Evidenced based practice (EBP) is a concept that has been widely enveloped by the health care industry. The benefits of EBP include cost savings, improved patient outcomes, and the translation of research findings to the bedside. In spite of the industry's acceptance of EBP, the literature is devoid of studies exploring the ways in which EBP is integrated into daily practice. This study used a qualitative approach to study the daily use of EBP by Acute Care Nurse Practitioners (ACNPs) which have far reaching implication for all health care providers who use EBP. A total of 10 practicing ACNPs from two large teaching and one community hospitals in a major, southern city in the United States, were interviewed. The transcripts were reviewed and thematic descriptors were identified. The ACNPs were overwhelmingly supportive of the use of EBP. EBP was the preferred method of delivering care, yet it was not regarded as a blanket prescription for care. A wide range of mitigating factors were identified, mandating careful consideration prior to applying EBP recommendations. The mitigating factors included: (1) beyond the barriers and balancing influencing factors, (2) to trust or not to trust, (3) balancing clinical knowledge and evidence in daily practice, (4) the patient is always right. In other words, balancing patient needs and desires often precluded the implementation of EBP tenets. This study's findings document the need for further study, improved instrument development, and educational initiatives that focus on the real world practice of integrating EBP among ACNPs and all health care providers.

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