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The area in which I work is an emergency department (ED)east of the Seattle metropolitan area. We are a level 3 trauma center. It is a fast-paced environment that is unpredictable. There are a few things that I have observed over the years while working there about implementing change in our department. Number one, communication is critical to whether the implementation of change will be successful. The staff needs to be aware of the needed change, and preferably have buy-in to the reason for the change. Number two, the leadership team needs to be present and help facilitate the change. Do not spring a change on the department and then leave us to figure it out. Number three, anticipate issues ahead of time and have a backup plan. If the plan does not work due to staffing, acuity, or technical problems don’t be afraid to pull the plug or help stand with the floor staff while they navigate the problem. When these practices are part of the EBP implementation process, things go relatively smoothly. The hospital in which I work does encourage new practices and new medical evidence. I am grateful for the administration to open-minded about policies and new advances.

Considering that I only work in the ED, I don’t have much experience to see how other areas of the hospital work in relation to EBP implementation. I have however recently worked in the local school district as a school nurse and can testify the difference between hospital nursing and public health nursing. While in the school district there were several areas of improvement that I noted and brought to the attention of the school district administrators. One is the need for a nurse at every school every day due to acuity and the number of students. Especially at the local high school where we have 1,300 students to one nurse. This includes special needs students with complex medical issues, diabetic students, asthma, and allergy students. According to Guttu, Engelke, and Swanson, (2004) the national standard for school nurse/student ratio is 1:750. This is assuming that students are healthy. 1:125 for complex nursing needs. It is also noted that 1 in 4 schools have no nurse at all. (Guttu, M., Engelke, M. K., & Swanson, M., 2004) Despite there being evidence that this the standard for school districts, there didn’t seem to be a strong governing body to report to or oversee these major issues. What seemed to me as a high probability for injury or neglect the school district saw as status quo. There was a disconnect between being a healthcare provider, educational provider, and administrator. The school nurse tended to be in limbo, not part of the education team or part of the administration or leadership team, they worked autonomously at a school site or multiple sites. Suggesting change through the EBP was difficult to navigate considering the above obstacles.