Change Proposal to Curb Nurses’ Shortage in Hospitals

This proposal aims to explore and bring into the limelight the most suitable change strategies that will effectively elevate the staffing level of nurses in hospitals.

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Change Proposal to Curb Nurses’ shortage in Hospitals.
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Table of Contents
Introduction......................................................................................................................................3
Background......................................................................................................................................4
Change Implementation to Improve the Quality of Care................................................................5
Change Strategies.........................................................................................................................5
Introduce Onboarding Program................................................................................................5
Allocation of More Funds to the Nursing Section...................................................................6
Convert Current Nurses into Recruiters and Compensate For Referrals.................................6
Design Schedules That Align With the Needs of Nurses.........................................................7
Proper job design......................................................................................................................7
Change Implementation and Management Models.....................................................................8
a) Plan-Do-Study-Act (PDSA)..............................................................................................8
b) Lewin's Model of Change Management...........................................................................8
c) Lippitt’s Seven-Phase Model..........................................................................................10
References......................................................................................................................................15

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Introduction
The health care industry is emerging as in faster rate in which the nursing industry is
lacking behind due to changes in management practices and systems (Margius and Huston,
2017). The National Health Service (NHS), for example, has witnessed numerous changes in the
health care industry since its initiation. Some of the most significant changes are massive
computerization and alterations in job design (Lumbers, 2018). For many healthcare settings, the
amendment is seen from emerging trends in the industry and by the prevalence of various
challenges or desire to meet clients' needs. This proposal predominantly focuses on the problem
of shortage in the number of nurses in hospitals. This challenge adversely impacts on nursing
leadership, management practices as well as delivery of quality care (Needleman & Hassmiller,
2009). With a continually growing population, people are also facing various health issues due to
which requirement for proper health care has increased. Therefore, there is a great urgency to
integrate high nursing services in health care (Hucsynski and Buchanam, 2013).
This proposal chiefly aims at exploring and bringing into the limelight the most suitable
change strategies that will effectively elevate the staffing level of nurses at Placement Hospital
(Placement Hospital, 2018). With the prevalence of the challenges being witnessed nationally,
the NHS’s Five Year Forward View is in support of local level strategies to increase the number
of nursing staffs (NHS England et al., 2014). Upon implementation of the proposed change
strategies, it is expected there will be a reduction in shortfalls of the national economy of the
country. The proposal will embark on various leadership and change management frameworks to
develop and implement appropriate change strategies. It is also worth noting that this proposal
takes into consideration the nursing practice as a whole (Addicott, Maguire, Honeyman and

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Jabbal, 2015). Hence, the strategies developed applies to all nursing practitioners from all
specialities.
Background
The challenges of nurse shortage are not only disturbing the national snare but also
affecting the entire globe. Future prediction reveals that the difficulties might be even more
widespread and intense in the coming generations (Marangozov, Williams and Bavan, 2018).
Primarily, the foundation of this challenge lies in the low numbers of individuals willing to be
recruited, trained, and hired to serve as nurses in the healthcare industry in comparison to
prevailing high demand. NHS is currently struggling with low nursing staffs while subsequently,
the current workforce is ageing (Steve and Veena, 2018). A 2016 report from an improvement
survey revealed a continuous surpassing of nursing supply by its demand (NHS Improvement,
2016). A report prepared and submitted to the Health Education England (HEE) showed that the
need for adult nurses by care providers was 180,000. This was contrary to a 2011 projection by
the providers where they had estimated demand of 165,000 adult nurses in 2013 (NHS
Improvement, 2016).
Another critical factor to the challenge is financial constraints. The government has been
suffering from financial limitations at both the trust and departmental levels (Buchan & Aiken,
2010). Consequently, nursing posts and training institutions for nurses being commissioned are
low in number (Steve and Veena, 2018). In an attempt to ease pressure on the interim workforce,
it was recommended by the Migration Advisory Committee in 2016 that 1500 country visa
should be issued to nurses outside the European Union (Steve and Veena, 2018). There is no
drafted post-Brexit plan to address the issue of nursing shortage because many nurses are from
various EU nations (Marangozov et al., 2018; NHS Improvement, 2018).

