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Complete Issue Analysis Paper

Angèle C. Wright

Frostburg State University


Complete Issue Analysis Paper: Change Process

The world is a dynamic place where often times, change is the only constant. Healthcare

is no exception. As the ease of communication increases through the use of electronic mediums,

new data is readily available to healthcare leadership; allowing them to see what new changes

and advances their peers are accomplishing and applying to their organizations throughout the

world. This enhanced accessibility also increases the frequency in which change is applied to an

organization’s protocols and practices, often leaving the front end users feeling anxious and

bewildered if the protocol change is not handled appropriately.

Change often brings about fear and trepidation in the hearts of most nurses, especially

those who cling to old practices like life preservers on sinking ships. Ever evolving protocols

and practices that are poorly communicated can create environments of panic and dread for those

who are uncomfortable with change; manifesting in discontented, surly, and unwilling

employees who can unwittingly sabotage the best of ideas. With reliance on new technology as

fail safes, such as scanning, increased use of electronic medication records, health records, and

intravenous medication pumps; those who are uncomfortable with technology may feel

marginalized or frustrated because it takes them longer to do a job that they have been doing

successfully for years. So how should upper management handle a new change that can

potentially improve patient outcomes while successfully engaging their staff to fully embrace it

without reservation? That depends on the efficacy of their change process.

In itself, the change process is not a new phenomenon. Various other industries have

utilized one form or another of the change process in an effort to improve efficiencies and

stabilize a process. In the text, Professional Nursing Practice: Concepts and Perspectives,

authors Blais and Hayes outline the 10 steps described in the change process best utilized for

nursing: problem identification, data collection, data analysis, plan development, anticipation of

opposition and support, building a coalition of supporters, change preparation assistance,

resistance preparation, feedback, and evaluation (Blais, Hayes, 2016, pp 293-294).

Often times, the reason for the change is predicated by a need to improve, a bad outcome,

or is mandated by a federal or state regulatory body. As a result, the organization may be

required to change in order to avoid a punitive damage and will have to push the change through

the pipeline to the front line staff for adoption. Stuck between the proverbial rock (agent forcing

the change) and hard place (front line nursing staff), an empathetic leader can ease the grief

associated with the change by outlining the reasons behind the change as much as possible.

With any change, whether it affects one’s private or professional life, one needs time in

order to process what, if any, effect this change will have on their day to day activities. If the

person is not given time to process their feelings on the subject, they may grow angry, defensive,

and unsupportive to the change. This anger can ferment into an insidious cancer that can spread

to others and permeate all facets of the organization; creating an environment that is unfertile to

the change taking root and flourishing. An effective leadership understands this and finds

opportunities to limit the power of the negative naysayers through education, empowerment, and

effective communication.

Conversely, when an organization has a well managed infrastructure that is conducive to

change, small process improvements can reduce inefficiencies and release resources to be used in

other areas that are in desperate need of assistance. An effective change process can engage the

most apathetic of employees and provide them with the necessary sense of ownership; one that

would not allow a new change to fail. By shifting the focus of the frontline nursing staff member

from a tactical one to one that is steeped in planning, the frontline employees are able to see

things from a different perspective and have a better understanding of all of the constraints that a

nursing manager or leadership team may have to consider before making a final decision. This

understanding may increase empathy for managers and acceptance for future changes to come.

A team that embraces change can also cause less stress for a manager or leadership team; well-

trained staff members can participate on projects on the behalf of managers, giving them more

time to focus on other responsibilities that desperately require their attention. Additionally, front

line staff members are more inclined to adopt a practice when it is presented by their peers

versus members of a leadership team. Furthermore, teams that embrace change often experience

more trust and openness, resulting in more productive, team-oriented work environments.

