Change Fatigue : Organizational Responsibility

These changes are then reinforced to employees by the Charge Nurses in Morning Huddles and in special called Safety Huddles throughout the week. While management is very open to change, implementation of the changes must be carried out by the actual hands-on personnel, and this often times leads to fear of the unknown. As Yoder-Wise (2015) states, “All changes, whether perceived as positive or negative, large-scale or simply, are scary and generate fear” (p. 307). In the short time I have worked in the ED, I have seen both support and resistance among co-workers regarding change processes. While some embrace change, others resist, and are set in their ways viewing change as inconvenient and an addition of time-consuming steps to an already stressful environment. Most whom I work with, when presented with the facts and evidence behind the change, view it positively and have no problem implementing it.

Workload was described to be heavy, stressful, increase in intensity and overtime hours. As a result 25.8% consider resigning, 20.2% consider retiring and 25.6% consider leaving profession. Another problem that was observed at individual level was poor commitment to care. One of the factors that often limited nurses to provide therapeutic care was the change in nurse to patient ratio. As nurses assignments increase with the increase in the number of patients (i.e. 1 nurse to 6-8 patients) the quality of care provided decreases. Nurses’ ability to maintain safe environment became challenging. As part of caring, nurses also showed decreased amount of time spent with their patient. This eventually led to nurses being less satisfied with their current job. Self – efficacy was often low. Nurses felt that they did not have enough knowledge and skills required for professional practice (Newhouse, Hoffman, & Hairston, 2007). This often led into stressful transition and the ability to care for a patient even harder. New graduate nurses often had difficulty maintaining leadership role. They often felt that they did not have the ability to self advocate and raise their voice to be heard by others. They often feared that they would be over heard and that no one would listen to them (Mooney, 2007).

“ The ADKAR model of change includes Awareness of the need for change, the Desire to support the change campaign, Knowledge of how to make this successful, the Ability to implement new strategies, Reinforcement of change implementation, and periodic re-evaluation (Hait,2006). These four elements promote evidenced- based practice change and the commitment from nurses to participate in professional activities.”(Robert & Pape, 2011, p. 43) A APRN’s we will have to be agents of change to provide the best care for our patients. When we identify a issue or concern we must have the ability to address it

Implementing a change in practice within these environments can produce anxiety or fear of failure in nurses, leading to a resistance to change. Several studies (Bozak, 2003; Lehman, 2008; Spetz, Burgess & Phibbs, 2012) expounded the need for a concise plan and clear communication between nurses and management when implementing a change of this nature. The use of Lewin’s Change Management theory can support nurses through the transitions and identify areas of strengths and resistances prior to implementing change. Without a framework for guidance, it can be difficult to keep on track.

The term burnout, according to Catalano, is a continuing depletion of energy and strength combined with a loss of motivation and commitment after prolonged exposure to high occupational stress (2015). When a unit or facility is understaffed, not only do the nursing staff get burnt out, the patients also don’t receive the quality of care they deserve. Due to the increase in workload, nursing staff are more prone to making mistakes and medical errors and sometime times do not fellow facility policies. The nurse-patient ratio aspect sometimes gets overlooked at and that could lead to possible medication errors, lack of communication, falls, neglect, abuse and/or death may occur. Sometimes, it become so overwhelming people turn to leave the workforce all together. When nurses and CNA workload increase, they become frustrated and unhappy, and the desire to leave

Change is a hard concept for most, but change in the hospital setting can be beneficial for both staff and patients. According to Mclean (2011), “Every change begins with an ending” (p.79). How people respond to change can make the process easy or hard depending on how the change is presented.

A positive force for change centers on the nurse’s strong desire to change current practices. The combination of the turnover rate, low morale, and higher percentage of new nurses, is the driving

According to Hunt (2009), feeling overworked is the number one cause for nurse turnover in health care settings. Other reasons at the top of the list include, lack of support from employers and few opportunities for advancement. Due to the nursing shortage, staffing has been an issue in many healthcare facilities. As a result, units are consistently short staffed, causing nurses to feel overworked and unsupported by management. Cline (2004) highlighted nurse frustration when a participant in the study stated, “When you’re constantly short-staffed and feel your managers aren’t supporting you at least by saying, ‘Thank you, I know you must’ve had a hard

Stressful work environments, long work hours and inadequate sleep all contribute to an increase in physical and mental exhaustion amongst nurses. Typically, people choose nursing as a career to help others and to make a difference in their lives, without realizing the number of duties this career demands. Nurses may suffer in silence when they are experiencing stress. The effects can impact safe and reliable care by decreasing job satisfaction, decreasing productivity, causing poor personal health, and compromising patient care. Many facilities would benefit from implementing evidence-based strategies to address nurse fatigue and burnout.

According to Banner Health ([Talent & Organizational Effectiveness], 2018), change requires leadership and management. To manage change Banner employs a scientifically proven change management methodology to guide individuals through change (Banner Health [Talent & Organizational Effectiveness], 2018). With the adoption of this change management the responsiveness to change by leadership and nursing staff results in openness and willing to engage. With this new renovation Banner is currently undertaking, this change management approach is essential and banner employees are embracing the changes. Banner communicates the changes efficiently through email and leadership for a smooth transition. Their goal is to increase the speed of adoption by

Nurses, who are working in an intense environment with prolonged and varied shift hours, are prone to insufficient sleep/rest. Moreover, with repeated exposure to self-sacrificial tasks and less recovery time, nurses are also prone not only with stress/sleep-related disorders but also to compassion fatigue. Hence, without effective self-care management and adequate support, Lanier (2017) stated that over a period of time, nurses tend to be apathetic to their patients and lose their interest in their job. Relatedly, when leaders do not acknowledge this problem and intervene, they eventually suffer from poor quality of patient care, less productivity, ruined reputation, and financial losses. Thus,

This article introduces health care managers to the theories and philosophies of John Kotter and

Growth and organizational evolution causes change, resistance to that inevitability and stress as a byproduct. The tactics individuals and leaders adopt can cause harmful consequences if not managed with sensitivity and awareness. Change can be threatening for those experiencing job insecurity (Robbins & Judge, 2007) or develop teams and co-workers that act at cross-purposes (Huy & Mintzbereg, 2003). Change can be a source of stress, but so can workload, leadership styles, and the shuffling of roles and responsibilities (Cooper, 2006). Management of resistance and stress is largely dependent on the organizations leadership to be the bulwark of these human traits by perceiving their sources and proactively attending to them.

Mitchell, G. (2013) 'Selecting the best theory to implement planned change', Nursing Management, 20, (1), pp. 32-37.

Nevertheless, managing change in the workplace shapes a feeling of uneasiness for a great many people, any change is uncomfortable.