing, 27(5-6), 1160-1169. Web.

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Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing and healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

Ramsey, Z., Palter, J. S., Hardwick, J., Moskoff, J., Christian, E. L, & Bailitz, J. (2018). Decreased nursing staffing adversely affects emergency department throughput metrics. Western Journal of Emergency Medicine, 19(3), 496-500. Web.

Son, Y.-J., Lee, E. K., & Ko, Y. (2019). Association of working hours and patient safety competencies with adverse nurse outcomes: A cross-sectional study. International Journal of Environmental Research and Public Health, 16(21), 4083. Web.

Stimpfel, A. W., Fletcher, J., & Kovner, C. T. (2019). A comparison of scheduling, work hours, overtime, and work preferences across four cohorts of newly licensed registered nurses. Journal of Advanced Nursing, 75(9), 1902-1910. Web.

Twigg, D. E., Kutzer, Y., Jacob, E., & Seaman, K. (2019). A quantitative systematic review of the association between nurse skill mix and nursing-sensitive patient outcomes in the acute care setting. Journal of Advanced Nursing, 75(12), 3404-3423. Web.

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