Nurse as a Change Agent
Content
Nurse as a change agent
Change agent means the person who helps or facilitates in bringing positive change in any area related to health. Nurse also plays the role of change agent. She has to play a vital role in bringing improvement in health aspect of people in individual, family and community level. A nurse can play role of change agent in health setting that may be in any health institutions, family or community. The nurse can play role of change agent in community, research, hospital and health educational institutions. To play effective role of change agent nurse has to focus on three main roles via visioner, facilitator and idea person. Being a visioner, nurse communicates, advices, coaches and provides feedback to bring change in any health and educational settings. Then to bring change she has to play role facilitator. Nurse has to educate people what change is needed so she should play role of educator as well. She should be an idea person to bring change. She helps in problem solving and research. She plays a role of problem solver. Hence, nurse plays a vital role as a change agent. Source: http://nursing-padma.blogspot.com/2011/01/nurse-as-change-agent.html Whether an employee of an organization or an independent consultant, the nurse can function as a catalyst and planner for change. Clinical expertise, theoretical knowledge, and a commitment to the outcome of the change project can empower the nurse to successfully assess, plan, implement, and evaluate the change process. Change in today's health care landscape is a daily, if not hourly, reality. The nurse manager must have strong leadership skills to navigate through change with a focus on the patient and the provision of safe and reliable care. The historical term for those leading change is "change agent." A change coach uses the coaching behaviors including guidance, facilitation, and inspiration to inspire others toward change, altering human capabilities, and supporting and influencing others toward change. An exemplar of the nurse manager's role as a change coach in practice is provided using American Organization of Nurse Executives' Care Innovation and Transformation initiative. It is the agile manager that is able to successfully move between the roles of change agent and change coach to continuously transform the environment and how care is delivered.
Being a change agent is one of the major roles of the nurse in the health care system. The nurse takes effect on the transformations of different lives, for both ill and well, through the various functions they perform. Chin and Benne in 1985 formulated a theory on the strategies in effecting changes to other people and to one’s self.
Empirical–Rational Strategies
Self-interest primarily drives people to act, and they do so rationally (Chin & Benne, 1985). Every individual has the capacity to make decisions and to act—based on one’s will, motivation and perseverance—to change. When the proper information is emphasized in a convincing and engaging way, people will discover the reason of the change and act in line with such intent (Chin & Benne, 1985). Motivation pushes an individual’s desire to change. The nurse can assume the role of instructor-facilitator-motivator. Credibility and reliability of the change agent are very vital to properly motivate and push a person to truly change. Of course, it would be very difficult (or impossible) to effect change if the agent is not credible and reliable. Brevity, clarity and some level of vigor are also essential factors in the transfer of information. To ensure accuracy, specialists should gather information, which must reflect up to date methodological methods. Once gathered information is transferred, such process involves a one-way process, where the change agent actively facilitates the transfer, reception and understanding of the information (Chin & Benne, 1985).
Dialogue should support the process of understanding, not changing or redefining the facts as determined and advanced by specialists (Chin & Benne, 1985). Empathy best describes this. The most important principle here is that you want to change the person with thorough understanding, not merely because it is the right thing to do. A person should change not because you want to or he/she needs to and he/she has to, but because it is for his/her own good. Dialogue should not be done with force that must be followed, but an understanding to communicate that you make a person feel the freedom to choose and to decide. Encouragement should always promote democracy and autonomy.
Normative–Re-educative Strategies
Intelligence is social—not individual—in realm. People are directed in their behaviors by a normative culture, or socially endowed and communicated norms, meanings, and institutions. Within a person, internal values, habits and meaning guide his/her actions. Thus, any change in the behavior or actions is a change, not only in the rational communication tools, but also at the personal level, namely in his/her values and habits. Likewise, any change in a person also affects the social level, bringing forth changes which provide alternatives in institutionalized relationships and roles, normative structures, and perceptual and cognitive orientations (Chin & Benne, 1969). All those involved in the system of change carry-out transformations based on their own direction (Chin & Benne, 1985). Support system is very vital for a person who wants to realize change. However, change is not easy to attain, and problems are encountered along the way. One way to address this is through a change in values, attitudes, relationships and norms between members of the system, as well as between the system and the external environment (Chin & Benne, 1985). Mutual collaboration is imperative among the members of the health care team in creating the final method to create change—no member of the system should dominate or use power on the others (Chin & Benne, 1985). Parts of the change process that must be assessed include the dynamics of the system (personality, privilege and power) and the deeper level of assumptions (Chine & Benne, 1985). One of the secondary objectives of the change process is to enhance the system’s general skills to manage its own change process in the future (Chin & Benne, 1985).
