Managing change: Nursing

Notes

MANAGING CHANGE

KEY POINTS
NOTES
INTRODUCTION
  • Outpatient surgical clinic
  • Traditional telephone communication moving to instant messenger application
  • Staff resistance to change

TYPES OF CHANGE
  • Change
    • Complex process that involves making an alteration or modification to something that already exits
      • Planned 
      • Unplanned

PROCESS OF CHANGE
  • Unfreezing
    • Individual warm up to the idea that change is needed
  • Moving
    • Implementation of change
  • Refreezing
    • New changes are integrated into culture
    • Become norm of everyday practice

RESPONSE TO CHANGE
  • Innovators
    • Enjoy change
    • Thrive on change
  • Early adopters
    • Adopt change quickly
  • Early majority
    • Prefer old way of doing things
    • Eventually accept chante
  • Late majority
    • Openly oppose change
    • Will accept change once others have first accepted it
  • Laggards
    • Work to keep old ways
    • Resistant to change
  • Rejectors
    • Actively oppose change
    • Try to sabotage change process

MANAGING CHANGE
  • Change leader
    • Formal leader 
    • Uses strategies to manage change
  • Be proactive in initiating change
  • Be compassionate
  • Willing to look inward to transform mindset
  • Listen to feedback
  • Provide reinforcement
  • Change agent
    • Informal leader
    • Encourages and facilitates change
    • Demonstrate empathy, humor, and respect 

Transcript

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Content Reviewers

Elizabeth Lucas, EdD, RN, CNE,Lisa Miklush, PhD, RNC, CNS,Gabrielle Proper, RN, BScN, MN

Nurse Jack is the manager of an outpatient surgical clinic. This clinic has just announced that some traditional telephone communication between healthcare team members will now take place through an instant messenger application on the computer. Nurse Manager Jack recognizes that there is some resistance within the nursing staff about this change so he speaks to the unit charge nurse, Nurse Taylor. Nurse Manager Jack says, “The other staff nurses respect your opinion, so I’m wondering if you can assist with the transition by adopting the change to act as an example for the rest of the staff.”

Nurse Taylor responds, “I know that instant telehealth communication between clinicians can improve continuity of care and client safety; I’d be happy to help!” Nurse Manager Jack and Nurse Taylor will work together with the other staff nurses to manage this change.

Change is a complex process that involves making an alteration or modification to something that already exists. Change can be planned or unplanned, also known as first order and second order change, respectively. Planned, or first order change, is a deliberate and organized process which has the goal of making improvements over time, such as transitioning to an instant messaging communication system. On the other hand, unplanned, or second order change, is usually unanticipated. This type of change involves completely disrupting how things are normally done in order to adapt quickly to developing situations. An example of this is when healthcare facilities had to quickly implement COVID-19 precautions during the onset of the pandemic.

Okay, so whether a change is planned or unplanned, it’s important to understand the change process so change can be effectively managed. One way to approach planned change is to break it into 3 stages: unfreezing, moving, and refreezing.

Just as you would defrost a frozen meal before cooking it, change must go through the initial step of unfreezing, which is when individuals warm up to the idea that change is needed. Now, the most important thing during the unfreezing step is effective communication and creating motivation; so, Nurse Manager Jack completes this step by helping his staff understand the problems caused by traditional telephone communication and announcing the switch to the instant messaging application during unit huddles. He also placed informative fliers in the unit breakroom about the benefits of the instant messenger application.

The next step is moving, which involves the implementation of change. This is generally the hardest step to overcome as individuals because effort is needed to learn new behaviors and ways of thinking. Nurse Taylor assists in this step by demonstrating how to use the messaging application with the staff and then guiding them as they complete it on their own.

The last step of planned change is refreezing, which is when the new changes are integrated into the culture of the clinic and become the norm in everyday practice.