Situation & Background
The proposed change is the creation of a new position within the hospital’s hierarchy: a healthcare unit nurse leader. This position would be in charge of cooperating and exchanging information with other care units, as well as supporting communication both internally within the unit and externally. Ideally, this would allow for a faster and more consolidated exchange of necessary information and better cooperation. It would also theoretically decrease the time nurses engaged in direct patient care would spend on other matters. Each healthcare unit would have its own nurse leader. Unfortunately, during the implementation of this change, several things were not considered. For example, the boundaries and guidelines for the position were not properly established, leading to confusion among newly appointed staff and other nurses.
Implications of Change
There are several implications of this change that can be seen immediately. There are no ethical implications, as the scope of work of the nurses engaged in healthcare would not change. The addition of the new position would not change the ethical standing of the practices being conducted. The social implications are that the nurses not engaged in the leader position would be less distracted with inter-unit affairs and have more time to dedicate to direct patient care. This is likely to improve patient well-being and have an overall positive effect on productivity. In order to avoid possible legal implications, the boundaries and guidelines of the nurse leader’s job would need to be carefully set out to make sure they do not contradict or make more difficult any of the regulations imposed by the hospital. The economic implications have to do with the cost of paying an additional employee or of increasing the pay of an already-existing employee that would be fit to take on this position. It is important to make the position appealing through increased pay, especially at the beginning stages. There are no political implications for the change.
Role of the APRN
As advanced registered nurses, our knowledge and insight is invaluable in the implementation process of any change. In this case, it would be beneficial to have APRNs at the forefront of the change. They should be involved in the determination of unit nurse leader responsibilities and boundaries. It would be highly beneficial to have them try the new system as mock unit nurse leaders and workshop the system from there. If possible, only APRNs should be considered for the position. If not possible, they should be involved in the hiring and training process of any new staff. The APRNs would support and educate the new hire on how the new processes work within the specific layout of the hospital, as well as guide them through any questions or issues they may have when they begin. The new unit nurse leader should continue to work with the APRNs to workshop the position until it is completely and lawlessly integrated.
Stakeholders
The main external stakeholders of this change are the patients. The hope of this change implementation is to improve the quality of care by allowing nurses more time to focus on their needs. While they would not be actively involved in the implementation, their feedback is very important to take note of.
The internal stakeholders are the nurses, other healthcare staff working in the units where the change will be implemented, and the HR department. The nurses are the largest stakeholders, as they will be intimately participating in the implementation of the change. However, other healthcare staff, such as PAs and doctors, will also be affected by the new processes and should be kept informed of any changes to avoid disruptions to their workflow. The HR department will be involved in new hiring and/or transfers of current employees to the position. They will also likely participate, at least to some extent, in the formation of the job parameters for the unit nurse leader position.
Change Theory
Ronald Havelock’s six-step theory is the best one for the implementation of this change, as it allows for a fluid transition with several frameworks and discussion steps. This prevents implementation that is too fast or that happens too soon. In the initial stages, planning and communication with other members of the healthcare team are vital in order to implement the change in a way that works best for everyone involved. Steps 2 through 4 focus on developing a framework for the unit nurse leader position and using that framework to implement it on a small scale. This small-scale workshop-stage change can be adjusted and then expanded to see how well it works before the change is properly implemented hospital-wide in Step 5.
This allows for decreasing the financial implications of the change by first trialing the process on a small scale. Major issues can be worked out with minimal disruption to the workflow. This would also extend to social and ethical implications as well – this method of implementation seeks to ensure a smooth and careful transition that would make it easier to adjust for both patients and healthcare workers. There is no political implications of this framework being used.
Enacting Change
As an advanced registered nurse, it will be up to me to conduct the necessary discussions with my fellow nurses and come to a general agreement on what needs to be implemented as part of this change and how. I would be on the front line of creating the unit nurse leader position, with assistance from my supervisors, and working out the exact job expectations and requirements. It would also be up to me to workshop the change as previously described, working with other advanced registered nurses to work out any issues that may arise. After the system is worked out and implemented, it would be up to me to train and support new staff or promote current staff that switched to this position. I would continue to observe how the change has been implemented and bring any adjustment recommendations to my superiors.
Impact of Failure
There are a number of possible outcomes for the failure of proper implementation. They all fall into two larger categories.
The first category concerns the disruption of the work process, causing dissatisfaction among healthcare professionals, which would lead to job dissatisfaction, increased stress, burnout, and possible loss of valuable employees. This could be caused by increased difficulty of communication due to the changed channels not working correctly. Proper communication with fellow staff members by the implementers of the change is vital to minimize this. Everyone should be properly informed and channels should be established, so there is always someone to ask what is happening or what has gone wrong. Additionally, the workshop implementation process is designed to minimize wide-scale implementation issues, as hopefully, most of the highest-tier issues would be worked out prior to full implementation.
The second category of the possible impact of the failure is the effect the failure would have on the patients and their well-being. The disruption and confusion among healthcare professionals could lead to delays in care and confusion among the patients, which would be a big issue for many of them. It could lead to patient dissatisfaction or stress. Similar methods as were used in dealing with the first category of issues can be used here. While it is not ideal to tell the patients all the details of the change, it is important to keep communicating with them to let them know that they have not been forgotten about. The slow and smooth implementation process should help here as well, as it would minimize issues and keep the workflow moving without large disruptions.
Additional Factors
There are many factors that may influence the success or failure of implementing change. It is important to take into account the specifics of the hospital and its employees. In order to avoid hostility and future arguments, the APRN will need to communicate properly with all healthcare professionals involved, but especially the nurses. A proper explanation of the change and the impact it will have on them specifically will have a positive effect on calming fears and anxieties. The process of implementation should be transparent and honest, with nothing being hidden or obscured from the nursing staff. In this way, the details of the position of unit nurse leader should be explained before candidates are selected to allow any nurses wishing to apply for the position the chance to do so. Secondly, a strong factor that will be difficult to control will be the financial situation of the hospital at the time of implementation. This will affect the availability of resources for training and workshopping and whether new staff can be hired to fill the position of the unit nurse leader or if members of the current team would need to be reassigned to this position instead. While it is impossible to control this parameter, it is beneficial to maintain some flexibility in order to adjust to it. Finally, the timing of the implementation of the change would need to be adjusted based on how busy the areas where the implementation happens will be. It would be more difficult to implement any changes during the busiest times of the year. However, the slow and steady implementation tactic selected for this process should alleviate some of that concern.
References
Hughes, V. (2019). Nurse leader impact.Nursing Management, 50(4), 42–49.
Smith, M. C. (2019). Nursing theories and nursing practice. FA Davis.
Udod, S., & Wagner, J. (2018). Common change theories and application to different nursing situations. Leadership and influencing change in nursing.