EBP Project Proposal: Change Management to Reduce Nurse Shortage

This evidence-based practice proposal addresses the critical issue of nursing shortages in the healthcare sector. It highlights the increasing demand for registered nurses due to factors like increased life expectancy, aging populations, and the rise in chronic conditions. The proposal identifies the negative impacts of nurse shortages, including increased stress, burnout, and potential medical errors. It explores the implementation of change management and organizational readiness strategies to improve health administration and reduce nurse turnover. The proposal includes an organizational culture and readiness assessment using the Organizational Readiness for System-wide integration of the Evidence-Based Practice (OCRSIEP) tool. The literature review supports the importance of organizational readiness in successfully implementing changes in healthcare settings. The proposal also outlines a solution description, change model, implementation plan, and evaluation methods for addressing the nursing shortage. This document is available on Desklib, where students can access a variety of study tools, including past papers and solved assignments.

Running head: EVIDENCE-BASED PRACTICE PROPOSAL
Evidence-Based Practice Proposal
Name of the Student:
Name of the University:
Author Note:

1EVIDENCE-BASED PRACTICE PROPOSAL
Abstract
There is a shortage of registered nurses in the medical fields and this picture is common world
over and it has been predicted by the big institutes that the shortage of the nurse is expected to
become to worse day by day. The increased number of demand of the registered nurses is due to
the increased amount of emphasis on the life expectancy, retirement of the baby boomers,
increased rates of the chronic conditions and preventive care. The registered nurses coordinate
and support the patient care, emotional assistance to the family of the patient and the patient,
giving advice to the same, educate the patients and the public on their health conditions.
Healthcare facilities explicitly require a specific set of nurses for a specific number of the
patients so as to maintain a quality and safety care. It is important to note that when a workforce
lacking a proper number or shortage, then it can have negative effects on the profitability and
performance of an organization. Due to the shortage of the nurses, of they have to work for
longer periods of time under the stressful conditions. Longer working hours often results into a
lower patient care quality, job burnout, job dissatisfaction, injury, fatigue, stress. The nurses that
are put under the stressful conditions can often lead to medical errors and the frequency of the
mistaking making tendencies increases. Reducing the nurse burnout on the other hand can save
the lives of the patient and as well as the money spend on the healthcare.

2EVIDENCE-BASED PRACTICE PROPOSAL
Contents
Introduction......................................................................................................................................3
Problem statement.......................................................................................................................3
Foreground question....................................................................................................................4
Organizational Culture and Readiness Assessment.........................................................................4
Organization's Readiness Level...................................................................................................4
Literature support/review.................................................................................................................5
Solution description.........................................................................................................................8
Change model................................................................................................................................12
Implementation Plan......................................................................................................................15
Maintenance of change..............................................................................................................17
Potential barriers to the implementation of the change management and related strategies.....17
Evaluation......................................................................................................................................18
Conclusion.....................................................................................................................................18
Reference.......................................................................................................................................20
Appendix........................................................................................................................................24

3EVIDENCE-BASED PRACTICE PROPOSAL
Introduction
Problem statement
Nursing workforce is a key entity that plays a major role in the tackling with the
problems and issues rising in the healthcare systems. Thus, to enhance the power of the nursing
profession there is a need to establish a proper and suitable conditions for the fulfilment of the
potential. It is needless to say that the nurses work under increased amount of stress and the
public healthcare system is already strained by the increased number of the aged population and
increased access to the healthcare systems (Driscoll et al., 2018). This makes the nurses to feel
the extra burden of the nurses with the weight of the patient upon their shoulders. It is important
to highlight that the in USA alone there will be large number of registered nurse jobs by the year
2022 and the number will rise by 100 thousand vacant spots per year. While it has been reported
by U.S Bureau of Labour Statistics that 500 thousand registered nurses will retire by 2022. It is
important to mention that the shortage of nurses creates opportunities for the nurses, but at the
same time it has potential negative implications (Kodama & Fukahori, 2017). The nurses also
have to work for the extended period of long hours and also under the stressful conditions that
can result into the job dissatisfaction, injury, fatigue. The increased pressure for the nurses render
them to make mistakes and made them prone to errors. This leads to a condition where the
patients are the sufferers and institutions must work to improve the safety for the nurses. The
nursing field is seen to be exhibiting and facing the lack of nurse workforces and the potential
reasons are the lack of the inequitable distribution of the nursing workforce, high turnover, and
the lack of potential educators. The three main reasons cited for the nurse workforce shortage are
the nurse burnout, ageing workforce, ageing population, career and family, violence in the
healthcare setting (Shea et al., 2014).

