Brigham and Women’s Hospital’s Nursing Change


The present paper considers the introduction of a mechanism for reporting staffing issues, concerns, and suggestions as a planned change intervention for the Brigham and Women’s Hospital Department of Nursing [BWHDN] (2016). This change should contribute to the solution to the ever-present problem of nurse shortage (Maenhout & Vanhoucke, 2013). The paper discusses the issue and uses a blend of the change theories by Lewin and Rogers to offer a step-by-step plan for the proposed change.

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Problem and Solution Identification

One of the key issues of modern healthcare organizations is the shortage of nurses, and one of the solutions is the efficient management of the nursing staff (Buchan, Duffield, & Jordan, 2015). In particular, effective staffing can be helpful (Maenhout & Vanhoucke, 2013). The American Nurses Association [ANA] (2015b) emphasizes the significance of optimal staffing that should incorporate the presence of the mechanisms for staffing evaluation.

However, BWHDN (2016) does not report the presence of a reporting mechanism for nurses’ considerations and suggestions. If this problem is resolved, the organization will gain another mechanism for staffing evaluation, which can be employed to achieve optimal staffing. Thus, the present paper proposes the development of a mechanism for nursing feedback on staffing issues and considerations.

BWHDN (2016) is interested in the quality and outcomes of its care. In particular, BWHDN’s (2016) vision consists of promoting global health, and its mission aims to improve the health of the community through nurse-led collaborative care. The proposed change is in line with these goals because improved staffing tends to promote safe and high-quality care (Maenhout & Vanhoucke, 2013). Also, the values of the organization include collaboration and professionalism, both of which will be employed with greater efficiency due to optimal staffing (ANA, 2015b).

Finally, the importance of the quality of care and patient safety is highlighted by the ethics code proposed by the American Nurses Association (2015a), and optimal staffing is promoted by the standards of practice developed by ANA (2015b). Thus, the proposed change is in line with BWHDN’s (2016) culture and supported by nursing standards.

Change Theory Choice

Change is a complicated process, and certain theories and models can be used to guide it for better outcomes (Marquis & Huston, 2015). For example, Lewin’s theory suggests that three stages of change exist: “unfreezing, moving (or transitioning), and refreezing” (Shirey, 2013, p. 69). The first stage presupposes increasing the awareness of the need for change, the second stage is the change itself, and the final one presupposes routinization. The approach is expanded by Lewin’s force field analysis, which focuses on determining the phenomena that can assist or hinder the process of change (Marquis & Huston, 2015, p. 166). These forces are assessed and manipulated throughout the change process.

Rogers’ theory of innovation includes the stages that are called “awareness, interest, evaluation, trial, and adoption” (Mitchell, 2013, pp. 32-33). The first stage presupposes building the awareness of the need for change, but before the change is acted upon, the decision to do so is made (Batras, Duff, & Smith, 2016). This element helps to avoid unnecessary changes (Marquis & Huston, 2015). After that, the change is trailed and evaluated, which may lead to redefinition, and, eventually, routinized.

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The Lewin’s approach is simple and has an important focus on the psychology of change, but it lacks complexity or non-linearity (Shirey, 2013). Rogers’ theory, on the other hand, exhibits non-linearity and is more complex, but it can be improved through the use of force field analysis and the consideration of the processes of freezing and unfreezing. It has been proposed that it is possible to fuse several theories (Mitchell, 2013), and the present paper suggests employing the combined benefits of the two approaches to make a hybrid theory for the proposed change.

Planned Change: Steps to be Made and Stakeholders

Both discussed theories require improving the awareness of the need for the change. As a result, it is important to consider stakeholders. The change process can and should be led by nurses, especially nursing leaders. Indeed, they are familiar with the interests of the organization’s nurses, and they should employ this knowledge and their leadership skills to the benefit of the change. However, staffing is a complex process (Maenhout & Vanhoucke, 2013), which is likely to involve multiple organizational levels. As a result, the stakeholders of the change are going to include the administration.

The support of the administration is crucial for the change process due to its influence on decision-making and resources, which is why nursing leaders need to attract their attention. A way to do so would involve the assessment of the problem and the preparation of a report, which should demonstrate the need for the introduction of a reporting mechanism for nurses. ANA (2015b) guidelines may be employed to guide the development of the report since they include some recommendations on optimal staffing.

The same report can be used to increase the awareness of the need for change among the nurses; the latter should be engaged in the discussion of the problem, and their reported cases can also be employed to attract the attention of the administration.

Thus, the attraction of the attention of the stakeholders is the first step of the change process. It is going to be interlaced with the investigation of the issue, which can be viewed as the second element of the plan. Moreover, the investigation is going to be employed for the assessment of possible solutions. The specifics of the reporting mechanism (or mechanisms) should depend on the available resources and preferences of stakeholders. Both these factors can be reviewed with the help of an organizational assessment and extensive discussion between the stakeholders.

The third step would involve the decision-making that is required by the Rogers’ theory. The stakeholders would be expected to review the information gathered during the previous step and decide to employ a particular mechanism. After that, the fourth step, which is the implementation, will begin.

The implementation process is complex and should include the trial, evaluation, and adjustment of the change as suggested by Rogers’ theory. Moreover, it should involve the work with the stakeholders, including Lewin’s force field analysis and motivation of the staff (Mitchell, 2013). Also, effective communication needs to be promoted (Mitchell, 2013), which can be achieved, for example, by soliciting feedback from nurses. Finally, after the successful adjustment of the change to the needs of the stakeholders and organizational resources, its routinization (refreezing) and maintenance can take place. The maintenance process predominantly hinges on nurses and their leaders.

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The problem of understaffing is a significant issue for modern healthcare organizations, but it can be resolved through the improvement of the staffing process. The latter can be achieved, among other things, through the introduction of efficient evaluation mechanisms.

For instance, BWHDN (2016) could introduce a nurse-centered mechanism for reporting staffing issues. A change theory can facilitate the development of the change plan; for example, the present paper uses a theory that incorporates the key notions of those by Lewin and Rogers to preserve their advantages and counter disadvantages. As a result, the proposed plan begins with awareness-building stages and ends with the routinization of the trialed, evaluated, and reformed change. It can be suggested that this theory can indeed guide the process of planning a nurse-led staffing change at the workplace.


American Nurses Association. (2015a). Code of ethics for nurses with interpretive statements. Web.

American Nurses Association. (2015b). Nursing: Scope and standards of practice. Web.

Batras, D., Duff, C., & Smith, B. J. (2016). Organizational change theory: Implications for health promotion practice. Health Promotion International, 31(1), 231-241. Web.

Brigham and Women’s Hospital Department of Nursing. (2016). 2016 annual report. Web.

Buchan, J., Duffield, C., & Jordan, A. (2015). ‘Solving’ nursing shortages: Do we need a New Agenda? Journal of nursing management, 23(5), 543-545. Web.

Maenhout, B., & Vanhoucke, M. (2013). An integrated nurse staffing and scheduling analysis for longer-term nursing staff allocation problems. Omega, 41(2), 485-499. Web.

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Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management – UK, 20(1), 32–37. Web.

Shirey, M. R. (2013). Lewin’s Theory of Planned Change as a strategic resource. The Journal of Nursing Administration, 43(2), 69–72. Web.

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