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The impacts of nurses' shortage have brought undesirable consequences to various nurse-
care users in the health care sector (Gordon et al., 2012). Due to lack of proper care, it has caused
a high level of maternal death and as well as the provision of quality care in obstetric
departments has been compromised (Francis, 2013). Nurse shortage is also a known obstacle to
the availability of timely care to patients in the emergency section. As care seeker in the country
is high in number as compared with the low number of care provider, the workload of the
available nursing staffs has increased (Francis, 2013). Thus, it can be said that the quality of care
given by the overloaded workforce is significantly low and it directly attributable to the shortage
of the number of nursing staffs.
Change Implementation to Improve the Quality of Care
Change Strategies
Nurse leaders in collaboration with management teams are responsible for handling and
solving emerging problems with the chief aim being to improve the quality of care. It is,
therefore, a leadership task for leaders to evaluate the nurses' shortage issue and derive
appropriate strategies to mitigate the problem. Discussed henceforth are several change strategies
with the potential to effectively curb the challenge.
Introduce the Onboarding Program
Various reports and studies have emerged to prove that the first perceptions of new
nurses in any healthcare facility subsequently affects job satisfaction (Avillion & Buchwach,
2010). As a result, the effects may elevate or decrease labour turnover among nurses, an issue
that significantly contributes to the overall shortage of nurses (Armmer, 2017). It is therefore
crucial for the hospital to design an onboarding program that will help new nurses align with
various aspects of the hospital for improved care delivery (Swihart & Figueroa, 2016). For the

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success of the onboarding program, it is crucial for the Newly Licensed Registered Nurse or
Newly hired nurse to get involved sincerely in the change program (Armmer, 2017).
Allocation of More Funds to the Nursing Section
Insufficient funds to facilitate hiring and maintaining nurses in the healthcare facility is a
factor that significantly contributes to the nurse shortage. When budgeting the available funds, it
is a matter of great urgency for the leadership team to allocate relatively more amounts of funds
in the Nursing Department (Jones et al., 2012). Such funds will play a large role in the hiring of
more nurses to fill in the demand-supply gap. Additionally, the funds can also be used to
improve the general working conditions for nurses in order to increase job satisfaction as well as
indulge them in long term projects that are in support of the nursing career (Robertson et al.,
2017). Robert Wood Johnson Foundation availed a report suggesting that changing/increasing
funds allocation facilitated the development of a suitable learning and working environment
(Olson, 2015). Consequently, the number of new nurses increase while the rate of nurse turnover
reduces.
Convert Current Nurses into Recruiters and Compensate For Referrals
It is evident that the present working force in the nursing department has a connection with the
excellent quality of nurses in terms of their friends or relatives. The leadership and management
group should embark on motivating the nursing team to bring in more nurses to join the working
force and curb the shortage (Hayes, 2018). The aforementioned is more achievable when the
management avails compensation to those nurses who recommend the new nursing member.
Design Schedules That Align With the Needs of Nurses
High rates of turnover as well as the unwillingness of new nurses to join the workforce
have been marked as a fundamental reason for the prevailing nurses' shortage. Leaders in

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healthcare settings have always found it hard to maintain a balance between personal life and the
professional life of nurses (Lin, 2015). It is primarily contributed by the demanding nature of the
nursing profession where nurses are required to spend more time in the work environment.
Consequently, many nurses are unable to bear with this and end up quitting to seek alternative
jobs that will support their objectives such as family time (Yoder-Wise, 2013). Making changes
in the working schedules of the nursing staffs allows nurses to have adequate time to attend their
affairs and a decrease in workload will play a significant role in increasing the number of nurses.
Proper job design
Poorly designed nursing jobs encourage turnover while at the same time discouraging
new nurses from joining the workforce of the facility. The nurse retention rate in healthcare
facilities where nursing jobs are poorly designed is low. It can be related by the role of
ambiguity, work overload or under load, poor remuneration, and unclear job expectations
(MacLean, 2014). It is, therefore, the leadership and management work to evaluate the current
job design of nursing and change them accordingly. Such changes would include more clear job
expectations as well as job positioning in line with nurses' capabilities to overworking or
underworking the staffs (Bogaert & Clarke, 2018). Consequently, the adaptation of proper job
design has been linked with motivating nurses as well as providing job satisfaction (Miner,
2015). As a result, well-designed jobs facilitate holding of the current nursing workforce as well
as attracting new and younger individuals to join the profession.
Change Implementation and Management Models
The management must embark on a variety of change management models for the
desired change to be imparted in the healthcare facility. Making the right choice of the most
appropriate leadership and management model is crucial to the achievement of the desired