Change in itself does not occur within a vacuum. As always, something must occur that

requires the change. If the status quo threatens the survival of the organization, then the need to

change becomes a necessity; regardless of one’s attitudes towards change and subsequently, the

change process. As previously mentioned, the change process is comprised of 10 steps: problem

identification, data collection, data analysis, plan development, anticipation of opposition and

support, building a coalition of supporters, change preparation assistance, resistance preparation,

feedback, and evaluation (Blais, Hayes, 2016, pp 293-294).

In a perfect world, the change agent would have the appropriate resources and time to

accurately follow the 10 steps in order to properly implement the new process. Management

would be able to prioritize the issues that will have the greatest impact on the unit and front line

employees would have sufficient time to see the value of the necessary change and accept it. But

unfortunately, it does not always occur in that manner. For instance, the American Recovery and

Reinvestment Act of 2009 required that all healthcare organizations adopt electronic health

records in order to maintain their Medicare and Medicaid reimbursement capabilities by 2014.

This mandate set off a series of changes throughout the industry and applied stress to

each organization’s existing change process because the change was not organic in its nature.

Other problems and priorities did not just evaporate because the federal government stated that

something else had to be done. Organizations had no choice but to acquire the necessary

technology in order to be compliant; and, they had to find a way to pay for it. This change

increased their debt or limited the amount of cash reserves on hand; leading to limited

investments in new capital expenditures or human resources. Some organizations had to reduce

their staff in order to remain viable while investing in the new technology, at the risk of

increasing the workload on the remaining staff and further alienating a disenfranchised work

community. If an organization was sorely lacking in necessary equipment to complete an

existing task, it can be demoralizing to its workforce to see resources spent on something else;

especially when the mandate was not fully communicated to them. This can then increase

opposition held by the front line employees and limit or delay the overall effectiveness of the

change; requiring the leadership teams to spend time enforcing the change utilizing punitive

measures and inadvertently increasing discontentment among the masses.

In any environment, problems always seem to outnumber solutions. Healthcare

organizations with nursing staffs are no exception. As frontline employees, nurses have a front

row seat to existing problems and how it affects their ability to care for patients. Unempowered

work groups may experience feelings of ineffectiveness or adopt masks of apathy or indifference

when new priorities overshadow much needed and well known existing improvement

opportunities. Without proper communication, the nurse can become halfhearted in their

delivery of care. If left unchecked, the nurse can eventually lose passion for the job; resolving to

do the bare minimum necessary to complete the task. This can affect the safety and care of

patients; leading them to chose other venues to supply their healthcare needs and thereby,

decreasing the organization’s revenue streams.

Improper handling of the issues can also desecrate the professional relationship between

the nursing staff and the leadership teams; creating rifts and chasms built on mistrust, suspicion,

and wariness. If a change occurs and the nursing staff is not properly educated on its merits, they

may view it as additional work. Without appropriate interventions by the leadership team, the

nursing staff may develop unsafe work-arounds in order to save time and miss the reason why

the change was implemented in the first place. Nurses may also miss opportunities to provide

appropriate education and care to their patient population because they are working so hard to

complete the task using the new technology; leaving the patient to feel like the focus is now on

the equipment versus the reason for their visit.

New changes can also affect the nurse’s ability to effectively communicate with the other

members of the healthcare team. Without proper training, the nurse may not receive the proper

orders and that could cause a delay in care provided to the patient. If changes are not

appropriately communicated to other members of the interdisciplinary team, delays in care can

cause unnecessary tension between them and the nurse; leading to an increased and unwarranted

collapse in their relationship.

The smallest pebble can cause an infinite number of ripples in a pool of water.

Healthcare organizations are susceptible to environmental forces that drive change without

consideration on how it will affect the individual nurse. For the experienced nurse who

previously excelled in an environment where technological applications were few and far

between, it can be embarrassing to now have to ask someone else with less experience how to

complete simple tasks. This discomfort with change, if not managed appropriately; can cause the

experienced nurse to feel marginalized and left behind. So how should a nursing leadership team

effectively manage change within their respective units, and moreover, nursing as a whole? The

quick answer is education.

