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Nurse Understaffing and Planned Change Theory

Change Model Overview

The theory of planned change (TPC) is a simple strategy that offers a linear process for approaching change management. It describes three elements or stages that help to transform the urge for change into practical remodeling. The first stage is called “unfreezing” and represents the process of problem recognition and identification of the need for change. This element also includes mobilizing other people to recognize the necessity for transformation in current practice. The process has already begun when speaking about the problem of nurse understaffing as nursing care omission emerged as a crucial problem in current healthcare, and scholars start to admit the importance of the issue (Dabney & Kalisch, 2015).

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The second stage of TPC is “moving” or “transitioning,” and it involves perceiving the change rather as a process than an event. This element is characterized by elaborating a detailed action plan and determining the stakeholders. Often, this stage is associated with problems concerning uncertainty and fear of change (Shirey, 2013). The second stage includes communication as a means to avoid overlooking the desired target while following the initial plan and making adaptations to it when needed. In short, “transitioning” is the active period of the change theory, and it has not yet started when speaking about the nurse understaffing problem.

The third step is “refreezing” or stabilizing and adapting to the change in order for it to become a part of the existing culture, policies, and practices. This stage aims at acquiring the new equilibrium and realizing it as a new enhanced norm of service. This stage is crucial as it supports the change’s sustainability over time. The process will start right after the plan proposed by the current paper has been implemented into practice.

Action Plan

While the national process of moving towards better nurse education may be too broad to grasp, the present paper seeks to introduce an action plan for a single healthcare provider to address the problem of nurse understaffing. As the proposed solution includes nursing education, there are six main stakeholders to be involved: a nurse leader, human resources managers, a nursing educator, and two nurses with varied qualifications.

While the nurse leader is to administer the process and offer emotional and professional assistance, the HR managers should develop criteria for assessing human resources necessary to create a measurement framework for evaluating nurses. At the same time, the nursing educator is to revise the education level of the staff according to the elaborated criteria and offer specific guidelines to eliminate the nurses’ incompetence. Finally, practicing nurses will be responsible for providing feedback during all stages of the change process to ensure change acceptance among other nurses.

The first step (unfreezing) will be to develop the criteria for the evaluation of staff’s competence and to gather initial data about the education level of the currently employed nurses. In other words, the management should realize if there is a problem and inform all the stakeholders about their findings (Shirey, 2013). They also need to identify supporting and restraining forces to facilitate future implementation.

The restraining forces often include the “lack of staff nurse motivation to assume formal nursing leadership roles, resistance of non-nursing departments for allocating leadership development resources to nursing, and noncompetitive nurse manager compensation when compared with larger competitors in the marketplace” (Shirey, 2013, p. 71). In brief, the first stage is central as it helps to determine the key stakeholders and to prevent the future emergence of problems.

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The second stage (transitioning) will be to develop exact procedures, determine the duty-holders, and provide education to the nursing staff. Identification of the timeframe for the intervention should also be made during the period. The third step (refreezing) will be to assess employees again to fix the results and set the new standard for nurses’ competence. The outcome will be measured based on the comparative analysis of the preliminary staff assessment and the final proficiency evaluation. The management staff should establish the form and the procedure of both estimates. In summary, TPC offers a specific pattern to follow, which is transformed to an action plan that helps to address the problem of nurse understaffing.

Potential Barriers

Actual circumstances may lead to the emergence of difficulties and barriers for administering the change process. In the current hectic conditions of any hospital, considering the nurse understaffing, the concerned employees may not have enough time to receive additional education during the working hours. The way of dealing with the problem may be to offer additional payments for attending the training courses and other means of non-financial motivation.

The second problem that may emerge is applying the TPC as it describes a linear process while education is sometimes non-linear. The method examined in the current paper should be considered as a one-time intervention; however, the process can be reinstated and become recurrent. In short, although the appearance of problems and complications is inevitable, issues can be dealt with applying the means proposed by TPC and beyond.


Dabney, B. W., & Kalisch, B. J. (2015). Nurse staffing levels and patient-reported missed nursing care. Journal of Nursing Care Quality, 30(4), 306-312. Web.

Shirey, M. R. (2013). Lewin’s theory of planned change as a strategic resource. JONA: The Journal of Nursing Administration, 43(2), 69-72. Web.

Yeo, M. T. (2014). Implications of 21st century science for nursing care: Interpretations and issues. Nursing Philosophy, 15(4), 238-249. Web.

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