Questions On Solving Problems Isn 't Always Easy

Currently healthcare is changing, “from the hospital into the community setting, shorter hospital stays, and an increase in day surgery procedures and an ambitious public health agenda have all increased demands on the workforce” (Carr & Pearson, 2005, p. 72). Therefore, the health care teams are now trying to adjust to the changes as well as meet the new demands (Carr & Pearson, 2005). As with most health care setting, there is a wide variety of health care workers with different skill sets. The diverse level of skills and roles in the health care system allows the increased workload to be spread appropriately when utilized correctly; this is called delegation. As with any situation if not performed correctly it could lead to

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.

“ 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

Healthcare environments are often plagued with dysfunctional behaviors that create antisocial, self-defeating behaviors (Porter-O’Grady & Malloch, 2014). Traditionally, healthcare providers were males that dominated the profession which created a sense of personal entitlement and resistance to change (Porter-O’Grady & Malloch, 2014). With the advent of the Affordable Care Act (ACA), healthcare is in the midst of a paradigm shift that embraces change, efficiency and collaboration, a foreign concept to some traditional providers. Traditionally, prior to the implementation of the ACA, physicians felt empowered and in control (Porter-O’Grady & Malloch, 2014). Under the ACA, healthcare organizations fervently transformed their facilities to accommodate the mandates of the ACA, such as CPOE. With this loss of control, physicians are angry and passively transfer that anger to the supportive nursing staff. Because hospital leadership traditionally did not challenge the physician behavior, this anti-social behavior is tolerated. Consequently, nurses develop fear, distrust and discouragement, which compromises the collaboration that is necessary to produce quality patient outcomes. Porter-O’Grady and Malloch (2014) outline ten principles to minimize this type of organizational toxicity that manipulates progress and collaboration. These principles are tools that work to transform the dysfunctional, toxic environment into a healthier,

"Results of this study point to the need to enhance nursing teamwork on patient care units. If nursing staff are not satisfied, like workers in general, they will be more likely to leave their position/occupation and/or to have a lower level of productivity. Moreover, increased teamwork would lead to safer and higher quality of care."

The meaning of a change agent is basically 2-fold; to accomplish change themselves and to also encourage the capacity to change in others (Stefancyk, Hancock, & Meadows, 2013). The nurse change agent needs to recognize the question, include the right population, intervention, compare to other groups, and expected outcomes (Eads & Maruzzella, 2016). The first example would have to be years ago when I worked on the surgical step-down unit. The nursing staff on the floor were inundated with our nurse to patient ratio, which was usually 7:1. In the surgical step-down unit, we would give hourly pain medications, multiple antibiotics, do extensive wound care, as well as ambulating patients three times a day. We had an RN patient flow coordinator that would help with bed assignments and discharges. The entire floor petitioned to do away with that position and give us another clinical nurse at the bedside instead. With the lower nurse to patient ratio, we would be able to manage our own discharges and properly take care of our patients. We fought and won and went from 7:1 to 5:1 with one nurse having 6:1 for the day. Another example was in the ICU, where I witnessed our nurse leaders advocating to change our policy on alcohol withdrawal. Our ICU has a 24-hour intensivist and as nurses, we would have to get written orders for each patient experiencing DT’s. Nationally there is a Clinical Institute Withdrawal Assessment (CIWA), that my nurse leaders wanted to initiate. Basically, it would allow the doctor to initiate the CIWA protocol and give the nurses a guideline to follow when treating alcohol withdrawal patients. It was passed due to the efforts of management and the involvement of the intensivists. We now have a standard to follow without having to call the doctor for each medication order.

Nevertheless, important changes in the workforce roles are necessary to enhance the process of care, remove waste, and improve quality. Each team member has a role to play in the health of the patient, family, and community, and what benefits the patient helps reinforce the health care system.

Nurses should be full partners, with physicians and other health professionals, in regarding health care in the United States(Institute of Medicine, 2011).Nurses should be full partners because who knows nursing and what nurses need better than a nurses themselves? In care environments, being a full partner involves taking responsibility for identifying problems and areas of waste, devising and implementing a plan for improvement, tracking improvement over time, and making necessary adjustments to realize established goals (Institute of Medicine, 2011).The expense of certain supplies and equipment could be decreased over time if nurses had more say in their environment and resources. On many floors in hospitals, certain supplies are not needed

A nurse leader allows change to happen at

This article presented a lot of new information to me about how big of a difference nurses can make in health care and nursing, and how to go about making an evidence-based change. When I think about advocating for patient care I always thought much more small scale, as in talking to a doctor about a specific patient’s needs, but this article alerted me to the large-scale impact that nurses can make on patient outcomes and our work environments. It’s really great that as nurses we have the ability to make bigger picture changes in the quality and safety of patient

There is constant change in health care and the amount of new evidence related to improved patient outcomes is so abundant it is difficult to keep up with new recommendations. Adoption of evidence-based practice and care by an interprofessional team requires good communication skills and reinforcement of the reasons for change. Efforts to communicate change effectively must create a sense of urgency and generates a vision and motivates staff to accept change. Williams, Rycroft-Malone, & Burton (2016), discuss the importance of change agents or intermediaries that serve as educator and role-models to adopt evidence-based practice. They concluded that an active and constant presence at the bedside by intermediaries develops trust, influence,

Change can be challenging and studies have shown that most nurses practice the way they were taught, not by what has been proven to work (White & Spruce, 2015). Strategies for implementing practice changes that involve careful planning and the utilization of employees who can motivate participation, be champions for change, and influence others are important (Huber, 2014). Job descriptions, mission statement, and vision should all be incorporated with evidence-based practice and it is useful to have discussions with staff during any meetings. Using a variety of interactive strategies to encourage the acceptance of change and having leaders that are positive examples, who advocate for the use of evidence-based practice, provide resources and processes, and who are accountable for their actions is essential. Health care culture is affected by current issues and trends such as the expectation of patient-centered care with improved quality and safety, reimbursement changes, introduction of electronic medical records, and the increased need for

Advance practice nurses have the ability to change the health care system as they play a critical role in improving health outcomes. In a clinical setting, implementing the recommended changes of monitoring, enhanced communication, greater collaboration and education of patients and more analysis of patients with a focus on their preferences and beliefs would create a more relaxed and trusting environment. This change would allow for better patient experience which would cause them to place greater reliance and confidence in the opinions and recommendations of providers and would more readily adhere to suggestions. A culture of medication adherence would be facilitated and would in turn build trust in the overall national healthcare system.

Transforming care at the bedside (TCAB) was developed through a joint effort by the Institute of Healthcare Improvement (IHI) and the Robert Wood Johnson Foundation (Lavoie-Tremblay et al., 2014). The initiative has four main areas of focus: safe reliable care, vitality and teamwork, patient-centered care, and value added processes (Lavoie-Tremblay et al., 2014, p. 16). The most notable change witnessed in practice as a result of this initiative has been a shift to patient-centered care. The current investigation considers this issue and the application of TCAB to the Institute of Medicine’s (IOM) six aims for improvement and patient centered teams.

This paper is written from the perspective of a nurse-manager for a hospital floor and focuses on a proposed change to that floor: the addition of a certified wound care nurse. It begins by describing the benefits of a specialized wound care nurse, the existing conditions on the hospital floor, and how each of the stakeholders would be impacted by such a change. It utilizes Lippitt's phases of change theory to describe how those changes would be implemented on the floor, outlining each of the phases in implementing such a change.