Scenario 1: Inpatient Nephrology Unit
In this scenario an issue in inpatient nephrology unit has been reviewed, where a gap in documentation of patient’s daily intake/output records have been revealed. Lack of documentation affects the patient’s plan of care, which is increasing the length of stay for the unit. The key issue that has been found in this scenario is the lack of communication within morning and night shift nurses, which is ending with misinterpretation of patient’s medical care.
Change theory of nursing was developed by Kurt Lewin, which includes three major concepts; these are driving forces, restraining forces and equilibrium. On the other hand, the author defined three stages in this nursing theory, these are unfreezing, change and refreezing. In the case scenario, the new nurse manager would explore leadership skills for introducing a change to mitigate the nursing issue (Grohar-Murray, DiCroce & Langan, 2016). For integrating this change, three steps of change theory would be followed; the initial step will be unfreezing, when a suitable strategy for solving the emerging problem would be found out. In the next step, the strategy is being implemented in the changed environment, it is the step to “move to a new level”, which will involve change in behavior, feelings and thoughts. The last step is freezing, when the changes are established for making these “standard operating process”. In the case scenario, the nurse manager has to increase driving force for implementing the change in a simple and positive way.
Strategies and Rationale
In the case scenario, the nurse manager will adopt the transformational leadership style for mitigating the issue, as this leadership style helps the leader to support or work for change, for redirecting the follower’s thinking according to the change. It will also influence the nurse manager to increase driving forces that will encourage followers to accept the change. To mitigate the current issue, the nurse manager will arrange a meeting with both the morning and night shift nurses, where the issue will be discussed thoroughly to identify the key issue. Upon discussion, ‘hand offs’ process will be integrated in the system (Kelly, 2011). During the meeting, nurse manager will collect the consent from followers to implement the change. As a driving force, a hand offs training would be introduced for quality service delivery. Through the system, morning shift nurse will convey all the patient information to the staff in next shift, thus, information about necessary documentation will conveyed and there would be no misinterpretation.
Successful implementation of change based on leadership style would be measured by evaluating staff satisfaction and improved patient’s outcomes, as a result of improved documentation. Some nurses might not accept the change, which might affect success of the intervention; to mitigate the issue, the staff can be empowered by integration f a reward system based on performance and reduced rate of documentation error.
cWhile making this change, nurse manager will follow professional and ethical standard. According to value statement 2, nurse manager will respect to follower’s value and will make informed decision-making, through ethical management of information. “Nurse manager will support the health, wellbeing and informed decision-making of people requiring or receiving care”.
Scenario 2: Outpatient Chest pain/Stroke Unit
In the current scenario, it has been seen that in stroke patients, administration of aspirin is not documented properly and time to CT scan for acute stroke patient is higher than the benchmark time. In addition, the organization has applied for Joint Commission accreditation. Thus, the organization also needs to prepare the staffs and operation for JC survey.
As discussed in previous section, change theory is based on three elements, driving force, restraining force and equilibrium. In the current scenario, there is retraining forces that are hindering Joint Commission accreditation achievement. The change theory will direct the nurse manager to adopt the best suited leadership style (Curtis, Vries & Sheerin, 2011). Thus, to mitigate the above discussed issue, nurse manager will adopt transformational leadership style.
Strategies and Rationale
In the current scenario, nurse manager will have two priorities to focus. One is proper documentation and other one is meeting the CT scan interpretation time for meeting Hospital outpatient core measure set standards for Joint commission accreditation survey. The nurse manager will introduce e-health record in the hospital system, for mitigating the aspirin documentation issue and will arrange team training for proper use of e-health record; it will reduce the documentation error. On the other hand, the cardiac specialist physician will determine examine compliance of joint commission measures with the hospital standard, and train the existing staffs regarding reducing CT scan interpretation time from 75 minutes to 45 minutes, thereby meeting the JC standards (Northouse, 2015). Transformational leadership style will facilitate this change by motivating followers. Transformational leadership in this context will help to influence followers to accept change in accordance to the current situation in organization. Moreover, in this leadership style, leader is not limited by his or his follower’s perception; rather change would be implemented on the basis of Joint Commission accreditation standards.
