Lewin's model of change nursing

Planned Change in the Intensive Care Unit

As humans, we are always looking to improve on what we have, innovations are created by trying new ideas. Problems are solved with changes that are implemented from the current system. Implementation of the change needs to be thoroughly monitored for the smooth transition from the established practice. There are various steps to be followed to execute a change in the established practice. Formulation of the idea, evaluation of the formed idea, through planning, implementation of the planned idea, reviewing the response of the new proactive and validation of the new practice. The purpose of this paper is to point out a growing problem in the unit I am employed in and to suggest a change for the better of the unit which is realistic in nature.

Problem

I work in the Emergency Room, specifically the Observation unit, the patient turnover is extremely high, in turn the stress levels can also be extremely high. Staffing shortage has become a growing problem in our unit thus leading to excess work and decreased quality of care in the unit. Staffing shortage is also taking a toll in the managerial level because the managers are now being forced to hire travel nurses to fill the vacant spots temporarily and this is leading to excess cost for the unit and organization(Bisk,2016). Nursing shortage is created because an increased number of nurses are leaving because of dissatisfaction about the increased workload, and the patient ratio(Marquis,2015). The staff will be asked to float to other floors on a regular basis due to the increased turn over on the unit. It is important for the organization to take steps to try to retain their staff nurses to improve patient satisfaction and employee satisfaction(Marquis,2015).

Realistic Change

A viable innovation or change that will improve satisfaction of nursing staff in the organization would be to allow the nurses to stay in their units and not have to float to other units so much. Scheduling or enough staff during the shift is also an important aspect that will improve patient safety and nurse satisfaction in the unit(Bisk,2016). Implementation of a float pool system will be a good idea to decrease the floating required for the full-time staff nurse. Floating the staff from an observation unit to an IMU unit (Intermediate Care) can lead to unsafe working situations for the nurse and the patient because of lack of experience with the acuity of the patient condition. A feasible solution to this problem is training new nurses on the frequently needy floor so that they will be well equipped to float to a unit that is short of staff, and provide them with incentives to float so that the nurse satisfaction will be on the rise. These incentives will be a good investment for the organization as it will help them retain the staff in the long run reducing costs of hiring temporary staff like travel nurses.

Alignment with Misson,Vision,Values

The brand promise at Memorial Hermann is “advancing health”. The Mission statement refers to Memorial Hermann as a non-profit organization with spiritual values that is committed to provide high quality health services in order to improve the health of people under the care of the institution. The vision statement is as follows “Memorial Hermann will be the preeminent health system by advancing the e health of those we serve through trusted partnerships physicians, employees and to deliver the best possible health solutions while relentlessly pursuing quality and value(Mission&Values,2016). Increasing the number of float pool nurses available to be called will improve nurse satisfaction, as it will mean that they will be able to stay in their units and will reduce stress. The staffing grid and shortage will reduce. Management will also benefit from it because they won’t have to pay as much as they do for the travel nurses who are temporary staff.

Professional standards must be taken into account when bringing up change in the established process. Nurses have a professional standard set by the American Nurses Association when it comes to responsibilities and rights that is available to each registered nurse employed in the nation. According to the ANA, nurses have the right to accept, reject or object any assignment given to them if they feel that it puts either the nurse or the patient in any health risk at all. It is the responsibility of the charge nurse or manager to access the level of experience and comfort level of the particular nurse before they float them to a particular unit that might be a higher level of care from their regular floor. The registered nursing licensure is subject to suspension and other penalties if the nurse is put in an environment where he or she is not able to perform satisfactorily leading to patient harm(Bisk,2016).

Change Model

A vision for change, a method for change and most important of all we need a will to change and to reinforce the change in order to make sure that the change stays in the organization. Improvements and innovations are a staple of any successful organization. If there is a lack of vision or an inadequate method that has not been thought out this will lead to an unsuccessful change. The model that will be used to explain the method of a successful chage is the “Lewin’s Model of Change”. Lewin’s model of change is described in a simple man’s terms with an example of a cube of ice. If you have a large cube of ice, and you want a cone of ice how will you make a cone of ice. First thing you need to do is to melt the ice, so that it can be changed into what you want, or defreeze it. Then the next step comprises of you “molding” or changing the iced water into the shape you want it to be which is a cone of ice. (Lewin’s change theory,2016). If we put this theory into perspective with the subject in question, the cube of ice is the current practice of excessive floating and staffing shortage. The management must defreeze, or cease the excessive floating and adding new float pool staff to the iced water. The second phase is molding of the iced water, or implementation of the chage by identifying the goals that are set and reminding staff of the purpose of the chage and anticipating the challenges that might be in the way and reinforcing the behavior and change. This change will lead to an improved staffing pattern and improved patient satisfaction and safety and management will get their cone of ice. The final phase it to “refreeze” or establish and consistently reinforce the new changes so that it will become the new normal and the staff will be able to adapt to the change in the environment and will not have an urge to go back to the old ways.

Implementing Change

Implementation of a change will always start with surveying and identifying the drawbacks of the current practices. Management from the unit will need to investigate among the employees to find out the staffing problems present, and the difficulties of floating an observation nurse to the intermediate care units. Once the challenges have been clearly identified, the necessary improvements should be made. Some steps include proper allocation of staff in the units according to their expertise and proper orientation to the staff to the unit (May Finch,2009). All nurses new or floating need to be made aware of the unit and given a good orientation about the practices and responsibilities while working on the unit. As an Observation nurse, we will be able to get adequate staffing to accommodate the high turnover of patients in our unit. The nurses floating to our unit will be expected to work fast and be proficient in admissions and discharges of patients. Communication is essential for any change to be successful, there needs to be good communication between the managers, and the nurses to ensure the smooth transition into the new environment to help promote better quality of care for the patients by improving the work environment for the staff.

Conclusion

As challenging as it may b, sometimes changing something that doesn’t seem to be working will lead to better productivity and satisfaction among employees. This will result in improved patient safety and satisfaction during their stay. Healthcare is an evolving industry that requires policies and practices to be refined to create new innovations and accommodate better practices to improve quality of care for the patients under the care of the organization. In this paper, I was able to identify a problem that is prevalent in the organization I work at. A realistic change was proposed and the implementation strategy was also discussed. The change discussed was in tune with the organization’s mission, vision and values. They model of change that can be used to facilitate the smooth transition was also discussed in the paper. Staffing is a primary concern in the healthcare industry. Taking care of the staff available has many benefits for the management and for the patient’s that come under the care of the staff. Employee satisfaction is one of the key attributes of a successful organization.

References

May C, Finch T. Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology 2009; 43:535–54

Bisk. (2016). Keeping Nurses: Strategies for Nurse Retention. Retrieved from New England College: http://www.newenglandcollegeonline.com/resources/healthcare-administration/keeping-nurses-strategies-for-nurse-retention/#.WF23a_krKUk

Johnson MJ, May CR. Promoting professional behavior change in healthcare—what interventions work, and why? Protocol for a theory-led overview of systematic reviews. Working Pap Health Sci 2014; 1:7.

Lewin's Change Theory. (2016). Retrieved from Nursing Theory: http://www.nursing-theory.org/theories-and-models/Lewin-Change-Theory.php

Marquis, B. L., & Huston, C. J. (2015). Leadership Roles and Management Functions in Nursing (Eighth ed.). Philadelphia, PA: Wolters Kluwer Health.

Mission & Values. (2016). Retrieved from Memorial Hermann Health System: https://www.memorialhermann.org/uploadedFiles/wwwmemorialhermanorg/Memorial%20Hermann%20Standards%20of%20Conduct%2007-2012.pdf.