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Health care organizations

Health care organizations are continuously immersed in change from the emergence of new policies, to promote quality care and improve patient safety to keeping pace with the rapid growth in knowledge and best practices. Establishing a solid framework for planning and implementing change is a wise move, as it provides a foundation for the extensive coordination that will be needed to successfully facilitate the change.

For this Assignment, you propose a change at the department or unit level and develop a plan for guiding the change effort.

To prepare:

Review Chapter 8 in the course text. Focus on Kurt Lewin’s change theory, and contrast it with other classic change models and strategies.

Reflect on problems, inefficiencies, and critical issues within a specific department, unit, or area in your organization or one with which you are familiar. Select one issue as a focal point for this assignment, and consider a change that could be made to address the issue.

Think about how the change would align with the organization’s mission, vision, and values as well as relevant professional standards.

Using one of the change models or strategies discussed in Chapter 8, begin formulating a plan for implementing the change within the department/unit. Outline the steps that you and/or others should follow to facilitate the change effort. Align these steps to the change model or strategy you selected.

Determine who should be involved in initiating and managing the change. Consider the skills and characteristics that are necessary to facilitate this change effort.

To complete:

Write a 3- to 5-page paper (page count does not include title and reference page) that addresses the following:

Identify a problem, inefficiency, or issue within a specific department/unit.

Describe a specific, realistic change that could be made to address the issue.

Summarize how the change would align with the organization’s mission, vision, and values as well as relevant professional standards.

Identify a change model or strategy to guide your planning for implementing the change. Provide a rationale for your selection.

Outline the steps that you and/or others would follow to facilitate the change. Align these steps to your selected change model or strategy.

Explain who would be involved in initiating and managing this change. Describe the skills and characteristics that would be necessary to facilitate the change effort.


Nursing Leadership

Identified problem

High nurse turnover is one of the recurring problems especially within the emergency department affecting the general care of patients. The reason why the US has the highest nurse turnover at 60 percent per annum is because of poor job satisfaction due to underprivileged working environment. According to Hayes et al. (2015), most nurses are leaving the profession due to lack of job satisfaction.

Problem Discussion

Nurses play important roles within the health care system because they have daily direct contact with patients. Nurses work in challenging environment including the emergency department, nursing homes, and community-based environments. One of the most common problems nurses face is fatigue, due to workload and increased scope of practice. Fatigue contributes to injuries and lack of job satisfaction (Hayes et al, 2012).

Workplace related violence is also an increasing concern among the nursing profession that is likely to contribute to high nurse turnover. The crowded nature of the emergency departments increases the risk of violence. Patients come in with different problems which at times exhibit aggressive behavior like emotional outburst. Managing aggressive patient behavior is one of the most challenging situations nurses face within the emergency department, some patients become violent causing injuries to nurses. This is the other common reason why nurses are quitting their profession (Hayes et al, 2012).

Work conditions contribute to high nurse turnover, factors like low wages and low-status nurse’s experience compared to another profession within the health care system affects the general job satisfaction among nurses. Considering the relationship between job satisfaction and wages, nurses being paid lower wages with minimal benefits are likely to quit compared those who are well paid. Low pay is repeatedly cited as the main causes of high nurse turnover within the emergency departments (Djukic et al, 2013). Nurse feels they have more responsibility, yet they are not paid well compared to other health care personnel.

            According to the World Health Organization, a healthy work environment determines the quality care patients receive. Therefore, apart from low wages poor staffing, personnel safety is also an important factor in determining jobs satisfaction among the several factors (Djukic et al, 2013).

Realistic change that could be made to address the issue

To minimize high nurse turnover, priority should focus on addressing the working environment. Work environment includes the physical structures, creating opportunities for nurses to advance their education to become more competent and adopting supportive leadership style. Continuous education will enhance the level of dedication to the nursing practice and also give them the opportunity to develop their careers. Nurses will grow within the ranks of their career expectation hence minimizing the nurse turnover (Boamah & Laschinger, 2015).

Addressing low wages is an important factor to be reviewed when addressing the high nurse turnover. Since job satisfaction is linked to nurse shortage, it is important to develop career growth opportunities within the organization to retain and also attract new graduate nurses.

