Assessment Description

As  an advanced registered nurse, you will serve as a leader within your  organization. Part of this role will entail being a change agent and  spurring positive change on behalf of patients, colleagues, and the  industry.

Consider a situation you experienced previously where  change did not go as planned in your health care organization. Create a 13-15-slide PowerPoint presentation in which you will assess the  situation and the steps that should have been taken to successfully  implement change. Create speaker notes of 100-250 words for each slide.  Include an additional slide for the title and references. For the  presentation of your PowerPoint, use Loom to create a voice-over or a  video. Refer to the topic Resources for additional guidance on recording  your presentation with Loom. Include an additional slide for the Loom  link at the beginning and another at the end for References.

Title Page (1 Slide) 

Body (13-15 Slides) 

References (1 Slide)

Include the following in your presentation:

1. Describe  the background of the situation and the rationale for and goal(s) of  the change. Consider the ethical, social, legal, economic, and political  implications of practice change in your response.
2. Outline the advanced registered nurse’s role as change agent within the interprofessional and dynamic health care environment.
3. Identify the key interprofessional stakeholders (both internal and external) that should be involved in change efforts.
4. Discuss  an appropriate change theory or model that could be used to achieve  results. Explain why the theory or model selected is best for the  situation. Include the ethical, social, legal, economic, and political  implications of applying the change management strategies to practice  change in your response.
5. As an advanced registered nurse, outline how you would initiate the change.
6. Describe  the impact to the organization if the change initiative is unsuccessful  again, and potential steps the interprofessional team could take if the  change is unsuccessful.
7. Predict what additional factors will  drive upcoming organizational change for the organization and outline  the advanced registered nurse’s role as change agent.

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APA Writing Checklist

Use this document as a checklist for each paper you will write throughout your GCU graduate program. Follow specific instructions indicated in the assignment and use this checklist to help ensure correct grammar and APA formatting. Refer to the APA resources available in the GCU Library and Student Success Center.

☐ APA paper template (located in the Student Success Center/Writing Center) is utilized for the correct format of the paper. APA style is applied, and format is correct throughout.

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Scholarly Resources: Scholarly resources are written with a focus on a specific subject discipline and usually written by an expert in the same subject field. Scholarly resources are written for an academic audience.

Examples of Scholarly Resources include: Academic journals, books written by experts in a field, and formally published encyclopedias and dictionaries.

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Adapted from “Evaluating Resources: Defining Scholarly Resources,” located in Research Guides in the GCU Library.

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In order to address the concerns of the outreach committee members, I would allow a discussion on the issue concerning the position statement on spiritual care. A transformational leader encourages their followers to question and challenge the organizational views and positions (DeNisco, 2021). During the change process, it is important to ensure that the views of all stakeholders are heard. I would therefore advice the dissatisfied outreach committee members to accommodate dialogue instead of issuing ultimatums in the event position statement is not revised or reversed. Probably, the members would change their views if they are informed on the importance of spiritual care.

A nurse leader can draw on the change theories in addressing the issues raised by the committee members. Some change models such as the Kotter and Lewin change models encourage the development of a unifying vision for the change project. The Kotter model emphasizes on the need for the leader to engage and empowers the others (Mahmood, 2018). On the other hand, the Lewin model focuses on the need to enable and prepare the others (Mahmood, 2018). When the members of the committee are prepared and enabled, they are likely to have confidence on the change process and therefore participate and take ownership of the position statement.

NUR 514: Implementing Change With an Interprofessional Approach Presentation References

DeNisco, S. M. (2021). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning.

Mahmood, T. (2018). What models of change can be used to implement change in postgraduate medical education? Advances in Medical Education and Practice, 9, 175–178. https://doi.org.10.2147/AMEP.S160626.

