Introduction the nurse manager to explore ways to

Introduction

In the
current context, healthcare industry evolves around change adapting to a change
has become a vital role (Marquis & Huston, 2016). This paper will discuss
my experience on a near miss medication error and how this incident has brought
a new change that was unexpected. There will be a discussion on the strategies
implied to overcome the challenges in adapting to a change.

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Description of Clinical Experience

This
is an experience that I encountered as an enrolled nurse in Orange Valley
Nursing Home. During my shift, I was assisting the staff nurse to serve
medications. The staff nurse was concerned when the prepacked medication for
hypertension looked different from the usual. To clarify her doubts, she called
the pharmacy to double confirm. That is when the nurse realised that the
medication order that was sent to the pharmacy was filled with antidepressant
medication (Topamax) instead of antihypertensive (Toprol-XL). To prevent
medication errors in the future, the issue was raised to the nurse manager to
explore ways to find a solution. The nurse manager called for an urgent meeting
with her team of nurse leaders to identify a solution. There was a change initiated,
to include both trade name and generic name in the medication order forms. Additionally,
the nurses will need to include the patient’s diagnosis in the medication order
form. With immediate effect, the forms were changed with the new implementation.
Some nurses perceive this as a good initiative whereas another group of nurses find
it as troublesome and time-consuming to include a few additional details. There
was another group of nurses who felt that this change was unnecessary.

Theoretical Analysis/Application

Like
how a coin has two sides to it, Kurt Lewin’s Force Field Model (1947) suggests
that there are forces that push towards a positive effect and positive perception
about change (Sullivan, 2010). These are the driving forces. Whereas on the
other hand, there is another aspect that will push towards resistance and
maladaptive to change. These are the restraining forces (Sullivan, 2010).

 

 

 

 

Figure 1.1. Kurt Lewin’s
Force-Field Model

This model clearly depicts that of an
organisation or an initiative that has driving forces and there will be an
opposing force at the same time. According to the theory, to achieve a
productive change first an inequality will occur between the driving forces and
restraining forces (Hussain, et al., 2016). This will unfreeze the current
behaviour of the involved participants. Behaviours will change to another level
where other opposing forces are brought into a level of equilibrium. Once the
new practices integrate into the involved parties, it becomes part of their
practice and organisation (Ellis & Hartley, 2012).

The process of meeting the ever-changing
demands of the internal and external client needs in healthcare is vital (Hussain,
et al., 2016). Therefore, there are three strategies mentioned in Kurt Lewin’s
theory which are (Ellis & Hartley, 2012):

1.    Unfreeze the existing equilibrium

2.    Move the target system to a new level of
equilibrium

3.    Refreeze the system at the new level of
equilibrium

                                                                                     

As the
experience of a near miss medication error was only encountered by one nurse,
it is often taken lightly by the other nurses who are not involved in that
situation. Often, it is perceived as a careless mistake from the uninvolved
nurses. This explains why other nurses feel that it is not important or a
hassle to change the medication order form. It was also perceived as an
additional workload for them.

Therefore,
it is the duty of the nurse manager to clearly explain to the staff of why a
change is required. At the same time, there could be a sharing session from the
affected nurse to the other nurses of how it felt to be in that scenario. During
the sharing, there could be an effective participation from the other nurses to
participate in the generating alternative solutions. According to the theory, this
is to unfreeze the situation by motivating the nurses to

 get ready for a change by improvising the old practices.

Once
the nurses are motivated to adapt to a change, there is an opportunity for them
to be ready for it. In this process, the nurses must internalise that new
process and effort so that the change will be effective. In this way, new
equilibrium could be attained according to the model.

Refreezing
would be the last strategy in the model. Refreezing could be done by, monitoring
the effectiveness of the medication form by receiving feedback from the staff.
This will keep the new change incorporated and reinforced on a regular basis to
sustain the change.

