LEWIN’S CHANGE MODEL AND STAFFING ISSUES IN ICUS2 Lewin’s Change Model and Staffing Issues in ICUs Overview of the Area of Change and Impact on Patient Safety Intensive care units (ICUs) and high dependent units (HDUs) play a significant role in improving the quality of life and sustaining life for patients suffering from terminal diseases. The clinical environment in ICUs and HDUs require continuous presence of specialists that are experienced in handling critical care to patients with the goal of reducing mortality rates and maximizing patient safety when administering medication and moving patients from one facility to another. Newly recruited nurses find it difficult working in ICUs and this has an impact on the quality of care administered. It is recommended that hospitals recruit retired ICU specialists to work alongside the newly recruited graduate nurses and guide them in their new environment to maximize the quality of care. This can be done by applying Lewin’s three-step model of change. In the “unfreeze” stage, the organization prepares its members for change. The “change” stage entails introducing the desired change by recruiting retired nurses, and the “refreeze” stage entails making change the part of the organization. This paper discusses how Lewin’s model of change could be used to introduce changes in ICUs by addressing patient safety issues as a factor linked to the recruitment of graduate nurses in ICUs. How Implementation of Change could be influenced by: Staff experiencing reality shock Reality shock is the leading cause of staff turnovers and stress for young employees in their work environment. According to Kodama (2017), graduate nurses find it difficult to transit to the new work environment as they strive to strike a balance between the work environment and the school environment. Using Lewin’s change model at this stage, the “unfreeze” approach will applied by explaining to the management team and employees why change is necessary. The
LEWIN’S CHANGE MODEL AND STAFFING ISSUES IN ICUS3 views and fears of staff experiencing reality shock will also be considered to make them feel part of the organization. Scully (2015) explains that staff experiencing reality shock need nurse leaders to guide and help them in the transition process as they adjust to the new environment. The initial approach will start at the core of the organization and challenging the views and attitudes to convince them to accept that there is a need for change. Organizational culture and models of healthcare Organizational culture can be a facilitator or a hindrance to successful career success and job satisfaction. According to Courtright and Kerlyn (2014), young employees experience work distress in their new environment, making it difficult for them to respond to critical issues in ICUs. However, with proper application of Lewin’s change model, it is possible to resolve the conflicts created at the “unfreeze” stage for effective changes. During the “change” stage, the desired change of introducing retired nurse specialists in ICUs to guide the newly recruited employees is implemented. However, some organizations may shun from this responsibility due to their culture and also because they are profit-oriented without taking into consideration the risk they pose to patients as discussed in Lee, Cheung, Joynt, Wong, and Gomersal (2017). When young nurses are exposed to work overload in ICUs, they are demotivated and end up quitting the profession due to lack of support. Expectations from employers for continuous quality improvement The expectation of the employer is that any change in the work environment is intended to improve the quality of life, reduce operational costs, and increase work output. According to Sartori, Costantini, Ceschi, and Tommasi (2018), presence of nurse leaders in the ICUs increase patient safety and reduce mortality rates while increasing the quality of life. Leilan (2019) further explains that graduate nurses find job satisfaction in their profession when guided by
LEWIN’S CHANGE MODEL AND STAFFING ISSUES IN ICUS4 experienced specialists. This reduces turnover rates, saving the employer from recruitment costs and other expenses that arise when employees leave the organization. Tappen, Wolf, Rahemi, Engstrom, Shutes, and Ouslander (2017) explains that organizations that focus on training and equipping young employees with skills tend to reduce the costs of training from external service providers due to advantages. This is an advantage to the expectation of the employer whose main goal is to maximize profits and deliver quality services. Managing relationships One of the limitations associated with change is that it attracts resistance from the stakeholders. Current employees tend to oppose change because they feel that it will interfere with the culture of the organization. According to Cummings, Bridgman, and Brown (2016), one of the main reasons that makes employees to resist change is that they feel insecure. For instance, introduction of retired nurses to the ICUs makes current employees to feel that they will be replaced or lose their employment opportunity. To manage conflicts are relationships that may arise due to different interests during the change process, Berry, Gillespie, Fisher, Gormley, and Haynes (2016) that the organization develops strategic approaches of resolving conflicts and involving employees in the change process. This has to be done at the “unfreeze” stage of Lewin’s change model through open communication and involvement of current employees so that they feel part of the change process. Unhealthy work relationships Unhealthy work relationships have adverse effects on the young employees, causing them to quit and seek alternative opportunities. This leads to work overload in the remaining workforce, leading to strenuous relationship between the employer and employees. Hussain, Lei, Atram, and Haider (2018) explain that unhealthy work relationships that arise due to varying
