Best practice in nursing refers to clinical actions and decisions grounded in the strongest available research evidence, combined with a nurse’s own clinical expertise and the individual patient’s values and preferences. This three-part framework is more formally known as evidence-based practice (EBP), and it has become the standard expectation across healthcare systems worldwide. Rather than relying on tradition or “the way we’ve always done it,” best practice means continuously updating how care is delivered based on what the evidence shows actually works.
The Three Pillars of Best Practice
Evidence-based practice rests on three equally important components. The first is research evidence: the findings from well-designed studies that tell us which interventions are effective and which are not. The second is clinical expertise: the judgment a nurse develops through years of direct patient care, pattern recognition, and hands-on problem solving. The third is patient values and circumstances: what matters to each individual patient, including their cultural background, personal goals, and life situation.
None of these three pillars works well alone. A nurse who follows research findings rigidly without adapting to the patient in front of them can miss important nuances. A nurse who relies solely on experience may continue using outdated interventions. And centering patient preference without any evidence filter can lead to ineffective or even harmful care. Best practice sits at the intersection of all three.
How Research Evidence Is Ranked
Not all evidence carries the same weight. Nursing and medicine use a hierarchy that ranks study types by their reliability. At the top are systematic reviews and meta-analyses, which pool data from many studies to reach a broader conclusion. Next come randomized controlled trials, where patients are randomly assigned to different treatments, reducing the chance of bias. Below that are cohort and case-control studies, which observe groups over time but don’t randomly assign interventions. Case reports and case series rank lower still. At the base sits expert opinion and anecdotal evidence.
In practice, this hierarchy helps nurses and healthcare teams evaluate whether a proposed change in care is backed by strong or weak evidence. When a hospital updates its protocols, for example, the strongest recommendations draw on systematic reviews, while weaker evidence may justify a pilot program or further study rather than an immediate policy change.
What Best Practice Looks Like in Daily Care
Abstract frameworks become concrete at the bedside. Two common examples illustrate how best practice shapes what nurses actually do every shift.
Medication Administration
Modern nursing teaches the “seven rights” of medication administration: right patient, right drug, right dose, right route, right time, right reason, and right documentation. These rights didn’t emerge from tradition. They evolved from research into medication errors, and each “right” addresses a specific failure point identified in safety data. Following all seven consistently is a best practice that reduces preventable harm.
Pressure Injury Prevention
Clinical guidelines from the Registered Nurses’ Association of Ontario recommend repositioning patients at risk for pressure injuries every two to four hours. Best practice also calls for a multicomponent approach to risk assessment, where nurses work with patients and caregivers to evaluate skin integrity, nutrition, mobility, and moisture. A validated classification system is used to categorize any pressure injuries that do develop, ensuring consistent communication across the care team. These specific interventions replaced older, less structured habits because research showed they measurably reduce injury rates.
Models That Guide Implementation
Knowing that evidence should guide practice is one thing. Actually changing how a unit or hospital delivers care is another. Several structured models help nurses and organizations move from research to action.
The Iowa Model uses a flowchart structure that walks teams through a step-by-step process. It starts with identifying a clinical trigger or problem, then moves through searching and appraising evidence, implementing a change, and evaluating results. Built-in feedback loops allow teams to return to earlier steps if results aren’t what they expected. The Iowa Model is often used when the goal is to directly introduce, reduce, or translate a specific practice.
The Stetler Model takes a slightly different approach, offering five phases rooted in critical thinking. It can be used by individual nurses or entire teams, making it flexible for smaller-scale projects like developing a new preceptor education program.
The ARCC Model focuses on building a culture of evidence-based practice across an entire healthcare system. It begins with assessing how well an organization already supports EBP, identifying both strengths and gaps. The core strategy is developing a critical mass of EBP mentors who work alongside bedside nurses to implement best practices. This mentorship approach addresses one of the biggest real-world challenges: the gap between knowing what the evidence says and having the support to act on it.
How Nursing Quality Is Measured
Best practice isn’t just a philosophy. It’s tracked through specific, measurable indicators. The National Database of Nursing Quality Indicators (NDNQI) collects data that hospitals use to benchmark their performance. Key measures include fall and injury fall rates, catheter-associated urinary tract infection rates, central line-associated bloodstream infection rates, hospital-acquired pressure ulcer rates, and nursing hours per patient day.
Other indicators focus on the nursing workforce itself: staff skill mix, nurse turnover rate, and the percentage of registered nurses with advanced education or certification. These workforce metrics matter because research consistently links nurse staffing levels and qualifications to patient outcomes. A scoping review of EBP impact found that the two most commonly improved outcomes were length of stay (reported in 15% of included studies) and mortality (12%), with roughly a third of studies addressing some aspect of infection prevention.
Why Best Practice Is Hard to Sustain
Despite clear benefits, significant barriers prevent nurses from consistently applying evidence-based practice. In a focus group study of practicing nurses, 83% said they did not feel empowered enough to change patient care procedures, even when evidence supported a change. Nearly 82% felt that research findings didn’t apply to their specific work environment.
The deeper structural barriers are equally stubborn. Nurses cite a lack of logistical infrastructure, such as not having dedicated time during shifts to search for or read research. Difficulty accessing databases and journals is another common obstacle, particularly for nurses working outside large academic medical centers. Insufficient training in how to find, evaluate, and apply research compounds the problem. And the nature of the work itself, with high patient loads and constant time pressure, makes it hard to pause and question whether a routine practice is actually the best one.
Attitudes play a role too. Nurses who trained before EBP became standard may be more skeptical of change, and organizational cultures that reward efficiency over innovation can discourage questioning established routines.
Professional Standards That Set the Bar
The American Nurses Association publishes the Nursing Scope and Standards of Practice, now in its fourth edition, which defines what competent nursing looks like. The standards cover two domains. Standards of practice describe the expected level of clinical care, including assessment, diagnosis, planning, implementation, and evaluation. Standards of professional performance outline expectations for ethical behavior, continuing education, collaboration with other disciplines, and quality improvement.
These standards frame nursing’s core purpose: protection, promotion, and optimization of health; prevention of illness and injury; alleviation of suffering; and advocacy for individuals, families, and communities. They apply wherever nursing care is delivered, not just in hospitals, and they establish EBP as a professional obligation rather than an optional extra.
AI and the Evolution of Best Practice
Artificial intelligence is beginning to reshape what best practice means in nursing. Clinical decision support tools that use predictive modeling are already being tested in areas like home health care for heart failure patients, where algorithms can flag deteriorating conditions before symptoms become obvious. A framework published in Digital Health proposes five domains for nurses engaging with AI: becoming aware of AI’s benefits and risks, preparing through education and training, daring to take leadership roles in AI adoption, declaring nursing’s perspective in institutional and policy-level AI decisions, and sharing outcomes and experiences through research and collaboration.
The practical implication is that AI literacy is becoming part of best practice itself. Nursing curricula are beginning to cover how algorithms work, what data they rely on, and how to interpret their outputs. At the same time, professional organizations are pushing for nurses to be represented on ethics review boards and algorithm evaluation committees, ensuring that AI tools are safe, usable, and appropriate for real clinical settings. The concern about over-reliance is real, and emerging guidelines emphasize that AI should support nursing judgment, not replace it.