The registered nursing associate (RNA) works alongside the registered nurse and other health professionals to provide patient care, support and education in a range of settings. The role of the RNA is to deliver direct care, with minimal supervision, using knowledge and skills that are current and clinically credible. To deliver high-quality, effective and safe care, the RNA needs to establish the evidence, combining this knowledge with practice at a local level to support decision-making. According to Muir Gray (1997), the delivery of evidence-based care is not simply about using the evidence, it also requires engagement with the patient:
‘Evidence based practice is an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits the patient best.’
Although inclusion of patients in the decision-making process is important, it is also imperative that the RNA has the evidence-based knowledge to share with the patient to assist them in making an informed decision.
To ensure that they are able to make the best decision for and with their patients, the RNA needs to recognise sources of knowledge and information. Miller and Hill (2018) suggested that those with experience use a degree of intuition when making clinical decisions, calling on their clinical expertise to support them. Some, however, would suggest that the use of habit or intuition is no longer an acceptable resource to support decision-making. A consensus would be that the RNA, registered nurse or other health professional not only needs to consider their individual expertise and the preferences of the patient, but also the clinical guidance and policy available.
As a Nursing and Midwifery Council (NMC) registrant, the RNA is accountable for their actions or inactions throughout the patient journey; they have a responsibility to practise safely and effectively. The NMC (2018)Code identifies that all registrants must ensure that all the advice and information they share with service users is evidence based. This requirement ensures the currency and correctness of the knowledge and, therefore, that information shared supports service users in making informed decisions about their care. In addition, the NMC (2021) promotes a culture of reflection and improvement through the revalidation process that all nurses and RNAs must engage with every 3 years. This process requires engagement with clinical practice, evidence of continuous professional development and reflection aimed at maintaining and improving patient care.
Discovery and development of new knowledge is the focus of research; however, evidence-based practice takes that new knowledge and focuses on its application to practice. Evidence-based practice is about establishing the evidence and combining this knowledge with practice at a local level to support decision-making to ensure patients receive the best care possible. As a provider of direct care, the RNA has a key role to play in establishing evidence-based practice.
The key to implementing evidence-based practice is to stimulate curiosity and identify a question to address. With the role of the RNA being so diverse, there can be numerous opportunities for the RNA to engage with evidence-based practice. Approaches the RNA can take to establish evidence-based practice are:
- Conducting systematic reviews of the literature to identify relevant research on a particular topic. This information can then be used to inform clinical practice and to support the development of clinical policy and guidelines.
- Collecting data on patient outcomes and experiences, as well as on the effectiveness of interventions. This information can be used to inform practice and improve patient care
- Participating in clinical audits to assess the quality of care provided and identify areas for improvement
- Applying evidence-based guidelines and protocols to patient care, ensuring that the most up-to-date and effective practices are being used.
- Educating patients and their families about the benefits of following evidence-based guidelines. This can increase patient adherence to treatment plans and improve outcomes.
Whatever the approach taken by the RNA to develop their knowledge and enhance practice, role modelling and leadership are necessary to bring about changes in practice. Advocating a culture of development and practice enhancement is fundamental to the successful implementation of evidence-based practice. Taking a transformational leadership approach, encouraging others through the sharing of knowledge, skill and passion for improving patient satisfaction and outcome is very much within the scope of the RNA.
Overall, the RNA can play an important role in promoting evidence-based practice in healthcare settings. By staying up to date with the latest research, collecting and analysing data and applying evidence to practice, they can help improve patient outcomes and ensure high quality care is being delivered.