Nursing education has to be communicated at all entry points within the profession to

reinforce that continuous change is a given; whether it occurs within the undergraduate realm or

during continuing education for experienced nurses. Frequent exposure to change lessens the

fear of the unknown and increases one’s comfort levels. Leadership teams have to treat their

nursing staff as the professionals that they expect them to be. It includes educating the nursing

staff about the change process and allowing them to follow the steps to make small, but

impactful changes on their respective units or departments. This can be achieved by providing

them with honest explanations about upcoming changes and offering appropriate opportunities to

participate in the change process when possible. This will allow the nursing staff to understand

what impacts the organization’s bottom line and contribute to the conversation on how to correct

any gaps or shortcomings that prevent the organization from reaching a specific goal.

By shifting the nursing staff paradigm from their tactical duties to a more global

perspective that encompasses the goals of the unit or department, that nurse can create synergies

with other staff members and help produce solutions that had previously remained elusive to the

leadership team. Educating the nurse on the change process not only allows them to

systematically bring about a change to a problem but it can give that person a voice that did not

exist prior. To finally have the power to be able to fix a problem is both an act and gift of

liberation. It elevates one from passively existing in an environment to a position of active

leadership and investment.


Nursing students should also receive appropriate education on the change process and the

positive impact it can have on them; both on a professional and personal level. First, this

information will provide the nursing student with the expectation that change will occur. What is

learned today may become outdated in years to come. Change should be anticipated and

encouraged in the hopes that it will hopefully improve patient outcomes. Second, if the nursing

student is exposed to change earlier in their career, they can begin to see opportunities for

improvement. This shift in perspective can also help them make adjustments to their methods of

completing tasks and achieving goals.

In order to succeed in this dynamic world, one must learn to peacefully coexist with

change. In an effort to effectively manage change, one must become familiar with the change

process. The steps within the change process allow the nurse to become acquainted with the

problem selection as well as the data collection and analysis process. This allows the nurse to

gain a better understanding of the problem and determine a solution that is fact-based, not just

based on opinion. The nurse can also anticipate any roadblocks to the solution implementation

by identifying how to handle the team members who may oppose the new solution. The nurse

can also identify the team members who are more apt to support the change and use their social

capital to help get the change more readily accepted. Regardless of how one may feel about

change, it is apparent that without clear and frequent communication, people will use fear-based

untruths to fill in the gaps. This can lead to dissolution of otherwise strong and effective teams.

Nursing is considered a noble calling. It is also a profession. It requires education to

order to enter the field of nursing. The training is conducted by fellow nurses and the training

material is comprised of teachings by nurses; consisting of nursing science that is based on their

research and knowledge. In order to maintain licensure and to support their nursing practice,

nurses are expected to continue their education and adhere to certain standards; failure to do so

will certainly result in the loss of one’s license and ability to practice (Cardillo, 2013, p. 1).

Nurses are responsible for the decisions made within their nursing practice and expected to

advocate on behalf of their patients; even if means not completing a task prescribed by a

provider. This profession is built on the core values outlined by The Essentials of Baccalaureate

Education for Professional Nursing Practice, which includes “altruism, autonomy, human

dignity, integrity, and social justice” (AACN, 2008, p. 4). Even though nurses carry out tasks

assigned by medical providers, they also perform autonomous duties, develop care plans, and

share education to help their patient achieve favorable outcomes. Beyond that, nurses are

expected to carry themselves in a professional manner that reflects the community’s perception

of them; regardless of the situation that nurse may face.



American Nurses Association. (2010). Nursing: Scope and standards of practice. Silver Spring,

MD: American Nurses Association

Blais, K.K., Hayes, J.S. (2016). Professional nursing: Concepts and perspectives. (7th ed.).

Upper Saddle River, NJ: Pearson Prentice Hall

Cardillo, D. (2013). Is nursing a profession or a job? American nurse today. Retrieved from