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Organizational and Change Theory Paper

Rita Mansfield

Walden University

NURS 4021, Section 10, Leadership Competencies in Nursing and Healthcare

September 14, 2014

Organizational and Change Theory Paper

This paper analyzes a change in schedule that occurred in the Cardiac Catheterization Prep and Recovery Observation Unit. The paper addresses how well the change process worked and the effectiveness of the change implementation. The purpose of this paper is to offer suggestions on how to better enact the schedule change to result in a smoother transition to the new procedures to ensure adequate staffing on work days. Organizational and Change Management

The Cardiac Catheterization Prep and Recovery Observation Unit had a staff of two nurses and one certified nursing assistant for each 12-hour shift. The unit opened on Tuesday at 0700 hours and remained open until 1900 hours on Friday to care for extended recovery patients after cardiac catheterization interventions. At the end of June 2014, hospital administrators directed that the unit hours expand to include Monday evening at 1900 hours until 1100 hours on Saturday. Unit admissions would also include patients from the emergency department for up to a 48-hour stay. The intent is for the unit o serve as an alternative to discharge or inpatient admissio

This change meant that a small staff of registered nurses and nursing assistants would need to cover additional shifts. The change was implemented on short notice and with no planning, consideration of staff limitations, specifics that define patient acuity levels allowed on the unit, or types of admissions taken on Friday that would still allow the unit to close by 1100 hours on Saturday.

Accepting admissions into the observation unit from the emergency department created a situation where the patient health conditions varied considerably. Admissions included orthopedic, medical-surgical, gynecological, and pediatric patients. Emergency department patients also involved greater challenges for the team given the need for more extensive assessment and monitoring requireme.

Implementation of the change resulted in chaos and concern for patient safety. There are constant schedule changes to ensure adequate staffing for all shifts. The night shift nurses are scheduling their Saturday shift after a working all night on Friday to avoid an additional drive in to work for a 4-hour shift. Working over 12-hours may contribute to a patient safety issues and impact a nurse’s job performan. Effective Change

Change must be implemented according to a plan to ensure a smooth transition and overall effectiveness of the new process. Expanding the hours of the unit without adequate planning created a situation where staff is working extended hours, and patient safety is comprised. Admissions occur rapidly, sometimes three to four patients at once, with a staff of two registered nurses and one nursing assistant per shift. Due to the limited staff, the team members are not able to have lunch or rest breaks within the 12-hours shift. Also, admissions on Friday are not planned to ensure closure of the unit by 1100 hours on Saturday. This results in nurses who are working over 16 hours if they work Friday night.

The new schedule could be more effective if it is put in place after following a change theory process. For instance, Lippitt’s theory to plan for and implement the change would help to ensure effectiveness of the new schedule and ensure that adequate resources are available to support the change. During the assessment phase, the problem is discussed, the capacity for change is reviewed, and resources needed are identi. In this case, the problem is covering additional shifts to keep the unit open in support of hospital operations. The capacity for change and resources involve determining staffing requirements and...
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