Power–Coercive Strategies
Power is legal and power has its privileges, so people must respect those in power (Chin & Benne, 1985). The nurse has the legitimate right and power to lead another person’s desire to change. Nurses have the power and responsibility to direct those in the system. In cases of non-compliance to directives, meting out reprimand is necessary (Chin & Benne, 1985). Observing the organizational structure, particularly following the orders of one’s superior is crucial to address the best interest of the organization. Most mid-level and top-level leaders have more experience, and thus, naturally mean that they know better, if not the best (Chin & Benne, 1985).
Summary and Conclusions
The basic assumption underlying the empirical-rational model is that individuals are rational and will follow their rational self-interest. Thus, if a change ―for the better‖ is suggested, people of good intention will adopt the change. This approach posits that change is created by the dissemination of innovative techniques. A primary strategy of this model is the dissemination of knowledge gained from research. In the normative-re-educative approach, the individual is seen as one actively in search of satisfying his/her needs and interests. The individual does not passively accept what comes to him/her, but takes action proactively to advance his/her goals. Further, changes are not just rational responses to new information but occur at the more personal level of values and habits. Additionally, the individual is guided by social and institutional norms. The
overarching principle of this model is that the individual must take part in his/her own (re-education) change if it is to occur. The model includes direct intervention by change agents, who focus on the client system and who work collaboratively with the clients to identify and solve their problems. Two strategies are germane to the normative-re-educative model. First is the scheme to focus on improving the problem-solving capabilities of the system. Next is the strategy to release and foster growth in the persons who compose the system. There is no assumption that better technical information can resolve a client’s problems. Rather, the problems are thought more likely to be within the attitudes, values, or norms of various client-system relationships. The assumption of this model is that people are naturally capable and creative and, if obstructions are removed, will rise to their highest potentials. The model’s strategies are based on the potentials that are already inherent in people and the system for change; thus it is not necessary that change be leveraged from outside the system. The power-coercive approach relies on influencing individuals and systems to change through rules, policies and external leverage, where power of various types is the dominant factors. Power-coercive strategies emphasize political, economic, and moral sanctions, with the focus on using power of some form to ―force‖ individuals to adopt to change. Its perspective is grounded in concepts of power, authority, and competing interests, with an image of negotiation. Source: http://rnspeak.com/fundamentals-of-nursing/nurse-as-the-change-agent/
Leadership in Nursing: Facilitating Change
The ability to facilitate change is an important nursing leadership skill, and you don’t have to be a nurse manager to develop it. Even staff nurses can step forward to identify activities that can make a difference in patient care or help the unit run more smoothly. Change is said to be inevitable, one of the few things in life we can count on. In health care, change often becomes necessary because of new technologies, legislation, policy reforms, changing standards of care, or even negative factors like staff shortages. Most health care organizations have some sort of process improvement program in place at the management level, with the goal of reducing costs, enhancing efficiency, and improving patient care by correcting bottlenecks and other workflow problems. But where do you fit into all of this? Many organizational studies have found that successful process improvement plans come not from top management, but from engaged employees who feel like stakeholders in the processes being targeted for change. So if you’re passionate about an issue, you have the ability to emerge as a leader and a facilitator of change. An Initiative for Change: Transforming Care at the Bedside Transforming Care at the Bedside (TCAB) is an improvement initiative that began in 2003, as a pilot program at three hospitals. Today, more than 60 hospitals have a TCAB initiative. The Robert Wood
Johnson Foundation (www.rwjf.org), which funded the pilot program, explains the unique ways in which TCAB can empower staff nurses to be facilitators of change: TCAB takes a unique approach to addressing quality of care issues by supporting nurses and other frontline staff to develop their own interventions, design new processes and adapt ideas from staff that improve care. This is a bottom-up, team-based approach to achieving quality rather than a top-down approach. Several characteristics distinguish TCAB from other quality improvement initiatives. First, TCAB engages the hearts and minds of front-line staff and unit managers in improving care processes. With TCAB, new ideas for transforming the way care is delivered don't come solely from hospital leaders or the quality improvement department, but from front-line nurses and other care team members-the people who spend the most time with patients and their families. If you’re a staff nurse and knows the importance of bedside nursing, one of the easiest ways you can begin to facilitate change is to propose that your unit start its own TCAB pilot program. Click here for an online toolkit. The toolkit clearly outlines suggested methods for testing the impact of small changes, them implementing them on a wider scale.
As a staff nurse, you are already an advocate for your patient. Now it’s time to consider the ways you can become an agent of change within your unit. It’s essential to be proactive, rather than living with the status quo, wherever the quality of patient care is at stake. You don’t have to wait for others to identify processes that can be improved upon – you can assume a nursing leadership role at the staff nurse level.