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results. Three change management models have been tried and considered valid. They are Plan-
Do-Study-Act, Lewin’s change management model and Lippitt’s Seven-Phase Model. Here, two
models have been discussed with respect to its application in the hospital to facilitate the
elimination of nurses' shortage issue.
a) Plan-Do-Study-Act (PDSA)
According to Tylor et al., 2014, PDSA is a more applicable model where the expected
achievements of it are known. There is an explicit statement of the idea to be tested as well as
the existence of known parameters with which success of the change or improvement can be
measured with (Kritek & Hickey, 2011). Since a discrepancy may arise from the actual result
and the expected outcome of the model, it is considered a safety precaution for the management
to first test the plan on a smaller sample before implementing the plan fully across the board
(NHS Improvement, 2018). There are three questions whose answers form the foundation of
PDSA model implementation. They are; what achievements are being aimed at? What
measurement parameters will be used to evaluate the results? And, what changes are actionable
to bring out the desired change? PDSA will, therefore, play a significant role in testing proposed
changes at the hospital (Kritek & Hickey, 2011).
b) Lewin's Model of Change Management.
According to Kurt Lewin, change implementation is a three-stage process with the key
stages being; unfreezing, changing and refreezing. Lewin also made it clear that for change to
occur, leaders and other concerned parties must perceive the need for the transition to occur
(Marquis & Huston, 2009). Consequently, action must be taken to embark on appropriate
behaviour that leads to the achievement of the desired change. The practices that eliminate the

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amendment must then be incorporated into the organization as a norm (Kotter, 2012). Discussed
henceforth are the three stages and their applicability at the hospital.
Unfreezing
By nature, people are bound to resist changes. The primary role of the unfreezing stage is
to ensure the awareness of current nurses regarding how the current status or acceptability levels
are affecting their (Sare & Ogilvie, 2010). The leaders must carefully scrutinize the current
processes, old behaviours, organizational structure as well as issue in nursing staff. It should be
linked to the existing problem of the low number of the nurse to visualize the need for change
(Wong, 2015). All processes related to hiring and retention of employees must be halted and
evaluated to establish precisely where change is required.
Actual change
Having created a changing atmosphere in the hospital, implementation of substantive
change is the next stage. After an in-depth evaluation of the processes related to hiring and
retention of nurses, the hospital's management should come up with appropriate strategies to
address the shortfalls identified (Bradley, 2015). Any designated plan that is to be embarked on
should undergo proper scrutiny to determine its effectiveness in bringing the desired changes.
Adequate communication, education, and support must also prevail for the transition to be
successfully implemented.

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Refreezing
This being the last stage, the new post-change state of the hospital must be solidified,
stabilized and reinforced. All changes that have been adopted to facilitate the hiring and retention
of nurses to control the shortage problem must be refrozen as the new status quo or norms of the
facility (Scully, 2015). Such changes would mainly be focused on organizational goals, people,
the structure as well as processes. According to Lewin, this stage is crucial as it holds the newly
adopted strategy by outweighing the old procedure of nursing care in the hospitals (Nagelkerk,
2005). Adequate efforts must be enacted to ensure that new goals regarding the nursing field is
well implemented. Effort must be made to take it towards success that results in the elimination
of the challenges.
c) Lippitt’s Seven-Phase Model.
Phase One: Problem Diagnoses
It is the commencement stage where change management is initialized. The step puts into
practice Lewin's unfreezing and supplements it with motivation and assessment (Gray, 2013).
Following precise analysis of the problem, a framework or guideline is first drafted. It is then
handed over to those who are likely to be most affected by the change (Guy and Gibbons, 2003).
To ensure that full participation of all parties that are to be modified by the proposed amendment
is evaluated and it is vital for managers to embark on democratic leadership style (Roussel,
2006). It is also of considerable significance to set a realistic timescale while simultaneously
starting on effective communication styles. The diagnoses should also consider Brexit, and its
implications must bring changes to the healthcare industry.

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Phase Two: Assess Capacity For Change.
For successful change implementation and sustenance, facilitators and driving forces
should outweigh the barriers (Lippitt, 1958). This phase, therefore, seeks to understand the
underlying obstacles and how to overcome them altogether. Additionally, it aims to unearth the
driving forces and apply them to ensure that various parties involved in change implementation
are motivated enough. As such, those actively involved and affected by the proposed change
should engage in effective communication to identify drawbacks and develop resolutions to
tackle them (Gary, 2013). One of the foremost anticipated challenges is resistance to change.
Consequently, an effective planned change and the problem-solving framework should be
embarked on. Force-field analysis, a framework coined by Lewin, seeks to explain how driving
factors can be increased to overcome resistance to change. It is, therefore, a suitable framework
to be adopted at the Placement hospital.
Phase Three: Assessment of Change Agent Motivation and Resources.
Motivating change agents is vital in the planning, implementation, and sustenance of
change in any organizations (Tomey, 2009). It is therefore in this stage that various
methodologies that can be used to motivate changes are evaluated. Nurse leaders are not always
healthcare managers but should at all times be motivated to influence other nurses positively
(Murphy, 2006). At placement hospital, team members from various professions should actively
participate in meetings and discussions to develop a variety of possible motivation methods. In
addition to this, team members should address any challenge and slackness. Financial resources,
which are vital for change success, need to be discussed at this stage.

