• Andrea R Fleiszer, Sonia E Semenic, Judith A Ritchie, Marie-Claire Richer, and Jean-Louis Denis.
• Ingram School of Nursing, McGill University, Montreal, QC, Canada.
• J Nurs Manag. 2016 Apr 1; 24 (3): 309-18.

AimTo describe how actions of nursing unit leaders influenced the long-term sustainability of a best practice guidelines (BPG) program on inpatient units.BackgroundSeveral factors influence the initial implementation of evidence-based practice improvements in nursing, with leadership recognized as essential. However, there is limited knowledge about enduring change, including how frontline nursing leaders influence the sustainability of practice improvements over the long term.MethodsA qualitative descriptive case study included 39 in-depth interviews, observations, and document reviews. Four embedded nursing unit subcases had differing levels of program sustainability at 7 years (average) following implementation.ResultsHigher levels of BPG sustainability occurred on units where formal leadership teams used an integrated set of strategies and activities. Two key strategies were maintaining priorities and reinforcing expectations. The coordinated use of six activities (e.g., discussing, evaluating, integrating) promoted the continuation of BPG practices among staff. These leadership processes, fostering exchange and learning, contributed to sustainability-promoting environments characterized by teamwork and accountability.ConclusionsUnit leaders are required to strategically orchestrate several overlapping and synergistic efforts to achieve long-term sustainability of BPG-based practice improvements.ImplicationsAs part of managing overall unit performance, unit leaders may influence practice improvement sustainability by aligning vision, strategies, and activities.© 2015 John Wiley & Sons Ltd.

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