Introduction
This document examines change in a department or unit. The identified change is allowing more autonomy for obstetric nurses to function according to their scope of practice and developed competencies; The unit or department is obstetrics. Kurt Lewin change model along with the Grandfolkie model were used as techiqques for the change development.
Identification of problem/Issue
Experts have contended that in the same way as how World Health Organization described health being not merely the absence of disease, but complete physical, mental and social wellbeing; similarly, healthy work environments mean more than the absence of malfunctions or irregularities, but one in which there is collective energy producing desired outcomes along with maximum patient satisfaction according to organizational shared goals (McAlearney, Terris & Hardacre, 2014). As such, the problem identified in this planned change paper relates to complications arising when nurses attempt to exercise autonomy in delivery of care in the obstetric/ maternity units.
Explanation
Advance Practice Nurses in their scope of practice are permitted to exercise degrees of autonomy in performing their tasks as midwives/obstetric nurses on the unit. Since this is a specialist role, APNs must also function in alignment with the obstetrician who is a specialist along with staff nurses who are not specialized and other category of nursing staff. Often conflict of interest emerges to the extent of creating serious malpractice issues. These occurrences inevitably alter the shared purpose of teamwork and organization goals, generally. Patient satisfaction levels are reduced to the detriment of wholesome customer relations (Manley, O’Keefe Jackson, 2014).
While professional autonomy means the authority to make decisions as well as freedom to conduct tasks and duties according to the professional’s knowledge base, yet when supervision as well as hierarchy in nursing management infiltrates this scope, nurses become impotent in their ability to exercise control over specific nursing tasks, which must be performed under supervision. Often extensive supervision compromises nurses’ potential to practice applying innovative competencies. There is always the fear of being reprimanded or even punished by a supervisor for utilizing innovation during delivery of care. This issue arises in my department very often.
Description of a Specific Realistic Change
A specific realistic change expected to restore autonomy in nurses’ functions on the obstetric unit is designing strategies that limit supervisors’ undermining obstetric nurses exercise of authority in delivery of patient care while still maintaining the shared purpose ideology. This strategy is necessary and applicable because according to the American Nurses Association organization expectation influence the degree of autonomy a nurses could demonstrate (Manley et.al, 2014).
As such, the change would encompass conducting two workshops involving obstetric staff and supervisors including obstetricians. This intervention is aimed at clarifying nurses,’ supervisors’ and obstetricians’ expectations of autonomy and shared purpose. The outcome of these workshops is to sensitize supervisors towards their role allowing nurses to functions within their line of authority. Action will be taken refraining supervisors from criticizing a nurse or otherwise humiliating him/her except if the action contradicts their scope of nursing and shared goals of the organization (Manley et.al, 2014).
Change Model
Kurt Lewin’s (1890-1947) change model has been selected as the strategy guide for enforcing this change. According to the theory the change management has three phases. They are unfreeze, transition and freeze. The unfreeze stage allows management to reduce or illuminate the features or structures that are maintaining the status quo in the inconsistency that is occurring. Transition occurs when the process of developing new behaviors has been initiated and the change begins to bloom. Freeze denotes acceptance of change or reverting to former ways to conducting business if current practices do not prove beneficial (Schaffer, Sandau & Diedrick, 2013).
In comparison to the Grandfolkie model there is an additional stage. Precisely, the stages are visualizing, planning, transition and evaluation (Schaffer et.al, 2013). Significantly, planning and visualization in my classification of change are vital elements, which ought to be considered. However, they both could be merged in Lewin’s unfreeze. During this breaking the status quo phase the initiator has opportunities to visualize and plan. Consequently, there is an equivalent.
The steps that will be utilized encompass Kurt Lewin three phases of change unfreeze, transition and freeze. The rationale for this application in restoring autonomy in the obstetric unit is its simplicity. The unfreezing stage would encompass deliberations in a workshop setting whereby the status quo of supervisors infiltrating the functional authority through criticisms will be removed through mutual agreements. Transition would encompass implementation of rules and regulations. These protocols would identify supervisors’ harassment of obstetric nurses in exercising autonomy while attending to women, during and after labor on the unit. Freeze is either continuing the change as permanent or improving on the achievements (Shirley, 2013)..
Persons involved in the change
The recipients of change would be nurses in the obstetric unit. Initiators are the department nursing leaders. Three would be assigned to monitoring the quality of supervisors/ obstetric nurses’ interactions with respect to compliance with the new nurse autonomy regulations. Monthly evaluations will be recorded based on answers offered on structured questionnaires administered to obstetric nurses and their supervisors. One nursing manager would design items on questionnaires. He/she will coordinate with the other two nurse managers regarding when and how the questionnaires will be administered and analyzed. The third nurse manger will analyze arrange for discussion and results distribution of the change.
Conclusion
The foregoing exposition related a proposed change in the obstetric unit in my healthcare organization. The problem was identified as superiors undermining the autonomy of obstetric nursing practice inhibiting high quality of care and innovation. Specific change interventions included limiting the authority supervisors use in imposing sanctions on this category of nurses in their department for asserting autonomy of functions. Nursing Administration collaboratively outlines measures regarding the change and posted them as regulatory action.
References
Manley, K. O’Keefe, H., & Jackson, C. (2014). A shared purpose framework to deliver person-
centered, safe and effective care: organizational transformation using practice development
methodology. International Practice Development Journal 4 (1); 2
McAlearney, S. Terris, D., & Hardacre, J. (2014). Organizational Coherence in HealthCare
Organizations: Conceptual Guidance to Facilitate Quality Improvement and
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Shirley, M. (2013). Lewin's Theory of Planned Change as a strategic resource. Journal of
Nursing Administration. 43(2):69-72. doi: 10.1097/NNA.0b013e31827f20a9
Schaffer, M. Sandau, K., & Diedrick, L. (2013). Evidence-based practice models for
organizational change: overview and practical applications. Journal of Advanced
Nursing, 69(5):1197-209.
