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NR 451 Week 6: Implementing Change Despite Resistance Discusssion
Change can be difficult to implement. Now that you are almost finished with your change project, if you were to implement your project in your clinical practice, what type of resistance do you expect from staff? List at least three ways that you can lessen the resistance you may encounter to help ensure the success of your project.
Class, Change in any setting is difficult, we go through changes every day, new laws, new way of doing things, new technology and so forth. Some embrace change as inevitable and others just refuse to change. My mother is an avid reader and has literally hundreds of books, trust me I know I have moved her twice in the past 10 years and know all the books she has. I bought my mother a nook several years ago and taught her how to use it. Instead of embracing this new-found way of reading thousands of books that are stored in one place, she chose to hide the nook and claim it was lost.
Recently she started having trouble with her eye site and could not read regular print books so I searched her apartment and found the nook, I charged it and set the font to large type and re-oriented her to its use. Again, she stashed it away saying it would not charge. Now I know that was not true, she just will not change to use of new technology, she will not learn to use a computer or tablet, she has no interest in doing that. Change scares her and that is the bottom line. As nurses, we are a lot like my mother, afraid of change, and this fear holds us back in our practice and in safe quality care and positive outcomes for our patients. There are several major barriers to the advancement of EBP which would bring about change in nursing. These include:
o Lack of knowledge and skill
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o Low comfort level with search techniques
o Perceived lack of time-REAL LACK OF TIME
o Challenges with critically appraising research
o Lack of organizational/administrative support
o Educational programs that continue to teach research the “traditional way” with focus on producing instead of using evidence
o Negative attitudes-skeptics and fear
I had one negative encounter with implementation of change early after I earned my masters’ degree. My barrier with leadership and their lack of knowledge and insecurity with staff effecting change. I was basically told after my presentation of my idea for change that I was hired as a staff nurse and nothing more. Their insecurity with staff effecting change that could improve patient outcomes along with their lack of knowledge in nursing research became the barriers to positive
patient outcomes. In the past year, the culture at that facility has changed and nursing research that includes the staff has been implemented. Tell the class about the barriers you may encounter in your practice if you were to attempt to implement a change? It could be from staff or leadership or both. Feeg, D. V., Suny Downstate Medical Center Department of Nursing , Nursing Research and Evidence-Based Practice Conference, May 26, 2010; Strategies for Overcoming Barriers in Implementing Evidence-Based Practice; retrieved from http://www.downstate.edu/icl/Feeg-Downstate2010Presentation-BarrierstoEBP.pdf o
Professor and class, It’s been said that “ changes are inevitable,” but clearly they have not work with some of my coworkers.I was assigned a project to create flowcharts for a department at my job. The goals were to create a new process that would be easy to use and decrease the time and help eliminate some of the problems that exist with the current process. This assignment was given to me three months ago with a timeline for completion in six weeks. I have created and revised the flowcharts four times following the specific narratives the department presented to me. During my research, I offered several prime solutions. One of the solutions was to revise the process from
manual to an electronic. The newer staff were excited and ready to proceed, however, the staff who used the manual process did not feel the need to change to electronic. In my presentations, I was able to demonstrate how the new process would be faster and easy to use. The department director and the older staff push back when the electronic solution was presented. I have no doubt that the fear of something new lies within the staff who are familiar with the manual process, and no matter what I said or did their response were the same.
According to our reading assignment for this week states that I need the endorsement of the participants and those impacted by the change in order to ensure that the innovation is implemented successfully. The current process has several problems that prevent easy flow and delay the transition from one step to another in a timely manner. Because of the support of the program director, I haven’t been able to transition the process to electronic, but it is still on the table for further discussion.
Agency for Healthcare Research and Quality (AHRQ). (2008). Patient safety and quality: An evidence-based handbook for nurses. Retrieved from http://www.ahrq.gov/qual/nurseshdbk/ §
This a great post. Thank you for sharing your experience with change. Fear is a huge problem with change, but like you said change is inevitable. I think all nurses are nervous about any changes that come up with new technology or new electronic solutions, because we did not go to school of computers but most of our jobs are computer based. This causes fear and resistance, and until the training is completed on the new technology or computer program you will have resistance.
That’s awesome that you were asked to create the flowcharts. But how very frustrating that some of your coworkers were not as excited. I know from personal experiences that some coworkers don’t really care what the evidence says, or what’s best for the patients but are more interested in how the change effects them. And I really agree with your response that, “its all about bottom line”. There was NEVER a truer statement than that. My department is in the process of attempting to hire more people. First my bosd has to submit for need, then it goes to committee, then fiance, and I think a couple other places, then she gets told if she can have the position or not. Then she can start the hiring process. The whole process can take 6 months or more! In the meantime the rest of the staff has to work extra and overtime, which can cause fatigue and burnout. I wish there was a quicker solution.
Change is tough for everyone, even the younger nurses, they are just more technologically savvy. I look at my grandson and realize he will never know what it is like to “write” a letter in his generation. I love technology myself but I know of many nurses my age who do not and would be perfectly happy going back to paper. That would be fine if your work and care did not effect the entire health and care of the patient. Now information can be shared in a blink of an eye. Sometimes it requires management to step up and say “its here and not going away” embrace it or fall behind.
Nursing is one of the most versatile occupations within the health care workforce.1 In the 150 years since Florence Nightingale developed and promoted the concept of an educated workforce of caregivers for the sick, modern nursing has reinvented itself a number of times as health care has advanced and changed (Lynaugh, 2008). As a result of the nursing profession’s versatility and adaptive capacity, new career pathways for nurses have evolved, attracting a larger and more broadly talented applicant pool and leading to expanded scopes of practice and responsibilities for nurses. Nurses have been an enabling force for change in health care along many dimensions (Aiken et al., 2009). Among the many innovations that a versatile, adaptive, and well-educated nursing profession have helped make possible are:
§ the evolution of the high-technology hospital;
§ the possibility for physicians to combine office and hospital practice;
§ lengths of hospital stay that are among the shortest in the world;
§ reductions in the work hours of resident physicians to improve patient safety;
§ expansion of national primary care capacity;
§ improved access to care for the poor and for rural residents;
§ respite and palliative care, including hospice;
§ care coordination for chronically ill and elderly people; and
§ greater access to specialty care and focused consultation (e.g., incontinence consultation, home parenteral nutrition services, and sleep apnea evaluations) that complement the care of physicians and other providers.
With every passing decade, nursing has become an increasingly integral part of health care services, so that a future without large numbers of nurses is impossible to envision.
Aiken, L. H., R. B. Cheung, and D. M. Olds. 2009. Education policy initiatives to address the nurse shortage in the United States. Health Affairs 28(4):w646-w656. [PMC free article] [PubMed]
Lynaugh, J. E. 2008. Kate Hurd-Mead lecture. Nursing the great society: The impact of the Nurse Training Act of 1964. Nursing History Review 16:13-28. [PubMed]
I enjoyed reading your post. You discussed the need for a large number of nurses, but the nursing shortage is already starting to impact various areas. New graduate turnover rate for their first employer is at 13% and 33% consider leaving (Heering, 2017). What do you think organizations can do to help prevent this? Why do you feel that new nurses are leaving nursing altogether?
See Also: NR 451 Week 2: Homework Assignment