Nursing and organizational change fatigue: beyond resistance Change fatigue is an organizational term defined as poor emotional responses to attempted change (McMillan & Perron, 2013). Change leaders will fail to follow through, there may be a lack of data transparency, staff are impatient with efforts, resources are quickly diverted to other initiatives, and value is increasingly questioned (Reineck, 2007). It can result from rapid continuous and relentless organizational or individual changes that are implemented in daily work practices (Buchanan et al., 2005). Nurses, as frontline staff closest to patients, are the healthcare group most often subjected to initiatives regarding patient care improvement. Whether as a result of evidenced-based care practices, quality measures, financial incentives, or regulatory statues, the trickle-down effect of change stops with the RN (McMillan & Perron, 2013). Thus, nursing is in the most danger of developing change fatigue. As RN’s are typically the largest part of any healthcare organizational labor force, institutions need to leverage nursing’s power to avoid change fatigue and enjoy positive initiative outcomes (Iacono & Altman, 2015). Limitations of Human Nature Research has long proven demonstrated the human brains’ limitations in recall. As one attempts to remember more than six to seven tasks, there are diminishing returns in efficiency. In addition, persistent exposure to stressful stimuli (as is very common in
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.
Those of us who graduated from nursing school and started their first job were full of dreams, aspirations, and had every intention of making a difference. Now fast forward five years; these same nurses have been on their feet for 16 hours and have not had time to eat or use the bathroom since leaving their homes this morning. The call lights will not stop going off long enough for them to give report to the oncoming nurses and once again they are late for their children’s dance recitals or soccer games. They can forget about trying to squeeze a yoga class in this week. I understand what it is like to rush to your car feeling as if some important task was forgotten; was Mr. Smith’s tube feed restarted, did room 8 receive their pain medication? Nurses all over the world are experiencing “burnout”. To avoid burnout, nurses must properly care for themselves by separating work from personal life, knowing when to say no, and making time for enjoyable activities to manage stress, because we cannot provide quality patient care if we are neglecting ourselves.
Staff nurses have great responsibilities in caring for patients. Often, these nurses experience heavy workload. Heavy patient load and stress contributes to burnout. Why is burnout important to discuss in relation to nurses? Burnout affects the performance of the nurse and the quality of care he or she provides to the patient. Therefore, it is imperative that staff nurses decrease the possibility of burnout and increase or maintain excitement and enjoyment in the field of nursing. If nurses do so, they will find joy in their work and quality of patient care will be increased. Contributors to burnout and
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).
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
Inconsistent nurse-patient ratios are a concern in hospitals across the nation because they limit nurse’s ability to provide safe patient care. Healthcare professionals such as nurses and physicians agree that current nurse staffing systems are inadequate and unreliable and not only affect patient health outcomes, but also create job dissatisfaction among medical staff (Avalere Health, 2015). A 2002 study led by RN and PhD Linda Aiken suggests that "forty percent of hospitals nurses have burnout levels that exceed the norms for healthcare workers" (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). These data represents the constant struggle of nurses when trying to provide high quality care in a hospital setting.
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
This paper seeks to expand upon the 2010 Institute of Medicine’s report on the future of nursing, leading change, advancing health and illustrating its impact on nursing education, practice and leadership. There is an ongoing transformation in the healthcare system necessitated by the need to achieve a patient centered care in the community, public, and primary care settings in contrast to previous times. Nurses occupying vital roles in the healthcare system, need improvements in the areas mentioned above to
The reading material and experiences that would make me a stronger change agent are imbedded in my program curriculum at Saint Joseph’s College Maine RN-BSN Program. The school and program offer “efficient, academically sound, cost-effective and convenient” bridging programmes to encourage student enrolment and reduce attrition. My program will help me to achieve higher levels of education and training through an improved education system that promotes seamless academic progression, and allow me to be a part of the future of nursing where “Nurses should practice to the full extent of their education and training.” My program studies will build on and enhance my clinical expertise, theoretical knowledge, making me a stronger change agent who is commitment to the outcome of the change project empowering me as the nurse to successfully assess, plan, implement, and evaluate the change
In a world where there is constant change, and individuals are constantly attempting to adapt and cope with these changes, the human experiences and responses to this process is central to nursing interest, (Meleis, 2012). Today’s global health problems in addition to the politically volatile health care system, and the rising cost of health care seem insurmountable. As nurses,
It is no surprise that in any career, people will be short staffed and under pressure to pick up the extra workload. With this ongoing issue these people will become stressed, burnout and ultimately leave the career. Patients pay the ultimate price when nurses work short in that their needs are not being met. Nurses are accountable to patient’s, their families, and co-workers and to themselves. When it comes to being short staffed and having unsafe workloads nurse’s need to step up and take the lead on providing change. “So, in the Twenty-First Century organization, we look for leaderful individuals who
When leading change, Nurse Manager’s (NM) and other nursing leaders take the time to step back, evaluate and gauge successes and shortcomings. As established goals are reached, time is provided to stop, look and
As the healthcare system is evolving and becoming more advanced and demanding, nurses, especially registered nurses(RNs), are threatened by the increased job demands and other stress-related factors that negatively affect their performance. Furthermore, advances in technology along with the nursing shortage and the retirement of baby boomers have put a strain on healthcare organizations which in turn has greatly increased the work demands leading to unhealthy working environments (Othman & Nasurdin, 2013; Van Bogaert, Wouters, Willems, Mondelaers, & Clarke, 2013). An unhealthy nurse practice environment in which there is no or little support to overcome different challenges that may arise from the job affect nurses’ capacity to be more engaged
In the healthcare field, nursing leaders and managers face consistent issues in their respective practices that force them to alter the way they work and the way they think. In taking on a role as a leader within the field, nursing leaders and managers also take on the role of ensuring that work within an organization runs smoothly regardless of new issues that may arise in the healthcare arena. For instance, in today's healthcare environment, the issues of nurse shortage and nurse turnover have the capacity to alter the healthcare field and many of its respective branches and organizations should these problems not be managed properly by the leaders in the field. In viewing the issue at hand and in discovering how nursing leaders and managers are expected to act, and do act, in order to approach this issues, along with pinpointing the best approach possible to aid this issue, one can better understand which leadership styles are necessary for leaders to function.
Without competent leadership change can have negative impact on both the employees and the patients. According to Wright (2010), lack of leadership in change management could lead to adverse outcomes such as resentment, rebellious attitudes, and could end up damaging the same people it intended to make better (p.20). Therefore, experts warned that it is very important to have competent leadership at the helm of change management (p.20). As the focus of providing leadership shifts to nurse administrators who are often in the frontline of change management, nurse administrator should use essential tools such as the American Organization of Nurse Executives (AONE) five domain of competence as a framework in change management.