Draft Design for Change

Draft Design for Change


Creation of a draft Design for Change proposal inclusive of your PICOT and Literature review information from your Course Project Milestone #1. (will attach)

Your plan is to convince your management team of a nursing problem you have uncovered and you feel is significant enough to change the way something is currently practiced.


1.Create a Draft proposal for your Design for Change Capstone Project. You will include the information from Milestone #1, your PICO question and literature review, as you compose this draft.(uploading)

Your plan is to convince your management team of a nursing problem you have uncovered and you feel is significant enough to change the way something is currently practiced.

2.The format for this proposal will be a paper following APA 6th edition.

3.The paper is to be 3-4 pages excluding Title page and Reference page.

4.As you organize your information and evidence, include the following topics:

a.Introduction to the plan with evidence-based problem identification and solution.

b.Change Plan overview using the six steps of the Rosswurm and Larrabee Model (1999)(uploading)

The paper needs to follow this format:

1.Assess need for change (problem identified)

2.Link problem-intervention-outcomes

3.Synthesize best evidence (incorporation of the literature review)

4.Design practice change

5.Implement and evaluate change (evaluation must be measureable and time bound)

6.Integrate and maintain change


5.Citations and References must be included to support the information within each topic area.

Scholarly sources are expected, which means using peer-reviewed journals and credible websites.

6.Tables and Figures may be added as appropriate to the project should be embedded within the body of the paper (see your APA manual for how to format and cite).

Creating tables and figures offers visual aids to the reader and enhances understanding of your literature review and design for change.

                                                                   Capstone Proposal for design change                         

                The problem found in most of the health centers is that there is shortage of nurses. The patients need a lot of care, forcing the few nurses to work overtime. As a result, the nurses do not perform effectively and, thereby, do not provide good results as expected. Working overtime is the technique which has been adopted by most health care centers to ensure that the patients are attended. This does not mean that this is the solution to the problem because even if the nurses overwork and are not able to attend all the patients as expected, they will not have performed their duties fully. The best solution to this problem is the change model, which was formulated by Rosswurm and Larrabee (1999). There have been some other techniques which have been assessed to help eliminate this problem but they have not been effective compared to the change model.

Step 1: The need for change.

            The relationship between patient care, overtime nursing, and nurse injuries in course of their duties is close. Adequate research studies suggest that mandatory overtime affects provision of quality services. Patient care is essential, but little emphasis is give leading to loss of many lives. Hence, mandatory overtime is not only associated to the manner of provision of services but also to other events that happen in the medical field.

             Nurses seem not be highly affected and discriminated on the issue of mandatory overtime. Other workers in other fields have restricted working hours, a different scenario when it comes to working hours of nurses. It therefore, becomes challenging to figure out the implication these working hours have on the nurses. Nevertheless, this does not mean that previously efforts have not been there to counter the problem of mandatory overtime.

            Over the years, legislatures have proposed laws to ban and limit mandatory overtime. However, this has failed to address the health concerns of the nurses as well as the patients. Challenges have also cropped up on the assessment of the health effects on the nurses such as fatigue and its effect on their performance (Gershon et al, 2009). This issue requires an urgent measure to remedy.

Step 2: interventions and outcome

              Mandatory overtime among health practitioners and denial of shifts offs that should come between overtime affects service delivery. Depriving these workers, sleep causes fatigues among the nurses affecting their levels of alertness. So far, the only solution advanced to help manage the problem of understaffing in various nursing facilities is mandatory overtime. This kind of overtime requires nurses to work for quite long hours without shifts off in between. This therefore, demonstrates the fact that understaffing has been managed through mandatory overtime. However, this strategy to manage shortage of nurses has had negative effects on patient care because of the fatigue and lack of alertness among the nurse caused by mandatory overtime.

             Nurses are also taking their own initiative to deal with chronic problem of understaffing. They improvise various mechanisms, one of them is coming up with own strategies such as self-scheduling as a mechanism to counter the mandatory overtime. Duties are apportioned according to the strength and the endurance level of nurses, which has to great magnitude helped to reduce overload brought by mandatory overtime.

