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NURSING & DOWNSIZING.
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Examines need for & effect of retraining floor nurses as multi-skilled health professionals, using Kurt Lewin's Field Theory as applied to organizational change.... More...
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Paper Abstract:
Examines need for & effect of retraining floor nurses as multi-skilled health professionals, using Kurt Lewin's Field Theory as applied to organizational change.
Paper Introduction:
RETRAINING FLOOR NURSES TO COPE WITH DOWNSIZING: APPLYING LEWIN’S FIELD THEORY AS IT APPLIES TO CHANGE
This research describes a planned change for the floor nurses in an acute care hospital in a small city located in a major metropolitan region. The planned change involves the retraining of floor nurses to cope with a downsizing the nursing department. Kurt Lewin’s Field Theory as it applies to organizational change is applied.
An increasing number of hospitals, in the pursuit of goals related to both efficiency and effectiveness, are implementing reorganization schemes that frequently involve downsizing, decentralization, or some combination of downsizing and decentralization (Barrett, 1995). Among health care professionals, nurses tend to be those most frequently displaced by
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Reorganizing and restructuring within a quality improvementenvironment is heavily dependent upon the concept of employee empowerment(Laschinger & Havens, 1997). D. The major strength of the theory inrelation to implementing changes required by the downsizing strategy is theease of application for an internal change agent. Force field analysisalso provides for a status quo wherein driving and restraining forces arein balance. S. Flexibility can be increased by creating a team-basedorganization with team members cross-trained to perform all aspects of theteam's work. The force field is comprised of factors thatfunction both as driving forces and as restraining forces with respect to aspecific action or phenomenon (Goad & Hough, 1993). There arenow strong incentives to increase flexibility and reduce costs by becomingflatter and leaner. Lewin's Field Theory as it applies to change is reviewed as anappropriate model for the implementation of change associated with thedownsizing of the nursing department in an acute care hospital. S., & Havens, D. Downsizing: doing it rationally. (1997, June). 187). Change Theory is appropriate for application overcoming the objectionsfrom nursing staff to the changes that will be required for the nursingdepartment to comply with the downsizing strategy that will be implementedby the hospital administration. NurseManagement, 26(5), 24, 28-29. If the change agent is, however, a member of nursingadministration at the hospital, such resistance may be ameliorated. The model recognizesthe possibility for jurisdictional shifts and the fact that professionalsseem willing to negotiate over their possible future and to engineer aninformal division of labor. D. An MSHP is aperson who is cross-trained to provide more than one function, often inmore than one discipline. One serendipitous outcome to the MSHP program may be anincreased empowerment for the professional nursing personnel working inMSHP teams, as a professional typically may be expected to lead such teams. An unanticipated negative outcome of the use of MSHPs may be an adversereaction by some patients who are unprepared for a change in the way inwhich care is being delivered. These combined functions can be found in a broadspectrum of health related jobs ranging in complexity from the non-professional to the professional level, including both clinical andmanagement functions. Kurt Lewin's Field Theory as it appliesto organizational change is applied. Schneller, E. Determinants of rural hospitalutilization of multiskilled health practitioners. Duringthe moving stage, nursing administration will execute the planning andimplementation elements of the change process. REFERENCES Barrett, M. Health ServicesManagement Review, 8(1), 64-72. Laschinger, H. New York:Springer Publishing Company, pp. An increasing number of hospitals, in the pursuit of goals related toboth efficiency and effectiveness, are implementing reorganization schemesthat frequently involve downsizing, decentralization, or some combinationof downsizing and decentralization (Barrett, 1995). The use ofMSHPs can both enhance employee productivity and improve the costeffectiveness of health services delivery (Fottler, 1996). Three stages are structured into change theory (Goad & Hough, 1993).The first stage, "unfreezing," is defined as the period wherein "changeagents create dissatisfaction," while "inspiring the motivation to acceptsome type of change" (Goad & Hough, 1993, p. 187). Theprincipal elements change theory are force field, motivators, and stages(Goad & Hough, 1993). The proposed intervention associated with the downsizing program forthe nursing department involves the retraining of floor nurses as MSHPs topreserve care quality while complying with plans to downsize the nursingdepartment. This potentially negative outcome, however,may be precluded by effective patient education. Fottler, M. While the change agent is not acomponent of change theory, the change agent is necessary for the effectivefunctioning of planned change. Theory-directed nursing practice. The theory is more a framework within which planned changecan be developed than it is a proactive approach to change implementation. Lewin's field theory with emphasis onchange. Overall, the outcomesassociated with the proposed intervention may be expected to be positivefor patients, the nursing department, the acute care hospital, the nursingprofession, and the health care system. The specific outcomes that are not occurring are defined inchange theory as the non-accomplishment of a desired job, a non-obtainingof wants and needs, and the non-achievement of growth or maturation (Goad &Hough, 1993). The strategy that will be implemented calls for the retraining offloor nurses as multi-skilled health practitioners (MSHPs). (1995). With respect to the planned changeassociated with the hospital's downsizing strategy, the refreezing stagelies at some indefinite point in the future. 