4EVIDENCE-BASED PRACTICE PROPOSAL
Foreground question
In the field of nursing there are several reason that contributes to the development of a
nurse shortage scenario and what will happen if the change management and organizational
readiness is implemented to minimize improper health administration and reduce the shortage of
nurses?
Organizational Culture and Readiness Assessment
The tool selected for the organization culture survey is the Organizational Readiness for
System-wide integration of the Evidence-Based Practice. This particular tool will specifically
help in the identification, evaluation and the investigation of the readiness of an organization
through the involvement into the evidence based practice.
Organization's Readiness Level
The capability of an organization to implement a change or embrace the necessary
changes defines it readiness. It is important to note one of the toughest thing is to deal with the
organizational changes and the changes that the people embrace while dealing the changes in the
change in the degree of centralization, education and training programs, job specialisation,
control and planning systems, and organization structures.
Organizational Culture and Readiness Assessment tool
The tool that will be used for the assessment is a survey that will present a reliable and a
valid survey of the scenario of the nurse workforce shortage. The name of the tool is called the
Organizational Readiness for System-wide integration of the Evidence-Based Practice
(OCRSIEP). It is a 25 scale item and this survey tool measures the extent to which the cultural
factors impacts and affects the system wide implementation of the evidence based practice. It

5EVIDENCE-BASED PRACTICE PROPOSAL
also affects the extent to which the overall perceived readiness is integrated into the evidence
based practice and it is then compared with the one 6 months ago. The respondents here indicate
their agreement with each of the item present in the Likert scale that has a score of 1- which is
equivalent to none at all; 5- represents very much. At the final stage, all the items are summed
and a total score is found to be ranging from 25 to 125. It is important to note that the higher the
score the more it is likely that the organizational will showcase the organizational readiness
towards the evidence based practice. The Likert scale is found to be exhibiting the content and
internal validity, along with the internal reliability of more than 0.85 (Yackel et al., 2013).
Literature support/review
This literature review is conducted to analyze the importance of change management and
the organizational readiness towards the reduction of the improper health administration and also
reduce the shortage of nurses. It has been highlighted by author that organizational readiness
helps in the change of the healthcare setting and is a vital factor towards the application of the
policies, practices, programs successfully. It has often been seen that the policies, practices and
the programs of an organization often fail due to the inability of an organization to establish the
change or the organizational readiness for the purpose of change. It is vital to mention that the
organizational readiness is referred to as the point to which the organizational members are
behaviorally and psychologically prepared towards the implementation of the organizational
change. It is seen that when the organizational change is high then the members are probable to
display a cooperative behavior, exert greater persistence and greater effort, and will be able to
initiate change (Hauck, Winsett & Kuric, 2013). This results in the proper application of the
change and likewise, when the organizational readiness is short then the members will be unable