Health care organizations apply different strategies to improve health outcomes. Practice change improves health outcomes by addressing performance gaps and introducing new processes (Busetto et al., 2018). However, change does not always occur as planned, which can have far-reaching impacts on financial assets and workplace relationships. Therefore, the purpose of this presentation is to describe a situation where change did not go as planned in the workplace and the steps that should have been taken to implement change successfully. Central discussion areas include a background of the situation, the nurse’s role as a change agent, and stakeholders essential in change management. Other areas include a presentation of change theory, impacts of unsuccessful change, and factors to drive upcoming organizational change.

The situation where change did not occur as planned involved the introduction of a zero-tolerance policy in the organization in response to increased cases of bullying. As Mrayyan (2018) stated, zero tolerance towards workplace violence encourages nurses not to endure violence and report it immediately after they encounter it. The law also severely punishes those who commit violent acts like bullying against health care providers. Like other practice change activities, the nursing staff was supposed to be adequately prepared for policy change to embrace it fully. Unfortunately, the management introduced the policy abruptly, which reduced the staff’s commitment to implementing it fully. Hence, it did not achieve the outcomes as projected.

Health care professionals should work in safe care environments to deliver quality patient care. According to Al-Ghabeesh and Qattom (2019), bullying is damaging to the health and productivity of nurses since it impairs their emotional health and increases their desire to quit their occupations. Therefore, zero tolerance towards bullying is a practical intervention for optimizing employee productivity and protecting nurses from the adverse effects of workplace incivility. Homayuni et al. (2021) found that bullying is associated with depression and distress in nurses, which hampers interprofessional collaboration and their ability to provide quality care. A zero-tolerance policy protects the staff from such health dangers and ensures civil conduct among employees as they work to achieve a common goal.

Nurse leaders should introduce and guide while looking forward to achieving multi-dimensional impacts. Practice change achieved by implementing zero-tolerance policies can help to promote ethical conduct among nurses, which is characterized by behaviors that prevent harm and ensuring that employees are responsible for their actions. From a social dimension, nursing practice is conducted in social environments with diverse practitioners. Preventing behaviors that hamper teamwork and cooperation is instrumental in building healthy relationships among diverse teams. Mrayyan (2018) stressed the importance of a zero-tolerance policy in preventing costly medical errors. Preventing such errors also minimizes legal issues stemming from patient harm and improves the organization’s reputation and relationship with partners.

The advanced registered nurse’s role as a change agent is critical for the progressive improvement of patient care outcomes. According to Rafferty (2018), nurses and nurse leaders are directly involved in patient care, and their influence, skills, and guidance are valuable in change implementation. Skills utilization is demonstrated by continuous assessment of practice gaps and introduction of interventions for enhancing performance. Nurse leaders also use their knowledge and skills to promote evidence-based innovation and lead behavior change practices like zero-tolerance policies, motivation programs, and infection control. Other roles include designing and delivering health policy as nurses and patient advocates and mentoring nurses to embrace change to reduce resistance toward new practices.

Stakeholders play a critical role in change implementation. The type, direction, and success of organizational change depend on stakeholder engagement, participation, and support (Jasinska, 2020). One of the key stakeholders involved in change efforts is the caregivers, including nurses and physicians. They are directly involved in change efforts since many practice changes cannot be conducted without them. The organization’s management plays a crucial role in supporting change through resources and preparing the organization for change. Other stakeholders with varying roles include patients, partners and suppliers, political and legal representatives, and accreditation agencies. These stakeholders should be adequately informed about organizational practices to determine whether the organization promotes care quality and patient safety as professionally obliged.

Kurt Lewin’s change management model is highly appropriate for change implementation in a dynamic health care environment. Its basic concepts include driving forces that push change in the desired direction, restraining forces that counter change efforts, and a state of equilibrium. As Hussain et al. (2018) explained, practice change occurs progressively in three basic steps: unfreezing, changing, and refreezing. Unfreezing is primarily about preparing the nursing staff and other stakeholders to understand and embrace change to counter possible resistance. The changing phase involves transitioning to new behaviors and work routines, while refreezing involves sustaining the new status to achieve lasting effects.

Change leaders apply different change models for different reasons. Besides guiding change management in a simple and straightforward process, Lewin’s change theory aims to understand and demonstrate why change occurs (Hussain et al., 2018). Accordingly, change leaders can justify the change and visualize the outcomes. Lewin’s theory also accounts for uncertainties and resistance to change. In most instances, resistance to change occurs when the nursing staff and other stakeholders are not engaged in the change process. To overcome resistance, Lewin’s theory stresses the need for clear and convincing communication and education about the need for the change during the unfreezing phase (Deborah, 2018). Above all, the phased change management helps change leaders to introduce and implement organizational change procedurally.

Organizational change has profound impacts on care quality and work processes. Hence, the change management strategies applied should be centered on achieving change without adverse impacts on behaviors, social relationships, and finances. Due to its straightforward nature and simplicity, Lewis change management model ensures that change is implemented without ethical misconduct or negative impacts on workplace behaviors. The simple process is also economical since it does not include many steps that can be tiring or consume massive resources. Change management through positive behavior change also protects patients, health care professionals, and other populations. Doing so protects the organization from possible reputational damage, which can be politically, ethically, and legally costly.

Advanced registered nurses should be aware of change implementation barriers before initiating practice change. After identifying the change and potential impacts, I would develop a comprehensive implementation plan to share with the management and the nursing staff. Next, I would communicate the change to nurses and all stakeholders since lack of it was the main reason for the initial change failure in the facility. Communication is crucial in the unfreezing phase of change management since it helps stakeholders to understand the change and its importance (Deborah, 2018). The next step would be actively engaging stakeholders to implement the change before its evaluation to determine whether it achieved the desired effects.

Change implementation is usually a lengthy, laborious, and resource-intensive process. It requires preparation, continuous communication, and engagement of stakeholders. Unsuccessful change implies potential misuse of the organization’s resources such as zero tolerance policy handouts and finances used communication and other crucial processes. Since the goal of the change process is to prevent bullying, failure to achieve this goal would increase nurses’ exposure to workplace bullying. Al-Ghabeesh and Qattom (2019) found that bullying lowers nurses productivity since it is psychologically harming, and the same would be witnessed in the organization. Other potential outcomes include increased risk to patient care and disappointment with the change process.

Nurse leaders should never give up with organizational change. Consequently, they should have a backup plan if change is unsuccessful. The most effective intervention to address the current scenario if change does not succeed is a collaborative process and impact assessment. In this case, nurses, nurse leaders, and the management would collaborate to assess why practice change failed and practical remedies. The role of the collaborative assessment would be helping the change team to address implementation barriers before reintroducing the change.  Such barriers include communication problems, a resistance culture, and a lack of stakeholder support (Busetto et al., 2018). As the implementation progresses, the change team should seek continuous feedback from stakeholders while monitoring reactions and impacts. Such an impact would help to fix any issue hampering the process timely and conveniently.

Successful organizational change is achieved through a combination of factors. Besides stakeholder engagement and communication as mentioned earlier, employee growth and development will play a crucial role in driving upcoming organizational change. Largely, employee growth and development will equip employees with the skills, knowledge, and attitudes necessary for continuous quality improvement in health practice. Organizations ready for change must foster innovation through nurse leaders who seek new ways to transform and influence higher care quality through new care delivery models (Snow, 2019; Mutonyi et al., 2021) Accordingly, the advanced registered nurse must be at the center of innovation and transformation through continuous assessment of performance gaps and fostering a culture of change in the organization.

As demonstrated in this presentation, the primary goal of practice change is to optimize health outcomes. As a result, nurse leaders and other health care professionals in advanced practice should continually assess performance gaps, promote innovation, and lead behavior-change practices. Since practice change should be systematic and procedural, the advanced registered nurse should initiate change using theoretical guidelines. Kurt Lewin’s change management theory can be applied to introduce change in the organization to achieve the best results. It stresses preparation for change and sustaining it, which are critical to successful change. Additional drivers of change in the organization include the management investing in innovation and employee growth and development programs.

NUR 514: Implementing Change With an Interprofessional Approach Presentation References

• Al-Ghabeesh, S. H., & Qattom, H. (2019). Workplace bullying and its preventive measures and productivity among emergency department nurses. Israel Journal of Health Policy Research, 8(1), 1-9. https://doi.org/10.1186/s12913-019-4268-x
• Busetto, L., Luijkx, K., Calciolari, S., Ortiz, L. G. G., & Vrijhoef, H. J. M. (2018). Barriers and facilitators to workforce changes in integrated care. International Journal of Integrated Care, 18(2), 1-13. http://doi.org/10.5334/ijic.3587
• Deborah, O. K. (2018). Lewin’s theory of change: Applicability of its principles in a contemporary organization. Journal of Strategic Management, 2(5), 1-11. https://stratfordjournals.org/journals/index.php/journal-of-strategic-management/article/download/229/274
• Homayuni, A., Hosseini, Z., Aghamolaei, T., & Shahini, S. (2021). Which nurses are victims of bullying: the role of negative affect, core self-evaluations, role conflict and bullying in the nursing staff. BMC Nursing, 20(1), 1-9. https://doi.org/10.1186/s12912-021-00578-3
• Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: a critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. https://doi.org/10.1016/j.jik.2016.07.002
• Jasinska, J. (2020). Stakeholders identification affecting the scope and the changes in the health care system. Frontiers, 1(03), 1-15. doi: 10.2020/fmcr/000013120
• Mrayyan, M. (2018). Work place violence: A “zero tolerance” policy. EuroMediterranean Biomedical Journal, 13(16), 078-079. 10.3269/1970-5492.2018.13.16
• Mutonyi, B. R., Slåtten, T., & Lien, G. (2021). Fostering innovative behavior in health organizations: a PLS-SEM analysis of Norwegian hospital employees. BMC Health Services Research, 21(1), 1-15. https://doi.org/10.1186/s12913-021-06505-1
• Rafferty, A. M. (2018). Nurses as change agents for a better future in health care: the politics of drift and dilution. Health Economics, Policy and Law, 13(3-4), 475-491. https://doi.org/10.1017/S1744133117000482
• Snow, F. (2019). Creativity and innovation: An essential competency for the nurse leader. Nursing Administration Quarterly, 43(4), 306–312. https://doi.org/10.1097/NAQ.0000000000000367

DeNisco & Barker (2019), identify a change model that is based on Complexity Science. Complexity Science, as applied to a healthcare environment, emphasizes that the environment is a complex adaptive system, with many individuals from different professions, expertise, educational backgrounds, religions, etc, who depend on each other in the work of the organization. These people are part of the organization as a whole, which is also a complex adaptive system (DeNisco & Barker, 2019). The change model has 8 steps. A very important point made in this model was the need to form a change team, stating that “changes should be planned and implemented by a change team, not by one or two people imposing their ideas and processes on others” (DeNisco & Barker, 2019. P. 132). This would allow for input from several people who may be affected by the change. The stakeholders are determined as one of the steps, along with the forces for and against the change. This model is a systematic process for identifying change need, developing a vision, identifying people and forces involved, developing a plan, implementing and evaluating the change and then incorporating the change into the organization. The stakeholders in the change process; management, clinical staff, support staff, whoever is on the committee, all have responsibility to participate fully in the team process. They will be expected to attend meetings, come prepared with assigned duties complete, and remain open to other changes that may come up as the adaptive system evolves.

This change model points out that there are driving forces for change, and restraining forces against change. In my work, one of the biggest restraining forces for us to overcome, and the reason for many of our failures to initiate and sustain change, was the clinical manager, who was very resistant to change. She said so many times, “this is the way it always has been done”. She also often initiated change from the top, and then never followed up, so change became more of a suggestion, not embraced by the rest of the stakeholders.