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LEWIN’S CHANGE MODEL AND STAFFING ISSUES IN ICUS5 cultures in the workplace. Newly recruited nurses may be bullied when they make mistakes. Similarly, Berry, Gillespie, Fisher, and Haynes (2016) explain that psychological distress affects productivity when graduate nurses are bullied in their new environment. To address this limitation, it is important that healthcare institutions train nurses on leadership skills for them to guide newly recruited nurses on how to adjust to their new environment. The impact of this approach workplace productivity and patient outcomes is that the new employees will feel a sense of belonging in their new environment, leading to positive outcomes in job performance. Key challenges to implementing change and how to address the challenges Recruitment of retired nurses in the ICUs and HDUs to act as change agents will face significant challenges from employees, employers, and the organization at large. While it is true that some challenges such as the organizational culture and resistance to change that emanate from employees can be addressed, different organizations may find it difficult to embrace this change due to financial challenges of recruiting retired nurses. According to Silver, McQuillan, Harel, Weizman, Thomas, and Nesrallah (2016), many organizations could consider shunning the recruitment of retired nurses and focus on training graduate nurses as they tend to cut operational costs. It is also quite difficult to convince the employer that the ICU and HDU facilities require continuous presence of nurses to deal with emergency situations that affect patients undergoing treatment in the critical care units. One of the approaches to address this limitation is to involve strategic decision-makers such as managers in the change process. The implementation of this decision will involve inviting the top managers of the healthcare organization to view the challenges that specialist nurses serving in ICUs and HDUs face. The board members of the healthcare organization will also be asked to read a compiled report on factors that undermine quality service delivery in
LEWIN’S CHANGE MODEL AND STAFFING ISSUES IN ICUS6 ICUs and HDUs and make inclusive recommendations on how to improve quality output. After reviewing the recommendations and explaining to the stakeholders the role of the retired nurse leaders and specialists in ICU and HDU, the board and the management team will be allowed enough time (preferably two months) to reflect on the proposed change and its impact on the organization and employees at the ICU and HDU departments. For the public-funded institutions, it will be possible to involve policy-makers and special interest groups to champion for desired changes from the government. Even though it is possible that the government may be reluctant to implement laws requiring that all healthcare institutions have enough number of specialists in the ICU and HDU facilities to improve service delivery and increase the quality of care. The limitation of funds will also be addressed by engaging managers in institutions to allocate sufficient funds to the ICU and HDU departments with the goal of making sure that the department runs its operations effectively with minimum interference. To address conflicts that may arise due to cultural conflicts and resistance to change, the existing members of the organization will be involved in the decision making to make sure that they feel part of the organization during the change process. The three steps of Lewin’s model for change management will be followed strictly to make sure that the organization realizes its potential goals and patient safety is maximized at all levels. Conclusion Job satisfaction for newly recruited nurses is an issue of concern for nurses working in the critical care departments. Newly recruited nurses find it difficult working and they may quit the profession due to challenges in their environment and work overloads. Introduction of retired nurse leaders and specialists in the ICU and HDU departments will make sure that newly recruited nurses are guided and motivated in service delivery as they work towards efficient
LEWIN’S CHANGE MODEL AND STAFFING ISSUES IN ICUS7 work delivery and adjust to their professional roles. Lewin’s model of change will be applied accordingly throughout the change process for the successful implementation of this project.
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