1 Peer #1 Christina Bradford  Top of Form Discussion Post: Evidence-Based Practice Evidence-based practice is inevitable in healthcare to "enhance quality, improve patient outcomes, reduce costs, and empower clinicians" (Melnyk & Fineout-Overholt, 2018, p. 7). The evidence-based practice provides the needed data to make appropriate decisions about patient care. Updated research data offers new knowledge and recommendations, leading to better patient outcomes. Evidence-based practice is essential in healthcare, and if not used, current practices become outdated and not in the patient's best interest. "Staff nurses are the clinical link in bringing evidence-based changes into clinical practice and only occur when staff continually ask questions about treatment and care, and implement those changes" (Crabtree et al., 2016). Working in the emergency department as a flow coordinator, I see many behavioral health patients daily; many of them are return patients. I feel this population is very underserved, so I looked at the American Psychiatric Association (APA) for answers. In looking into this Association, the vision, mission, values, and goals are evident that this organization "strives to be the premier psychiatric organization that advances mental health as a part of general health and wellbeing" (American Psychiatric Association, 2022). Part of the APA's values is to promote scientific research, and its mission is to promote universal access to high-quality care for anyone needing treatment for mental disorders. This is key to meeting the goals of the organization to improve education and training. The APA backs its values and mission because the organization has an abundance of evidence-based practice guidelines that give pertinent and up-to-date information to clinicians for the most appropriate treatment recommendations for patients. There is also a wealth of information available for families of patients. In the emergency department, behavioral health patients are often not started on medications for diseases like schizophrenia or bipolar; the physicians leave it to the facility where the patient is being transferred to. Patients will sit in the emergency room for weeks while waiting on a bed at an accepting facility. The research and evidence-based practice is done, and the information is evident by this organization which would be very helpful if used appropriately. Before researching this organization, I had no idea that this information was available to clinicians. "Despite the multitude of positive outcomes associated with evidence-based practice, clinicians do not consistently implement them or follow evidence-based guidelines" (Melnyk & Fineout-Overholt, 2018, p. 12). This organization has clearly done the work; we as clinicians should follow the guidelines and not have the attitude that this is the way it has always been done, so keep doing it the same way. References American Psychiatric Association. (2022). APA’s Vision, Mis ...

1. 1
Peer #1
Christina Bradford
Top of Form
Discussion Post: Evidence-Based Practice
Evidence-based practice is inevitable in healthcare to "enhance
quality, improve patient outcomes, reduce costs, and empower
clinicians" (Melnyk & Fineout-Overholt, 2018, p. 7). The
evidence-based practice provides the needed data to make
appropriate decisions about patient care. Updated research data
offers new knowledge and recommendations, leading to better
patient outcomes. Evidence-based practice is essential in
healthcare, and if not used, current practices become outdated
and not in the patient's best interest. "Staff nurses are the
clinical link in bringing evidence-based changes into clinical
practice and only occur when staff continually ask questions
about treatment and care, and implement those changes"
(Crabtree et al., 2016).
Working in the emergency department as a flow coordinator, I
see many behavioral health patients daily; many of them are
return patients. I feel this population is very underserved, s o I
looked at the American Psychiatric Association (APA) for
answers. In looking into this Association, the vision, mission,
values, and goals are evident that this organization "strives to
be the premier psychiatric organization that advances mental
health as a part of general health and wellbeing" (American
Psychiatric Association, 2022). Part of the APA's values is to
promote scientific research, and its mission is to promote
universal access to high-quality care for anyone needing
treatment for mental disorders. This is key to meeting the goals
of the organization to improve education and training. The APA
backs its values and mission because the organization has an
abundance of evidence-based practice guidelines that give

2. pertinent and up-to-date information to clinicians for the most
appropriate treatment recommendations for patients. There is
also a wealth of information available for families of patients.
In the emergency department, behavioral health patients are
often not started on medications for diseases like schizophrenia
or bipolar; the physicians leave it to the facility where the
patient is being transferred to. Patients will sit in the emergency
room for weeks while waiting on a bed at an accepting facility.
The research and evidence-based practice is done, and the
information is evident by this organization which would be very
helpful if used appropriately. Before researching this
organization, I had no idea that this information was available
to clinicians. "Despite the multitude of positive outcomes
associated with evidence-based practice, clinicians do not
consistently implement them or follow evidence-based
guidelines" (Melnyk & Fineout-Overholt, 2018, p. 12). This
organization has clearly done the work; we as clinicians should
follow the guidelines and not have the attitude that this is the
way it has always been done, so keep doing it the same way.
References
American Psychiatric Association. (2022). APA’s Vision,
Mission, Values, and Goals. American Psychiatric
Association. www.psychiatry.org
Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016).
Improving patient care through nursing engagement in
evidence-based practice. Worldviews on Evidence-Based
Nursing, 13(2), 172–175. https://doi.org/10.1111/wvn.12126
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based
practice in nursing & healthcare: A guide to best practice (4th
ed.). Wolters Kluwer Health
Peer #2
Bottom of Form

