LDR 615 Benchmark – Change Initiative: Implementation, Evaluation, and Sustainability
The University of Texas Medical Branch (UTMB) facility prides itself in being a premier institution of care. The application of evidence-based practice in several of its units has made it improve on its provision of services. However, the human aspect of the hospital has demonstrated certain weaknesses that the leadership should address. An analysis of the UTMB reveals that the ratio nurses to patients goes beyond the recommended level of 1: 6. The analysis further revealed that the high nurse to patient ratio exists due to a high turnover rate at the facility. As such, addressing the turnover rate will play an important role in ensuring that the ratio aligns with the recommendation of the American Nurses Association of 1:6. The present paper will thus focus on the implementation, evaluation and sustainability of the nurse turnover change initiative at the UTMB medical-surgical unit.
12 Tips for Surviving Your First Nursing Night Shift
The Necessity for Change
The issue of nurse turnover has evolved into a rapidly growing human resource problem within the modern healthcare landscape. Hospital administrators have pointed out that nurse turnovers carry significant consequences, disrupting hospital service operations (Tang & Hudson, 2019). The University Medical Center’s (UMTB) medical-surgical unit has experienced the adverse effects of high nurse turnover, as evidenced by its elevated nurse-to-patient ratio. This high turnover rate has led to an increased risk-adjusted mortality rate at the medical-surgical unit. Furthermore, patients in this unit experience longer lengths of stay compared to other units.
Struggling to meet your deadline?
Get your assignment on LDR 615 Benchmark – Change Initiative: Implementation, Evaluation, and Sustainability done by certified MDs and PhDs in the USA. ORDER NOW!
The presence of high turnover rates in the UMTB medical-surgical unit has also resulted in a rise in the cost of care for individual patients. The extended length of stay in the unit has significantly increased the expenses incurred per patient since the onset of increased nurse turnover. Indications suggest that the high turnover rate has driven up operational costs (Tucker et al., 2019). An analysis reveals that the cost of hiring and training new nurses for the medical-surgical unit has surged as nurses leave.
Nurse shortages and staffing problems have emerged due to the loss of nurses in the medical-surgical unit. The unit is now faced with the challenge of an imbalanced composition of remaining experienced nurses and new ones, which results in an increased workload for the existing staff. Nurse managers struggle to arrange work schedules and deal with the need for increased overtime. This situation has taken a toll on the morale of the nurses in the unit, adversely affecting various aspects of healthcare quality.
Driving Factors
The driving forces behind nurse turnover encompass multifaceted factors, including economic, social, and political aspects. The medical-surgical unit at UMTB grapples with issues like the lack of support from nurse leadership. Organizational factors, such as the absence of effective leadership, play a significant role in nurse turnover (Scruth, Garcia, & Buchner, 2018). The nurse leadership in the UMTB medical-surgical unit lacks the necessary skills to motivate the nursing staff, contributing to high turnover rates. Additionally, the high nurse-to-patient ratio increases the workload for nurses. Overworking nurses through practices like forced overtime makes them susceptible to burnout, exacerbating the turnover problem.
Limited growth opportunities in the unit lead nurses to seek employment in places where such opportunities abound. External factors, including the local labor market, do not favor the hospital, contributing to the high turnover rate. Furthermore, the State of Texas lacks regulations on nurse-to-patient ratios, which prompts hospitals to maintain high ratios to save costs (Cimiotti et al., 2019). Intense competition from other healthcare providers has also accelerated nurse turnover in the UMTB medical-surgical unit. An analysis of the healthcare environment reveals that competitors may have better policies and offer more incentives, attracting nurses away from UMTB.
The high turnover rate has a direct impact on the remaining nurses and the patients. The remaining nurses are burdened with increased workloads due to understaffing and forced overtime, which leads to burnout (Scruth, Garcia, & Buchner, 2018). Patients, on the other hand, suffer from reduced service quality. The effects of nurse turnover on quality parameters have, in turn, negatively impacted patient satisfaction with the services provided in the medical-surgical unit at UMTB.
