How to implement change in nursing

Change Implementation and Management Plan

11/02/19

Change Implementation and Management Plan

Nurses can provide a higher standard of compassionate patient care only when the organization maintains a healthy work environment which includes overall health of work environment, better nurse staffing and retention, less moral distress and lower rates of work place violence (AACN, 2018).

The purpose of this paper is to present an executive summary of the current issues in the work place where I work, a proposed change plan and its justification, type and scope of the change, identification of the stakeholders, a change management team, how to communicate the proposed change, and finally how to overcome the risk associated with this change.

Summary of the current issue

Based on the Clark’s work place assessment, the organization where I work received 54 points. It falls on an ‘unhealthy work environment’ category. This organization is under the state administration. The level of trust among and between the leadership and other members of the work place are satisfactory but the communication between the members of the team is never transparent and it always create confusion among the staff. Individual achievements are never appreciated and less opportunity for the professional growth or advancing the career in this organization. The work load is too high as the nurse to patient ratio is very high and the safety of the nurse in the work environment is very low as they have to work in a less protected unit where extremely violent individuals are admitted for psychiatric treatment. More over many nurses have to tolerate bullying by senior coworkers.

Proposed Change

In order to have a change in the work place environment the first step to take is to bring awareness of the issue to the management, and the employees.

Formation of a small group of health workers who can volunteer to meet the management and make them aware of the current issues can be the initial step in the proposed plan

Encourage more staff to attend the continuing educational programs.

Regular meeting at the unit level with all the health care employees to address the issue should be included in the plan

Encourage nursing staff to bring out the issues what they face in the clinical site instead of hiding them because of the fear of loss of license or job.

Recruitment of a new management team who support the staff who ever bring forward the issues of the unit and suggest solutions and keeping adequate nurse patient ratio by retaining the nurses.

Encourage unit level communication and trusting relationship among the employees.

Initiate steps to address the uncivil workers in the unit level by using challenging conversation with DESC model.

Justification of the proposed plan

According to Aronsson et al. (2015) depressive symptoms are potential outcomes of poorly functioning work environment and the research results concluded that employees both men and women who report lack of decision latitude, job strain and bullying will experience increasing depressive symptoms over time.

As the poorly functioning work environment has a negative impact on the employees physical and psychological health causing an indirect impact on patient care, it is important to make changes to an unhealthy work environment in any healthcare setting.

Skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership are the six standers to maintain a healthy work environment (Clark, 2015).

By recruiting managerial staff and nurses, the work load of the staff will be balanced which will have a positive impact on the quality patient care.

This will facilitate transparent communication at different levels of the organization and make an easy implementation of every plan of change.

Justification of the proposed plan (Continued……)

Recruitment of new nurses in the organization will reduce staff burn out and incivility.

The appropriate staffing at managerial levels and providing sufficient resources for professional growth and development are steps that can be taken to create stronger work team.

DESC model can be used to improve the communication and team work skills which in turn improve the quality of patient health care.

The DESC model has four elements to address the incivility. It can be done by describing the situation, expressing concerns, stating other alternative, and the consequences related to the incident.

Type and scope of the proposed change

The proposed model for change implementation and management plan in the organization level is Gifford Model

Based on relations, change and task there are three leadership and management behaviors in this model

In the relations-oriented phase the focus is on the staff communication and collaboration with inter-professionals

Change –oriented phase reinforce vision and goal of change, advocate for change and additional resourcesinternally and externally.

The task-oriented phase conduct regular leadership meeting, monitor performance and outcomes, procure resources, education and training and policies to reflect change.

This type of implementation model has a potential to develop knowledge on change management among healthcare managers (Eldh et.al 2016)

Stakeholders impacted by the change

The proposed change can bring a lot of improvements in the personal and organizational level.

The different stakeholders benefitted from the change are nurses in the clinical setting, clinicians, psychiatric technicians the mangers, administrative staff, clerical staff, nurses in the staff development units and above all the patients.

Change management team

The development of a change management team is vital in the implementation process.

The involvement of nurse managers, clinicians, nurses on the floor, nurse leaders, nurses in the staff development unit , the administrative staff and the clerical staff should make the change management team. Each person can provide suggestions to make changes in the work environment in order to improve the working conditions.

Communicating the plan

There are different methods to communicate the proposed plan to the stakeholders.

The most convenient method of communication is sending e-mails to the stakeholders of the change

Using bullet boards on each unit is another way of communication about the plan of change.

Inservice-education regarding the issue and the plan of change is an effective method of the implementation process.

Conducting face to face meeting is another method of communication.

Power point presentations are effective way of making the stakeholders understand the proposed plan and its scope

Risk mitigation plans

Based on the previous efforts made by professionals, it is possible to face some risks related to the implementation process such as failure to accept the proposed plan by the organizational administration/ management, disagreement between the stakeholders regarding the benefit of the proposed plan, lack of enough support by the unit managers or the nurses, lack of interest among the employees in participating and implementing proposed plan.

A well planned proposal can avoid some of these risks. Bringing awareness about the issue by sending E-mails or informing through presentations, bullet boards before a face-to-face meeting with the stakeholders can increase the knowledge among the employees regarding the importance of bringing change in the work place. Addressing the above mentioned risk possibilities during the implementation process will make the process a step ahead.

Conclusion

In conclusion, a justified plan of change for the current issues in the organization has been explained. The stake holders involved, the change management team, the communication methods and the risk associated with the implementation process and its mitigation technics has been detailed.

References

American association of critical-care nurses (2018). Healthy work environment. Retrieved from https://www.aacn.org/nursing-excellence/healthy-work-environments?tab=Patient%20Care

Aronsson, G., Bendz, L. T., Grape, T., Hall, C., Hammarstrom, A., Hogstedt, C.…. Theorell, T. (2015). A systematic review including meta-analysis of work environment and depressive symptoms. BMC Public health. Retrieved from https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1954-4

Clark, C. M (2015). Conversations to inspire and promote a more civil workplace. American nurses today, 10(11), 18-23. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2015/11/ant11-CE-Civility-1023.pdf

Eldh, A. C., Ehrenberg, A., Olsson, C. B., Palmcrantz, S., Tistad, M., Tomson, G., Wallin, L (2016). Developing leadership in managers to facilitate the implementation of national guideline recommendations: A process evaluation of feasibility and usefulness. International journal of health policy and management, 5(8), 477-486. Retrieved from http://www.ijhpm.com/article_3183_5015382bcf9183a74ef7e79b0a941f65.pdf