However, current hospice figures demonstrate that only about twenty percent of all elderly individuals that die are enrolled in hospice programs. Implementation and Monitoring

The needs of this new program will require thorough training and once implemented, precise monitoring. "When you approach a problem in the way your work group functions, you're implementing an organizational change. By taking a critical look at your process, and using some theories from organizational design, you can fix the problem -- and change your organization to make quality more likely." (Derby, 1999) The training will be a key because of the potential requirements associated with the Hospice program that may require completely new skill sets for the majority of our staff. The fact is that many of our nurses may not have acquired the necessary skills prior to joining our team. "Great nursing is impossible without completing the cycle of the nursing process. Being skilled in one or some of the phases and not the whole is useless." (Rubenfeld & Scheffer, 1995, p. 174)

Organizational change such as implementing a mandatory overtime program involves an already complex process. "This is true whether you are changing an entire company, or making adjustments within your project or work group." (Derby, 1999)

The mandatory overtime program requires a smooth transition so the multiple relationships of the staff will need to be monitored on a daily basis. "The easiest kind of model to develop is a simple diagram of effects. To model a system, you need to have some idea of measurable events within the system. The measurements don't have to be exact.... But they do have to be observable evidence of the events in the system." (Derby, 1999) Therefore, because the original aspect of the mandatory overtime will be used to implement the training phase of the in-house hospice program, several key aspects of motivation shall be monitored.

We will monitor upon implementation the following:

Shift Workload

Requests for overtime release

Testing outcomes and class participation during training

Moral during training and during regular shifts

Errors such as prescription errors

Absenteeism

Turnover (Derby, 1999)

Describe the change theory used and the steps needed for implementation

Required overtime is very common in the healthcare industry. Due to current nursing professional's shortages, we often hear of double and even triple shifts especially on weekends and during a busy period such as holidays. "Most people can put up with it for a short period of time and continue to function, although less effectively." (Derby, 1999) However, because of the demands of the nursing profession, tolerating overtime over the course of a long period leads to professionals not performing to their fullest.

The implementation theory will be to only implement the mandatory overtime when absolutely necessary so as not to 'burn out' the nursing staff. It is well understood that the process of mandatory overtime will reduce morale and efficiency and quality suffer. We certainly do not want to force out the existing nursing staff by causing undue turnover...

"The reality is that efficiency goes down quickly and the intended benefits are seldom realized." (Derby, 1999)
The nurse supervisor will identify a team of three RN's to monitor the entire process. Each will be responsible for providing the supervisor with feedback to their particular areas of expertise. The shift monitoring nurse will be required to monitor daily shifts absentee rate as well as monitor the daily logs for errors and incidents. The training nurse lead will be responsible for monitoring the training outcomes and will be required to monitor the overall attendance rate for hospice training. The actual trainer of the hospice skill sets will be required to update the nurse supervisor of morale and participation in the program.

Nurses are professional learners by nature so these processes do not look as though they will cause as much dissention as the possible shift problems when not training. Once the nurse supervisor has the data, she will make weekly progress reports to the facility board as to the progress of the training program. The future implementation of the hospice in-house will be reevaluated prior to implementation based on the results of the training process.

Conclusion

In conclusion, this two part report aimed to create a plan for an organizational change whereby the internal nursing staff would be required to perform duties during periods of mandatory overtime in order to complete a training process to add Hospice services to our facility. The combination of responsibility will provide the facility an excellent opportunity to provide a highly sought after social service for the immediate community and would raise the level of respect and confidence for our facility while at the same time creating a new source of revenue and maybe even a potential for academic and educational offerings for other facilities looking to follow in our footsteps. As noted, the program will require some mandatory overtime for the nursing staff but the intention is to make this process as pain free as possible.