Bridging the gap between evidence-based guidelines and clinical practice excellence: The role of mentorship

Abstract

Despite the established need for evidence-based practice (EBP), its implementation in nursing remains inconsistent due to organizational, presentation, and individual barriers. Mentorship is frequently cited as a solution, yet its specific mechanisms for bridging evidence to practice are underexplored. This study aimed to examine how mentorship functions as a strategy to support EBP implementation. First, we discuss how mentorship addresses nurse-related barriers by providing just-in-time coaching and role modeling, enabling mentors to build mentees’ critical appraisal skills and clinical confidence. Second, we examine how mentorship mitigates presentation-related barriers by enabling mentors to act as knowledge brokers, translating complex evidence into accessible, context-specific guidance for the bedside. Third, we outline how mentorship addresses organizational or setting-related barriers by embedding EBP into formalized structures, including defined mentor roles, protected time, and evaluation metrics. To operationalize these mechanisms, we propose an implementation mapping framework that identifies key actors, targeted actions, and measurable outcomes while addressing structural challenges such as limited protected time. We conclude that formalized mentorship is essential for transforming theoretical evidence into sustainable bedside practice and fostering a culture of excellence that directly improves patient outcomes.

What is known?

• •Evidence-based practice (EBP) is essential for improving patient outcomes, safety, and healthcare efficiency, yet its implementation in nursing remains inconsistent.
• •Barriers to EBP are well documented and include organizational constraints, limited accessibility and presentation of evidence, and nurse-related factors such as low confidence and limited research skills.
• •Mentorship is widely recognized as a valuable approach for professional development in nursing.

What is new?

• •This study advances a conceptual analysis of how mentorship can be operationalized to address nurse-, presentation-, and setting-related barriers to EBP. It identifies specific mechanisms, including just-in-time coaching, contextual translation of evidence, and mentors as knowledge brokers.
• •Additionally, we also propose an implementation mapping framework with defined actors, actions, and measurable outcomes, positioning mentorship as a structured, system-level strategy to support sustainable EBP adoption in clinical practice.

1. Introduction

The nursing profession must continually evolve to address the diverse and complex needs of patients amid global, technological, and systemic challenges like climate change, artificial intelligence, and underfunded healthcare systems [1,2]. These urgent pressures necessitate that nurses are empowered to provide effective and efficient care through the evidence-informed application of best practices [3,4]. However, the discourse surrounding what constitutes warranted evidence in nursing, and the persistent gaps in its application, have long been documented in the literature [[5], [6], [7], [8]]. This ongoing discussion remains critically important given the dynamic scope and context of nursing and the pluralistic nature of nursing evidence or ways of knowing [9], both of which influence how it is understood and applied in clinical practice.

Given the increasing complexity of patient care and constrained resources, the integration of evidence-based practice (EBP) is essential to ensuring patient safety, enhancing nursing efficiency, informing policy and institutional protocols, and supporting the evaluation of outcomes and reporting improvements in patient, organizational, and system metrics [10,11]. Yet, noticeable gaps in the implementation of EBP into clinical practice persist [12,13]. In their systematic review of 53 studies using the widely validated BARRIERS scale [14] to assess barriers to research evidence utilization in nursing, Jabonete and Roxas [12] found that setting-related factors, including organizational characteristics, were the leading barrier to research utilization in nursing practice. This was followed by presentation-related factors, including communication and the accessibility of evidence [12]. Nurse-related factors, encompassing nurses’ research values, skills, and awareness, were the next identified barriers to evidence implementation in nursing practice [12].

Studies in both high- and low-income healthcare settings [3,[15], [16], [17]] reported persistent challenges with organizational support, access to evidence, and nurses’ confidence in applying research. Given these persistent barriers, mentorship has been proposed as a strategy to bridge gaps in EBP implementation. Mentorship addresses nurse-related barriers by enhancing skills and confidence, organizational barriers by signaling institutional support for EBP, and presentation barriers by contextualizing complex research for clinical practice [18,19].

Mentorship is a structured, strategic system designed to bridge gaps between evidence and practice. While there is no single consensus definition [[20], [21], [22]], it generally involves relationships that provide career guidance, role modeling, and psychosocial support [[23], [24], [25]]. In nursing, mentorship is understood as a dyadic, evidence-based partnership between an experienced professional and a less experienced protégé, aimed at translating guidelines into clinical expertise [26]. Effective mentors typically possess substantial clinical experience and formal qualifications, and often hold established institutional roles, including head nurse, clinical educator, or research nurse, alongside their mentoring responsibilities [27,28]. While these formal qualifications and institutional roles enhance a mentor’s credibility, effective mentorship also relies on personal qualities such as empathy, active listening, and a genuine willingness to invest in the mentee’s development [29,30].

However, discussion of how mentorship addresses EBP barriers remains limited [31], highlighting a critical area for conceptual exploration. For instance, in a recent scoping review on nurse mentoring, the authors found that only one study focused on using mentoring support to facilitate EBP [32]. Furthermore, another recent study showed that limited leadership experience among nursing administrators impedes the opportunity to leverage mentorship to bridge the gap between institutional policy and clinical EBP [33]. These findings highlight the need for a conceptual discussion to identify actionable strategies for effectively implementing mentorship, ensuring that EBP is translated into everyday nursing practice.