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Phase Four: Selecting Progressive Change Objectives.
In this stage, a final change draft is in-scripted clearly outlining the entire process. All
factors addressed in phases one, two and three, among them resources, force-field analysis, and
costs should be put into consideration. Objectives that need to be developed at this stage should
be specific, measurable, achievable, realistic, and time-bound (SMART). Additionally, this stage
will be supported by the Plan-DO-Study-Act (PDSA). Nurse leaders and change Managers
should be given training on three key supporting pillars of change strategies. They are;
normative-re-educative, power-coercive, and empirical-rational approaches (Gary, 2013). Out of
the approaches, one approach or a combination of two approaches or all the three approaches can
be selected by the change agents on the required basis embarked on depending on their
appropriateness.
Phase Five: Select Appropriate Role for Each Change Agent.
The most important figures in the planning, management, implementation and change
sustenance are Managers and Nurse Leaders. They mainly play a significant role in resources
and staff management. Hence, they are the two key factors that form the spine of change
implementation (Gary, 2013). It is at this stage that purposes change into the reality by allocating
roles to various change agents. Each change agent is assigned tasks depending on their
profession and capabilities, skills and knowledge. This will ensure that all team members are
involved in the change process through the assignment of functions. For team members with
similar skills, it necessary for them to play similar roles. Therefore, such parts can be subdivided
according to subtask assigned to individual agents. Since resistance in undertaking various
functions is likely to occur by change agents, Force-field analysis will play a vital role at this
stage (Tomey, 2009).

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Phase Six: Change Maintenance.
After the implementation of change strategies, maintaining the change is the next
essential step. The fundamental aim of this stage is to ensure that the introduced change is upheld
until members of the Placement hospital accepts it as part of their culture (Pearson et al., 2006).
Proper communication channels should be developed to ensure the flow of feedback, progress
levels, inter-professional collaborations, as well as motivation. Additionally, effective
communication in conjunction with interpersonal skills should be employed to ensure that
mutual relationships that support the introduced change are developed and maintained (Martin,
2006). To motivate change agents and inspire adherence to change, two-factor motivation theory,
developed by Herzberg should be employed (Herzberg, Mausner and Snyderman, 1959). It is
also at this stage that various training and learning needs will be addressed and appropriate
action taken to meet the requirements.
Phase Seven: Terminating the Helping Relationship.
Successful change maintenance consequently leads to incorporation of the change in the
organizational culture. The results of the change are evaluated, and a plan is developed on how
resources and change agents are to be withdrawn. Indicators brought forth in the PDSA will be
used to assess whether or not the change strategies embarked on have helped Placement hospital
alleviate the nurses’ shortage challenge. As recommended by Francis (2013), the nurse-patient
ratio will be an essential evaluation focus point. Increased hiring, reduced nurse vacancies as
well as a reduced rate of nurses' turnover will be visible indicators of change success. Nurse
leaders and managers should also collect feedback from patients to determine any improvements
in care delivery. Positive feedback will be an indicator of successful change implementation.

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Communicating the Change
There are various ways through which Placement Hospital leaders can deliver changes to
their staff. First is by use of internal memos (Bryan, 2009). Information can also be passed on
from the leaders to the team through departmental heals. Meetings will also effectively serve the
purpose (Hicks & Nicols, 2011). Multiple digital platforms such as televisions can be used to
invite qualified members of the public to express their interest in filling new vacant positions
created during the change process.
Conclusion
Conclusively, the inevitable nature of change management in various practices and
systems in the healthcare industry and the nursing sector is directly attributable to emerging
trends and challenges. In the United Kingdom, for example, numerous changes have been
witnessed in the National Health Service. In this case, the change will aid the delivery of quality
care by reducing patient waiting time, facilitating patient-centred care as well as increasing job
satisfaction among nurses. The primary expected challenge is resistance to change and lack of
sufficient funds to support the change. Lastly, leadership is the backbone of successful change
implementation as leaders will steer the entire process.

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