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Problem Description & Proposed Change
While doing my clinicals, I noticed that Registered Nurses (RNs) were scheduling their own duties when visiting patients in their homes, preferring to deal with those that did not exhibit critical health problems as to be admitted in hospital. The basic assumption among RNs was that critically ill patients consume a lot of time in preparing them for hospital admissions. This assumption created a problem in that the available LVNs could not book the critically ill patients to hospitals as their license does not allow them to assume the role of admitting patients. Consequently, the problem can be described as unfair distribution of manpower in home health agency due to RNs own scheduling practices as they visited patients in home care.
I propose that the home health agency should adopt technology-based duty scheduling application that will allocate roles depending on experience and the requirements of licensure set by health agencies in dealing with home-based patients. This way, LVNs will be able to extend care to less critical patients in home settings, while RNs will have to cater for the critically ill and admit them to the hospital according to their health demands.
Impacts of the Change on Organizational Culture
The intended change is incremental in nature since it purposes to fix the problem of unproductive distribution of manpower in home-based health. However, the change is non-routine as it will introduce a technology-based application to the internal environment of the home health agency to be used to delegate roles to RNs and LVNs (Austin & Claassen, 2008). Consequently, the organizational culture will be impacted in terms of adoption of new organizational values related to scheduling of roles, as well as shifting of expectations and assumptions that previously existed among the RNs to accommodate new technology-based scheduling arrangements.
Impacts of the Change on Nursing Functions & Roles
Owing to the shift in expectations and assumptions regarding the scheduling of roles in home health, it is expected that some resistance may be demonstrated by RNs who may want to maintain the status quo; that is, keep the role of visiting home-based patients who are not critically ill. As suggested by Austin & Claassen (2008), employees tend to resist change when they perceive, consciously or unconsciously, that the change will be a threat to their professional practices, status, responsibilities, or identity. However, when the proposed change is finally put in place, the agency will benefit from reduced work-related pressures, allegations of favoritism in visiting patients, and availability of RNs to cater for the critically ill. Overall, the perception of balanced workload among RNs and LVNs will not only bring increased job satisfaction among the staff, but ensure that the health and social needs of home-based patients are successfully met using available resources, leading to increased patient satisfaction.
Cost Implications & Justifications for the Proposed Change
Definitely there exist some anticipated costs that must be met for the proposed change to be fully implemented. The proposed change, which is likely to take three months to implement, is likely to incur the following costs:
|Item||Approximate Cost ($)|
|Technology-based duty scheduling application for home health agency||2580|
|Computer access (equipment, data systems, etc)||2000|
|Training charges for operators (2)||1700|
|Frontline LCD systems to display routines of RNS and LVNs on daily basis||2000|
We can use a simple cost-benefit analysis to justify the cost of the proposed change to the agency’s executives and decision makers. If the department is to maintain the status quo, it shall be expending a minimum $5000 per month in paying for extra hours done by RNs in visiting home-based patients, lose around $10000 per month in underemployment of LVNs, and suffer irreparable image and reputation loss as critically ill home-based patients feel let down by RNs. Overall, the quantifiable cost of implementing the proposed change will only be $9500 against a cost of $15000 plus image loss if the agency retains the status quo. Consequently, the institution stands to gain $5500 in addition to enhanced reputation if it implements the proposed change.
Measuring the Impact of the Proposed Change
Six months after the implementation of the proposed change, a survey will be conducted to assess the level of home-based patients’ satisfaction with the care given, and the level of staff satisfaction with work roles and automated role scheduling. In addition, in-depth interviews will be conducted with both RNs and LVNs to measure how automation has improved the efficiency and effectiveness of scheduling activities, as well as how it has promoted participation, choice, and fairness in home-based care (Douglas, 2011). Positive scores will demonstrate that the project was a success.
Conceptual Model Used
The proposed change employs trait and process leadership conceptual model not only for its effectiveness in allowing leaders to use their beliefs, values, ethics, and character to influence others to adapt to a certain change (Clark, 2008), but also for its capacity to enhance non-routine change. Leadership traits, such as personality, self-confidence, trust, intelligence, decisiveness, achievement drive and cooperativeness (Clark, 2008) will go a long way to reduce staff resistance to the intended change and make RNs and LVNs realize that the change will benefit them as well as patients.
Austin, M.J., & Claassen, J. (2008). Impact of organizational culture: Implications for introducing evidence-based practice. Journal of Evidence-Based Social Work, 5(1/2), 321-359. Web.
Clark, C.C. (2008). Creative nursing leadership and management. Sudbury: Jones & Bartlett Learning.
Douglas, K. (2011). What every nurse executive should know about staffing and scheduling technology initiatives. Nursing Economics, 29(5), 273-275.