Why Evidence-Based Projects Don’t Stick
And What Leaders Can Do About It
This time of year, across many health care settings, evidence-based practice and quality improvement projects are underway.
Graduate students partner with units, teams engage thoughtfully with the evidence, and meaningful work begins. And yet, nurse leaders often notice a familiar pattern:
Promising projects generate insight and energy, but struggle to persist once the academic timeline ends.
This is not a critique of students, faculty, or nurse leaders. Rather, it reflects a structural reality of how scholarly work is commonly introduced into complex clinical environments—often without clear mechanisms for continuity once the initial implementation cycle concludes.
From an implementation science perspective, this pattern is both understandable and addressable. Implementation science is often associated with frameworks, strategies, and research methods. But in clinical settings, it shows up most clearly in the conditions leaders inherit after a project ends: who owns the work, who is accountable for outcomes, and whether the system is designed to support ongoing use of the evidence.
The Real Issue Isn’t the Evidence—It’s the System Treating EBP as a Standalone "Project"
Many nursing scholarly projects are thoughtfully designed and grounded in evidence. Where they struggle is not rigor, but sustainability. Sustained change in clinical practice requires:
Authority to set expectations
Ongoing reinforcement across shifts and roles
Integration into workflows, policies, and social norms
In other words, it requires leadership ownership, not student ownership.
Scholarly projects are often treated as something that happens to a unit rather than something that is owned by a unit. When that happens, even strong projects are unlikely to survive beyond the project period.
This is a common failure mode. Without an explicit handoff into leadership structures, sustainability becomes accidental rather than designed.
Projects enter clinical settings as time-limited collaborations,
but exit without an authoritative owner.
A Leadership Reframe That Changes Everything
Evidence-based practice and quality improvement projects do not belong to the student. They ultimately sit with nursing leadership.
Students contribute time, structure, and expertise—particularly in reviewing and synthesizing evidence. But decisions about whether practice should change, which outcomes matter, and how that change is sustained require clear leadership ownership, rather than time-limited academic roles.
This shift is subtle but powerful. It reframes scholarly work not as an external academic exercise, but as a core leadership responsibility embedded in ongoing operations. But, for that ownership to be real rather than symbolic, leaders must be given sufficient time and operational support to carry it forward..
What Sustainable Projects Look Like
When this works well, nurse leaders:
Identify a problem appropriate for an evidence-based solution. One that aligns with operational priorities and falls within their span of control. Students that select their own projects often do not have sufficient knowledge of the unit’s challenges.
Partner with students to search and synthesize the evidence. Leveraging academic expertise without outsourcing ownership takes advantage of the student’s time and skill.
Co-design implementation with sustainability in mind. Including how expectations will be reinforced, monitored, and integrated into daily work. Designing sustained implementation is a core, required component of EBP.
Anchor ownership of the change within nursing leadership. While unit leaders play a central role, sustained practice change requires alignment across nursing leadership functions that support, reinforce, and sustain practice. Embedding the practice into communication, workflows, orientation, and performance conversations creates continuity over time.
Implementation Is the Hard Part. And That’s Okay.
Implementation is complex, and involves understanding the social and functional dynamics within clinical environments including fatigue, competing priorities, staff turnover, and cultural norms.
Changing nursing practice means navigating real-world constraints—and that is not a failure of motivation or commitment. It is the core work of leadership in complex systems. Viewed this way, the challenge is less about buy-in and more about how ownership, continuity, and follow-through are structurally supported once responsibility shifts from study to practice.
Nursing practice change is the core work of leadership in complex systems.
The Often-Unspoken Risk: Erosion of Trust
There is a less visible—but very real—risk when scholarly work does not translate into sustained practice.
Nurses invest time, attention, and effort into these projects. When changes quietly fade, the cost is not just inefficiency—it is erosion of trust. Nurses become less willing to engage in future initiatives, leaders expend credibility reintroducing “the next project,” and meaningful opportunities for improvement may be lost.
Over time, repeated cycles of effort without durable return make evidence-based work feel extractive rather than empowering. Even well-intended initiatives can contribute to fatigue and skepticism if staff experience them as temporary or symbolic rather than genuinely integrated into practice. And ultimately – research suggests that erosion of trust can impact nurses’ job satisfaction and intent to leave.
Protecting trust requires ensuring that when nurses invest their energy in evidence-based change, that investment leads somewhere enduring. Designing for sustainability is not only an operational concern—it is a relational one.
How we support evidence-based practice and implementation
For nurse leaders navigating these tensions—particularly those overseeing EBP councils, Magnet® innovations and improvement, or recurring student partnerships—implementation science offers a practical lens for designing change that actually improves care, not just completes projects.
When implementation is treated as a core leadership competency and leaders are provided the structure and support to exercise it, the familiar cycle of “projects that don’t stick” begins to break. Ownership becomes clear, effort is sustained beyond academic timelines, and leaders can see a direct line between staff work and the outcomes they are accountable for—quality, safety, and durable practice change.
Keep leading,
Pam