3. Louna Delivre
· Top of Form
Where in the World Is Evidence-Based Practice?
The translation of research evidence into clinical practice
remains painfully slow, often spanning from years to decades
(Melnyk, B. M., & Fineout-Overholt, E., 2018). Sackett et al.
defined EBP as the conscientious use of current best evidence in
making decisions about patient care. Moreover, Evidence-based
Practice (EBP) enhances healthcare quality, improves patient
outcomes, reduces cost, and empowers clinicians; this is known
as the quadruple aim in health care (Bodenheimer &
Snsky,2014; Melnyk & Fineout-Overholt, 2015; Tucker, 2014).
Since Florence Nightingale, nursing has been enriched by using
research in practice, but on March 21, 2010, when Affordable
Care Act was passed, EBP came to light, and research on EBP
increased significantly. Nevertheless, it does not prevent EBP to
remains TABOO for some organizations.
Today I chose American Nurses Association (ANA) as the
healthcare organization to review and determine if EBP appears
in their mission, vision, philosophy, and goal. Their vision is to
"Lead the profession to shape the future of nursing and health
care." According to Brown et al., EBP is considered to be the
gold standard in nursing practice, but the actual implementation
of EBP has been inconsistent due to barriers related to nursing
workload, lack of organizational support, lack of EBP
knowledge and skills, and poor attitudes toward EBP. ANA
exists to advance the nursing profession by fostering high
standards of nursing practice, promoting a safe and ethical work
environment, bolstering nurses' health and wellness, and
advocating for health care issues that affect nurses and the
public (ANA, n.d.). Therefore, ANA is the first organization
that uses evidence-based practice to educate and advocate on
behalf of the nurses.
ANA work is grounded in EBP by contributing to expanding the
role of Registered Nurses (RN) and Advanced Practice

4. Registered Nurses (APRN) in the delivery of basic and primary
health care and recognizing the essential value of nurses in all
health care settings, and how they serve in so many diverse
roles and specialties. Nurses serve on the frontline of health
care and have a unique opportunity to improve patient care
through EBP (Hockenberry, Walaen, Brown, &
Barrera). Therefore, nurses can offer insights and contributions
on how to improve health care in this country. Thus, with an
aging population and an overburdened healthcare system,
technical advances in health care are simply not enough. Nurses
represent another side to the equation, where knowledge and
expertise are balanced with care and compassion. Through
empowering nurses to lead health care change, we can truly
improve health care for all (ANA, n.d.).
ANA is the first healthcare organization that any nursing
student and nurse professional should be a member of because
ANA is not a specialty organization. Still, ANA represents the
interests of the nation of registered nurses. As you all know,
healthcare organizations can facilitate networking, mentorship,
new skills, help you stay connected with your community, etc.
It was interesting to learn how ANA can equip me with many
resources as an APRN student and professional, including a
step-by-step information guide to prepare me for my ANCC
APRN certification. Their website is UpToDate and gives more
InSite information on nursing-related education. I learned more
about APRN policy and regulation, the scope of practice,
advocacy, and the many advantages of becoming a member of
this organization.
References
American Nurses Association: ANA
Enterprise https://www.nursingworld.org
Brown, C. E., Ecoff, L., Kim, S. C., Wickline, M. A., Rose, B.,
Klimpel, K., & Glaser, D. ( 2010 ). Multi‐ institutional study of
barriers to research utilization and evidence‐ based practice
among hospital nurses. Journal of Clinical Nursing, 19 ( 13‐ 14

5. ), 1944 – 1951. DOI: 10.1111/j.1365-2702.2009.03184.x
Hockenberry, M., Walaen, M., Brown, T., & Barrera, P. (2008).
Creating an evidence-based practice environment: One
hospital's journey. Journal of Trauma Nursing, 15 (3), 136 –
142.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based
practice in nursing & healthcare: A guide to best practice (4th
ed.). Philadelphia, PA: Wolters Kluwer
Bottom of Form
3
Peer 1
Melissa Jackson
Top of Form
National Healthcare Issue
The National healthcare issues I chose is the Primary Care
Provider shortage. According to the American Association of
Nurse Practitioners (AANP) (2019) there are over 270,000
Nurse Practitioners licensed to practice in the United States.
This is a big leap up from 248,000 in 2018, and 120,000 in
2007. The AANP states “current provider shortages, especially
in primary care, are a growing concern, yet the growth of the
NP role is addressing that concern head-on.” NPs and PAs can
help lessen the physician/PCP shortage and provide an influx of
patients with access to quality care. In order for this to happen
there has to be a care delivery model that works for both the
patient and the provider. Norful et al. (2018) stated “successful
co-management can alleviate individual workload, prevent
burnout, improve patient care quality, and lead to increased
patient access to care.” Improved patient outcomes are the
desired end result for all healthcare professionals. So, finding
the happy balance among different levels of providers is a must
to reach those goals.
Impact on the Work Setting