187). The effect ofworkplace empowerment on staff nurses' occupational mental health and workeffectiveness. W. Initially, therefore, thechange agent will be focusing on the unfreezing stage and the transition tothe moving stage of the process. Suderman, E. The model has become associated with thequality improvement movement. C., & Fottler, M. Change theory implies that the unfreezing, moving, and refreezingprocess will begin once again when dissatisfaction with the implementedchange occurs. The additional functions (skills) added to theoriginal health care worker's job may be of a higher, lower, or parallellevel. A growing consensus holds that MSHPs cancontribute to extending professional roles, reducing shortages ofpersonnel, reducing costs, and improving care quality (Hyde & Fottler,1995). 179-198. The second stage,"moving," is defined as participant attitude and behavior changes inrelation to the planned change (Goad & Hough, 1993). retraining floor nurses to cope with downsizing: applying lewin's field theory as it applies to change This research describes a planned change for the floor nurses in anacute care hospital in a small city located in a major metropolitan region. The role and impact of multiskilledhealth practitioners in the health services industry. Change theory assumes that a change agentwill identify sources of dissatisfaction, determine the character of thefactors responsible for this dissatisfaction, formulate a planned change toaddress the problem, and then implement the planned change. (1995, January-February). The"unfreezing" stage in Lewin's change theory is the period wherein changeagents create dissatisfaction, while motivating relevant persons within thegroup to accept some type of change. B. The approach is grounded in the belief thatan inherent weakness exists within a hierarchical and rigid division oflabor in which task allocation is dominated by formal jurisdictions,licensure, and certification (Schneller & Ott, 1996). S., & Ott, J. The planned change involves the retraining of floor nurses to cope with adownsizing the nursing department. Among health careprofessionals, nurses tend to be those most frequently displaced by thecontemporary downsizing and decentralization strategies (Suderman, 1995).While the size of the nursing staff in the acute care hospital that is thesetting for the planned change must be reduced, the major nursing probleminvolves the need to preserve the quality of patient care whileaccomplishing the downsizing objectives. As a result of intense competitive pressures during the currentdecade, health care organizations have had to downsize, restructure,retool, and transform their business strategies (Fottler, 1996). The objective of the nursing administrators inthis situation is to develop a change strategy for the nursing department,gain hospital administration approval for the strategy, gain nursing staffsupport for the strategy, and implement a strategy that will serve theinterests of patient care, the nursing staff, and the hospital to themaximum extent feasible given the constraints of downsizing. Contemporary models ofchange in the health professions. In Ziegler, S. (1993). The change agent referred to in Change Theory is defined as an"individual who is skilled in change theory and the practice of plannedchange" (Goad & Hough, 1993, p. The major weakness ofthe theory is the fact that change recommended by a change agent who amember of the hospital staff might meet substantial resistance from somemembers of the professional staff of the nursing department who might viewchange agent as an advocate of hospital administrator objectives withlittle concern for the objectives of the professional staff in the nursingdepartment. Journal of Nursing StaffDevelopment, 11(1), 7-12. Downsizing of the nursing department will occur as so directed by thehospital administration. The need for changes in the nursingdepartment to comply with the hospital downsizing strategy, thus, must beestablished by the change agent through the presentation of facts thatsupport the planned change. Hyde, J. Motivators for change are defined as confirmations that someform of desirable outcome is not being attained under existing operationalconditions. (1995, May). Nursing administration at the hospital will function as the changeagent (within the context of Lewin's change theory) in this process. The "refreezing" stage in the theory is the period wherein newbehaviors are practiced and reinforced. The changeagent cannot identify sources of dissatisfaction and the underlying causalfactors without performing assessing and diagnosing actions. The "moving" stage in theory is the period wherein participantattitudes and behaviors are modified in relation to the planned change.The change agent must be especially persuasive to effect such attitudinaland behavioral changes among the objectors to the planned change. M. Journal of Nursing Administration, 27(6), 42-5 . Downsizing: Implications fornursing educators in a hospital setting. K. The theoryis referred to as "change theory" in the remainder of this review. Hospital & Health ServicesAdministration, 41(1), 121-136. (1996, Spring). The third stage,"refreezing," is defined as the period within which "new behaviors arepracticed and reinforced" (Goad & Hough, 1993, p. During the unfreezing stage, nursingadministration will execute the assessing and diagnosing elements of thechange process. Goad, S., & Hough, L. During the refreezing stage, nursingadministration will execute the evaluation element of the change process. Hospital & HealthServices Administration, 41(1), 55-75. (1996, Spring).
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