Organizational Change NUR 514 Discussion
Organizational Change NUR 514 Discussion
is frequently observed at the charge nurse level as a bystander. The change is obvious, but the stakeholders and model are unknown. It was difficult to shift from a nonprofit acute care hospital to a for-profit facility after being purchased by a major corporation. The majority of the change was unfavorable in the eyes of the nursing personnel. There was the dismissal of support workers, the substitution of subpar supply, leadership gaps, and protracted contract negotiations that caused considerable delays in step and other raises. The nursing staff would likely respond, “Not terrible, but we made it through,” if you inquired how the change went. The main players that affected the transformation plan would respond differently if you questioned them because it was successful. Five years later, everything are still going as usual, and there are plans for a new hospital.
Today, every hospital in the region is a for-profit institution. Healthcare prices are rising and hospitals are combining at an accelerated rate in the United States (Findlay, 2018). Nearly 1 in 5 hospitals were acquired or merged with other hospitals between 2013 and 2017. (Findlay, 2018). Mergers are typically crucial for the hospital’s existence. The only way to keep up with current data management, rising technology, and top clinical personnel is to merge with major enterprises (Findlay, 2018).
However, at what expense to the localities that these hospitals serve. You’d expect that community services would suffer, but a recent study revealed that for-profit hospitals with 300 beds or more and nonprofit facilities both spent more on charitable care, albeit slightly more so (Garber, 2020). The same analysis revealed that whether the institutions were nonprofit or for-profit made no difference to the most significant variation in charity care spending, which was between states (Garber, 2020). Major organizational change is difficult, and some nursing specialties suffer; yet, the bigger picture suggests that survival is necessary.
Did it go well or not? Was there any correlation in how the organizations used stakeholders or change models?
What is Nursing Leadership in ?
The nursing leader’s role includes clinical and managerial responsibilities that may differ depending on clinical setting or position in the organizational hierarchy. Looking at nursing leadership literature in the context of informatics reveals that leaders are critical to technology integration in all areas of nursing practice (Honey & Westbrooke, 2016; Hussey, Adams & Shaffer, 2015; Kerfoot, 2015; Technology Informatics Guiding Education Reform, 2014). The ongoing transformation of healthcare necessitates the development of informatics skills and competencies for nurse leaders; it is no longer optional if one wishes to lead effectively in the technological age (Collins et al., 2017; Honey & Westbrooke, 2016; Hussey & Kennedy, 2015; Hussey, Adams & Shaffer, 2015; Kerfoot, 2015; Lloyd & Ferguson, 2017; Phillips et al., 2017; Remus, 2016; Simpson, 2013; Staggers et al., 2018; Strudwick, 2016; Technology Informatics Guiding Education Reform, 2014; Troseth, 2014). Nursing leaders who improve their informatics skills can work more effectively to ensure the “successful selection, development, and competent use of devices and clinical systems” (Kerfoot, 2015, p 342). Furthermore, at higher levels, nurse leaders with informatics competencies and knowledge will be required to inform policy and decision making related to ICT implementation (Honey & Westbrooke, 2016; Hussey et al., 2015; Simpson, 2013; Strudwick, 2016; Technology Informatics Guiding Education Reform, 2014).
Nurse leaders, with their clinical backgrounds, are also well-positioned to provide a holistic perspective as organizations develop integrated models of care that leverage technology, such as telehealth, to transform patient care delivery (Hussey et al., 2015; Hussey & Kennedy, 2016; Simpson, 2013; Technology Informatics Guiding Education Reform, 2014). When nursing leaders leverage technology and nursing practice properly, they can create project synergy and strengthen their ability to advocate for ICT solutions that meet patient needs and yield sustainable quality patient outcomes (Honey & Westbrooke, 2016; Hussey & Kennedy, 2015; Hussey et al., 2015; Remus, 2016; Technology Informatics Guiding Education Reform, 2014; Troseth, 2014). Simply put, leaders who develop and implement informatics competencies can help bridge the gap between clinical nursing practice and information technology (Hussey et al., 2015; Hussey & Kennedy, 2016; Lloyd & Ferguson, 2017; Simpson, 2013; Technology Informatics Guiding Education Reform, 2014).
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Nursing Leadership in Healthcare Informatics Drives Interoperability
While the use of ICTs has become more widespread and new models of care emerge that capitalize on technological advancements, nurses continue to have usability issues related to ICTs in practice (Staggers et al., 2018). Common issues reported include EHR designs that do not support how nurses document or interact with patient information, computerized provider order entry (CPOE) systems that do not account for nursing activities, or lack of interfaces with biomedical devices and other patient data collection systems (Hussey & Kennedy, 2016; Staggers et al,. 2018; Technology Informatics Guiding Education Reform, 2014). For nurses this could translate into challenges with electronic documentation in the EHR, delays in care if physicians are required to enter nursing orders, or the need to access multiple systems for information to develop a comprehensive understanding of the patient picture (Hussey & Kennedy, 2016; Staggers et al., 2018; Technology Informatics Guiding Education Reform, 2014). Ultimately, lack of consideration for nursing workflows during planning and design can result in a fragmented system that functions contrary to the TIGER recommendation for professional interoperability- the sharing of expertise and knowledge across disciplines in a meaningful and transparent way (Technology Informatics Guiding Education Reform, 2014). According to Staggers et al. (2018) this “means nurses become the human interface and integrator among disparate systems” (p 192). As such, nurse leaders need to develop a deeper understanding of nursing informatics and merge it with their clinical knowledge to effectively inform, influence or lead technology related initiatives that impact nursing workflow at the point of care (Hussey et al., 2015; Hussey & Kennedy, 2016; Kerfoot, 2015; Lloyd & Ferguson, 2017; Simpson, 2013; Technology Informatics Guiding Education Reform, 2014).