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to interpret the change as an unwanted change and it will help in the participation of the change
process. While it has been highlighted by author that the organizational readiness within the
healthcare setting is considered as an important issue. While a study conducted by author
provided a psychometric analysis towards the supporting a theory, brief and new organizational
readiness for the change, which the authors called the Organizational Readiness for
Implementing the change (ORIC) (Storkholm et al., 2018). The assessment of the content
adequacy indicated that the change efficacy and the change commitment reflected the abstract
content of the two faces for the organizational readiness. Field study and the confirmatory and
the exploratory factor in the field and the lab have confirmed two correlated factors and it
exhibited the high item loading as well as the good model fit. While at the same time the
reliability analysis of the both the field and the lab study have highlighted an inter item
consistency. The agreement and the reliability statistics reinforced the accumulation at the
discrete level readiness insights towards the organizational level analysis. Thus, it can be said
that the ORIC serves as a valid, reliable and a brief measure of the organizational readiness and
this could advance the application practice and research. For the research purposes, such a type
of the measure will enable the testing of the theories for the purpose of determining the
consequences and determinants of the organizational determinants (Melnyk et al., 2018). The
advancements can effectively lead to a large amount of vital questions like: is the organizational
readiness effective for all the kinds of the variations and for all the types of the organizations?
can the readiness be considered as a condition that will be sufficiently effective towards the
application of the change? are there any readiness threshold that must be met before the
beginning of the application of change? Is it mandatory for all the organizational representatives
prepare for the change or the readiness is necessary for only a small group of the individuals? It

7EVIDENCE-BASED PRACTICE PROPOSAL
is important to mention that the healthcare leaders must develop an implementation strategy
along with the ORIC so that they can assess the organizational readiness before a change in a
specific setting type. This will be helpful towards the development of the implementation
strategies and also the allocation of the resources for a specific type of change. while it has been
highlighted by author that proper measurement of the organizational readiness can effectively
reduce the number of change efforts conducted by the healthcare organizations. while at the
same time it is important to mention that such an effort can lead to not achieving the desired
benefits and also not fail altogether (Kaplan et al., 2014).
A study conducted by author shows the results that the OCRSIEP survey has proved to be
successful towards the enhancing the organizational readiness and the organizational culture for
the purpose of evidence based practice. The commitment of the nursing staff towards the
evidence based practice have increased due the evidence based practice 101 sessions. This
assumption considered by the authors have highlighted that the evidence based practice based
survey showed a high difference in the scores in the post and the pre-evidence based practice 101
sessions (Aarons et al., 2016). The evidence based practice 101 sessions can also be considered
as a reason where the large number of the nurses have a string foundation of the skills and
knowledge. Furthermore, it has also bene highlighted that the administrators within organization
are committed to the evidence based practice, the nurse scientists are also available that helps in
the generation of the evidence. Thus, it can be said that the implementation of a
multidimensional evidence based program is capable of sustaining a practice change and it
provides a template for the execution of the evidence based program and it has also been showed
through studies that the integration of the five different strategies help in achieving a proper
sustainability. Furthermore, the establishment of an organizational culture for the evidence based

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practice includes the support of a leadership team towards dedicating resources, including the
end users, integrating the evidence based practice into the performance based reviews and it
promotes the application and dissemination of the evidence based practice into the healthcare
facilities. It has also been highlighted that the evidence based program will help towards the
shaping the nursing as well as he organizational culture (Schaffer, Sandau & Diedrick, 2013).
The authors of the study have confirmed that the program is found to be successful and it has
enhanced the organizational culture towards the readiness for the evidence based program as it
has integrated the beliefs of the nursing staffs. Furthermore, it is also important to highlight that
the nursing beliefs also enhances along with their ability to implement the evidence based
practice into the practice. The nursing staffs were provided adequately with the tools and
knowledge for using the evidence based nursing practice. While the evidence based program
toolkit helped in the encouraging and disseminating the same to the other healthcare facilities.
This knowledge directly or indirectly helps towards reducing the shortage of the nurse workforce
and at the same time increases the effectiveness of the nurse work efficiency (Yackel et al.,
2013).
Solution description
Each of the healthcare institutes that have a unique set of factors with the capability of
determining the services that are rendered to the patients. Thus, there is a need to formulate a
strategy that can be used successfully in a healthcare industry. To establish success, the leaders
of the healthcare facility must include the prime performance indicators. The following are the
solutions that can help in reducing the impact from the constrained nursing workforce.
 The organizational leaders in the healthcare sector/facilities must ensure that the
hiring managers and the recruiters improve their hiring skills and these personnel

