How nurse manager’s position in the hospital hierarchy influences evidence-based practice implementation in nursing: A qualitative case study of the Nigerian acute care setting

Abstract

Background and objective: Evidence-based practice (EBP) is widely acknowledged as an essential aspect of healthcare delivery. Nurse managers are expected to contribute to the development of organisational cultures promoting EBP. However, there are indications that nurse managers are not necessarily empowered to drive implementation due to hierarchical constraints. This study explores how nurse manager’s position in the hospital hierarchy influences EBP implementation in nursing, in the Nigerian acute care settings.

Methods: A qualitative case study methodology is utilised to gather data from two large acute care settings in Nigeria. Drawing on semi-structured interview, twenty-one ward managers and two nurse managers were interviewed. Data were transcribed and inductively analysed to generate four overarching themes.

Results: Nurse managers were hugely constrained by lack of autonomy to mobilise resources for EBP related activities. The hierarchical structure of the settings promoted top-down decision-making processes which in turn, limited nurse manager’s visibility in the boardroom. Consequently, nurse managers were excluded from key strategic planning within the organisation and could not drive EBP implementation.

Conclusions: Findings highlight need for nurse managers to have greater visibility and managerial influence to enable them create opportunities for implementation of EBP in nursing. Implications for nursing management: Administratively, there is need for nurses to have greater involvement in management. Adequate authority and leadership visibility as well as managerial influence would enable nurse managers create opportunities for successful implementation.