Source: http://www.nursetogether.com/leadership-in-nursing-facilitating-change
Change agent means the person who helps or facilitates in bringing positive change in any area related to health. Nurse also plays the role of change agent. She has to play a vital role in bringing improvement in health aspect of people in individual, family and community level. A nurse can play role of change agent in health setting that may be in any health institutions, family or community. The nurse can play role of change agent in community, research, hospital and health educational institutions. To play effective role of change agent nurse has to focus on three main roles via visioner, facilitator and idea person. Being a visioner, nurse communicates, advices, coaches and provides feedback to bring change in any health and educational settings. Then to bring change she has to play role facilitator. Nurse has to educate people what change is needed so she should play role of educator as well. She should be an idea person to bring change. She helps in problem solving and research. She plays a role of problem solver. Hence, nurse plays a vital role as a change agent. Source: http://nursing-padma.blogspot.com/2011/01/nurse-as-change-agent.html Whether an employee of an organization or an independent consultant, the nurse can function as a catalyst and planner for change. Clinical expertise, theoretical knowledge, and a commitment to the outcome of the change project can empower the nurse to successfully assess, plan, implement, and evaluate the change process. Change in today's health care landscape is a daily, if not hourly, reality. The nurse manager must have strong leadership skills to navigate through change with a focus on the patient and the provision of safe and reliable care. The historical term for those leading change is "change agent." A change coach uses the coaching behaviors including guidance, facilitation, and inspiration to inspire others toward change, altering human capabilities, and supporting and influencing others toward change. An exemplar of the nurse manager's role as a change coach in practice is provided using American Organization of Nurse Executives' Care Innovation and Transformation initiative. It is the agile manager that is able to successfully move between the roles of change agent and change coach to continuously transform the environment and how care is delivered.
Being a change agent is one of the major roles of the nurse in the health care system. The nurse takes effect on the transformations of different lives, for both ill and well, through the various functions they perform. Chin and Benne in 1985 formulated a theory on the strategies in effecting changes to other people and to one’s self.
Empirical–Rational Strategies
Self-interest primarily drives people to act, and they do so rationally (Chin & Benne, 1985). Every individual has the capacity to make decisions and to act—based on one’s will, motivation and perseverance—to change. When the proper information is emphasized in a convincing and engaging way, people will discover the reason of the change and act in line with such intent (Chin & Benne, 1985). Motivation pushes an individual’s desire to change. The nurse can assume the role of instructor-facilitator-motivator. Credibility and reliability of the change agent are very vital to properly motivate and push a person to truly change. Of course, it would be very difficult (or impossible) to effect change if the agent is not credible and reliable. Brevity, clarity and some level of vigor are also essential factors in the transfer of information. To ensure accuracy, specialists should gather information, which must reflect up to date methodological methods. Once gathered information is transferred, such process involves a one-way process, where the change agent actively facilitates the transfer, reception and understanding of the information (Chin & Benne, 1985).
Dialogue should support the process of understanding, not changing or redefining the facts as determined and advanced by specialists (Chin & Benne, 1985). Empathy best describes this. The most important principle here is that you want to change the person with thorough understanding, not merely because it is the right thing to do. A person should change not because you want to or he/she needs to and he/she has to, but because it is for his/her own good. Dialogue should not be done with force that must be followed, but an understanding to communicate that you make a person feel the freedom to choose and to decide. Encouragement should always promote democracy and autonomy.
Normative–Re-educative Strategies
Intelligence is social—not individual—in realm. People are directed in their behaviors by a normative culture, or socially endowed and communicated norms, meanings, and institutions. Within a person, internal values, habits and meaning guide his/her actions. Thus, any change in the behavior or actions is a change, not only in the rational communication tools, but also at the personal level, namely in his/her values and habits. Likewise, any change in a person also affects the social level, bringing forth changes which provide alternatives in institutionalized relationships and roles, normative structures, and perceptual and cognitive orientations (Chin & Benne, 1969). All those involved in the system of change carry-out transformations based on their own direction (Chin & Benne, 1985). Support system is very vital for a person who wants to realize change. However, change is not easy to attain, and problems are encountered along the way. One way to address this is through a change in values, attitudes, relationships and norms between members of the system, as well as between the system and the external environment (Chin & Benne, 1985). Mutual collaboration is imperative among the members of the health care team in creating the final method to create change—no member of the system should dominate or use power on the others (Chin & Benne, 1985). Parts of the change process that must be assessed include the dynamics of the system (personality, privilege and power) and the deeper level of assumptions (Chine & Benne, 1985). One of the secondary objectives of the change process is to enhance the system’s general skills to manage its own change process in the future (Chin & Benne, 1985).
