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DQ: How have you seen or experienced organizational change within an organization?

NUR 514 Topic 3 Discussion 1

DQ How have you seen or experienced organizational change within an organization

At the level of charge nurse, organizational change is often experienced as a bystander. The change is apparent; however, the stakeholders and model are a mystery. Being bought by a large organization and going from a nonprofit to a for-profit acute care hospital was a rough transition. From the viewpoint of the nursing staff, most of the change was not favorable. There was the loss of ancillary staff, changes to inferior supplies, gaps in leadership, and highly drawn-out contract negations resulting in significant delays in step and other raises. If you asked the nursing staff know how the change went, they would probably say, “not good, but we made it through.” If you asked the major stakeholders who influenced the change plan, their answer would be different because it was a success. Five years later and it is business as usual with talks of a new hospital on the horizon.
All the hospitals in the area are now for-profit facilities. This is a trend in the United States, hospitals are consolidating at an accelerating rate, and healthcare costs continue to rise (Findlay, 2018). From 2013 to 2017, nearly 1 in 5 hospitals were acquired or merged with another hospital (Findlay, 2018). In most cases, mergers are necessary for the survival of the hospital. To keep up with advancing technology, modern data management, and top clinical talent, merging with large corporations is the only option (Findlay, 2018).
Nevertheless, at what cost to the communities these hospitals serve. You would think community services would suffer; however, a recent study showed only slightly higher spending in charity care for nonprofit facilities and showed higher charity care spending in for-profit hospitals with 300 beds or more (Garber, 2020). The same study showed that the most significant deviation in charity care spending was from state to state and had little bearing on whether the facilities were nonprofit or for-profit (Garber, 2020). Major organizational change is complex, and some areas of nursing suffer; however, the more significant picture points to the necessity to survive.

Findlay, S. (2018, July 19). Can a Community Hospital Stick to its Mission When it Goes For-Profit? Retrieved from npr.org: http://npr.org/sections/health-shots/2018/canacommunityhospitalsticktoitsmissionwhenitgoesforprofit

Garber, J. (2020, October 1). Nonprofit and for-profit hospitals provide similar levels of charity care, study finds. Retrieved from Lown Institute: https//lowninstitute.org/nonprofitandfor-profithospitalsprovidesimilarlevelsofcharitycare,studyfinds

The 2010 IOM report had four key messages or recommendations for nurses to position themselves strategically in healthcare provision. Firstly, the report stresses the need for nurses to practice to the fullest level of their education and training without any hindrances imposed by state boards of nursing. The message influences nursing practice as it means that nurses should be barred from practicing what they have trained on in different specialties (Price & Reichert, 2018). Secondly, the report asserted that nurses should engage in lifelong learning to acquire higher levels of education and training based on a better education system. The message means that the nursing practice requires professional nurses to engage in continual professional development to attain the latest skills and knowledge in healthcare provision, especially the deployment of technology.

RESPOND HERE (150 WORDS, 2 REFERENCES)

This is insightful, Marion; organizational change can sometimes become sudden due to the lack of involvement of some professionals in the change process. In most cases, charge nurses are left out in the decision-making processes, a scenario that makes it so hard for them to realize that the change process has been initiated (Nielsen et al., 2020). The change from profit to a non-profit organization can prove to be a challenge for most healthcare workers due to the changes in the roles for nurses that ought to be implemented. Given the increase in demand for effective healthcare care services, the change processes are always dynamic; this is a trend in the United States, hospitals are consolidating at an accelerating rate, and healthcare costs continue to rise (DeNisco et al., 2016). Sometimes, when organizational changes are implemented, nurses, particularly charge nurses, experience challenges in the process of transition. Therefore, there is the need to involve nurses in the decision-making processes geared towards implementing changes in the healthcare systems.

References

Nielsen, P., Albertsen, K., & Meng, A. (2020, September). Impacts of organizational change on senior employees. In The Nordic Working Life Conference, Aalborg. https://vbn.aau.dk/en/publications/organisatoriske-forandringers-betydning-for-seniorer

DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for

          the profession (3rd ed.). Jones & Bartlett Learning.

At my previous job, the hospital policy on bloodwork/labs became a topic of interest for change. Between the lab directors and the medical directors, they decided to implement a trial that included changing how the patient labels were printed for the bloodwork. Originally, the labels included the patient’s name, date of birth, medical record number (MRN), the physician’s name in which the patient was admitted under, and the date that the patient was admitted. The proposed new labels would include the same information, but would also include the color of the tube that the bloodwork was to go in, as well as a barcode.

Although the thought process was that the new labels would help the doctors, nurses and phlebotomists easily place the correct sample

DQ How have you seen or experienced organizational change within an organization
DQ How have you seen or experienced organizational change within an organization

in the correct color tube top, the exact opposite occurred. The computer system became at fault as the barcodes were not matching all the patient information and tube top colors; labs and colors did not correlate with each other. For example, a CBC normally would be in a lavender tube top, yet the label would print mint green, which was meant for a BMP. This led to many errors after the blood was sent to the lab. Labs were not being run right away, including STAT labs, and some were even put in the wrong color tubes. Some lab results were not coming up for the correct patient as well. This was a MAJOR patient safety issue. Having the wrong lab results for the wrong patient is beyond dangerous, especially something as serious as a type and screen.

Administration quickly found out about all of the errors in the first week that the new labels were rolled out. The new labels were put on hold, and we went back to the original labels which were working just fine to begin with. We were told that IT and the lab would be working to resolve the issues and that the new labels would be trialed again once it was deemed OK and safe to utilize. I have since left that position but when I left that job, the new labels still had not be re-instituted.

