A recent Lancet editorial by Clark et al. (2012) highlighted the gap in nursing between evidence and practice. In this editorial, we explore one of the reasons why this gap may exist in parts of Europe. According to our experience, especially in countries where English is not the first language, we confirm the findings reported by Milner et al. (2005) that nurses' use of research-based evidence tends to decrease with the increase of their working seniority. The main reasons for this are that senior nurses very often have difficulty understanding English-language publications, they lack confidence in assessing the quality of research due to the different type of education they received, and they prefer to use self-experienced knowledge because of their many years of practice. According to Dalheim et al. (2012), evidence-based practice could be successfully implemented if barriers, such as the ones reported above, are identified and removed.

European sources (Commission of the European Communities 2008, OECD/European Union 2012) report a rapid increase in nurses' average retiring age and therefore in the average age of nursing professionals. In 2007, the mean retirement age of nurses in Italy was 59·9 years, whereas in 2012, they retired at the mean age of 60·7 years (men at the age of 61 years, and women at the age of 60·6 years). In Europe, approximately half of the nurses in at least five Member States have an average age of over 45 years (OECD/European Union 2012). This phenomenon, for the reasons mentioned above, has a significant impact on the gap between evidence and practice in nursing, underlining the urgent need to adopt specific educational strategies capable of removing barriers and enhancing the use of evidence-based practice. Educational strategies specifically designed for senior nurses should be provided, mainly involving lifelong learning programmes that focus on how to translate evidence into practice by asking them to find solutions for a set of real-life complex problems that stimulate critical thinking, decision-making, and clinical judgement on the basis of evidence.

According to the Commission of the European Communities (2008, p. 6–7), the ‘key to maintaining a sufficient workforce, in the face of the impending retirement of the ‘baby boom’ generation, is to educate, recruit and retain young practitioners while reinvesting in the mature workforce’. Some of the influencing factors and possible areas for action suggested by the Commission of the European Communities include: (i) ensuring better working conditions for health workers; (ii) increasing staff motivation and morale; (iii) taking advantage of the growth in the proportion of over-55s in the workplace and those who no longer have family commitments; (iv) organizing chronic disease management practices and long-term care provision; and (v) considering ‘return to practice’ campaigns to attract back those who have left the health workforce.

Therefore, in the light of this context, especially non-English speaking senior nurses who have many years of experience urgently need specific lifelong learning courses that systematically focus on how to translate evidence into practice. In addition, there should be a system that measures the impact of these courses on the quality of health care and patient safety. The use of valid and reliable observation scales that measure the nurses’ cognitive skills across their professional life will be able to produce standardized data related to the impact of these skills on the patients’ health outcomes, especially if the patients’ conditions are complex, due to their ageing and multiple diseases (Persoon et al. 2012). To conclude, we feel that, at least across Europe, common continued professional development programmes focusing on a wide and interdisciplinary range of opportunities aimed at translating evidence into practice would need to be designed and implemented.


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  2. References
  • Clark A.M., Thomson D.R., Watson R. & Norman I. (2012) The state of nursing and evidence-based practice. The Lancet 380, 472.
  • Commission of the European Communities. (2008) Green Paper on the European Workforce for Health COM 725 final. European Commission, Brussels, Belgium.
  • Dalheim A., Harthug S., Nilsen R.M. & Nortvedt M.W. (2012) Factors influencing the development of evidence-based practice among nurses: a self-report survey. BMC Health Service Research 12, 367. doi:10.1186/1472-6963-12-367.
  • Milner F.M., Estabrooks C.A. & Humphrey C. (2005) Clinical nurse educators as agents for change: increasing research utilization Clinical Sciences Building. International Journal of Nursing Studies 42, 899914.
  • OECD/European Union (2012) Health at a Glance: Europe 2012. Organisation for Economic Co-operation and Development (OECD), Paris, France. doi: 10.1787/9789264183896-en
  • Persoon A., Schoonhoven L., Melis R.J.F., Van Achterberg T., Kessels R.P.C. & Olde Rikkert M.G.M. (2012) Validation of the NOSCA: nurses' observation scale for cognitive abilities. Journal of Clinical Nursing 21, 30253036.