6053 Wk 4

Main Discussion Post

Implementing change in an inpatient medical unit can be daunting. Meetings must be held with the staff and offered during various shifts to include everyone. Supporting the change takes additional effort to achieve the desired outcome. Many attempts at change do not succeed due to a lack of structure or planning (Marquis & Houston, 2017).

Two staffing changes were made at the local hospital resulting in less available leadership for the staff nurses during their shifts. One change was removing a full-time house supervisor on day shift and instead, having that responsibility divided between the nurse managers and assistant nurse managers on a rotating schedule. The second change was for the unit charge nurse to have a patient assignment in addition to their responsibilities of running the unit during their shift. Both of these changes had an impact on the availability of nurse leaders for the staff nurses. If the nurse manager is house supervisor for the day they are less available to their unit and with the charge nurse now having a patient assignment, they too are less available to complete leadership obligations. Unfortunately, the rationale for these changes was not made available to the staff nurses. One can only assume budgetary restrictions and nurse staffing issues may be involved. While patient safety should be a top priority, having less access to nurse leaders does not appear to be on that track. A goal commonly found within organizations is creating a culture of continuous quality improvement (McAlearney et al., 2014).

Assuming the change in the charge nurse’s duties was related to staffing changes, a proposed suggestion would be to staff the units with the appropriate amount of nurses so the charge nurse can have a limited number of patients or no patients in order to be able to perform leadership duties. Mitchell (2012) discusses the change theory of Kurt Lewin who identified three stages needed to implement change unfreezing, moving, and refreezing. In the charge nurse issue, unfreezing would be the change that is needed to return the charge nurse to her regular managerial duties, moving would be the hiring of additional nurses to sufficiently staff the unit, and refreezing would occur once the unit is fully staffed.

References

Marquis, B. L., & Houston, C. J. (2017). Leadership roles and management functions in nursing (9th ed.). Philadelphia, PA: Wolters Kluwer.

McAlearney, A. S., Terris, D., Hardacre, J., Spurgeon, P., Brown, C., Baumgart, A., & Nystrom, M. E. (2014). Organizational coherence in health care organizations: Conceptual guidance to facilitate quality improvement and organizational change. Q Manage Healthcare, 23(4), 254-267. doi: 10.1097/QMH.0000000000000044

Mitchell, G. (2012). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37. Retrieved from Walden Library databases

APA format, 2 referernces, discussion reply please