9EVIDENCE-BASED PRACTICE PROPOSAL
must be trained properly so that they can recruit the qualified registered nurses
(Harris, Rosenberg & O'Rourke, 2013).
 The nursing schools, the registered nurses, and healthcare facility leaders must
promote nursing to the general public and it must be conveyed that that the
registered nurses are trained as lifesaving professionals and it is also important to
note that the profession of nursing have several possibilities. While it is also
important to mention that a positive image of nurses can increase the chances of
individual opting nurse care.
 The federal and the facility leaders need to be proactive and creative so that the
critical thinking is applied and the more qualified registered nurses are recruited
and a health supply of the registered nurses are maintained. The shortage of the
registered nurses affect the quality of nursing care rendered to the patients. While
it is also important to mention that the lack of the proper strength puts a strength
on the existing registered nurses. This results into the intention to leave job, job
dissatisfaction and burnout (Golden, Silverman & Issenberg, 2015).
 The shortage of the registered nurses if persists then the healthcare facilities can
provide early recruitment to the position of the registered nurses to the nursing
students of the final year in the nursing schools.
 Peer consultation, opportunities for the interpersonal learning, extending the
professional autonomy and job rotation can also help the registered nurses to
become satisfied with the job and this will help in increasing the retention of the
nurses.

10EVIDENCE-BASED PRACTICE PROPOSAL
 The healthcare facility leaders must increase in order to sustain as well as support
the students of nursing and the newly employed registered nurses (for example
research committees, mentoring programs, preceptors, clinical, residences, etc.)
on the job. The new student and the newly registered nurses can get knowledge by
interacting with the other nurses during the work hours.
 The nurses are the role models and the educators that are essential towards the
creation of the essential professional identity. The healthcare facility leaders must
preserve a strong leadership into the work environment and this will enable in the
creation of an engaging and satisfying workforce for the registered nurses.
 The healthcare facility nurses can encourage and groom the licensed practical
nurse to a next level so that they can become a registered nurse. The nurse leaders
can also as a financial support, scholarships, provide assistance and tuition
classes.
 Benefits and compensation are the influential factors that plays a vital role in the
retention and the recruitment efforts. The healthcare facility leaders must reward
and compensate the registered nurses accordingly so that they can stay
competitive in the healthcare industry.
 The healthcare facility leaders can also share the opportunities of job sharing to
the registered nurses that are willing to modify their job status from full time to a
part time nurse. The opportunities of job sharing provide an important aspect of
retaining the talent of the registered nurses so that they do not move to another
organization and the also do not change their profession due to their denial of the
part time status (Parkinson & Parker, 2013).

11EVIDENCE-BASED PRACTICE PROPOSAL
 The healthcare facility leaders that enact a phased form of the retirement plan and
the leaders also ensure the smooth transition or the transfer of knowledge to the
newly recruited registered nurses. The successional planning forms the backbone
and is one of the crucial aspect of planning and retirement of the eligible nurses.
 The recommendations and the research findings can also encourage the
governments so that they can integrate the statutory standards and requirements
for the purpose of mandating the work shift of less than 12 hours for the
registered nurses. It has been found that the working for more than 12 hours leads
to increased number of mistakes due to job burnout. The less than the 12-hour
work shift can positively promote the safe work environment for better patient
outcomes. Furthermore, the government can also be benefitted from the healthy
employees that have the intellectual capital and that can assist in the development
of a healthy individual.
 Development of proper communication programs- the healthcare leader must
emphasize on creation of a positive work environment, establishing solid
communication and employee engagement. The furthermore, the solid
communication development can also help in the development of trust and also
helps in open dialogue. The healthcare leaders can also consider the experiences
of the existing registered nurses so that that they can improve the communication
between he employees and their leaders (Couper & Hugo, 2014).
 Employee engagement- the healthcare leaders can work towards the increasing
the employee engagement so that they can assure the employee satisfaction. This
can be accomplished by maintaining and hiring the qualified leaders and