Government chief nursing officers' perceptions of barriers to using research on nurse staffing: An international e-mail survey

The increase in global health care problems has emphasized the need for health policy planners, including chief nursing officers (CNOs) to use best available evidence when planning and advising on how to deliver quality health care. CNOs are nurses in high ranking government positions. Current problems include a global nursing shortage causing low nurse staffing. Studies have found that low nurse staffing is associated with poor patient and nurse outcomes. Research utilization remains slow despite the increase in dissemination of research findings through many private and governmental organizations and more options and technology to share research evidence globally. In this study, an electronic information message about the impact of nurse staffing on patient and nurse outcomes was presented to CNOs from 110 countries. The CNOs' perceptions of local barriers to utilizing these research findings were then assessed in an electronic survey. The study was guided by the five stage model of diffusion of innovations. The study examined the four factors that influence the first two stages: Knowledge/Awareness and Persuasion. The four factors, characteristics of the adopter, organization, innovation, and communication, were measured using an adapted version of the BARRIERS scale. Barriers to utilization of research on nurse staffing were found in all four characteristics. The top barrier was lack of reports and studies in one place. Other barriers were lack of cooperation within the organization and lack of awareness of the research findings. The study also found that nursing shortages, not educating enough nurses, and inadequate budget to employ enough nurses were major problems. Differences according to Gross National Income (GNI) were also noted. The identified barriers and other factors can be used by CNOs and other health policy advisors in subsequent planning for and implementation of adequate nurse staffing. The study also uncovered methodological issues that should be considered in future studies using international e-mail surveys such as language barriers and the increased burden caused by e-mail attachments.