Successful implementation of these strategies will enhance quality of services in the hospital, thereby enhancing the chance of getting Joint Commission accreditation. While implementing new interpretation time for CT scan, resistance might come from old staffs, through in-depth training regarding the importance of 45 minutes instead of 75 minutes in CT scan would help them to understand the rationale behind the change. Finally, through an internal survey of staffs can help to measure outcomes (Shirey, 2013).
To implement change in the current context, the nurse manager will follow all the professional, legal and ethical standards. While implementing the e-health record, according to the data protection act 1998, all the information will be kept confidential. According to the value statement 7 and 1, the nurse manager will value quality nursing care for all patient and will manage al the information in an ethical way. Moreover, according to code statement 1 and 2, he will ensure safe and competent practice in accordance with the professional and broader health system standard, which will also include the hospital outpatient set of measures provided by Joint Commission to achieve accreditation.
Scenario Three: School nurse
In the current case scenario, school nurse addressed a huge community issue. In the school locates in a small rural conservation town, significant increase in STD has been addressed and it has also been observed that 3 girls in junior class are pregnant. The community insists school to teach students about only abstinence, and the school board does not want to anger community. However, lack of knowledge throughout the community is a major community health problem, which needs to be addressed immediately along with a change.
Change theory includes three elements, restraining forces, driving forces and equilibrium. There are several restraining factors to implement change in the community; one of the key restraining factors is community member’s participation in this issue, they just wanting to avoid the issue, instead of finding a solution (Sandstr?m et al., 2011). On the other hand, school board is also supporting community members, instead of taking a community based approach. The change theory will help the school nurse to identify the problem and find the strategy to mitigate the issue by influencing driving forces.
Strategies and Rationale
In the current context, school nurse have to adopt a democratic leadership style initially, to support the community members, by giving value to their culture and perception. It will help to establish trust of community members towards change. While integrating change in the system, transformational leadership will be the best option. Initially, the school nurse will start from the school level and the health promotion regarding reproductive health and contraception will be integrated in regular routine along with their, where students will also get the opportunity of regular health check up. It will have a long term vision of raising awareness through the entire community. However, as school board does not want to anger parents, initially students will be influenced to spread their awareness within the community. Through a simultaneous evaluation, the awareness would be evaluated. After 3 months, a community campaign regarding STD transmission and reproductive health will be conducted, where the need for including reproductive health studies to be included in school syllabus will be discussed with parents and other community members (Yoder-Wise, 2014). To implement the change, it transformational leadership style will be suitable as it helps to influence driving forces in the community, thereby raising awareness.
The success of intervention will be measured at the end of campaign, by surveying students and parents as well as assessing the rate of current rate of STD and teenage pregnancy in school girls. However, there might be hindrance in adherence of school girls regarding adherence with the intervention and health check up. In this context, a counselor can be recommended to be appointed in school, for empowering students and enhancing their compliance with the intervention (Mitchell, 2013).
According to value statement 6 in “code of ethics for nurses”, “nurse will value a culture of safety in health care and communication”. According to conduct statement 2 in professional conduct, “school nurse will respect the dignity, culture, ethnicity, values and beliefs of people receiving care and treatment and of their colleagues”.
Curtis, E. A., de Vries, J., & Sheerin, F. K. (2011). Developing leadership in nursing: exploring core factors. British Journal of Nursing, 20(5), 306.
Grohar-Murray, M. E., DiCroce, H. R., & Langan, J. C. (2016). Leadership and management in nursing. Pearson
Kelly, P. (2011). Nursing leadership & management. Cengage learning.
Mitchell, G. (2013). Selecting the best theory to implement planned change: Improving the workplace requires staff to be involved and innovations to be maintained. Gary Mitchell discusses the theories that can help achieve this. Nursing Management, 20(1), 32-37.
Northouse, P. G. (2015). Leadership: Theory and practice. Sage publications.
Sandstr?m, B., Borglin, G., Nilsson, R., & Willman, A. (2011). Promoting the implementation of evidence?based practice: A literature review focusing on the role of nursing leadership. Worldviews on Evidence?Based Nursing, 8(4), 212-223.
Shirey, M. R. (2013). Lewin’s theory of planned change as a strategic resource. Journal of Nursing Administration, 43(2), 69-72.
Yoder-Wise, P. S. (2014). Leading and managing in nursing. Elsevier Health Sciences.