LA+1B

1. Clearly articulate what the nature of your change is; 2. Collect data to support your decision to create a change; 3. Use Lewin’s Change Theory to guide what steps you will follow in pursuing your change project; 4. Determine how you might share your vision for change and engage your stakeholders; and 5. Apply Lewin’s Force Field Analysis to your project, and identify potential strategies to shift the equilibrium in a favourable direction.
 * LA 1B - May 9th, 2012 **

Hi group! Here if the information we had discussed during class. Feel free to edit/add. -Allison

__Learning Activity 1B: Group C__

1. Clearly articulate what the nature of your change is.

The change proposed is an alteration in staff level and mix on a 32 bed cardiology/post-cardiac surgery unit. The proposed change is from 7 RNs to 6 RNs and 2 LPNs.

2. Collect data to support your decision to create a change:

All excellent and essential data sources! 3. Use Lewin’s Change Theory to guide what steps you will follow in pursing your change project.
 * Literature review on the effectiveness of team nursing, as well as any previous attempts at a change in staff mix and level on a similar unit
 * Cost effectiveness of the proposed change
 * Scope of practice and expected roles of RNs and LPNs
 * CRNBC and CLPNBC position on staff mixing
 * Unit information regarding patient acuity/stability
 * Logistical information regarding how assignments and daily tasks would be assigned
 * Education/in-services to address gaps in information and skill level
 * Health Authority policy
 * Expectations of behaviour
 * Information regarding horizontal violence in the workplace

Unfreezing: Preparation for change

Communicate with stakeholders Identify a need for change (ex: why is this happening? Is is a push from management or identified by the stakeholders?) Complete Lewin’s Force Field to identify driving forces and restraining forces Data collection as stated in question 2 also what are the potential issues with this change - i.e. from a nursing perspective, admin, etc.

Movement: Planning, implementation and evaluation of change

Continue with Lewin’s Force Field in maximizing driving forces and minimizing restraining forces ADPIE Create time sensitive goals (keeping in mind to maintain a gradual change process) Maintain the ability of stakeholders to communicate (anonymously if desired) Celebrate the ‘small wins’

Refreezing: Support and stabilization of change

Maintain support services for stakeholders ADPIE - for initiating changes required as a result of evaluation? Maintain opportunities for evaluation of the proposed changes Publish/share the results of the proposed change and effectiveness (or ineffectiveness)

4. Determine how you might share your vision for change and engage your stakeholders.

Identified stakeholders:
 * Patients/community members
 * RNs
 * LPNs
 * Health Authority
 * Managerial staff
 * Interdisciplinary team members

Our vision would be shared through open communication in the forms of personal discussions, staff meetings, online communications (email or discussion boards), focus groups, questionnaires unit clipboards and any additional self identified preferred methods of communication. Good! Make sure you consider involving stakeholders in the change, not only consult them but let them play a role and be instrumental in the change taking place in order to increase investment.

5. Apply Lewin’s Fore Field Analysis to your project, and identify potential strategies to shift the equilibrium in a favorable direction.

Driving forces: - cost - savings? - workload - will workload increase or decrease for the RNs? - increased patient/family satisfaction - increase or decrease? - RNs can focus more on higher-acuity patients instead of lesser-acuity ones - potentially, but their duties may be divided in overseeing LPN work and what if most patients in the unit are high acuity?

Restraining Forces: - "sacred cow" --> Some of the RNs may say something along the lines of, "we've always done this without LPNs, we've never had to have them employed here, this is not how we do things here, etc." - Horizontal violence amongst nurses - Patient safety

Strategies to shift equilibrium in favourable direction: - Educating RNs about this change, and letting them know of this in a timely manner - Workshops on horizontal violence - Educating RNs of the positive aspects of having LPNs on the unit, i.e. more time spent with higher-acuity patients