title: Factors influencing advanced practice nurses' ability to promote evidence-based practice among frontline nurses.
abstract: BACKGROUND
  Advanced practice nurses (APNs) have an important role in promoting evidence-based practice (EBP) among frontline nurses (FLNs). Factors influencing FLNs' engagement with EBP are well documented but little is known about factors that affect APNs' ability to facilitate evidence in practice.
  
  
  OBJECTIVE
  To identify factors that influence APNs' ability to promote EBP among FLNs.
  
  
  METHODS
  A multiple case study of 23 APNs from hospital and primary care settings across seven English health authorities was undertaken. Data collection comprised interviews and observation of APNs and interviews with FLNs and other healthcare professionals. Data were analysed using the Framework approach.
  
  
  RESULTS
  Four groups of influencing factors were identified: (1) Personal attributes of APNs included knowledge and skills in EBP, clinical credibility with frontline staff and leadership style. (2) Relationships with stakeholders included APNs' interactions with FLNs and the level of support from managers and medical colleagues. (3) Aspects of the APN role included their sphere of responsibility and workload. (4) Organisational context included the organisational culture, FLNs' workload, professional networks and available resources.
  
  
  CONCLUSIONS
  Educational preparation for APNs should enable them to develop expertise in EBP plus interpersonal and leadership skills to manage relational dynamics in clinical settings. APN role specifications should provide the opportunity to promote EBP. The organisational culture should be conducive to enabling EBP with managers supportive of this aspect of the APNs' role.
  
  
  CONCLUSIONS
  APNs need to be supported to address the individual, interpersonal and organisational factors, which influence their ability to promote EBP. Organisational commitment at the highest level is key to APNs' ability to fulfil this aspect of their role.
authors: School of Nursing and Midwifery, University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. kate.gerrish@sheffield.ac.uk
authors: Kate
authors: K
authors: Gerrish
authors: Mike
authors: M
authors: Nolan
authors: Ann
authors: A
authors: McDonnell
authors: Angela
authors: A
authors: Tod
authors: Marilyn
authors: M
authors: Kirshbaum
authors: Louise
authors: L
authors: Guillaume
mesh_terms: D057179:Advanced Practice Nursing / Q000379:methods* / Q000458:organization & administration* / Q000592:standards; D055318:Evidence-Based Nursing / Q000379:methods*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D019982:Organizational Case Studies; D059017:Primary Care Nursing / Q000379:methods* / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration / Q000592:standards