How can nurses participate in or lead in change management?

Readers' comments (25)

• Anonymous | 23-Jan-2012 1:20 pm

  First you need to know what is the duty of a doctor and what service they offer before you can implement changes. It looks as if the public have been brain washed by media to beleive "Nurses Save Lives" and the duty of a nurse is to prevent doctors killing patients.
  
  I could not stand and ignore what goes on in the NHS and how nurses treat fellow human. Unfortunately doctors are helpless and so people who come to get help from professionals like me are made to suffer due to lack of proper education. As doctors we work under constant supervision (often humiliated by our seniors) for almost ten years yet we cannot claim to be perfect.
  
  So how do you think your members getting trained for six months and certificate by a nurse offer diagnosis, advice or treatment ? They are not only bringing shame to your profession but making a mockery of our moral and ethical responsibility.
  
  Please advice these nurses who are keen to help bring in changes in the NHS to join the medical school and be trained to work as a doctor. As a nurse you will not know what goes on behind the scene when a junior doctor makes a mistake and so they will maintain the high standard of care and compassion.

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• Anonymous | 23-Jan-2012 2:21 pm

  the government and particularly Lansley do not appear to understand the basic principles of the management of change and especially point no. 5 above! how can the acceptance of radical reforms and change be successful if such principles are not skillfully applied.

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• Anonymous | 23-Jan-2012 2:23 pm

  Anonymous | 23-Jan-2012 1:20 pm
  
  
  "First you need to know what is the duty of a doctor and what service they offer ..."
  
  your facts about the role and qualifications of nurses appear rather confused.

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  DH Agent - as if ! | 23-Jan-2012 3:10 pm

  Before this debate gets 'nasty' re doctors v nurses, what is this concept of 'change management' ?
  
  If nurses come across things they believe could be improved 'if we did 'X' instead', then it is simply a case of properly elaborating your proposal and reasoning, to whomever could implement the change.
  
  Which would be similarly true for something a doctor beleived could be improved, or a cleaner believed could be improved.
  
  Why is the world, so over-complicated: whatever happened to 'sense' !
  
  If the contention is just that nurses could effect changes which are within their normal working role and have already been decided upon, then surely this is simply stating that the people whose behaviour is to alter, are the people who are involved in altering their own behaviour (something so trivial, as to not need pointing out).

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• Anonymous | 23-Jan-2012 3:26 pm

  michael stone | 23-Jan-2012 3:10 pm
  
  before you mess up yet another debate, how about going and reading something about modern management theory and the management of change which can, as suggested in this article and the one in the link, be very usefully applied to nursing. it is not as simple as you make out. we are now managing a health service in the 21st century and no longer one in previous eras!

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  DH Agent - as if ! | 24-Jan-2012 11:12 am

  Anonymous | 23-Jan-2012 3:26 pm
  
  You (I assume it is the same anonymous) have again commented that I have commented, but not commented about the topic - persistent behaviour on your part.
  
  If you disagree with the points I make, then by all means provide a reasoned critique of them - you don't do that, do you !

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• Anonymous | 24-Jan-2012 11:46 am

  michael stone | 24-Jan-2012 11:12 am
  
  i really do not wish to enter into any further discussions with you but my answer to your above comment, last para, is no because as I have said before, I am interested in commenting on nursing matters with other nursing colleagues and change management is a topic I am particularly interested in from a nursing point of view.
  
  there is a large body of knowledge on this important subject which is important to the future of nursing and which I suggested you look at before introducing your own reductionist views and I fear you may block further debate and learning as you have done many times now.
  
  having seen you pattern of commenting behaviour now for a considerable time I tend not to read your comments in any great detail unless I find they are obstructing the discussion in which case I have, initially politely, pointed this out to you, as have quite a few others, but in your own interest, and in lack of respect for other commentators you chose to ignore any polite requests, even those which gave some justification. I also note there have been quite a few that were far less polite than mine, although I point out mine have also become less polite (although unlike some, mine do not contain personal or unreasonable attacks) as this seems to no avail.
  
  comments from anyone are normally welcome at any time and especially those from outside the profession which offer different perspectives essential to nursing but you overstep the boundaries and comment where issues need debate from a nursing perspective within the theory of nursing which you know nothing about and contribute nothing to the body of nursing knowledge essential for learners.
  