Therefore, this study aimed to explore specific strategies that mentorship can use to facilitate EBP implementation. This exploration is essential for guiding practical approaches to bridging the gap between evidence and clinical excellence.

2. Strategic mechanisms of mentorship in evidence-based practice

Beyond its general significance, mentorship plays a crucial role in bridging the gap between clinical practice excellence and EBP, ensuring that theoretical knowledge is effectively translated into skilled, competent nursing practice. To achieve this objective, effective mentorship must be implemented as a targeted strategy that counters the specific barriers identified in the literature.

The first mechanism addresses nurse-related barriers, such as low confidence and poor critical appraisal skills. To directly counter these deficits, clinical settings must establish mentorship as a formal, protected, relational strategy. This requires incorporating a structured program focused on the essential elements of skill development, emotional support, and professional growth [34]. Through this relationship, mentors provide just-in-time coaching and role-modeling, transforming abstract EBP principles into tangible clinical wisdom. This relational strategy is essential for building the clinical confidence necessary for the nurse to move beyond simply following a guideline and to actively integrate critical appraisal and personal research values into daily decision-making [35]. Ensuring this strategy remains context-specific requires careful consideration of the diverse nursing specializations.

Moving to the second challenge, mentorship must address presentation-related barriers, including the difficulty in accessing, understanding, and locally translating complex evidence [12]. Therefore, organizations must incorporate guideline-based competencies directly into the mentorship curriculum. This means establishing specific, quantifiable goals [36], for example, “critically appraise and adapt three key practice statements from a Fall Prevention EBP guidelines” rather than a general objective. Target mentorship competencies may include: a) evidence literacy to acquire critical understanding of the various types of evidence; b) sustainable change practice, ensuring that EBPs are effectively implemented and lead to lasting systemic change; and c) implementation leadership to develop leadership and management skills required to guide teams through the process of evidence implementation [3]. Teaching and mentoring activities may include guided journal club sessions, collaborative context-mapping workshops to identify local barriers and facilitators, role-playing stakeholder meetings, and mentee-led audits of clinical practice following EBP implementation [37,38]. Assessments and deliverables may include direct observation of practice, the creation of a Knowledge Translation Action Plan outlining strategies to sustain a change initiative over time (addressing challenges such as resource constraints and organizational culture), and evidence appraisal activities.

By embedding EBP content, mentors function as knowledge brokers [39] who bridge the divide between global evidence and local clinical application. In this capacity, they provide the context-specific interpretation that macro-level policies often lack, guiding mentees through the critical appraisal of evidence and the adaptation of guidelines to the specific nuances of the clinical setting. These responsibilities are operationalized through regular meetings and ongoing formative support as mentees translate evidence into daily practice [39,40]. Mentors must possess competencies such as a deep understanding of the EBP principles, strong communication and coaching skills, critical appraisal abilities, implementation science literacy, and the ability to navigate and interpret local healthcare settings [41].

Deliverables for mentors in this role may include individualized Knowledge Translation Action Plans and ongoing formative feedback reports on the mentee’s progress in adapting these guidelines. For example, beyond mere dissemination, the mentor’s primary function in addressing presentation-related barriers is to facilitate clinical health literacy. High-level EBP guidelines are frequently ‘encoded’ in dense, academic prose that can feel alienated from the fast-paced, high-acuity ‘language of the ward.’ Consequently, a core mentor responsibility is contextual translation, ensuring that evidence is cognitively accessible and formatted as actionable bedside heuristics.

Finally, for mentorship to be seen as a sustainable, high-value investment that overcomes setting-related barriers, its success must be measured by metrics that reflect EBP adherence (organizational commitment). While evaluation criteria lack consensus [33], organizations must employ statistically sound methods [34]. Crucially, these metrics must link mentor-mentee interactions to adherence rates to EBP guidelines (e.g., measuring compliance with a specific EBP protocol before and after a defined mentorship period). Consequently, organizational support is paramount. This includes providing resources like regular meetings and seminars [42] and, critically, offering incentives and protected time for mentoring activities [43]. Multidisciplinary and interdisciplinary mentoring is also strongly advocated [42,44]. This embedded approach solidifies the organizational culture by normalizing EBP as a core expectation, thus sustaining the macro-level gains of EBP guideline adherence.

3. Challenges to mentorship in research/knowledge translation into clinical practice

As effective as mentorship is for successful skill development pathways, it is not without its pitfalls. These challenges largely fall into structural and relational categories, which must be addressed through policy to ensure mentorship successfully bridges the EBP-to-practice gap. The most pervasive challenges documented among nursing populations relate to structural and administrative barriers, primarily the lack of protected time for mentors and the heavy job demands placed on experienced nurses and middle-level managers [45]. Without a designated time, mentoring is often viewed as an additional burden, leading to burnout; consequently, using a supernumerary mentor has been suggested as an effective strategy to mitigate this time constraint [46]. Furthermore, structural issues often manifest as a lack of clarity regarding the mentor’s specific role and the proper design of mentorship programs [47]. This ambiguity is compounded by a persistent lack of recognition or incentives for mentors, which diminishes experienced nurses’ motivation to participate [45]. Similarly, poor administrative oversight and inadequate training on the dynamics of the mentor-mentee relationship can compromise the consistency of EBP-focused support [48].

