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Angèle C. Wright
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
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
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
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nursing: problem identification, data collection, data analysis, plan development, anticipation of
Often times, the reason for the change is predicated by a need to improve, a bad outcome,
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.
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
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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
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.
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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
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
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
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patients; leading them to chose other venues to supply their healthcare needs and thereby,
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
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
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
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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
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
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
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.
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,
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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
References
American Nurses Association. (2010). Nursing: Scope and standards of practice. Silver Spring,
Blais, K.K., Hayes, J.S. (2016). Professional nursing: Concepts and perspectives. (7th ed.).
Cardillo, D. (2013). Is nursing a profession or a job? American nurse today. Retrieved from
https://www.americannursetoday.com/blog/is-nursing-a-profession-or-a-job/