Power–Coercive Strategies
Power is legal and power has its privileges, so people must respect those in power (Chin & Benne, 1985). The nurse has the legitimate right and power to lead another person’s desire to change. Nurses have the power and responsibility to direct those in the system. In cases of non-compliance to directives, meting out reprimand is necessary (Chin & Benne, 1985). Observing the organizational structure, particularly following the orders of one’s superior is crucial to address the best interest of the organization. Most mid-level and top-level leaders have more experience, and thus, naturally mean that they know better, if not the best (Chin & Benne, 1985).
Summary and Conclusions
The basic assumption underlying the empirical-rational model is that individuals are rational and will follow their rational self-interest. Thus, if a change ―for the better‖ is suggested, people of good intention will adopt the change. This approach posits that change is created by the dissemination of innovative techniques. A primary strategy of this model is the dissemination of knowledge gained from research. In the normative-re-educative approach, the individual is seen as one actively in search of satisfying his/her needs and interests. The individual does not passively accept what comes to him/her, but takes action proactively to advance his/her goals. Further, changes are not just rational responses to new information but occur at the more personal level of values and habits. Additionally, the individual is guided by social and institutional norms. The
overarching principle of this model is that the individual must take part in his/her own (re-education) change if it is to occur. The model includes direct intervention by change agents, who focus on the client system and who work collaboratively with the clients to identify and solve their problems. Two strategies are germane to the normative-re-educative model. First is the scheme to focus on improving the problem-solving capabilities of the system. Next is the strategy to release and foster growth in the persons who compose the system. There is no assumption that better technical information can resolve a client’s problems. Rather, the problems are thought more likely to be within the attitudes, values, or norms of various client-system relationships. The assumption of this model is that people are naturally capable and creative and, if obstructions are removed, will rise to their highest potentials. The model’s strategies are based on the potentials that are already inherent in people and the system for change; thus it is not necessary that change be leveraged from outside the system. The power-coercive approach relies on influencing individuals and systems to change through rules, policies and external leverage, where power of various types is the dominant factors. Power-coercive strategies emphasize political, economic, and moral sanctions, with the focus on using power of some form to ―force‖ individuals to adopt to change. Its perspective is grounded in concepts of power, authority, and competing interests, with an image of negotiation. Source: http://rnspeak.com/fundamentals-of-nursing/nurse-as-the-change-agent/
Leadership in Nursing: Facilitating Change
The ability to facilitate change is an important nursing leadership skill, and you don’t have to be a nurse manager to develop it. Even staff nurses can step forward to identify activities that can make a difference in patient care or help the unit run more smoothly. Change is said to be inevitable, one of the few things in life we can count on. In health care, change often becomes necessary because of new technologies, legislation, policy reforms, changing standards of care, or even negative factors like staff shortages. Most health care organizations have some sort of process improvement program in place at the management level, with the goal of reducing costs, enhancing efficiency, and improving patient care by correcting bottlenecks and other workflow problems. But where do you fit into all of this? Many organizational studies have found that successful process improvement plans come not from top management, but from engaged employees who feel like stakeholders in the processes being targeted for change. So if you’re passionate about an issue, you have the ability to emerge as a leader and a facilitator of change. An Initiative for Change: Transforming Care at the Bedside Transforming Care at the Bedside (TCAB) is an improvement initiative that began in 2003, as a pilot program at three hospitals. Today, more than 60 hospitals have a TCAB initiative. The Robert Wood
Johnson Foundation (www.rwjf.org), which funded the pilot program, explains the unique ways in which TCAB can empower staff nurses to be facilitators of change: TCAB takes a unique approach to addressing quality of care issues by supporting nurses and other frontline staff to develop their own interventions, design new processes and adapt ideas from staff that improve care. This is a bottom-up, team-based approach to achieving quality rather than a top-down approach. Several characteristics distinguish TCAB from other quality improvement initiatives. First, TCAB engages the hearts and minds of front-line staff and unit managers in improving care processes. With TCAB, new ideas for transforming the way care is delivered don't come solely from hospital leaders or the quality improvement department, but from front-line nurses and other care team members-the people who spend the most time with patients and their families. If you’re a staff nurse and knows the importance of bedside nursing, one of the easiest ways you can begin to facilitate change is to propose that your unit start its own TCAB pilot program. Click here for an online toolkit. The toolkit clearly outlines suggested methods for testing the impact of small changes, them implementing them on a wider scale.
As a staff nurse, you are already an advocate for your patient. Now it’s time to consider the ways you can become an agent of change within your unit. It’s essential to be proactive, rather than living with the status quo, wherever the quality of patient care is at stake. You don’t have to wait for others to identify processes that can be improved upon – you can assume a nursing leadership role at the staff nurse level.
Source: http://www.nursetogether.com/leadership-in-nursing-facilitating-change
