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A Recipe for Becoming a Change Agent

Monday March 6, 2000
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You don't need a crystal ball to tell you that change is ever-present in daily life and in nursing practice. And because change is a constant, a change agent must be sensitive to personal needs of the staff and must have well-developed strategies to ensure everyone is on the same page as changes occur.
Many years ago, a self-help expert named Earl Nightingale (no relationship to Florence) said there are many ways to do something, and new ways after that, and new ways after that. Kathleen Webster, RN, MSN, vice president of patient services at Hudson Valley Hospital Center, Peekskill, New York, couldn't agree more.
"The job is never done," says Webster, "and the environment is always changing. We constantly have to rethink what we do. One of the plights of the change agent is sudden change - an unexpected shift in leadership or a crisis of some sort. On that level you don't get to do the all-important planning for a successful change. Other change, such as mergers, downsizing, addition or deletion of services, changing role responsibilities or ancillary staff changes, or new technology, equipment or product lines usually offer time to plan change.
"In hospital nursing, your world is always changing," she explains. "It's a very demanding, fast-paced job, and whatever stability exists must come from consistent leadership that trickles down to staff. Comfort and stability that contribute to job satisfaction come from management. Little things can throw a nurse into a frenzy - like having to go to another department for supplies - and can upset the routine. So you can't over-emphasize the need for planning to deal with change. "
Use the Right Tools
"You need to be certain the tools for change are always there," says Webster. "Excellent communications and establishment of trust between management and staff are always the right tools. In fact, they are the first tools you should use."
"After a new nurse enters the facility and completes the orientation," Webster says," I bring him or her in for a one-on-one meeting. That way, when change occurs the nurse will feel comfortable enough to walk up to me in the hallway and talk about it. Without a face-to-face meeting, I may seem distant, which may not help when it comes to change."
For successful changes, a manager must not only recognize the staff, but must empower them to be change agents. "More and more I'm finding the need to include staff in the entire process." Webster adds, For example, changing the shift schedule from eight to 12 hours and seeking staff input for their preferences. Should we change completely? Do we mix eight- and 12-hour shifts? Letting the staff come up with a sample schedule is a good idea.
"We had a new nurse who went through orientation and was ready to start when suddenly child-care issues arose and she could only work from 9 AM to 5 PM," says Webster. "Years ago you'd have to say 'that's too bad' and let her go. Today you ask how you can accommodate that nurse because turnover is costly and the time it takes to fill the vacancy is longer. We have invested resources in that nurse and want retain him or her. The nurse does in fact work from 9 AM to 5 PM. This change needed to be finessed with the staff, who learned to adjust to the shift change rather than lose the nurse. The overlap in time turned out to be a good thing." Not all changes offer clear advantages and there is often substantial resistance to overcome.
"We've been addressing retention issues and embracing new staff," she says. "Now we're looking at incorporating staff into the hiring process so they actually participate in the interview of a candidate and become part of the decision-making process. We believe this will enhance the new person's chances for success. Our first experience with this was positive. However, if your results turn out to be less than positive, work out unmet expectations with staff and develop an action plan. Review the expectations realistically."
Turnover Is Not Easy as Pie
Management personnel must take into account that turnover is difficult for everyone. According to Webster, staff must understand the reason for turnover and that some factors are outside of management or staff control.
"In relocation, for example," she says. "We have to look at things that are within our control and discuss them. I had to become more flexible in structuring the work environment to retain nurses. So far, downsizing and layoffs have not been a problem for us, but no matter what the situation, you must articulate the reasons for change. You need to seize every opportunity for staff input, and be able to think outside of the box about how the change will effect staff. As a change agent, you must anticipate all possible reactions that may occur and know how to address them. As soon as there is less of a threat and staff knows they have a voice, there will be fewer problems related to the change."
"I find that in department meetings, the common and recurring theme is fairness and participation. Nurses want to see that the manager is fair and equitable."
Too Many Cooks in the Kitchen?
Too many cooks can spoil the stew, but Webster explains that if staff is interested enough to participate, they should be heard. Not everybody's idea or suggestion can be accommodated. However, many very good ideas and practical solutions come from staff. Many suggestions, she says, can be incorporated into the final plan.
Other changes that may cause concern are -
∑ changing the patient services; new procedures, new technology, and new general services
∑ changes in work requirements, such as those mandated by regulatory agencies that have nursing implications such as new policies, new forms, and documentation requirements
∑ changes in expectations as they relate to service excellence
"For instance," Webster says, "We've undertaken a comprehensive program for operational excellence. With this comes an expectation for institution-wide cultural change. It starts with asking staff to sign a commitment to excellence. It is a way of saying, 'Yes, I agree with this philosophy."
Change is a part of our daily work and comprehensive education is the key to success. With understanding and trust comes cooperation - cooperation makes change smoother for all.