Step 3: Synthesis of evidence

               According to Daniels (2003) mandatory overtime means, “work hours imposed on an employee over an agreed-upon, predetermined work schedule.” Most of the nurses get their pay hourly. In case mandatory overtime is banned, then their amount of wages may be interfered with. Most of the nurses who depend on the overtime work to earn extra living may be affected by the ban. Some nurses are guilty of taking high wages and therefore decide to offer extra services (Olds and Clarke, 2010). The only way to deal with nurse shortages is to face the problem head on and solve it (Huston 2013). The commercial vehicle and forestry sector also have issues with this type of situation. Those drivers who do exra work and deprive themselves sleep end up causing accidents. They are not able to keep alert thereby the accidents (Kovner et al., 2009). The mandatory overtime hours for the nurses have increased from 0.23 to 0.39 hours, which has resulted due to the nurse shortage (Gershon et al., 2009).

Step 4: The practice change design

There is a need to implement changes on the mandatory overtime. The changes which are adopted should be able to cater for this problem (Huston, 2014). The number of hours that the nurses work should be addressed whereby they should be provided with enough time to rest. That will ensure that they are always alert and are able to perform effectively. The number of nurses should also be checked. More nurses should be trained and employed to eliminate this problem of shortage of nurses. They should be enough to cater for all the needs of the patients. Both the medical and emotional needs (Kovner et al., 2009). Effective results will be got when there are enough nurses.

Step 5: Implementation and Evaluation of Change

More nurses should be trained and distributed to the health care centers which are faced with the problem of nurse’ shortage. The managers of these centers should however check first on what the hospital needs before going for more nurses. The nurses should also be assessed and it should be ensured that those taken have the required skills. There is also need for evaluation to know whether the nursing services have improved after the problem of nurse shortage is addressed. The services offered to the patients should turn out to be effective after addressing of the problem.

Step 6: Integration and Maintenance of Change

Research should be carried out in the heath care centers to find a way of how these changes will be integrated and maintained (Rogers et al., 2004). The integration of these changes depends on the hospital setting while the maintenance will depend on the medical facilities offered by the nurses. These changes will have an effect to the nurses, the patients and the entire fraternity. Evaluating these changes will help determine the strengths and weaknesses of the changes thereby helping the management to work on the weaknesses of the change to avoid failing of the change. Research on how to develop the implemented changes should be carried out to ensure quality services.


Overtime working has got so many effects and not only to the patients but the whole field of the nursing sector. Mandatory overtime affects the quality of services provided to the patients. Extreme events may also be witnessed from mandatory overtime. Implementing these changes will be of advantage to the entire nursing sector. The nurses will perform effectively since they are not fatigued. The changes should be frequently evaluated to ensure that they are effective.


Daniels, Rick. Nursing Fundamentals: Caring & Clinical Decision Making. Australia: Delmar Learning, 2004. Print.

Gershon, R..R., Pearson, J.M., Sherman,M.F., Samar, S.M., Canton, A.N., & Stone, P.W. (2009).            The Prevalence and Risk Factors for Percutaneous injuries in Registered Nurses in the Home Health Care Sector. American Journal of Infection Control, 37(7), 525-533

Huston, C. J. (2014). Professional Issues in Nursing: Challenges & Opportunities. Baltimore, MD: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Kovner, C.T., Brewer, C.S., Greene, W., & Fairchild, S. (2009). Understanding New Registered Nurses’ Intent to Stay at their Jobs. Nursing Economic, 27(2), 81-98.

Olds, D.M., & Clarke, S.P. (2010). The Effect of Work Hours on Adverse Events and errors In

Rogers, A.E., Hwang, W.T., Scott, L.D.,Aiken, L.H. & Dinges, D.F. (2004). The Working Hours             of Hospital Staff Nurses and Patient Safety. Health Affairs, 23(4), 202-212.

Rosswurm, M. A., & Larrabee, J. H. (1999). A Model for Change to Evidence‐Based        Practice. Journal of Nursing Scholarship31(4), 317-322.