Stakeholder Assessment
The proposed change to address the issue of nurse turnover involves a multifaceted approach. It includes instilling the organizational culture during the hiring process, effectively communicating organizational goals, and offering growth opportunities through competency-enhancing courses. Nurse managers will take a central role in the change initiative. During this process, nurse managers will need to change their approach in terms of communicating the unit’s goals, objectives, and culture to new nurses to integrate them into the team (Hughes, 2017). New nurses at the facility will benefit greatly from the change initiative, encountering a new way of doing things that may encourage them to stay longer. Veteran nurses will also benefit from the change initiative since it will reduce their workload and provide increased opportunities for growth within the facility.
The Role of Nurse Leaders in the Change Initiative
Nurse leaders act as change agents in implementing changes to enhance nursing and improve the working conditions of floor nurses. In the current change initiative, nurse leaders will play a crucial role in establishing improved interpersonal relationships with new nurses during interviews and orientation. They will ensure effective communication about the reorganization of growth opportunities for existing nurses and how they align with organizational objectives (Nelson-Brantley & Ford, 2017). To ensure that nurses stay with the facility for an extended period, nurse leaders will explain the importance of adhering to the organizational culture and how the change initiative will impact nurses going forward. Nurse leaders will oversee the implementation of various aspects of the change initiative.
Lippit’s Seven-Step Change Theory will be instrumental in the change initiative at the UMTB medical-surgical unit. Using this theory, the author will diagnose nurse burnout, evaluate the capability and motivation for change, assess the motivation of the change agent, identify available resources, and set progressive change objectives. Additionally, the change agent’s role will be explained to employees to ensure clarity in expectations and to sustain the change through feedback, effective communication, and coordination regarding the effects of the change (Burke, 2017). Gradual termination of the helping association of the change agent will also occur.
Change Agents and Their Roles
Change agents play pivotal roles in managing the change process. Identifying these change agents and outlining their roles is essential in a change initiative. In the current project, the Chief Financial Officer, as part of the management, will need to support the project. Their role involves securing resources for the project by persuading the business management of the project’s significance (Jones-Schenk, 2017). Additionally, a quality improvement adviser must participate in the project, with their main role being to convince administrative leadership of the project’s impact on quality parameters.
Furthermore, the nurse manager will act as a change advocate for the project. The nurse manager’s role as a change advocate involves showing commitment to the project’s objectives and influencing others to become actively involved (Kodama & Fukahori, 2017). The author will also identify a nurse from the remaining nursing staff to serve as a change advocate. This nurse’s role will entail persuading other nurses of the project’s importance and communicating the leadership’s objectives to them.
Utilizing Change Theory for Developing Strategies
The change endeavor aimed at reducing nurse turnover rates will be executed based on Lewin’s Change Model. This choice is rooted in the model’s premise of influencing organizational behavior (Shani & Noumair, 2017). The model will serve as a guiding framework to harness the driving forces that can steer UMTB employees at the medical-surgical unit in the desired direction as envisioned by the unit’s leadership. Additionally, this theory will empower the unit’s leadership to gauge the strength of the forces contributing to high nurse turnover and prescribe the necessary interventions to curtail it.
The initial step of the model involves “unfreezing,” which necessitates altering existing behaviors to attain equilibrium, conformity, and overcome resistance. During this phase, the unit’s leadership and change agents will conduct a thorough analysis of internal and external factors that support the need for change. Internally, factors such as nurse burnout, elevated readmission rates, deteriorating quality indicators, and increased mortality rates will compel the leadership to recognize the urgency of the change initiative (Halter et al., 2017). Similarly, external factors, including declining patronage, reduced patient satisfaction metrics, and diminishing revenues, will be used to convince the management. Equipped with information regarding the necessity for change, a dedicated team will be established to oversee the enhancement of interpersonal relationships through effective communication and other strategies, fostering change within the medical-surgical unit at UMTB.
The second phase of the change initiative, following Lewin’s model, is the actual change process. During this phase, the implementation of effective communication strategies will be instrumental in effecting change. The nurse leadership within the unit will adopt an informal communication approach to leverage informal social connections and relationships, thus improving interprofessional relationships between leadership and nurses at the medical-surgical unit (Zbieg, Batorski, & Żak, 2016). Additionally, a more formal communication method known as the cascade strategy will be utilized, wherein nurse managers will train nurse leaders, who will subsequently train nurse advocates responsible for conveying the information to their peers. The “unfreezing” process will encompass the initiation of the change initiative, with improvements in interpersonal relationships commencing from the interview stage.