Barriers to Change

As mentioned by Hewitt (2013),
there are various barriers that would refrain the nurses to accept the change. Some
of those are as follows:

Communication

Communication
is the key to any problem resolution. It could also be a barrier to accept a
change. In the clinical situation, if the nurse manager is not clearly
communicating with the staff about the change could lead to unnecessary
misunderstanding. At the same time, if the staff is not willing to understand the
purpose; communication becomes ineffective.

Participation

It is
essential to involve the staff during a brainstorming process for a solution.
In the clinical situation, this was not the case. As it was perceived as not
important by the nurse manager and she only involved the nurse leaders in the
process. If the other staff are involved during the brainstorming, there will
be minimal resistance to change during that phase. The feeling among the staff
that change is unnecessary or it will not help the current situation could be
avoided.

Implications for Professional Practice and Management

Through
this experience I understood the challenge being faced by a nurse manager when
implementing a change. It is not easy to convince every staff to follow the
direction that might serve the best for all. It is an art that could be mastered
through experience. This does not only allow me to understand the dilemma of a
nurse manager, also to understand how a staff could be receptive towards
change. Most of the time as nurses, we will be overwhelmed with the paperwork. If
there was a new implementation of documentation, we might perceive it as an
additional workload. This is what I witnessed in the clinical experience.

As nurses,
we must always be open to new initiatives that could improve patient safety. This
is the mindset that I would like to adopt when I join the workforce as a full-time
staff. With this mindset, I could apply the Code of Ethics Value Statement 5
and 6 which are; “To Provide Care in a Responsible and Accountable Manner” and “Maintain
Competency in the Care of Clients” (Singapore Nursing Board, 2018). If I encounter
the same incident in the future, I will approach the new initiatives receptively
and follow the code of ethics. I will remain vigilant when serving medications to
preserve the patient safety. If there was an opportunity for me climb up the
career ladder to be a nurse manager, I will apply the principles of managing
change within the organisation and bear in mind that not all staff will be
receptive towards a change. It also balls down to how I will manage if there
was a resistance towards change happens using the strategies mentioned by Kurt Lewin
(1947).

Introduction

In the
current context, healthcare industry evolves around change adapting to a change
has become a vital role (Marquis & Huston, 2016). This paper will discuss
my experience on a near miss medication error and how this incident has brought
a new change that was unexpected. There will be a discussion on the strategies
implied to overcome the challenges in adapting to a change.

Description of Clinical Experience

This
is an experience that I encountered as an enrolled nurse in Orange Valley
Nursing Home. During my shift, I was assisting the staff nurse to serve
medications. The staff nurse was concerned when the prepacked medication for
hypertension looked different from the usual. To clarify her doubts, she called
the pharmacy to double confirm. That is when the nurse realised that the
medication order that was sent to the pharmacy was filled with antidepressant
medication (Topamax) instead of antihypertensive (Toprol-XL). To prevent
medication errors in the future, the issue was raised to the nurse manager to
explore ways to find a solution. The nurse manager called for an urgent meeting
with her team of nurse leaders to identify a solution. There was a change initiated,
to include both trade name and generic name in the medication order forms. Additionally,
the nurses will need to include the patient’s diagnosis in the medication order
form. With immediate effect, the forms were changed with the new implementation.
Some nurses perceive this as a good initiative whereas another group of nurses find
it as troublesome and time-consuming to include a few additional details. There
was another group of nurses who felt that this change was unnecessary.

Theoretical Analysis/Application

Like
how a coin has two sides to it, Kurt Lewin’s Force Field Model (1947) suggests
that there are forces that push towards a positive effect and positive perception
about change (Sullivan, 2010). These are the driving forces. Whereas on the
other hand, there is another aspect that will push towards resistance and
maladaptive to change. These are the restraining forces (Sullivan, 2010).

 

This model clearly depicts that of an
organisation or an initiative that has driving forces and there will be an
opposing force at the same time. According to the theory, to achieve a
productive change first an inequality will occur between the driving forces and
restraining forces (Hussain, et al., 2016). This will unfreeze the current
behaviour of the involved participants. Behaviours will change to another level
where other opposing forces are brought into a level of equilibrium. Once the
new practices integrate into the involved parties, it becomes part of their
practice and organisation (Ellis & Hartley, 2012).

