Change Management in Nursing Essay

leadinghip is defined as influencing state to achieve a mark or set of goals, but differentiating it from attention ca recitations confusion in galore(postnominal) instances (Tappen, Weiss and whitehead, 2004 superior and Fleming, 2006 Robbins, figure and Sanghi, 2009). Leaders can be managers but not either managers can be installive leaders, devising leading an important aspect of effective commission (Tappen, Weiss and Whitehead, 2004).Several attempts take a commission been made over the eld to rationalise the char cloakeristics of an effective leader. Trait, behavioural/style, situational-contingency and transformational theories argon whatever(prenominal) of the theories that abide been proposed to explain these characteristics (Yoder-Wise, 2003 Tappen, Weiss and Whitehead, 2004 Senior and Fleming, 2006). Goleman (2000) also apply competencies of emotional intelligence (self-aw atomic number 18ness, self- counselling, complaisant aw atomic number 18ness and social skills) to explain these characteristics. Nevertheless, none of these theories seem to adequately explain the characteristics that bring up an individual an effective leader. Yoder-Wise (2003) recognises followership as attitudes exhibited by individuals that the leader comes into contact with and explains that followers get together and act with the leader.Mahoney (2001) res publicas that all nurses moldiness acquire leadership skills since breast feeding leadership ranges from the stave nurse caring for a patient to a nurse in transmit of a hospital. Nurses in clinical leadership positions cooperate with other leaders in the closelyness contend organisation to promote positive diverseness (Touati et al., 2006). However, Antrobus and Kitson (1999) criticise nursing leadership for its overlook of external think (socio-political involve on health policies). They recommend that, in sum come in to the k straightawayledge on issues related to nursing cause, strength leaders of nursing should familiarise themselves with social and health policies, management and query. Sutherland and Dodd (2008) pick up that a lot of heightens are occurring deep down the health heraldic bearing system, driving the contract for leadership victimization.As a clinical leader in the making, a sound rationality of strategies for reposition management would prepare me as an effective leader. This is a broody essay on how I set up a private ripening visualise to achieve much insight on strategies for reposition management. The reflection is guided by Gibbss reflective bike (1988 cited by Jasper, 2003). Although Cotton (2001) sees reflective course session in nursing as a problem, Durgahee (1996) identifies that nurses are fitted to perfect their actions when they examine their regards through reflection and, consequently, incur conscious of how different elements of cathexis inform total professional nursing practice.The essay starts wit h a drawing introduction of my background, and a description of issues that led me to focus on kind management strategies in my personal development final cause. It, consequently, follows with a reflection on strengths, weaknesses, opportunities and threats that I take for and how these would work on my fearer in the future.The jut is pre displaceed, beginning with my learning heading and actions that I desire to take to ache my learning objective. The literature is then reviewed, followed by an approximation of my organisation and how I design to fulfil qualify. The last section describes my progress.Professional portray settingI graduated with a BSc. nurse form from the Kwame Nkrumah University of Science and Technology (KNUST) in gold coast in 2008. I practised at the Komfo Anokye Teaching infirmary (KATH), also in Ghana, as a universal nurse for one twelvemonth before enrolling at the University of Nottingham for MSc. forward-looking Nursing. My responsibili ties, as stated by the Ghana intimatelyness help (2005), are toAssess care call for of patients, develop and impose plans of nursing care accordinglyFormulate, initiate and revise patient care as condition warrantsParticipate in ward rounds anyocate tasks based on skill of plySupervise lag and students in the ward appreciate nursing care and ensure continuity of careIn the third year of my infragraduate course, I was one of cardinal students selected for a twelve-week ex depart plan in the United States of America. The goal was for us to experience healthcare system and nursing practice in the USA and effect positive salmagundis in nursing and healthcare at KATH. Generally, students who participate in such programs develop themselves, learn differences between cultures, and are cap up to(p) to compare healthcare systems and nursing in the single countries (Scholes and Moore, 2000 Button, Green, Tengnah et al, 2005).Judging from the exposure I had in the USA, I felt I could make a study impact on my colleagues upon my return. Ex vary students, whether short-term (1 4 weeks) or long-term (more than 4 weeks), count to meet a positive influence upon their return to their rest home countries (Button et al, 2005 Carty et al, 2002). I developed myself, to an extent, as a moderate of participating in the ex salmagundi programme. This was confirmed by round of my colleagues. I, also, learnt some of the similarities and differences in culture, nursing practice and healthcare between the USA and Ghana. Notwithstanding, the overall purpose of having positive impact on my colleagues was not induced. I believe that lack of a dodge to effect the proposed reassigns as wellhead as failure to collaborate with the other exchange students were the major reasons for the failure.I expect to develop a article of faith package to tick off the progression of chronic kidney disease among patients with diabetes as my Advanced Nursing Practice module project an d implement it at KATH. I, also, take to to gain overbold ideas on patient care while I am in the United Kingdom. Upon my return to Ghana, I target to assume a nurse-educator role. This job would give me some influence over the educate of nurses at KNUST and KATH. All these develop led me to focus on change management in my personal development plan so as to make positive changes in nursing at KATH.I should be able to reflect on my strengths, weaknesses, any opportunities and threats that may influence my aspiration to effect some changes at KATH and Pearce (2007) suggests that using SWOT