Overcoming Obstacles to Change
The success of the change initiative will hinge on the support of stakeholders, including the organization’s leadership and personnel. Potential barriers may encompass a lack of support from the leadership and limited financial resources from the administration. Ineffective communication could also impede the initiative. To address these challenges, change initiative advocates will advocate for adequate funding while using data to convince the administration of the project’s necessity (Clayton, 2019). Furthermore, the formulation of an effective communication strategy to convey the initiative’s objectives to the leadership and delineate the roles of various change agents will help overcome these barriers. Monitoring the implementation process will allow the change team to address unforeseen issues in a timely and intelligent manner.
Methods of Evaluation
The evaluation methods for the change initiative will focus on improving the quality parameters and the well-being of nurses. The success of the project will be significantly determined by a reduction in mortality rates, enhanced patient satisfaction, and a decrease in the cost of care per patient. Moreover, other factors, such as the financial position of the unit, the turnover rate, and the nurse-to-patient ratio after the initiative’s implementation, will demonstrate the project’s effectiveness (Nelson‐Brantley & Ford, 2017). Evaluation of the change initiative will be based on comparative data collected before and after its implementation. The analysis of this data will reveal whether the project has succeeded based on individual parameters.
Strategies for Sustaining Change
To ensure the sustainability of change, it is crucial to identify potential threats to the project. The National Health Service Sustainability Model will be utilized for this purpose. Following this, UMTB will employ tools such as process control boards, performance boards, improvement hurdles, and standard work to guarantee the sustainability of change. Process control and performance boards will help change agents review the project with leadership, while standard work will visually communicate best practices supported by the organization as a result of the change initiative (Silver et al., 2016). Improvement hurdles will assess the project through meetings between leadership and nurses, facilitating the enhancement of interpersonal relationships.
Overall Effectiveness of the Change Plan
The mission statement of UTMB emphasizes the delivery of the highest quality patient care. The fact that reducing nurse turnover will improve quality parameters implies that the change initiative aligns with the facility’s mission statement and its goals. The change initiatives address stakeholder concerns by ensuring that the hospital’s patronage will improve, patient satisfaction will increase, and other quality parameters of the facility will also improve. As for the community, the enhancement of services through an improved nurse-to-patient ratio will ensure that the people of Texas benefit from quality healthcare as promised by the facility.
References
Burke, W. W. (2017). Organization Change: Theory and Practice. Thousand Oaks, CA : SAGE Publications
Cimiotti, J. P., Li, Y., Sloane, D. M., Barnes, H., Brom, H. M., & Aiken, L. H. (2019). Regulation of the nurse practitioner workforce: Implications for care across settings. Journal of Nursing Regulation, 10(2), 31-37.
Clayton, W. R. (2019). Overcoming barriers impeding nurse activation of rapid response teams. OJIN: The Online Journal of Issues in Nursing, 24(3).
Halter, M., Pelone, F., Boiko, O., Beighton, C., Harris, R., Gale, J., … & Drennan, V. (2017). Interventions to reduce adult nursing turnover: A systematic review of systematic reviews. The open nursing journal, 11, 108.
Hughes, V. (2017). Leadership strategies to promote nurse retention. Sci J Nurs Pract, 1(1), 1-5.
Jones-Schenk, J. (2017). Fostering personal power during change. The Journal of Continuing Education in Nursing, 48(8), 343-344.
Kodama, Y., & Fukahori, H. (2017). Nurse managers’ attributes to promote change in their wards: A qualitative study. Nursing open, 4(4), 209-217.
Nelson‐Brantley, H. V., & Ford, D. J. (2017). Leading change: a concept analysis. Journal of advanced nursing, 73(4), 834-846.
Scruth, E. A., Garcia, S., & Buchner, L. (2018). Work life quality, healthy work environments, and nurse retention. Clinical Nurse Specialist, 32(3), 111-113.
Shani, A. B., & Noumair, D. A. (2017). Research in organizational change and development: Volume 25. Bingley, UK: Emerald Publishing Limited.
Dont wait until the last minute.
Provide your requirements and let our native nursing writers deliver your assignments ASAP.