Beyond these administrative hurdles, relational challenges frequently occur early in the mentor-mentee relationship and often stem from fundamental mismatches between individuals [49]. Such mismatches, often due to differences in experience, communication style, or clinical focus, can compromise the quality of mentorship and, in some cases, negatively affect patient outcomes [50,51].

Programmatic challenges encompass broader issues in the design and sustainability of mentorship programs. These include the modality of delivery, as virtual or remote mentorship can limit relational depth and engagement [45]. Also, high mentee turnover, particularly in remote settings, can lead to mentor fatigue and undermine the long-term success of promoting good clinical practices and EBP adoption [51]. Addressing these programmatic barriers requires thoughtful program design, administrative support, and deliberate strategies to sustain quality and ensure EBP is effectively translated into clinical practice.

4. Implications

The methodical use of EBP guidelines is necessary to promote excellence in clinical practice. To transform the conceptual insights discussed in this study into an actionable blueprint for practitioners and policymakers, the proposed mentorship strategy can be operationalized through an implementation mapping framework [52]. This framework ensures that mentorship is not merely an abstract relationship but a structured intervention with clearly defined components. According to Proctor et al. [52], before deploying the strategy, organizations must establish a measurement framework aligned with the current implementation stage. In the early stages of a mentorship program, evaluation should prioritize acceptability (measured through participant satisfaction) and feasibility (assessed through the success of pair matching and meeting frequency) [52]. As the mentorship program matures, the focus may shift toward sustainability and fidelity in implementing the EBP protocols. By utilizing standardized measurement toolkits to identify specific metrics for each outcome, organizations can ensure that the program remains data-driven and responsive to local clinical needs.

Following this evaluative setup, the intervention is structured around identifying the primary actors, including experienced nurse-mentors, healthcare practitioners, and policymakers. These individuals serve as knowledge brokers and organizational leaders, providing essential administrative support and protected time needed to navigate the tension between global evidence and local clinical realities. The implementation is driven by targeted actions such as collaborative context mapping to identify unit-level barriers, guided journal clubs to build evidence appraisal capacities, regular meetings to monitor progress and identify learning opportunities, and co-creation of Knowledge Translation Action Plans [37]. These efforts specifically target the micro-level clinical setting, including the individual nurse’s decision-making process and the unit’s workflow, where barriers to EBP guideline adoption may be prevalent. Ultimately, the success of the mentorship intervention is measured through implementation outcomes, such as increased EBP guideline adherence and practice sustainability, increased mentor capacity, and service outcomes, including enhanced patient safety and clinical efficiency, and enhanced organizational support [52]. By defining these components and their corresponding metrics within a blueprint, organizations can move beyond a general call for mentorship toward a reproducible, measurable model for evidence-based excellence.

5. Conclusions

This study sought to explore how mentorship can support nurses in implementing EBP and to identify the benefits, challenges, and structural factors that influence its overall effectiveness. By functioning as knowledge brokers and facilitators of clinical health literacy, mentors transform abstract evidence into the pragmatic ‘language of the ward,’ ensuring that clinical excellence is both achievable and sustainable. To survive the compounding pressures of modern healthcare, professional bodies and administrative leaders must move beyond informal support toward formalized, EBP-tailored mentorship policies. By providing protected time for mentorship, implementing competency-based curricula, and establishing robust evaluation metrics, organizations can operationalize mentorship as a structured strategy that builds critical thinking, enhances evidence-informed leadership, and sustains EBP adoption, thereby fostering a culture of clinical excellence that ultimately improves patient outcomes.

Data availability statement

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

CRediT authorship contribution statement

Emmanuel Akwasi Marfo: Conceptualization, Writing - original draft, Writing - review & editing, Handling correspondence. Matthew I. Olatubi: Conceptualization, Writing - original draft, Writing - review & editing. Bukola Salami: Conceptualization, Writing - original draft, Writing - review & editing. All authors meet the ICMJE criteria for authorship and have reviewed and approved the final version of this manuscript.

Declaration of competing interest

The authors have declared no conflict of interest.

Funding

Dr. Emmanuel Marfo is supported by a postdoctoral fellowship from the Social Sciences and Humanities Research Council of Canada, as well as stipends from his postdoctoral supervisor, Dr. Bukola Salami, through her Tier I Canada Research Chair. Dr. Matthew Olatubi is supported by Cumming School of Medicine through the Achievers in Medical Sciences Postdoctoral Fellowship.

Declaration of generative AI and AI-assisted technologies in the writing process

During the preparation of this manuscript, the authors used Gemini (Google LLC) to carry out proofreading. After using this tool, the authors reviewed and edited the content as needed and took full responsibility for the publications content.

Appendix A. Supplementary data

The following is the Supplementary data to this article: