Title: Nurses Shift Changeover at the Patients’ Bedside
Over time, nurses have changed shifts with incoming nurses through discussions in hallways, or through the use of written reports. In many instances, these reports and discussions are effective. At other times, however, nurses have been known to overlook issues, due to incorrect information, or even miscommunication. This has led to instances where the patients’ safety is severely compromised. Some institutions have therefore found it better to conduct the shift changeover at the patient’s bedside. This ensures that the incoming nurse, assisted by written reports, is able to appreciate every aspect of the patient care. This method is particularly important since it includes the patient in the changeover, and they, therefore, feel as part of the process. While there are concerns about the privacy of information exchanged during discussions, the safety of the patient is enhanced and should be prioritized. This paper discusses the importance of this change, and what leadership, change management, and evidence can be employed to make it a success. Additionally, the role of innovation in healthcare is discussed in relation to the different approach to changing nurses’ shifts.
Change refers to a shift in how things are currently done. The change may be instigated intentionally or may be forced upon an organization by environmental forces. Change is inevitable in the current circumstances. It is, therefore, imperative for organizations to come up with change management techniques that will enable them to harness the change forces and make it a success. The change discussed in this paper is originated by organization’s leadership (Lorenzi &Riley, 2000; 2003).
While change is depicted as necessary, and even inevitable, organizations are frequently failing to implement change. By some estimates, as much as 70% of change processes in organizations end up failing or at least do not result in the desired results. This has been blamed on the failure of leaders in organizations to properly formulate and lead the processes required to implement change. In other instances, managers and leaders are ill – placed to deal with the likely upheaval that follows change implementation. To be better placed to handle change and boost success chances, managers need to understand the scope and necessity of the impending change. With this, they can be able to make the necessary plans, including preparing staff for it(Song, 2009; Ferreira & Abbad, 2013).
Once leaders have established the necessity of change and understood its scope, their next role is to come up with policies and processes that will help in the implementation of the change. Planning for change is important since it helps leaders in mapping out how the organization in general and its specific components are going to be affected(Gould, Kelly, White, & Chidgey, 2004). For instance, the change in how nurses change their shifts is not only a nursing affair. It will affect medical and non-medical personnel as well as the patients. The leader is therefore charged with ensuring that any changes he effects consider all these aspects. This involves placing key staff to manage the process and dealing with employee resistance(Song, 2009).
In the next phase of the change, leaders lead the organization in implementing the change. The change may be carried out in phases, to see the actual effects and make necessary adjustments, or it may be done wholesomely in line with organizational needs for the change(Siviter, 2011). Once this has been done, the leader shifts to any deviations from the plan, or change policies that are not producing the desired effect. The processes can be adjusted, or be replaced altogether with better policies. As leaders do this, they can be guided by specific leadership models, such as the transformational leadership theory, or the transactional leadership theory(Williams, 2014).
The transformational leadership theory emerged in the 1970s. It aims to show leaders as the products of the processes of interactions with their follows. These interactions result in good relationships that are high on trust, thereby motivating both the leader and the followers. The theory is important in change management since followers need to trust that the change their leader is proposing is the best not only for them, but also for the organizations they lead (Hader, 2013). The transactional leadership theory advocated for a positive and mutually beneficial relationship between the leader and the follower. The leader succeeds by coming up with a system that rewards or punishes the follower in line with the leader – assigned task. At the same time, the leader ensures that this system in well aligned with both individual and organizational objectives. In change management, leaders must try to personalize change. This means that their followers should be able to see that the change being proposed affects them both personally and as an organization. This will enable themto take more ownership of the change process(Abdourabl, 2012).
The transformational leadership theory would most apt for the change being proposed at the hospital. The change will be led by a manager or leader who has the trust, and therefore the backing of his followers. Like in many other institutions, hospitals are interconnected in their functions (Phang, 2014). A major change that affects the nursing staff, for instance, is also likely to affect doctors and other medical and non-medical personnel. This group includes health information management professionals and laboratory technicians among others. Transformational leadership is able to appeal to all these groups to embrace change, and with the strong relationship and trust, deal with any fears that might lead followers into resisting change. In practice, the change process will require followers and leaders to be motivated in making their organization a better institution. They will need to trust each other, and thereby cooperate in ensuring that the change process initiated by the leader succeeds(Abdourabl, 2012; Al-Sawai, 2013).
It is an accepted fact that nursing leadership is an essential element in the improvement of global health care situation. This is informed by the important role that nurses play in shaping health policy, both within the hospital and at a national level. Additionally, nurses are able to form strong bonds with patients. Using these, they can be able to identify the most important patient – centered care initiatives. The change discussed in this paper, for instance, proposes a change that will make healthcare more patient- centred, and extensively exploit nurses’ special role in providing healthcare to their patients. Leadership in clinical behaviors, can therefore, be demonstrated, and have a powerful impact, on all levels of nursing care(Hartley & Bennington, 2010).
SWOT Analysis
A Swot analysis is a thorough internal assessment of an organization’s status. The assessment is carried out by analysing the strengths, weaknesses, opportunities and threats that face an organization, or a process within it, with the eventual aim of making it better. Swot analysis is also important since it looks at both internal and external elements of an organization or a process, and details the effects of these interactions.
Strengths
Bedside shifts amongst nurses have been successful in improving the accuracy of information exchanged between nurses during the changeover process. This has resulted in better outcomes for patients’ science the information shared between them is accurate, as opposed to when the reports are shared between nurses in other settings, such as hallways. Since the information is relayed to the other nurse in front of the patient, the patient has a better understanding of the process and is, therefore, more involved. As hospitals try to achieve patient – centered care, this is a useful avenue of doing so. It has also been established that by changing shifts at the bedside, nurses are able to leave work on time. This is because both nurses understand that they have to be present for the changeover (Gregory, 2014). This has implications for employee morale, as well as patient safety. It’s important to note that a happy nurse translates directly to a happy and better feeling patient since they are treated well with a lot of empathy, love and care. As nurses become more involved with the health of their patients, they are also able to create the rapport necessary to provide high quality care to patients. This practice, therefore, enhances the quality of health services a hospital offers (Wakefield et al, 2012).
Weaknesses
The process of bedside shift changes is costly to implement and maintain. Nurses need to have sufficient time with patients, meaning that overall; the hospital will need additional nurses to sufficiently provide their services. The process also needs extensive training, so that nurses can properly(Sand-Jecklin & Sherman, 2014; Spinks, 2015). This also should involve a continuous development program to develop every personnel at the hospital. The development include trainings as mentioned above, surveys where both clients and the nurses focus on three questions which are what need to be changed to improve quality of service, what are you doing that satisfactory and what changes would everyone else like to see. Also brainstorming sitting with management helping to solve problem.
Opportunities
Through this method, it is possible for the healthcare institution to significantly improve the quality of services offered. Additionally, the change can be used to pilot other care projects intended to improve the overall quality of services. The nurses shift changeover policy will only be orchestrated with the full support and participation of the entire hospital. Its success will, therefore, serve as a template for the organization, as it tries to effect further changes in the hospital(Rush, 2012).
Threats
Nurses have fears that the sharing of information may sometimes be contrary to HIPAA regulations. They may, therefore, resist change due to fears that they may commit gross misconduct in the line of duty. This will need more training and a thorough understanding of HIPAA regulations, as well as the bedside changeover policy. At the same time, patients may not be overly comfortable with the frequent sharing of personal information with a wide variety of nurses, care must be given to patients who have these fears, to help array them and enable themto understand that the exercise is in their best interests. The reaction of the nurses to the changes should also be considered. Negative changes will be countered by strong leadership which will inspire trust and motivate the participants of change(Sand-Jecklin & Sherman, 2014).
Change is a three – step process, and not an event. The process fromcurrent, through a transition to the new normal, is present in all forms of change, whether they are voluntary or forced by circumstances. The change process in most organizations never stops. In hospitals, this is even truer since these institutions are tirelessly seeking ways to improve service delivery to their patients, and streamline operations. However, change can only be successful if it is well managed. Organizational change is an aggregation of individual changes. The process may be challenging for some, and change management helps provide the necessary support to these employees so that the intended change can be actualised. Individual change is more successful when the individual is aware, has desire and knowledge about the change, has the ability to sustain the change, and sustain it(Prosci, 2017).
Organizational change involves a set of plans that need to be effected to support individual change. Training is of vital importance. Through training, the skills of the individual are improved, and they havereadied for the changes afoot. Communication during the process is also crucial. Participantsin the change process need to be fully aware of every step of the way so that they can be better(Prosci, 2017).
Lewin’ theory is a three- step model that can be well applied to the case. Since change involves opposing forces, successful change can only be achieved once leaders are able to understand these forces, and consequently shift the power of the forces, thereby effecting change. The unfreezing, movement and refreezing are the main parts of this process according to Lewin. After unfreezing, a new equilibrium is achieved, and the results frozen as the new normal. Prochaska and DiClemente’s theory of change also follows a similar process but is more detailed. According to the two theorists, change is a five – step process which involves pre – contemplation (the period before the change), contemplation, preparation, action, and maintenance. In this manner, this theory is a cyclical process. It helps in showing that change is not linear, with a definite beginning and end. Rather, it is a process that may sometimes fail to achieve the desired results, forcing adjustments to be made to it(Kritsonis, 2005). For the purposes of this change, Prochaska and DiClemente’s theory will be applied, due to the complexity of the change (Caldwell, 2008).
The change model implemented will have five phases. During the pre-contemplation phase, the hospital’s nurses conduct their affairs as usual. Changeovers are done through a discussion in the hallway, followed by a brief note either handed over here or written and left at the patient’s bedside. Due to the problems being faced in this way of doing things, the hospital’s management is contemplating a new model to replace it. The new shift changeover will include a way of nurses and discussing the patient at the bedside, and thereafter exchanging any other material that may be necessary. This will enable the new nurses to better care for the patient, despite not having experienced the specific case(Peterson & Mace, 2006).
In the third phase of the process, management and employees start preparing for the change process. This may include extensive training for the impending changes, and dealing with any concerns about it. The process should also involve clear communication to ensure all participants in the change process are on the same page, especially the nurses and their supervisors. One the preparations are done, the fourth process commences. This is the period of actual change. The change is rolled out, and nurses are no longer handing over patients in the patients’ absence. Throughout the process, a close monitoring of the process is undergoing. This will ensure that the change takes the course it was supposed to take, and that any issues involving the change are swiftly dealt with. After the change has fully been implemented, management will adopt this as the new way of doing this. There are steps to make the change permanent, using further training, and scrapping away the old ways of doing things (Hewitt – Taylor, 2013).
The role of nurses in the whole process cannot be overemphasized. As the primary drivers of change, they work as change agents. This means that through time, the organization will be able to achieve highly significant and positive changes in their operations. The changes will be in terms of the quality of healthcare delivered to patients, and in the morale of personnel. While it may be costly, there should be an increase in revenues, something which will offset this added cost.
Nurses are crucial players in healthcare provision. It is, therefore, obvious that in the process of carrying out a change that will have a profound effect on the way that nurses perform their duties; the clinical aspect of the hospital’s services will be fundamentally changed. It then follows that because of the nurse’s role in healthcare, the proposed change will change the way that not only nurses operate, but also other professionals including clinical officers, doctors, health information officers among others.
One of the most important aspects of quality healthcare is effective communication between medical personnel concerning a patient. Bedside shift changes between nurses have been found to be one of the most effective ways of ensuring communication between nurses is accurate. This ensures that nurses will give the right medication and the right information both to their patients and to other personnel. The result is an improved service at the hospital. The change was effected at a 20 – bed hospital and resulted in improved statistics in all areas of patient care(Wakefield et al, 2012).
The method that is followed during the change is sometimes as important as the change itself. Research has established that when nurses are fully involved in the process. Since they are the primary agent of change and the core element in the change process, it will only make sense if they are enabled to own the process. This can be done in consulting them before change is implemented, and electing champions amongst them, who will help the other nurses in preparation and implementation of the process(Herceg, 2015).
Change management is greatly assisted by the appreciation of the complexity involved. For instance, the change process proposed in this paper has five phases, each with its own intricacies. The main barriers to change are resistance to change, as well as the lack of a clear plan. Resistance to change comes in when people are unable to accurately predict what the future bodes for them in connection with the change. When management is not clear in communication and does not adequately train the change agents to better embrace the change, their plan is destined for failure. When managers cannot predict the destiny of the organization and its members after a change that they have introduced, they will give rise to confusion and resistance from employees, undermining the chances of success (Al Abri, 2007).
From the above analysis, it is clear that shift change at the bedside is strongly supported by evidence, and will result in several benefits, for all involved. The most important aspects will be bringing nurses on board for the implementation and providing strong leadership that can be deemed to be transformational and inspirational to all parties involved.
Conclusion
Change management is necessary, due to its inevitability and the current world that is constantly and rapidly changing. As shown in Prochaska and DiClemente’s theory, change is not a linear process, but a cyclical one. For an organization, the most important thing is to be prepared for change, by adequate preparation, and having the right leaders takes charge of the process. These leaders will build mutual trust through relationships, and ensure that the individuals who are most responsible for the change actually lead in championing it.
In some instances, the change is far reaching; such as the one proposed above, the change has clear advantages for everyone involved. However, it still arouses some issues which, without appropriate resolution, may spell doom for the whole process of change.
References
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