Nursing administrators are responsible for excellence in the management of people, capital, financial flows and other aspects and processes of the systems which support patient care in the health care setting (Schuettner et al., 2015). To that end, the nurse administrator is a role model who sets to example, the tone and the process that motivates staff as well as plans, organizes and evaluates the goals and the systems to achieve them (Schuettner et al., 2015). The nurse administrator can best understand the needs and expectations of this role, including the critical need to lead ward or setting culture by having a foundation in theory, risk management, quality management and evidence based practice (Salmella et al., 2011).
Developing and implementing change management
Change can be difficult. It is for this reason that a critical task for the nurse administrator, in addition to the more technical aspects of planning process and systems to achieve the goals of the change and meet milestones, is in “directing, guiding, motivating, supporting and communicating without losing their cultural ethos of caring and use various leadership styles to bring about actual change” (Salmella et al. 2011, 473) In other words, to reduce the risk that resistance will interfere with achieving the change that will lead to improvement in quality of care, it is important to know how to approach change in terms of the soft skills of leadership, as well as analytical skills. Problem solving in this regard does not end with process.
One example of change management and advanced nurse leadership is found in the implementation of electronic medical records (EMR), which is a task that has been, or will be, faced in most contexts in which nurse administrators and advanced nurse leaders work. There are two major aspects to such a change project, that being ensuring that the processes, equipment, training and technical aspects are in place, tested and ready for use by staff; the other is reducing resistance to said processes by staff by ensuring that they are aware, prepared, trained in the new systems which ensure that EMR is achieving the goals of more accurate information which is both secured and more easily accessible to those who need it (Griebenow et al., 2015).
The relationships of theory and change management
Theory can assist with the implementation of change management by providing a framework for those tasks that cannot possible be completed by checklist, particularly leading the change. Theoretical frameworks and approaches come in many different forms for many different philosophies and contexts and it is important that the right fit be found between the theory, the intended outcomes and goals and the context. There is no perfect or grand unified theory, and therefore nurse administrators require the analytical skills to make the determination regarding what is appropriate and needed.
Leadership is one area of developed theory that can assist in the approach to change management, and it required well understanding one’s own leadership style and capacity well in advance of attempting something as important as change management in the health care context. One theoretical model, for example, sees three dimensions to change management which results in ensuring patient care during the change itself by focusing on the three dimensions of leading relationships, processes and culture (Salmella et al., 2011). In all of these areas role modelling appropriate approaches and behaviors, and reinforcement of ethics and the caring aspects of nursing culture in both relationships and processes, is seen one theoretical approach which has better outcomes and results in terms of the desired change while ensuring patient care is not compromised (Salmella et al., 2011).
Another theoretical lens is termed the TeamSTEPPS approach, which has the priority of patient safety and care during change. The theory describes three possible change management strategies, those being from the bottom up in terms of staff, or top down in terms of management decree or a hybrid (Stewart et al., 2015). Research has shown that of the three the most effective is ensuring that a hybrid which consists of both top down and bottom up strategies has the best results (Stewart et al., 2015).Findings such as this can provide insights for nurse administrators given many change initiatives (Stewart et al., 2015).
Evidence based practice cannot be stressed enough, and this because gaps between theory and implementation can create unacceptable risk or quality during the management of the change, or in the resulting change which is achieved. In fact, ensuring that evidence based practice becomes a priority for the determinations of changes may in fact be the change initiative to be managed (Rousseau & Gunia, 2016). Evidence based practice both informs the change management, but the change management initiative can inform future projects by capturing insights and reporting on realities, and therefore itself becoming further evidence of the practice of change management in the nursing context.
Risk and quality considerations in change management
Determinations of risk in change management are essential long in advance of any implementation, as the potential to compromise patient safety or outcomes is not an option. The purpose of change is improvement, and that improvement should begin with the management of the change itself, and this is part of the nurse administrator’s role in risk and quality management. Given that without attention to risks and quality considerations in the change management project these are likely to suffer, and if these suffer then patient care is reduced leading to lesser outcomes, it is clear that all care should be taken to have the theoretical understanding that can guide such actions.
Where change has not basis in evidence based practice or theory the nurse administrator is “flying blind” despite the accumulation of information, data and further analysis which has been previously conducted in order to assist in such an endeavor. It is widely understand in advanced nurse leadership that health care reform and change management is a group effort and one which requires the participation of all nurses. It is therefore not an option to ignore such accumulated knowledge and guidance when patient care can be compromised. The success of the change can be achieved without exposure to such risks, providing the nurse administrator has these as priorities.
It’s all related
Theory, risk, quality management, and evidence-based practice are all interrelated when it comes to change management in the nursing or healthcare context. When one area is weak, all areas become less strong, and it is not possible to achieve excellence without careful attention to each area. Theory is related to risk, quality management and evidence based practice because it can guide the actions which reduce risk and increase quality, and evidence based practice should be the foundation of theories of change management used in the nursing context. Learning and being guided by that which has as a foundation actual change management in the health context is critical. This is an important aspect of risk reduction which should not be missed. By leading changes for improvement the result is increased quality, but quality management is still an important aspect of the change itself.
Conclusion
Nurse administrators are responsible for one of the most challenging and important aspects of health care reform by initiating changes which result in higher quality care as well as more efficient operations. The importance of such outcomes cannot be underestimated; however achieving such ends requires careful planning to institute the change itself.
- Griebenow, L., Timm, J., Senn, M., & Stancl, M. (2013). Case Study: Developing Nursing Partnerships to Support a Successful Electronic Medical Record Implementation. Computers Informatics Nursing, 31(1), 1-6.
- Rousseau, D. M., & Gunia, B. C. (2016). Evidence-Based Practice: The Psychology of EBP Implementation. Annual Review of Psychology, 67, 667-692.
- Salmela, S., Eriksson, K., & Fagerström, L. (2012). Leading change: a three‐dimensional model of nurse leaders’ main tasks and roles during a change process. Journal of advanced nursing, 68(2), 423-433.
- Schuettner, K. A., Van Sell, S. L., & Sheriff, S. (2015). Nursing Administration Degree as the Foundation of Practice for Future Nurse Managers. Nurse Leader, 13(4), 86-97.
- Stewart, G. L., Manges, K. A., & Ward, M. M. (2015). Empowering sustained patient safety: the benefits of combining top-down and bottom-up approaches. Journal of nursing care quality, 30(3), 240-246.