After reading about the 8 Step Change Model, I do not feel that many of the steps were properly utilized. According to DeNisco & Barker (2016), when a change idea is proposed by administration, educational experience and data should be utilized to demonstrate why the change is necessary. A team vision should also be a part of the change process, as it will not only affect one group of people, and should be questioned and discussed before implementing the plan to do said change (DeNisco & Barker, 2016). I feel that when the idea of new lab labels was initiated, it came out of nowhere. The staff like myself who did the bloodwork and sent to the lab was not asked for our opinions and there was no discussion of the reasoning behind the new labels. I believe if administration had utilized the 8 Step Change Model and took the time to incorporate the IT team for the computer aspect of the labels, many patient errors could have been avoided.

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Resources

DeNisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for

          the profession (3rd ed.). Jones & Bartlett Learning.

 

RESPOND HERE (150 WORDS, 2 REFERENCES)

 

This is insightful, Katherine; an organizational change process requires the involvement of all the stakeholders. To successfully implement the change process in the healthcare system, there is the need to engage professionals who may be directly impacted by the change process (Yang et al., 2018). Also, when the administration proposes a change idea, educational experience and data should be utilized to demonstrate why the change is necessary. Bloodwork often requires individuals or healthcare professionals with expertise in undertaking different activities within the department. Therefore, before engaging in the transformation processes, their opinions or perception of the change process is necessary. Most organizations are always involved in the change processes to enhance efficiency and quality in healthcare delivery processes. However, failure to incorporate all the stakeholders may impact the achievement of the desired outcomes or objectives. Creating changes in the bloodwork, particularly the development of a new labeling system, requires support from IT experts to reduce errors that may lead to adverse treatment outcomes (Jalbert et al., 2019).

References

Yang, Y., Choi, J. N., & Lee, K. (2018). Theory of planned behavior and different forms of organizational change behavior. Social Behavior and Personality: an international journal46(10), 1657-1671. https://doi.org/10.2224/sbp.6832

Jalbert, R., Gob, A., & Chin‐Yee, I. (2019). Decreasing daily blood work in hospitals: what works and what doesn’t. International journal of laboratory hematology41, 151-161. https://doi.org/10.1111/ijlh.13015

I experienced organizational change as a new grad. The hospital I worked at typically hired new nurses; the year I joined was their first time implementing a new graduate nurse residency program. The program was through Vizient and is utilized at many other healthcare organizations. Vizient’s program is one year long, uses an evidence-based curriculum, and includes an EBP project (Vizient Inc., n.d.). The program could be helpful as a new nurse, but the transition was a bit messy as this organization was not experienced with new graduate residencies. It was a learning experience for the organization but unfortunate for the new grads. We faced instructor turnover, nurses signing others into class when the others were never physically present and were quite unwelcomed by seasoned nurses in the ICU. I do not feel that the residency benefited me, and it was extra stress on top of my daily duties as a new ICU nurse.

As cited by DeNisco & Barker (2016), “Kotter (2012) suggested that more than 70% of all major change initiatives in organizations fail because managers do not see the change holistically and follow it through” (p.110). Our hospital contained three large ICUs with about 90 ICU beds. Thirty new grads were hired into the ICU, and we all began working simultaneously. I believe the nurse residency program fell through as leaders were not prepared to handle and adequately support the onboarding of so many new graduates at once. We did complete the program, but I wouldn’t say it was successful.

I believe my situation is an example of linear change, which has a cause-and-effect outlook (Porter & Malloch, 2018). The hospital needed more ICU nurses, implemented a new grad residency to assist with hiring in this area, and anticipated to produce vital ICU nurses. However, this was not the case. Ten of the ICU new grads left within the first year, and less than half remain at this hospital two years later. It was a challenging experience that hopefully taught the organization and its stakeholders a lot about the retention of new nurses.

References:

Denisco, S. M., & Barker, A. M. (2016). Advanced practice nursing: Essential knowledge for the profession (3rd ed.). Burlington, MA: Jones & Bartlett Learning.

Porter-O Grady, T., & Malloch, K. (2018). Leadership in nursing practice: Changing the landscape of health care (3rd ed.). Burlington, MA: Jones & Bartlett Learning.

Vizient Inc. (n.d.). Vizient/AACN nurse residency program. https://www.vizientinc.com/our-solutions/clinical-solutions/vizient-aacn-nurse-residency-program

 

RESPOND HERE (150 WORDS, 2 REFERENCES)

This is insightful Melissa, all major change initiatives in organizations fail because managers do not see the change holistically and follow it through. Every change process requires careful planning and the involvement of different stakeholders. Implementing a new graduate nurse residency program has been successful for organizations that consider adequate planning and effective approaches. However, the program has failed in some organizations that lack effective implementation models. Successful implementation of the new graduate nurse residency program needs consideration of effective models from other institutions (Asber, 2019). When a healthcare institution is planning for the change process, there is always the need to consider the resources available as well as the expertise from the relevant fields (Bokhour et al., 2018). In the case of implementing a graduate nurse residency program, the institution should consider experienced research professionals who are able to analyze different processes. Additionally, when the administration proposes a change idea, educational experience and data should be utilized to demonstrate why the change is necessary.

References

Asber, S. R. (2019). Retention outcomes of new graduate nurse residency programs: An integrative review. JONA: The Journal of Nursing Administration49(9), 430-435. 10.1097/NNA.0000000000000780

Bokhour, B. G., Fix, G. M., Mueller, N. M., Barker, A. M., Lavela, S. L., Hill, J. N., … & Lukas, C. V. (2018). How can healthcare organizations implement patient-centered care? Examining a large-scale cultural transformation. BMC health services research18(1), 1-11. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-2949-5