  I do not wish to waste any more of my time communicating with you on this matter and if you cannot adhere more respectfully to the etiquette of online commenting I will again take this up with NT.

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• Anonymous | 24-Jan-2012 11:53 am

  "You (I assume it is the same anonymous) have again commented that I have commented, but not commented about the topic - persistent behaviour on your part."
  
  furthermore I reject you statement above as I do not come on the site to comment about your comments, but to comment on the issues under discussion which I have do regularly.

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  Mertha Nyamande RMN | 27-Jan-2012 9:58 am

  Pardon my ignorance on this debate, but i am not sure how this became a Doctors vs Nurses debate. As i understand, this is about how Nurses can participate or lead in change management. You surely do not have to be a Doctor to participate in change management, even a janitor can.
  
  Nurses and doctors however, are not on opposing sides and therefore should not be working against each other, but compliment each other. In my experience, as a senior nurse, you often get junior doctors coming into a specialised environments and would not have an understanding or experience of how the systems work, nor understanding of the patient's history, background or complex medical/care needs. So we have to work together to guide each other, most importantly understand each other's limitations. Gone are the days where the doctor said and the nurses do. we are professionals in our own rights and have the right to disagree or question a course of treatment prescribed.
  
  This discussion has taken a different/wrong turn. It would be helpful if people commenting focus on the topics rather that taking this as an opportunity to have a rant about what they are not happy with.

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• rae ali | 27-Jan-2012 8:31 pm

  The debate has went out of the subject. Nurse has achieved a stage of being in charge of the care they are providing, they should have their say on patient's care matters, but there is a gap, experience is great, still we need the skills and the knowledge to provide the change. From experience some nursing adminstrators they are static about what they know, and they only see from one side, nurses who are on the wards they still lack the skills to implement change, good luck

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• Anonymous | 27-Jan-2012 10:48 pm

  I am an experienced nurse and I too seem to have missed to point as to why there is some debate of doctors v nurses. Where did that come from? I don't understand the Michael Stone bashing either in this blog or others. I personally don't feel threatened by non-nursing comments, in fact I embrace them and think they can add another slant to any debate, even if they miss the point sometimes.

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• Anonymous | 27-Jan-2012 10:56 pm

  ..added to above comment. I really should address the article. Identifying what needs to be changed is the easy part. Implementing it can be more difficult, you have to get the team on board, involved and have some ownership. Maintaining change, and not drifting back into old practices is the most difficult. In my experience this is where organisations fall down, without the provision of sustained follow-up, feedback and evaluation.

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• Anonymous | 27-Jan-2012 11:22 pm

  a good understanding of the underlying principles of change management theory, as mentioned in the above key points, is very helpful as it provides useful tools and a framework for motivating and implementing which have more chance of being more positive, successful and lasting.
  
  an initial stakeholder analysis with clear ideas about the project and adequate explanations of the reasons for any change and getting people involved from the start and working together with the from the outset can help persuade individuals of the advantages of bringing about the suggested or intended changes. if all those involved are given a feeling of shared ownership in the project it is more likely to be successful. They should be involved at every stage from the assessment of the situation and the need for change, throughout the planning phase to its implementation and then, as mentioned, above also involved in providing feedback and regular evaluations.

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• tinkerbell | 28-Jan-2012 5:56 pm

  Mertha Nyamande RMN | 27-Jan-2012 9:58 am
  
  Well said.

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• tinkerbell | 28-Jan-2012 5:57 pm

  Anonymous | 27-Jan-2012 10:56 pm
  
  So true.

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• tinkerbell | 28-Jan-2012 6:38 pm

  michael stone | 24-Jan-2012 11:12 am
  
  Michael i do not wish to insult you personally, none us are perfect and none of us are 'total' experts. But you do appear to be able to be reductionist and also intellectually complicated. I don't doubt you are very skilled in debate but I found it 'arrogant' and 'patronising' to young nurses that you suggested on another post that some young nurses would not understand dying. Same could be true of some older nurses, fortunate enough to still have all their loved ones alive. How would you know that? They may have entered into nursing at a young age for the very reason that something profoundly sad happened to them.
  
