Inside Ethiopia’s Health System: Why Evidence-Based Nursing Still Struggles

A national review by researchers from Wollega University and Jimma University finds that while most Ethiopian nurses value evidence-based practice, fewer than half consistently use research to guide patient care. Training, leadership support, education, and internet access improve adoption, but heavy workloads, limited resources, and weak institutional systems continue to hold it back.

In hospitals and health centers across Ethiopia, nurses make critical decisions every day. They monitor patients, administer treatments, and respond to emergencies. But how often are these decisions guided by the latest medical research?

A major new review by researchers from the School of Nursing at Wollega University and the School of Nursing at Jimma University set out to answer that question. By analyzing 19 studies conducted over the past decade, the researchers examined how widely Ethiopian nurses use evidence-based practice, what encourages it, and what prevents it. Their findings reveal a system in transition: willing, but not yet fully equipped.

What the Numbers Reveal

The review found that only 46.7 percent of nurses in Ethiopia regularly use evidence-based practice in their daily work. That means more than half are not consistently applying research findings when making clinical decisions.

Evidence-based practice, often called EBP, means combining scientific research, professional experience, and patient needs to guide care. It is widely seen as a gold standard in healthcare systems around the world. In many high-income countries, more than 60 percent of nurses report using EBP. Ethiopia’s rate shows progress, but also a clear gap.

The good news is that most nurses believe in it. Around four out of five nurses have a positive attitude toward evidence-based care. About half show good knowledge of EBP principles. In simple terms, many nurses understand its importance and support the idea. The challenge lies in putting it into practice consistently.

What Helps Nurses Use Evidence

The review highlights several key factors that increase the chances of nurses using research in their work.

Training stands out as one of the strongest drivers. Nurses who received specific EBP training were more than twice as likely to apply research in their clinical decisions. Knowledge also matters. Nurses with a stronger understanding of EBP were nearly three times more likely to use it.

Confidence plays a major role. Nurses who feel capable of interpreting research findings and applying them to patient care are far more likely to do so. Education level also makes a difference. Those with postgraduate qualifications or leadership roles, such as head nurses, show higher use of evidence-based practice.

The workplace environment is equally important. Nurses working in referral or teaching hospitals are much more likely to use research evidence than those in smaller primary facilities. Access to the internet and updated clinical guidelines significantly increases the likelihood of using EBP. Simply having reliable online access can double the chances that a nurse will apply research in practice.

Supportive leadership also helps. When hospital managers encourage research use, provide time for learning, and promote professional development, nurses are more likely to follow suit.

The Barriers Standing in the Way

Despite positive attitudes and growing awareness, serious obstacles remain.

The biggest barrier is time. Many nurses face heavy patient loads and staffing shortages. Long shifts and administrative tasks leave little room for reading research or reviewing guidelines. In busy wards, immediate patient needs naturally come first.

Limited resources are another major challenge. In many facilities, especially in rural areas, internet access is unreliable. Computers may be scarce, and updated guidelines are not always available. Even when resources exist, nurses may not have enough training to use research databases effectively.

There are also cultural barriers. In some hospitals, traditional routines and personal experience still guide decisions more than scientific evidence. Nurses often rely on peer advice or long-standing habits. Without strong leadership encouraging change, these patterns continue.

Finally, many hospitals lack formal systems to monitor or evaluate the use of evidence-based practice. Without accountability or clear expectations, EBP becomes optional rather than standard practice.

A System Ready for the Next Step

The review paints a balanced picture. Ethiopian nurses are not resistant to evidence-based care. Most believe in its value. Many have basic knowledge. The desire for improvement is there.

However, real progress will require stronger support systems. Expanding training programs, improving internet access, and ensuring updated guidelines are available in all facilities would make a major difference. Leadership engagement is also essential. When managers champion evidence-based care, nurses are more likely to adopt it.

Teaching and referral hospitals show that improvement is possible. With better infrastructure and institutional support, higher levels of EBP use are achievable. Extending these advantages to primary and district hospitals could help close the gap.

In the end, evidence-based nursing is about improving patient outcomes. It reduces errors, strengthens decision-making, and ensures that care keeps pace with new knowledge. Ethiopia has laid the foundation. The next step is turning positive attitudes into consistent action across every level of the health system.