In an environment where everyone is supportive job satisfaction is likely to increase, therefore, supervisors and the general management need to work together and consult their subordinates to encourage nurses to feel valued. Nurse retention will depend on how the organization values its staffs. To fulfill the organization mission and vision, it’s important for nurse managers to work in collaboration with the human resource department to facilitate better strategies of motivating nurses (Boamah & Laschinger, 2015).

Implementing the change within the department/unit

Grol et al (2013) suggests that, to apply Kurt Levin’s change theory, it is important to understand three major elements of behavior; freezing, unfreezing and refreezing. This involves identifying strategies of eliminating old behavior patterns that are not producing good results. In this case, behavior such as negative attitude towards the nursing profession and lack of collaboration between nurses and other personnel are some of the negative behavior that needs to be abandoned. Unfreezing involves the process of increasing the driving force that would enable individuals adopt the desired behavior and direct them away from situations that are counterproductive (Grol et al, 2013).  

Levin’s change theory is about changing the negative thoughts and feelings to become more liberated and make productive choices. Refreezing is the other elements of change theory that involves adapting new habits that will be part of the daily routine to meet the set objectives.

Using Levin’s theory nurse managers can assess the root causes of high nurse turnover including lack of motivation, low wages, and poor working environment. This theory will enable managers to focus on relevant information needed to address the identified problem and develop appropriate and sustainable strategies to accomplish the organization mission (Grol et al, 2013).

To implement comprehensive change strategies within the emergency department that will help minimize the rate of nurse turnover, it is important to obtain the necessary approval and gain the support of all the stakeholders. Getting approval from the hospital management imply engaging the responsible individuals to gain their support in implementing the proposed solutions within the emergency department (Boamah & Laschinger, 2015).

According to Boamah & Laschinger.(2015), the implementation process involves adopting the changes within the normal organization routine. Nurse supervisors and other medical personnel need to offer supportive work environment for nurses and consult them to make them feel valued.   The nursing board and the national nursing association need to hold review meetings to determine some of the challenges facing nurses that contribute to nurse shortage.  For example issues of nurses being limited to leadership position needs to be addressed to encourage the nursing practice. Nursing roles need to be addressed to define their scope of practice 

To successfully implement the proposed changes, all the relevant stakeholders need to be sensitized regarding the proposal. Sensitization workshops will require resources like training materials like posters and handouts for participants.  An expert on human resource management needs to facilitate the workshop to inform the hospital magnet about some of the benefits of implementing the proposal (Boamah & Laschinger, 2015). To capture the participant’s attention, power point presentation will include visual images to show some of the challenges within the nursing profession and the need to address these challenges. Other important assessment tools include use of questionnaires and conducting period surveys to collect recommendation that can be useful in improving the proposed changes (Grol et al, 2013).


The nursing shortage is as a result of job dissatisfaction within the nursing profession which is a problem facing several countries including the US. Nurse’s role cannot be underestimated; there is need to address some of the challenges that might affect effective service delivery to implement lasting solution to address the recurring nurse shortage within the emergency departments.


Boamah, S. A., & Laschinger, H. (2015). The influence of areas of worklife fit and work‐life

 interference on burnout and turnover intentions among new graduate nurses. Journal of

 Nursing Management.

Djukic, M., Kovner, C. T., Brewer, C. S., Fatehi, F. K., & Cline, D. D. (2013). Work

 environment factors other than staffing associated with nurses’ ratings of patient care

 quality. Health Care Management Review, 38(2), 105-114.

Hayes, B., Douglas, C., & Bonner, A. (2015). Work environment, job satisfaction, stress and

 burnout among haemodialysis nurses. Journal of nursing management, 23(5), 588-598.

Hayes, L. J., O’Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F. & North, N.

 (2012). Nurse turnover: a literature review–an update. International journal of nursing

 studies, 49(7), 887-905.

Grol, R., Wensing, M., Bosch, M., Hulscher, M., & Eccles, M. (2013). Theories on

            implementation of change in healthcare. Improving Patient Care: The Implementation of

 Change in Health Care, Second Edition, 18-39.

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