Promoting evidence-based nursing through collaboration, autonomy, and agency: A qualitative case study.

Objectives: Evidence-based practice (EBP) is widely accepted as central to high-quality nursing care, yet integration into acute care settings remains uneven. Nurses play a vital role in applying evidence, but organizational hierarchies, time constraints, and limited interprofessional collaboration often restrict their ability to lead or sustain EBP. This study explored how nurses enact, adapt, and promote EBP through interprofessional collaboration, everyday clinical leadership, and access to continuing professional development. Methods: An embedded comparative case study design was used, informed by interpretive and ethnographic principles. The research was conducted across two large hospitals in England with differing leadership and governance structures. Twenty-five participants were included, consisting of nurses, nurse managers, and physicians. Data were collected over six years through 25 semi-structured interviews, 60 h of non-participant observation, and review of policy and quality improvement documents. Data were analyzed using reflexive thematic analysis. Results: Five key themes were identified: leadership practices and organizational support; professional identity and EBP ownership; interprofessional collaboration and communication; structural barriers and resource constraints; and capacity building through learning and feedback. Nurses enacted EBP through informal leadership, peer mentorship, and grassroots innovation. Structural barriers such as limited time, unequal access to continuing professional development, and fragmented collaboration significantly affected implementation. Conclusions: Nurses play an active and sustained role in leading EBP through their relationships, clinical judgment, and commitment to care quality. However, their efforts are shaped by the broader organizational systems in which they work. Supporting interprofessional collaboration, distributed leadership, establishing EBP mentoring roles, and ensuring equitable access to continuing professional development are essential for consistent and inclusive evidence use. Hospital managers and policymakers should prioritize structural investment in team-based learning, inclusive governance and digital access.