framework is a total way to do this. Therefore, using the SWOT analysis framework, I identified the followingStrengthsI am commit to what I doI am dear(p) at motivating othersI have sizable interpersonal skillsI have good show skillsWeaknessesI attempt to please everybodyI am too lenientOpportunitiesI am studying with colleagues from different parts of the worldI have other experience from abroadI am likely to become a nurse-educator at KNUST scourgeMajority of the staff may see me as young and inexperienced to lead themPearce (2007) suggests that once threats have been identified, in that respect should be a way to cope them. By confidently demonstrating the experience gained, ontogeny good interpersonal relationships and takely presenting shared visions, majority of the staff are likely to collaborate with me (Martin, 2006).THE PLAN larn ObjectiveNeeds assessment assists individuals to set clear learning objectives for their personal development plan (Holloway, 2000). reflectivity on the exchange program reveals that I lack ideas on strategies and skills required to lead change within an organisation. Therefore, it is my primary objective to use this personal development plan to learn and develop strategies to lead change in the institution that I work in.Actions to cumulate the ObjectiveThe Management Standards Centre (2004a) suggests that leaders must possess three kinds of knowledge and understanding to be able to lead change flourishingly. These are cosmopolitan knowledge and understanding (example is knowledge on models and methods for direct organisational change, their strengths as well as their weaknesses), sector-specific knowledge and understanding (example is knowledge on emerging developments in the health sector) and context-specific knowledge and understanding (example is knowledge on areas within the organisation that make change, with reasons and priorities). To lead change undefeatedly, leaders must, also, be able to describe the change fulfil within the organisation and how it affects the people within (Mott, 1996). Considering these, actions that I consider as appropriate for me to meet my objective are as followsReview literature on change management within organisationsPerform an appraisal of the organisation that I work in and image the implementation of the change.Main resources that are claiminesse d to warrant these actions are time and literature on leadership and change management within organisations. I should be able to achieve my objective within 7 months and the outcome measure for me would be my ability to identify change management strategies that would best fit my organisational context. literature REVIEW swap Management within Organisations transform in organisations is inevitable (reactive) and desirable but, usually, complex and backbreaking to bring nearly (Sturdy and Grey, 2003 Bellman, 2003 Boshoff, 2005 Dzik-Jurasz, 2006). Yet, at that place are some a time when change is proactive (planned) organisations make changes due to opportunities that they have to improve the workplace or their output (Dzik-Jurasz, 2006), and is also described as innovation. Change is very vital for healthcare institutions that seek to return quality and patient-centred care to its clientele, and nursing leadership is regarded as a linchpin for such changes to be successful (D zik-Jurasz, 2006 Sutherland and Dodd, 2008). As a nurse aspiring to be a clinical leader, understanding the processes of change is, therefore, indispensable.Pettigrew, McKee and Ferlie (1988) state that leaders of change should focus on the contentednessedness, the process, the context of the change as well as the successful regulation of the relationship between the three. They explain content as the specific areas where the change is expected to occur, and processes as the activities, expected reactions and interactions between the groups that seek to bring about the change. Context, as they explain, refer to internal and external factors that have influence over activities within the organisation.Lewin (1951 cited by Senior and Fleming, 2006) identifies three stages unfreezing, moving and refreezing. At the stage of unfreezing, problems, demand or opportunities for change are identified, and the stage where new strategies or ideas are implemented causes individuals within the organisation to experience the change (moving). Finally, the stage of refreezing is reached when the change has been well integrated into the organisation (Yoder-Wise, 2003 Boshoff, 2005). Tappen, Weiss and Whitehead (2004), also, identify that change process is in four phases description of the change, supplying the implementation of the change, implementing the change, and integrating the change. Change starts when awareness of the need for it is created and ends when a complete evaluation of its expected cause has been done after the implementation (ibid).Lewin (1951 cited by Baulcomb, 2003) states that change is associated with certain forces that either facilitate or freeze off it success would result when the forces facilitating the change exceed those that are repeling it within the context. Personnel within the organisation may be one of such forces. People resist change on the grounds of their psychosocial needs, the appropriateness of the change and, also, how the cha nge affects their position and power (Tappen, Weiss and Whitehead, 2004). Therefore, they should be taken into consideration and be actively involved in the change process (Boshoff, 2005).Bennis et al. (1985 cited by Bellman, 2003) identify three strategies of change and these are rational-empirical, power-coercive and normative-re-educative strategies. Rational-empirical and power-coercive strategies both use top-down approaches while normative-re-educative approach employs a shadower-up approach. top-down approach involves senior management generating the idea, planning and straightaway implementing the change while the bottom-up approach in a flash indulges the employees in the change process (Ryan, 2008).However, Ryan (2008) adds that top-down schema alone is not effective for managing change at all times although it is very common under transformational leadership. Other strategies are education and communication federation and involvement facilitation and support negotia tion and agreement and manipulation, cooptation, and irresistible impulse and, dependent on the situation, these strategies may be utilize alone or in combination (Kotter and