6. The current provider shortage is having a major impact in the
work setting. Patents are having difficulty finding providers,
waiting longer to be seen, utilizing emergency services
unnecessarily, paying high costs for services and, (I fear)
overall losing faith in the healthcare system. Since the ACA
was put into effect and more people had access to healthcare,
there has been a strain on the system. There just aren’t enough
physicians to go around. The healthcare system is being
overloaded. Utilizing NP’s is one obvious solution to the issue.
A downside is that some states severely limit the scope of NP’s
and don’t utilize them to their full potential and education Only
50% of states allow for NPs to have Full Proactive Authority.
During the pandemic some of these restrictions were lifted and
it allowed for more access to care. I believe this has shown how
much of an impact the Advanced Practice Nurse can have on the
issues we are currently facing.
Health System Response
I currently reside in Georgia, and will be moving to Alabama in
the spring. Neither of these states grants NP’s Full Practice
Authority (FPA). It is my hope that these states soon adopt FPA
to allow NPs to provide a greater reach of healthcare, especia lly
in the more rural and underserved parts of GA and AL.
Allowing for full FPA will “improve access to care, streamline
care and make it more efficient, decrease cost, and protect
patient choice” (Issues at a Glance: Full Practice Authority,
2022). With a healthcare system that is currently overloaded, it
is in the best interest of the patient population to improve
access to care.
References
American Association of Nurse Practitioners. (2019, March
29). Nurse Practitioner Role Grows to More Than 270,000.
Retrieved August 29, 2022, from https://www.aanp.org/news-
feed/nurse-practitioner-role-continues-to-grow-to-meet-primary-
care-provider-shortages-and-patient-demands
Issues at a Glance: Full Practice Authority. (2022, April).
American Association of Nurse Practitioners. Retrieved August

7. 29, 2022, from https://www.aanp.org/advocacy/advocacy-
resource/policy-briefs/issues-full-practice-bri
Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018).
Nurse Practitioner–Physician Comanagement: A Theoretical
Model to Alleviate Primary Care Strain. The Annals of Family
Medicine, 16(3), 250–256. https://doi.org/10.1370/afm.2230
Peer #2
Christina Bradford
Top of Form
National Healthcare Issues: Nursing Shortages
Nursing makes up one of the largest areas of healthcare. The
United States has experienced nursing shortages for years.
According to the Bureau of Labor Statistics, "registered nurses
are listed among the top occupations as job growth; however, it
projects there will be 175,000 job openings for registered nurses
each year through 2029" (American Association of Colleges of
Nursing, 2022). Over the years, the nursing shortage has
become a national healthcare issue, above many other problems.
Many factors evolve around the current nursing shortages in
healthcare. "The nursing profession continues to face shortages
due to a lack of potential educators, high turnover, and
inequitable workforce distribution that stems from an aging
population, nurse burnout, and population growth in the United
States" (Haddad et al., 2022).
I have worked in the emergency department for 20 years, and
the nursing shortages have increased tremendously.
"Organizations face increased pressures to improve outcomes,
keeping employees from being burned out and disengaged
becomes an increasing concern" (Jacobs et al., 2018).
Organizations focus on patient satisfaction and meeting hospital

8. productivity numbers instead of nursing job satisfaction and
less employee turnover. "The quadruple aim includes principles
of population health, management of healthcare costs, and
enhancement of the patient care experience, including quality
and satisfaction, and a proposed fourth aim to include strategies
to improve work life with a focus on the provider experience"
(Marshall & Broome, 2021, p. 69). For an organization to be
successful, leaders must identify and prioritize healthcare
delivery, all while improving the work life of the healthcare
workers.
Over the years, I have seen first-hand the problems with limited
nursing staff in the emergency department. Understaffed days
have led to staff taking more than the 1:4 ratio and, at times, a
high acuity assignment involving multiple intubated patients.
During the peak of Covid, this became an everyday
responsibility of the emergency room nursing staff. This
expectation became not only overwhelming and increased
nursing burnout but became a huge safety concern on many
levels. During this time, our leadership created a staff-led team
for our department that would meet monthly. This monthly
meeting with staff was very beneficial for staff to voice
concerns and come up with solutions to the staffing matrix
while still providing patient care. The leadership team and staff
created a matrix for adequate daily staffing based on current
trends in the department. The department can put in a request
before the shift for how many additional nurses are needed to
care for the patients that are held in the department, and these
nurses are sent to take on the admissions. This has helped
tremendously so that the emergency department nurses can care
for ER patients instead of admitted patients. This incentive also
gave the nurses a feeling that the leadership team listened to the
department's request. "A strategic leader continually thinks of
the organization with a perspective from higher levels, taking a
large perspective of analysis, and looking into the future and
must think conceptually and creatively" (Marshall & Broome,
2021, p. 56). This type of thinking helps the department move

