NR 451 Week 6: Implementing Change Despite Resistance -

NR 451 Week 6: Implementing Change Despite Resistance

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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.

Lauren Spears
Oct 9, 2017Oct 9, 2017 at 9:16pm
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Hey Lametary,

I agree that change should be started on a
foundation of trust, education and open
conversation. This makes everyone comfortable
and more willing to accept the new changes. I
also agree that changes make people feel out of
control. Change is a process and should be taken
slowly.
Thanks for the post!

Lauren


Collapse SubdiscussionJulie Miller
Julie Miller
Oct 2, 2017Oct 2, 2017 at 2:48pm
Manage Discussion Entry
Professor and Class, this weeks' discussion
pertains to change and resistance to
change. Change is often associated with words
like insecurity, emotional, exhausting, uncertainty.
Change can be defined as the act of substitution
new and unfamiliar behavior or process for old
comfortable measures, (Sherman,2011). We are
continuously experiencing change, in workplace
environment, in our homes, even within
ourselves. Change, even for the good or positive
change, produces a sense of stress to some
degree within us. Its' the fear of unchartered
waters, sort of speak. According to the article by
Sherman(2011), within the workplace setting,

there are some steps to soften the blow of
change. 1. Create a sense of urgency about the
need for change- Inspire staff to see the need for
change. 2. Build a team- this should include
individuals that are skilled with ability as well as
have positive attitudes that support teamwork. 3.
Develop and communicate the vision- define what
change, why change and how it will happen. 4.
Communicate buy in – keep staff informed and
respond to their needs during the process of
change 5. Create easy goal- manage a system
change in bite sized pieces. 6. Empower action –
remove obstacles, provide feedback and reward
progress. 7. Do not let up- build and encourage
each other in determination and persistence and
report any progress. 8. Make the change stick-
weave it into the work culture and practice in a
tangible way.
As I have shared, we are changing to EPIC
software within our organization. This weekend
was Go Live. I am a night shift super user and will
be working 60 hour weeks this month to provide
staff with additional "at the elbow "support
through this transition. Our organization has done
an excellent job in preparing us , providing
additional expert support, upper management
presence, and today is day 2 and it has run rather
smoothly so far. After reading this article, I can
see how many of the steps above were utilized
and integrated over the past 5 months as we
prepared for this as an organization and a unit.
These steps have reduced resistance , and
allowed staff to prepare and embrace the
inevitable change. Attitude has played a major
role in this change over . There is an undeniable
length between professional work
environment/atmosphere and quality healthcare
and optimal outcomes,(ANA,2015). Although
many of us have verbalized a "dread" feeling, it is
actually the process of change we have
dreaded rather than the actual change
itself. What I mean by that , is , many of us are
excited for the actual software change, we feel
EPIC will be an improvement. It is the process of
learning something new, trying to get proficient in
our workflow and comfortable with the

applications of EPIC that we are dreading,
because it is not our "comfort zone". Some of our
processes will function the same, but many will
change. Some of those changing are for the
better, actually an easier approach in fact, but the
actual process of doing it different leads to feeling
of uncertainty and question.

American Nurses Association. (2015). Nursing:
Scope and standards of practice (3rd ed.). Silver
Spring, MD: Author.
Sherman, Rose.(2011). Why is Change Hard?
retrieved from Emerging RN leader, Nov. 2011.
o

MELISSA MADDOX
MELISSA MADDOX
Oct 3, 2017Oct 3, 2017 at 6:16am
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Julie and class,
Congratulations on the smooth change to EPIC, it
is a great program and has the best interface for
communication with providers and support staff if
used correctly. Sometimes those little things are
lost in orientation of new nurses and staff but the
education department because there is a time
constraint for them (days instead of months) to
get the new staff up and running. Super users
are very useful in this case as they are always
there as a resource. Good for you!
o