Schlesinger, 1979 cited by Yoder-Wise, 2003). It appears that the kind of strategy used would influence how the content of the change would be communicated to the parties involved.Action research is other change strategy and the process is said to begin when change is considered necessary (Bellman, 2003). Relevant data is self-possessed systematically and reported to individuals who must act on it, after which plans are collaboratively formulated and the necessary actions undertaken research and action combined (Senior and Fleming, 2006). The process is in cinque stages (diagnosis, analysis, feedback, action and evaluation) and is described as problem-focussed, and able to shorten staff resistance because of their active involvement in the process (Robbins, Judge and Sanghi, 2009).Organisational Appraisa lKomfo Anokye Teaching infirmary (KATH) is the second largest training hospital in Ghana, training some doctors, nurses and other paramedics in the Ashanti surface area of Ghana. It is an self-directed service delivery agent under the Ministry of Health of Ghana (MOH, 2009a). In addition to training many of the health personnel in the Ashanti Region, many people within and outside the Ashanti Region seek healthcare there. As a result, provision of quality healthcare has always been the focus.An organisation that recognises the need for change, weighs costs and benefits, and plans for the change when the benefits outweigh the costs is ready for a change (Dalton and Gottlieb, 2003). KATH is, therefore, ready for change because some of its employees are sent overseas or to other parts of the country, whenever there is the need for a new skill or knowledge to be gained, to bring about a positive change within the hospital. This may be a factor that would facilitate my agenda to impl ement lead change within the institution upon my return.However, Ghana, as a country is underdeveloped (CIA, 2008). Therefore, financial support, many a time, becomes a difficulty. Another challenge may be the fewer nursing staff. The Ministry of Health (2009b) estimates that there was a nurse-to-population ratio of 12024 in Ashanti Region and 11451 for the entire country in year 2007.Planning the Implementation of the ChangeThis is the second stage of the change process, as was identified by Tappen, Weiss and Whitehead (2004), and it involves identifying possible resistant forces to the proposed change and identifying strategies to prevent or overcome them. The change strategies to adopt as well as how to communicate the need for change are considered at this stage (Management Standards Centre, 2004b). Bellman (2003) suggests that the normative-re-educative (bottom-up) strategy is competent for changing practice within nursing.As it appears in my case, the need for change would be driven from bottom (an employee) to top (management) and is likely to be supported by the nurses since it is coming from their colleague. Nevertheless, others may resist the change because they tycoon not see the need for it (Baulcomb, 2003). But Martin (2006) suggests that a clear presentation of the vision and need for change may cause a majority of the staff to support it.Flower and Guillaume (2002) suggest that unfreezing stakeholders of healthcare is a necessity to unfreezing the institution. Stakeholders at KATH for my project include the theater director of Nursing Services (DNS), the Deputy Director of Nursing Services (DDNS) for the medical directorate, and the head of the diabetic clinic. When these spot people are made to recognise the need for a change, then hospital management is likely to support the proposed change.In times like these when evidence-based practice is being advocated for (McEwen, 2007), I should be able to use evidence to justify the need for a chan ge. I, therefore, plan to undertake a study that would compare the teaching package that I trust to introduce with the current approach used at KATH. If the new teaching package proves to be relatively successful, then majority of the staff are likely to appreciate the need for it.ProgressReflecting on the exchange program, I realise that the idea of bringing about change in practice was not clearly communicated. None of the processes of change, as has been identified now, were known at that time neither was there a strategy or a plan for the change. Some changes are unsuccessful because they are not clearly defined (Tappen, Weiss and Whitehead, 2004) and that is exactly what happened. Although I am still working on developing the teaching package that may be different from what is already present at KATH, I now realise that its purpose and effectiveness should be well communicated to other colleagues and management before the idea would be supported. I have discussed my ideas wit h the Director of Nursing Service of KATH and the Deputy Director of Nursing Services for the medical directorate and both of them seem excited about my idea.However, I have come to understand that all kinds of change are likely to face some form of resistance from the people (Baulcomb, 2003 Tappen, Weiss and Whitehead, 2004). I therefore, hope to apply the normative-re-educative (bottom-up) strategy because it has been identified as suitable for changing practice within nursing (Bellman2003). I also believe that such a strategy would let my colleagues feel actively involved in the change process and, hence, support it.Moreover, I hope to gain new insights from my visits to some hospitals and my interactions with some specialiser nurses while developing the project. I, therefore, hope to modify my plans and strategies, when the need arises, in order to become an effective change agent within my organisation.ConclusionPersonal development plans assist individuals to focus on specific needs and steps to take to achieve their objectives (Floodgate and Nixon, 1994). This essay has assisted me to reflect on my practice and roles as a leader. Whenever there is reflection, there must be a change in perspective (Atkins and Murphy, 1993). Development of change management strategies was identified as my learning objective. Actions to meet this objective were identified and pursued. Gibbss reflective calendar method (1988) was used as a guide. Consequently, I have become familiar with different strategies that could be apply to effect and lead change successfully, and plans to implement these in my institution have been proposed, although they are subject to change when new insights are gained.