Change Management in Duke University School of Nursing

This article discusses the issues faced by Duke University School of Nursing and proposes a change management plan to improve nursing skills and quality services. It also highlights the importance of budgeting and resource allocation in achieving these goals.

Running head: CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
Change Management in Duke University School of Nursing
Name of the University:
Name of the Company:
Authors Note:

1CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
Executive Summary
Duke University School of Nursing is facing issues related with lack of transparency and
visibility regarding the inappropriate behaviors of the nursing graduates. Within this, mention
can be made of the issue of high turnover rates within the nursing staffs, which has aggravated
the complexities of infections like bedsores. One of the striking issue in this direction is the
wrong medication due to the inadequate skills of the nurses. Increase in the death rates compel
the healthcare professionals to make plans for the adopting ballot machines, so that the nurses
can opt for flexible working shifts and duties. Along with this, infusing MSN graduate programs
and diplomas would improve their nursing skills and quality services offered by them. Budgets
would be crucial in terms of maintaining the balance between the organizational resource and the
human resources. Revision of the budgets would avert the scenarios of discrepancies at the time
of decision-making and recruitments. Investing resources in this course can facilitate the
institution to attain goals of improved nursing skills and enhanced nursing facilities quality
which can ensure high returns in the form of client satisfaction with attaining increased revenue
and ROI of 145.63%.

2CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
Table of Contents
1. Introduction......................................................................................................................3
2. Description of current situation.......................................................................................3
3. Description of new program............................................................................................5
4. Market Analysis...............................................................................................................6
5. Implementation plan........................................................................................................7
6. Evaluation plan................................................................................................................9
6.1. Structure, Process and Outcome Measures...............................................................9
6.2. Return on Investment..............................................................................................10
7. Financials.......................................................................................................................12
7.1. Program Budget......................................................................................................12
8. Conclusion.....................................................................................................................12
References..........................................................................................................................14
Appendix............................................................................................................................16

3CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
1. Introduction
American Association of Colleges of Nursing published that graduates from the DNP and
MSN programs have some specific skills and by such level, students are generally are
comfortable with navigating the evidences but have not just managed the components related
with leading a quality improvement project (Bagley et al., 2018). Moreover, healthcare is also
considered to be a business that positively impacts client’s outcomes and the offered care should
be financially sustainable. The nursing institution that is selected in this report is Duke
University School of Nursing and it will analyze the irrational projection of the relationship
between the nurse and the patients within the healthcare settings. Along with this, the
recommendation of recruiting more nurses would be proposed for providing proper care and
nourishment to the patients.
2. Description of current situation
According to the revelations of the American Nurses Association (ANA), inadequate
number of nursing staffs have worsened the condition of the patients’ health. Striking results
indicate the rise in the instance of infections, medication errors and even death rates. Financial
constraints has compelled the personnel to encounter high turnover rates. The major drive behind
this are the long working hours and complicated treatment processes (Nursingworld.org, 2019).
This turnover acted as a compromise with the health needs of the patients. Reference can be cited
of the staffing costs, which highly contributes to intensive care. Reduction in the number of
nursing staffs has simultaneously influenced the purchasing decisions of the patients in terms of
booking the beds in the healthcare settings (Ncbi.nlm.nih.gov, 2019).

4CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
Ambiguous relationship between the nurse workload and patient conditions adds to the
health complexities. The outcome is different for different countries. In UK, the ratio between
nurse and the patients is 1:2. Mention can be made of USA, where the ratio between nurse and
the patients is 1.29:3.8. According to the reports published by Annals of Intensive Care in 2017,
high nursing staff ratios decreased the likeliness of survival for the patients. Analysis of 845
patients resulted in the outcome the patients have 95% chance of survival if the nurses adhere to
the workplace norms regarding patient nurse ratio (Ncbi.nlm.nih.gov, 2019).
From analyzing the current situation of the nursing institute along with analyzing the impact
of such issue on Duke University School of Nursing the PICO question answered is indicated
below:
 Problem: From analyzing the current situation in Duke University School of Nursing, it
has been observed that the nursing institution is dealing with the issue of offering
effective nursing care program in the institution in improving the nursing care services.
The nurse to patients’ ratio was also observed to be decreasing as due to poor nursing
quality offered number of patients is decreasing in the medical institution setting.
 Intervention: The medical institution is focused on hiring more nurses to enhance the
medical facilities offered to the patients. Implementing changes in the nursing course is
deemed to be necessary in training the future nurses with necessary skills related with
improving the miscommunication about their role in the nursing departments within staff
expectations about potential levels of support and collaboration.
 Comparison: Nursing facilities shortage can affect patient care in the medical institution.
Lack of sufficiently skilled nurses can result in increased medical errors in the nursing
institution such as increase in infections and death rate. Along with this, infections like

5CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
bedsores have also increased in its levels and intensity. This is because of the lack of
proper care and attention towards hygiene and cleanliness within the services.
 Outcome: Implementing suitable nursing training through newly introduced advanced
MSN course can facilitate Duke University School of Nursing in decreasing medical
error through improving nurse to patient ratio.
3. Description of new program
In order to improvise on the current situation of the University, more nurses qualified
nurses need to be hired. For this, proper framework needs to be followed for the acquiring the
desired outcomes. Duke University School of Nursing can make estimates for maintaining the
balance between nurses and the patients. For this, equal division of labour can be planned. For
example, one nurse can be provided with the duty of 5 patients. However, according to the rules
and regulations of Coalition to Protect Safety, this kind of duty allocation can heavily impact the
patient volume (Nursingworld.org, 2019). The department of Mental Health Services opines that
ballot machines can be acquired for levying the nurses with the opportunities to select the
patients. These machines can be costly, compelling the University to curb on the treatments of
opioid and services related to mental health. However, the community hospitals would not be
able to afford such machines, indicating aggravation for the complexities in the health of the
patients. If proper planning is not done timely, the situation can worsen, compelling the
healthcare institutions of the University to close down (Garber et al., 2018).
Along with this, MSN Program in Healthcare Informatics can be introduced by the
University. The program would make the nurses familiar to the effective means for providing
quality treatment to the patients according to their health needs. According to the current trends,

6CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
MSN and DNP programs would be combined, so that the graduates attain a doctoral degree
along with the Master’s degree (Montgomery & Byrne, 2016). The new nursing program of
MSN will focus on including subjects based on four advanced practice area that includes Nurse
Practitioner, Certified Nurse Anesthetist, Clinical Nurse Specialist and Certified Nurse course
with mix of practical and hands-on training (Paul, 2015).
4. Market Analysis
Strengths
 Availability of nursing staff expertise for
more than 5 years despite of the problem
related with nursing shortage (Martsol et al.,
2015).
 Increased availability of job description at
all the nursing levels.
 Periodic evaluation of for the nursing staff.
 Different program development by means
of continuous education department along
with the training courses.
Weaknesses
 Decreased commitment of the hospital
regulations and policies
 There is decreased competition among the
nurses themselves along with the
healthcare providers
 Lack of work innovations along with
creativity work atmospheres (Tagher et
al., 2016)
 Understaffed departments along with
increased workloads on nursing staffs
 Miscommunication regarding the role of
some other hospital departments or units
in staff expectations regarding the
potential levels of support and
collaboration.

7CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
Opportunities
 Strong relationships along with
collaboration with heath department and the
nursing institute
 The nursing institute serves a large
population because of which it has more
available connections and resources.
 Opportunity to develop training courses and
programs through collaboration with the
DNP and MSN programs along with trainee
students in the institute (Windey Schivinski
& Craft, 2018).
Threats
 Lack of enough learning Courses
accredited with collaboration with the
DNP and MSN programs.
 Unavailability of good community
outreach initiatives (Udlis & Mancuso,
2015)
 Absence of technology advancement
along with updated devices
 Nursing shortage leading to an increase in
the infections like bedsores
 Lack of external fund resources in
development of nurses along with the
employees of nursing institute.
5. Implementation plan
Problem Assessment Interventi
on
Compari
son and
Planning
Implementation
or Outcome
Evaluation Timefr
ame
 Absence of
proper
framework for
Introducin
g ballot
machines
If the
nurses are
provided
In case of
implementing
frameworks,
Financial flexibility
would be crucial for
maintaining the
Three
Years

8CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
allocating
duties of the
patients to the
nurses
 Lack of enough
learning
Courses
accredited with
collaboration
with the DNP
and MSN
programs.
for the
nurses to
select the
number of
patients,
they wish
to provide
care
with the
opportuni
ty to
select the
number
to
patients
they wish
to care
for,
productiv
e
performa
nce can
be
expected.
However,
financial
condition
needs to
be
reviewed
for the
review of the
financial condition
would be
beneficial for
introducing quality
facilities for
treating infection
like bedsores
In case of MSN
Programs, the
curriculum will be
implemented in the
institution through
breaking down into
following manner:
 First year:
Entry-level
nursing
coursework
 Two years:
Combined
advanced
master’s
balance between the
existing facilities
and the proposed
facilities.
Preparation of
budgets would assist
in making plans for
adopting the ballot
machines.
The MSN program
evaluation metrics
that will facilitate in
analyzing the
effectiveness of
implementation of
such program is
indicated below:
 Improved
learning of
nursing
graduators
on the heath
care policy,

9CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
averting
straining
the
budgets.
The
program
will
planned
for the
duration
of three
years to
complete
coursework
and training
that will
encompass
preparation
for
“National
Council
Licensure
Examinatio
n Test”
theory and
practice on
special skills
and heath
care ethics.
 Improved
transparency
and visibility
regarding the
appropriate
behaviors of
the nursing
graduates
though
attaining
specialised
nursing
skills.
 Improved
nurse to
patients ratio

10CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
6. Evaluation plan
6.1. Structure, Process and Outcome Measures
To deal with such issue of decreasing quality of nursing services in the institution and
lack of external fund resources in development of nurses along with the employees of nursing
institute. Lack of enough learning Courses accredited with collaboration with the DNP and MSN
programs has necessitated implementation of MSN programs are to be introduced in the
institution.
The structural changes that will be made in the nursing institution to the support the
program is to make the institution an open system that will include interrelated subsystems and
supra-systems those can process input, throughput along with output of nursing services and
information (Claywell et al., 2016).
The necessary resources those will be needed by Duke University School of Nursing in
supporting the new MSN course are faculty members qualified for offering master degree
teachings, accrediting the MSN learning program with guidelines provided by “American
Association of Colleges of Nursing” and study materials for graduates these will have program
curriculum and course description (Garber et al., 2018).
The MSN program evaluation metrics that will facilitate in analyzing the effectiveness of
implementation of such program is indicated below:
 Improved learning of nursing graduators on the heath care policy, theory and practice on
special skills and heath care ethics.
 Improvement in the quality of nursing care facilities offered by the MSN students along
with increased client satisfaction.

11CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
 Innovation within the health care services including revision in the recruitment and
selection policies, standardizing the healthcare practices of providing clean beds to the
patients getting admitted (Udlis & Mancuso, 2015). Typical evidence of this lies in
introduction of the ballot machines for the nurses to vote for the number of patients, they
wish to provide treatment.
6.2. Return on Investment
From analyzing the graphs indicated in both the figures below it has been gathered that
increasing MSN leading programs implementation resulted in enhanced career opportunities for
nurses and improved nursing facilities in several nursing institutions. In addition, figure 2
indicates the opinions gathered from the MSN gradates that reflected the special skills attained
by nursing students from the programs is observed to improve their nursing skills and quality
services offered by them (Cipher, Shrestha & Mancini, 2017). Such results indicate that
implementing the MSN course can facilitate Duke University School of Nursing in can result in
increased ROI (Return on Investment) for the institution. This is for the reason that investing
resources in this course can facilitate the institution to attain goals of improved nursing skills and
enhanced nursing facilities quality which can ensure high returns in the form of client
satisfaction.
ROI= Net Profit/ Total Investment * 100
= (287611/ 197495) * 100
= 145.63%

12CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
Figure 1: Improved Nursing Services Quality Trend
(Source: Tagher et al., 2016)
Figure 2: Nursing Skills Improvement after Undergoing in-depth MSN Program
(Source: Tagher et al., 2016)

13CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
7. Financials
7.1. Program Budget
The program budget is indicated in the appendix section and based on the budget it can
be explained that the budget is profit earning after implementing the MSN course.
8. Conclusion
The nursing institution that was selected in this report is Duke University School of
Nursing and it will analyze the situation faced by the institution along with proposing the
changes in order to improve the situations faced by the institution. From analyzing the current
situation in Duke University School of Nursing, it has been observed that high turnover rates
among the nurses acts as a compromise with the health needs of the patients. Specifically, it
increases the levels of infection like bedsores. One of the main reasons for this is the long
working hours, which generate disinterest among the nurses towards catering to the health issues
of the patients. Unfamiliarity to the necessary skills results in medication errors, aggravating the
complications in the health issues of the patients. In order to improvise on the situation, the
University needs to follow legislations. Within this, emphasis can be placed on revising the
recruitment and selection policies for the nurses. Considering the same, the new program will
consider including the nursing courses in affiliation with “American Association of Colleges of
Nursing” MSN program in the institution. Undergoing the MSN program will facilitate the
nurses in attaining improved and specialized skills along with advanced training that is necessary
in offering high quality nursing care in a specialised role such as a nurse practitioner.

14CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
References
Bagley, K., Hoppe, L., Brenner, G. H., & Weir, M. (2018). Transition to Nursing Faculty:
Exploring the Barriers. Teaching and Learning in Nursing, 13(4), 263-267.
Brady, M. (2015). Academic Progression for Associate Degree Nursing Students: Evolution, Not
Revolution. Journal of Nursing Education, 54(7), 359-360.
Cipher, D. J., Shrestha, S., & Mancini, M. E. (2017). Demographic and Academic Factors
Associated With Enrollment in Online MSN Programs. Journal of Nursing
Education, 56(11), 670-674.
Claywell, L., Wallace, C., Price, J., Reneau, M., & Carlson, K. (2016). Influence of nursing
faculty discussion presence on student learning and satisfaction in online courses. Nurse
educator, 41(4), 175-179.
Garber, J. S., Foti, D., Murray, R. R., Pennington, D. S., Marcum, C., & Vishneski, S. (2018).
Nursing Faculty Caring Behaviors: Perceptions of Students and Faculty.
Homepage | Duke University School of Nursing. (2019). Retrieved from
https://nursing.duke.edu/
Martsolf, G. R., Auerbach, D. I., Spetz, J., Pearson, M. L., & Muchow, A. N. (2015). Doctor of
nursing practice by 2015: An examination of nursing schools' decisions to offer a doctor
of nursing practice degree. Nursing outlook, 63(2), 219-226.
Montgomery, K. A., & Byrne, S. K. (2016). How Doctoral-Level Advanced Practice Roles
Differ From Master’s-Level Advanced Practice Nursing Roles. DNP Role Development
for Doctoral Advanced Nursing Practice, 113.

15CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
Ncbi.nlm.nih.gov (2019). Are high nurse workload/staffing ratios associated with decreased
survival in critically ill patients? A cohort study. Retrieved 23rd Feb 2019 from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413463/
Nursingworld.org (2019). About us. Retrieved 23rd Feb 2019 from
https://www.nursingworld.org/
Paul, P. A. (2015). Transition from novice adjunct to experienced associate degree nurse
educator: A comparative qualitative approach. Teaching and Learning in Nursing, 10(1),
3-11.
Tagher, C. G., Robinson, E. M., Hart, J., Schleyer, M., & DiMinno, A. (2016). Fostering
Workforce Development through Meaningful Experiences: Pathways to a Nursing
Degree Program.
Udlis, K. A., & Mancuso, J. M. (2015). Perceptions of the role of the doctor of nursing practice-
prepared nurse: Clarity or confusion. Journal of Professional Nursing, 31(4), 274-283.
Windey, M., Schivinski, E., & Craft, J. (2018). Revisiting and Refining the Nurse Residency
Program Leader Role. Journal for nurses in professional development, 34(6), 336-337.
1.

16CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
Appendix
All figures in USD Unit
Unit
Cost
Quantit
y Total
Cost
A Staff Costs 88,600
A1 Programme Manager (PM) Month 800 12 9,600
A2 Education Manager (EM) Month 2,000 12 24,000
A3 Office Manager (OM) Month 900 12 10,800
A4 Accountant Month 2,400 1 2,400
A5 Recruitment costs Unit 2,000 1 2,000
A6 Educating staff Month 450 12 5,400
A7 Marketing expenses Month 450 12 2,800
A8 Salaries Month 12

17CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
450 2,800
A9 Office assistant Month 350 12 4,200
A10 Drivers Month 250 36 9,000
A11 Guards Month 250 24 6,000
A12 Cleaner Month 250 12 3,000
A13 Medical costs
Person
Month 50 132 6,600
B Programme Administration 17,110
B1 Stationery Month 100 12 1,200
B2 Phone/fax Month 600 12 7,200
B3 E-mail Month 200 12 2,400
B4 Courier Month 30 24 720
B5 Office rent Month 12

18CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
200 2,400
B6 Electricity Month 30 12 360
B7 Bank charges Transfer 83 10 830
B8 Audit Item 1,500 1 1,500
B9 Books, manuals, publications Lumpsum 500 1 500
B10 Other
C Local Transport 10,980
C1 Fuel
Vehicle
Month 150 36 5,400
C2 Vehicle maintenance
Vehicle
Month 50 36 1,800
C3 Vehicle insurance
Vehicle
Year 300 12 3,600
C4 Nairobi local transport PersonDay 6 30 180
C5 Other -

19CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
D Capital Equipment 58,000
D1 Computer hardware (inc. printer) Item 2,000 4 8,000
D2 Photocopier -
D3 Fax -
D4 Office furniture/equipment -
D5 4WD Vehicles Item 25,000 2 50,000
D6 Other -
E Training and phisical space 8,400
E1 Training materials Workshop 200 12 2,400
E2 Workshop costs Workshop 500 12 6,000
E3 Other -
F Materials Development 5,000
F1 Design work Manual 1,000 2 2,000

20CHANE MANAGEMENT IN DUKE UNIVERSITY SCHOOL OF NURSING
F2 Reproduction Unit 1,500 2 3,000
F3 Other -
Z Contingency 9,405
TOTAL 197,495