Frances Hughes

Frances Hughes
Oct 3, 2017Oct 3, 2017 at 10:49am
Manage Discussion Entry
Dear Julie,
Congratulations on the change to EPIC. It really is
a great program, and I know how exhausting it is
to change from whatever you were using before
to "Go Live" with EPIC.
I continue to learn new things and tools available
on EPIC everyday. Yesterday someone showed
me how to record my vital signs for several hours
instead of highlighting a column and saving each
hour or 15 minutes.
I enjoyed reading your post on change as I went
through this myself a few short years ago. You
made an excellent observation. When going
through such a major change like new EHR
systems, being prepared and educated and then
having proper support or removing obstacles is
the best way to implement such a huge change.
When dealing with change it is important to
alleviate as much stress as possible by
educating, supporting and having a teaching

environment to prevent stress. Stressful work
environments create anxiety, powerlessness,
psychological consequences for nurses, and lead
to turnover and decrease in staff (ANA,2015).
Thank you
Frances
ANA,(2015). ANAs Principles of Environmental
Health for Nursing Practice. Retrieved
fromhttp://www.nursingworld.org/MainMenuCateg
ories/WorkplaceSafety/HealthyWork Enviornment

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Wanda thanks for your posting. It is very unfortunate that we have to think of money. If the hospital operates at a loss, our salary would not be substantial and we would not receive any raises. Nurses do not see the big picture, it is not until we are exposed to healthcare management that we really realize that we have to think about money as well as the quality care we provide along with taking into consideration patients experiences. Healthcare is a business just like any other business. One reason for thinking money is Medicare reimbursement. Medicaid pays hospital supplemental payment for fee-for-service to their Medicaid beneficiaries, this payment varies from state to state and could be billions of dollars annually. Hospitals have to meet certain criteria of Medicaids the rule and regulation and failing to meet these criteria can cause the hospital to lose millions of dollars. Nurses are forced to make changes to meet the standards and criteria for Medicaid reimbursements. For example hospitals across the United States have made changes on how to the delivery care and documentation on conditions and procedures of Core Measure patients, which is one of the program of Medicaid to reduce patients readmission and provide the quality care for these patients. According to the information on the Medicare website, “Hospital Readmission Reduction Program- The Affordable Care Act authorizes Medicare to reduce payments to acute care hospitals with excess readmissions Links to an external site.that are paid under CMS’s Inpatient Prospective Payment System (IPPS), beginning October 1, 2012. The program focuses on patients who are readmitted for selected high-cost or high-volume conditions and procedures, namely, heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), hip/knee replacement, and coronary artery bypass graft surgery.”

Reference:

Medicare.gov, Hospital Compare.(2013). Linking quality to payment, Retrieved from

https://www.medicare.gov/hospitalcompare/linking-quality-to-payment.htmlLinks to an external site.

Grading Rubric Guidelines

Performance Category	10	9	8	4	0
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions Evaluates literature resources to develop a comprehensive analysis or synthesis. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions. Evaluates information from source(s) to develop a coherent analysis or synthesis. Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion. Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) without any interpretation/evaluation. The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions. Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge – Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources; Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources. Applies concepts to personal experience in their professional setting and or relevant application to real life Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson. Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life Does not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post. Posts are superficial and do not reflect an understanding of the lesson content Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive Dialogue Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. *(5 points possible per graded thread)*	Exceeds minimum post requirements Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days. Replies to a post posed by faculty and to a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days Replies to a question posed by a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days. The main post is not made by the Wednesday deadline Does not reply to a question posed by a peer or faculty	Has only one post for the week Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the thread No connections are made to the topic
	Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APA Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition	2-3 errors in APA format. Written responses have 2-3 grammatical, spelling, and punctuation errors. Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format. Writing responses have 4-5 grammatical, spelling and punctuation errors. Writing style is somewhat focused.	6-7 errors in APA format. Writing responses have 6-7 grammatical, spelling and punctuation errors. Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format. Writing responses have 8-10 grammatical, spelling and punctuation errors. Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format. Written responses have more than 10 grammatical, spelling and punctuation errors. Writing style does not facilitate communication. The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost				-5 points lost
Total Participation Requirements *per discussion thread*	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement *per discussion thread*	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.

Also Read: NR 451 Week 5: Core Competencies for Nurses