  Neither you, nor i are totally expert on dying as we haven't yet died.
  
  We all have our weakness, mine is swearing in posts whenever i feel really passionately about something, like OUR NHS being privatised.
  
  No one has ever challenged me on it as far as i am aware but that doesn't mean they shouldn't. I might not agree with what they say but i defend their right to say it and mine to respond and i might also concede that they have a point.
  
  

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• Anonymous | 28-Jan-2012 11:57 pm

  Tinkerbell, I have to agree with the points you raise above.
  
  I find it very disappointing that Michael Stone makes comments on so many pages and manages to turn any meaningful discussions to focus on him instead of on the content of the articles and which seems to have brought a few to a close. strangely he seems to have some morbid fascination with nursing.
  
  I think what he does not realise is that nursing theory and practice is not black and white or carved in stone but is a continually evolving process based on the results of years of developing experience through personal observation, practice and continuous personal and professional development.
  
  

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• tinkerbell | 29-Jan-2012 10:38 am

  As a team leader in inpatient care i must admit that implementing change is so difficult to implement. I like to adopt a collobarative approach and involve the team, explain the need etc., to improve patient care. A straightforward example would be one that i have been bashing away at for some years, not using mobile phones in a clinical area where there are patients. I said that i was not opposed to them using their mobiles in the staff office and felt i was being reasonable. Everyone appeared to agree that this was not good, not therapeutic and detracted from the patient care etc., but it didn't stop some of them. Every time i turned my back i would find a couple of old die hards, with their phones out, feeding a patient, whilst chatting to another colleague.
  
  In the end i had to involve upper management who sent them all a memo saying that in future no mobiles would be allowed on the unit, they would have to keep them in their lockers and not on their person and if found to be non compliant would result in a disciplinary interview. What a shame it had to come to that.
  
  Over many years of trying to implement change for better practice I find it so frustrating but realise it takes the utmost determination & patience and continual review. The frustration is realising that no matter how much things may improve, it takes an absolute age for it to be accepted by all, and just when i think we are making progress we will slip back to square one and have to start the whole process over again.
  
  Not everyone will be on board even if the change is for the best. As the initiator you will need to drag some of the staff kicking and screaming. Not everyone welcomes change, they find it anxiety provoking and will continually challenge and rebel. But as one of our managers said once 'adapt or die'. I think he was using the darwinian model. If a request to change is reasonable and an attempt to improve patient care why should anyone object? They will probably have a different agenda going on that is actually not nursing related. As in all walks of life there are usually some other 'issues' going on. Even rebelling is conforming, just the other extreme.
  
  Persistant determination is what is required and regular re-evaluation that what is being attempted is achieved until it becomes unconscious competence.

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• Anonymous | 29-Jan-2012 10:50 am

  http://www.mindtools.com/
  
  helpful link for the process of change management and tools which can be used
  
  Google key terms such as those below also gives useful information
  
  change management
  stakeholder analysis
  force field analysis

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• Anonymous | 29-Jan-2012 11:25 am

  Some further information
  
  Further key word for search
  change agent in nursing
  change agent definition
  nurse activism
  ______________________________________________________________________________
  Pediatr Nurs. 1990 Nov-Dec;16(6):603-5, 618.
  The nurse as change agent.
  Kaplan SM.
  Abstract
  Whether an employee of an organization or an independent consultant, the nurse can function as a catalyst and planner for change. Clinical expertise, theoretical knowledge, and a commitment to the outcome of the change project can empower the nurse to successfully assess, plan, implement, and evaluate the change process.
  PMID:
  2082280
  [PubMed - indexed for MEDLINE]
  http://www.ncbi.nlm.nih.gov/pubmed/2082280
  ________________________________________________________________________
  http://www.ehow.com/about_5544426_change-theories-nursing.html
  
  Nurse Activism
  http://nurse-activism.com/role.html
  __________________________________________________________________
  Evidence-Based Practice: The Clinical Nurse Specialist as Change Agent
  Patricia A. Heale, MSN, RNc
  Newton-Wellesley Hospital
  

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