The Patient Protection and Affordable Care Act (PPAC; Public Law. No. 111-148) addresses the need for the use of scientific evidence within health care initiatives. Integration of evidence can be complex and involve multiple systems for successful application of evidence-based decision making. As pediatric health care professionals begin to understand how the PPAC will impact the care we provide to our patients and families, it is essential that nurses are aware of the issues and possible implications to clinical practice. In this initial article, definitions and relationships between evidence-based practice (EBP), public policy, and the new organizational paradigm will be explored. In addition, issues and barriers relevant and critical to evidence use within health care organizations are addressed. In a subsequent article, strategies for facilitating changes in organizational and individual nurse behaviors toward a context of EBP will be discussed.