NR 451 Week 6 Discussion Post: Implementing Change Despite Resistance

NR 451 Week 6 Discussion Post: Implementing Change Despite Resistance

Implementing Change Despite Resistance – 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.

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his is not an easy task.  I never want to come to work on my days off.  Maybe a gift card 

is purpose.  In my opinion, people that are interested in management, often join committees.  According to Barry, “Compensating employees on the committee with bonuses, overtime pay or perks such as additional time off can be useful in persuading them to take part.” 

http://yourbusiness.azcentral.com/motivate-staff-part-committee-16866.htmlLinks to an external site. 

No one likes change, but to keep healthcare evolving, change has to be implemented constantly. We always hear nurses say, “that’s how I’ve always done it”. Change can be very hard especially for those that have not had to change in years. Change is not done just because, there is a reason for change to be implemented into the work setting to make practices better. I like this old process of change integration. The need for change becomes apparent once the problem is identified and a suitable solution is created. Involvement is sought from those who would be affected by the change and the changes are integrated (Andrews, 1993). 

If I implemented early discharge planning in acutely ill or injured hospitalized older adults to decrease hospital readmissions, I would expect resistance from nurses to “not have the time” to talk about the patients discharge plan because “that is what the social worker is for” and it just adds more “stress to our job”. From a nurse’s perspective, this just adds more to their “work load”, but providing them with an efficient way to complete this process could transition the change smoothly. “Nursing work can be both physically and emotionally exhausting” (American Nurses Association, 2015, p.22). I have heard the phrase, “the facility and administration wants to look good on paper, but they have no idea what the nurses are expected to do on a day to day basis”. I think that resistance will be met until the implementation is put into place and adjusted continuously until those who the change or implementation is affected see a positive outcome from the change.

I would make sure communication to the stakeholders, or those that the change will be affected by, have been educated on the process and voice their thoughts. This can be a difficult task especially if the stakeholders were not involved in the planning stages, so involving them early in the process would be important. I would educate them on the reason for this change and the numbers of readmission occurring because of ineffective communication or understanding at the time of discharge. The stakeholders could have a lack of education with why these readmissions occur. I would be sure to educate them on the benefits for patients, staff, and the facility. Educating those involved in change is very important and may help reduce resistance (Curtis and White, 2002). 

References: 

American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author. 

Andrews, M. (1993). Importance of nursing leadership in implementing change. British Journal Of Nursing, 2(8), 437-439. 

Curtis, E., & White, P. (2002). Resistance to change: causes and solutions. Nursing Management- UK, 8(10), 15-20. 

Every change will have to be “tweaked” after implementation to better the process.  The pain for nurses and stakeholders is short as long and the change is flexible and has the ability to be edited and responsibilities are worked out. How would you track the added time to nursing?  How would you find out how the change impacted nurses time? 

Evidence based practice (EBP) is one reason facilities have been so successful, such as Magnet hospitals. They have implemented systems that foster evidence-based care which has improved patient centered care and nurse satisfaction. Patient safety and quality of care have benefited nursing greatly. We need the older experience, but we also need to take the burden out of care which comes with the technology (Saver, 2006). Although I am not exactly sure how to track the added time to nursing, I would imagine the change might be tracked from the start to the amount of times the change was tweaked and implemented into practice. To find out how the change impacted the nurses time, I would create a survey or interview the nurses and stakeholders to find out how the change impacted their time. Was it a successful change? Sometimes change looks good on paper and in the talks, but once it is given to the stakeholders to be implemented the change can be a problem for everyone. 

Reference: 

Saver, C. L. (2006). Nursing- today and beyond. Journal Of American Nurses Association, 1(1). Retrieved from https://www.americannursetoday.com/nursing-today-and-beyond/ 

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. 

Well, “change can be uncomfortable, difficult, and requires a new way of thinking and dojng.” Many do not like change, when they are stuck in their old ways, and not willing to learn and embrace new things, they believe the change is a waste of time, unnecessary,  and will not make it better. I witnessed myself how negative and closed mine many can be, and not willing to try, many are fearful and may feel a lack of competence, control, and a lack of support. While implementing a new way of discharge intervention to prevent early 30 day readmissions, first establish trust, listen educating, open conversation, allow employees to engage and participate.  

  Reference: 

American Nurses Association, 2015. Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author. 

http://www.thebalance.com 

I agree that people are often resistant to change. “In the FY 2012 IPPS final rule, CMS finalized the following policies with regard to the readmission measures under the Hospital Readmissions Reduction Program: Established a methodology to calculate the excess readmission ratio for each applicable condition, which is used, in part, to calculate the readmission payment adjustment” (Readmissions-Reduction Program, 2016). With this ruling, it is no longer a suggestion that facilities decrease readmission. This is a ruling that affects the finances of the facility. When a facility loses money, change is inevitable. Even though non-managerial employees may be resistant to change, the upper management is very supportive of opportunities to decrease admissions to increase financial gain. These times are the best to put all your ideas on the table. It is the best time for nurses to have their voices heard. Facilities are in the money-making business and nurses have the opportunity to make a difference. 

Reference: 

Readmissions-Reduction-Program. (2016, April 18). Retrieved October 03, 2017, from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatient PPS/Readmissions-Reduction-Program.html 

Spoken like a true administrator!  :-)  When DRGs were the payment of the day, we were kicking patients out way to early to free up beds for the next customer.  I felt this was unethical and apparently the HHS and CMS found this to be a reason for hospital readmission.  This too was for hospital profits.  Not all organizations did this but it was happening more often that it should have. Nursing must follow their own conscience as to what is right for the patient and not always the organization.  Organizational profits are certainly important, with out them we would not have a paycheck but profits gained due to poor patient outcomes is not what we are in the business for.