The process of meeting the ever-changing
demands of the internal and external client needs in healthcare is vital (Hussain,
et al., 2016). Therefore, there are three strategies mentioned in Kurt Lewin’s
theory which are (Ellis & Hartley, 2012):

1.    Unfreeze the existing equilibrium

2.    Move the target system to a new level of
equilibrium

3.    Refreeze the system at the new level of
equilibrium

                                                                                     

As the
experience of a near miss medication error was only encountered by one nurse,
it is often taken lightly by the other nurses who are not involved in that
situation. Often, it is perceived as a careless mistake from the uninvolved
nurses. This explains why other nurses feel that it is not important or a
hassle to change the medication order form. It was also perceived as an
additional workload for them.

Therefore,
it is the duty of the nurse manager to clearly explain to the staff of why a
change is required. At the same time, there could be a sharing session from the
affected nurse to the other nurses of how it felt to be in that scenario. During
the sharing, there could be an effective participation from the other nurses to
participate in the generating alternative solutions. According to the theory, this
is to unfreeze the situation by motivating the nurses to

 get ready for a change by improvising the old practices.

Once
the nurses are motivated to adapt to a change, there is an opportunity for them
to be ready for it. In this process, the nurses must internalise that new
process and effort so that the change will be effective. In this way, new
equilibrium could be attained according to the model.

Refreezing
would be the last strategy in the model. Refreezing could be done by, monitoring
the effectiveness of the medication form by receiving feedback from the staff.
This will keep the new change incorporated and reinforced on a regular basis to
sustain the change.

Barriers to Change

As mentioned by Hewitt (2013),
there are various barriers that would refrain the nurses to accept the change. Some
of those are as follows:

Communication

Communication
is the key to any problem resolution. It could also be a barrier to accept a
change. In the clinical situation, if the nurse manager is not clearly
communicating with the staff about the change could lead to unnecessary
misunderstanding. At the same time, if the staff is not willing to understand the
purpose; communication becomes ineffective.

Participation

It is
essential to involve the staff during a brainstorming process for a solution.
In the clinical situation, this was not the case. As it was perceived as not
important by the nurse manager and she only involved the nurse leaders in the
process. If the other staff are involved during the brainstorming, there will
be minimal resistance to change during that phase. The feeling among the staff
that change is unnecessary or it will not help the current situation could be
avoided.

Implications for Professional Practice and Management

Through
this experience I understood the challenge being faced by a nurse manager when
implementing a change. It is not easy to convince every staff to follow the
direction that might serve the best for all. It is an art that could be mastered
through experience. This does not only allow me to understand the dilemma of a
nurse manager, also to understand how a staff could be receptive towards
change. Most of the time as nurses, we will be overwhelmed with the paperwork. If
there was a new implementation of documentation, we might perceive it as an
additional workload. This is what I witnessed in the clinical experience.

As nurses,
we must always be open to new initiatives that could improve patient safety. This
is the mindset that I would like to adopt when I join the workforce as a full-time
staff. With this mindset, I could apply the Code of Ethics Value Statement 5
and 6 which are; “To Provide Care in a Responsible and Accountable Manner” and “Maintain
Competency in the Care of Clients” (Singapore Nursing Board, 2018). If I encounter
the same incident in the future, I will approach the new initiatives receptively
and follow the code of ethics. I will remain vigilant when serving medications to
preserve the patient safety. If there was an opportunity for me climb up the
career ladder to be a nurse manager, I will apply the principles of managing
change within the organisation and bear in mind that not all staff will be
receptive towards a change. It also balls down to how I will manage if there
was a resistance towards change happens using the strategies mentioned by Kurt Lewin
(1947).

Conclusion

In conclusion,
patient safety is not only important at a clinical level but also in an
organisational level. Using change management strategies mentioned by Kurt
Lewin (1947), patient safety initiatives could sustain and be incorporated
effectively in the organisation (Sullivan, 2010). To institutionalise an
initiative it is important for staff not to be sceptical towards a change and
be receptive to it.

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