9. forward for the better.
References
American Association of Colleges of Nursing. (2022). Nursing
Shortage. www.aacnnursing.org
Haddad, L., Annamaraju, P., & Toney-Butler, T.
(2022). Nursing Shortage. StatPearls
Publishing. www.ncbi.nlm.nih.gov
Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K.
(2018). Engaging employees in well-being: Moving from the
triple aim to the quadruple aim. Nursing Administration
Quarterly, 43(3), 231–245.
Marshall, E., & Broome, M. E. (2021). Transformational
leadership in nursing (3rd ed.). Springer Publishing
Company. https://doi.org/10.1891/9780826193995
Bottom of Form
Christina Bradford
RE: Discussion - Week 1
COLLAPSE
Top of Form
National Healthcare Issues: Nursing Shortages
Nursing makes up one of the largest areas of healthcare. The
United States has experienced nursing shortages for years.
According to the Bureau of Labor Statistics, "registered nurses
are listed among the top occupations as job growth; however, it
projects there will be 175,000 job openings for registered nurses
each year through 2029" (American Association of Colleges of
Nursing, 2022). Over the years, the nursing shortage has
become a national healthcare issue, above many other problems.
Many factors evolve around the current nursing shortages in

10. healthcare. "The nursing profession continues to face shortages
due to a lack of potential educators, high turnover, and
inequitable workforce distribution that stems from an aging
population, nurse burnout, and population growth in the United
States" (Haddad et al., 2022).
I have worked in the emergency department for 20 years, and
the nursing shortages have increased tremendously.
"Organizations face increased pressures to improve outcomes,
keeping employees from being burned out and disengaged
becomes an increasing concern" (Jacobs et al., 2018).
Organizations focus on patient satisfaction and meeting hospital
productivity numbers instead of nursing job satisfaction and
less employee turnover. "The quadruple aim includes principles
of population health, management of healthcare costs, and
enhancement of the patient care experience, including quality
and satisfaction, and a proposed fourth aim to include strategies
to improve work life with a focus on the provider experience"
(Marshall & Broome, 2021, p. 69). For an organization to be
successful, leaders must identify and prioritize healthcare
delivery, all while improving the work life of the healthcare
workers.
Over the years, I have seen first-hand the problems with limited
nursing staff in the emergency department. Understaffed days
have led to staff taking more than the 1:4 ratio and, at times, a
high acuity assignment involving multiple intubated patients.
During the peak of Covid, this became an everyday
responsibility of the emergency room nursing staff. This
expectation became not only overwhelming and increased
nursing burnout but became a huge safety concern on many
levels. During this time, our leadership created a staff-led team
for our department that would meet monthly. This monthly
meeting with staff was very beneficial for staff to voice
concerns and come up with solutions to the staffing matrix
while still providing patient care. The leadership team and staff
created a matrix for adequate daily staffing based on current
trends in the department. The department can put in a request

11. before the shift for how many additional nurses are needed to
care for the patients that are held in the department, and these
nurses are sent to take on the admissions. This has helped
tremendously so that the emergency department nurses can care
for ER patients instead of admitted patients. This incentive also
gave the nurses a feeling that the leadership team listened to the
department's request. "A strategic leader continually thinks of
the organization with a perspective from higher levels, taki ng a
large perspective of analysis, and looking into the future and
must think conceptually and creatively" (Marshall & Broome,
2021, p. 56). This type of thinking helps the department move
forward for the better.
References
American Association of Colleges of Nursing. (2022). Nursing
Shortage. www.aacnnursing.org
Haddad, L., Annamaraju, P., & Toney-Butler, T.
(2022). Nursing Shortage. StatPearls
Publishing. www.ncbi.nlm.nih.gov
Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K.
(2018). Engaging employees in well-being: Moving from the
triple aim to the quadruple aim. Nursing Administration
Quarterly, 43(3), 231–245.
Marshall, E., & Broome, M. E. (2021). Transformational
leadership in nursing (3rd ed.). Springer Publishing
Company. https://doi.org/10.1891/9780826193995
Bottom of Form
Bottom of Form