Changes in Healthcare Aligning with Organizational Values

Planning and Implementing Change in Healthcare:
Creating a Mentoring Program
One of the most common problems on all nursing units is the tendency of nurses to “eat their young,” or to be highly critical of younger and less experienced nurses. Given the need to recruit and retain new nurses to address the deficit of retiring nurses and to ensure that currently employed nurses are not overburdened and overworked, addressing this issue is particularly pressing. The proposed change is to institute a mentoring program to facilitate dialogue between new hires and existing staff. This will increase goodwill, improve training and communication, and reduce errors, thus hopefully reducing the phenomenon of nurses “eating their young.”
Proposed Change
To remedy the problem, it is necessary to address the root cause or phenomenon. “In most cases, nurse bullying is the result of ineffective communication and coping skills in a high stakes environment,” (Katz, 2014, par. 8). According to the Academy of Medical Surgery Nurses (AMSN) (2012), mentoring has found to be an extremely effective way of creating workplace cohesion and sharing skills between different generations of nurses. “Mentoring is a reciprocal and collaborative learning relationship between two, sometimes more, individuals with mutual goals and shared accountability for the outcomes and success of the relationship” (“Introduction to Mentoring,” 2012, par. 1).
Instituting such a program within the hospital will communicate the unacceptable nature of workplace bullying and underline the need to support new nurses being integrated into the hospital. One of critical foundations at the heart of mentoring according to the AMSN (2012) is that of honoring the need to support the nurse’s progress from novice to expert; mentoring allows nurses to slowly gain in expertise under supervision so they can accumulate the types of lived experiences that can gradually make responding to patient needs seem more instinctual than forced. This prevents some of the frustration that older nurses experience dealing with younger nurses who may have textbook learning but little life experience. Mentoring is based upon adult learning, which ensures that the adult learner has control over her experience and can tailor the mentoring to practical, hands-on experiences that will be useful in later practice.
Alignment with Mission, Vision, and Values
Ultimately, the mission of every healthcare institution is to assist patients and promote health. But this also means showing respect for employees. Without a culture of respect for nurses and a reasonable foundation for continuing education, patient care will suffer. A workplace where bullying takes place is not a healthy place for either nurses or patients. That is why it is so vital to create a mentoring program that is simultaneously effective and engaging. Mentoring programs are also aligned with the teaching vision of the hospital, to both educate patients and nurses. It is aligned with the values of health promotion, sharing with others, and teamwork to ensure that high-quality healthcare is delivered to all patients.
Change Model: Outlining the Steps
Many models of organizational change currently exist. But virtually all of them are fundamentally based on the Lewin Change Model, which suggests that change is a process of unfreezing, change, and refreezing. The Lewin Model is effective in its simplicity and the fact that it underlines the need first and foremost to get powerful organizational actors on board with the change, before the change can be embarked upon. “To prepare the organization successfully, you need to start at its core – you need to challenge the beliefs, values, attitudes, and behaviors that currently define it” (“Lewin’s Change Model,” 2017, par.9). With no motivation and will among nurses to change, sabotage is likely through an unwillingness to participate, bad-mouthing the change, or a refusal to support the needed paradigm shift to one which is supportive of incoming nurses.
Enacting the first step of the Lewin Model, unfreezing, means formally and informally communicating to employees the urgency that change is needed. For example, nurses must be persuaded that bullying and staff attrition is a serious problem at the hospital. As well as appealing to organizational values, it can be noted that attrition hurts all nurses. When nurses are short-staffed, this leads to a higher risk of medical errors due to nurses being overtired and over-burdened, plus the fact that nurses are more likely to have to work back-to-back shifts to compensate. Organizational values, such as the need for kindness and civility in the workplace, should also be invoked. Finally, there is a liability issue, as when nurses are harassed they may appeal to HR or even for legal redress.
Change resistance is frequent during the actual change process. Nurses may complain that they do not want extra duties to engage in a formal mentoring program or to be trained in how to mentor fellow nurses. They may be skeptical about its efficacy. When change resistance runs deep, this is all the more reason to dig in and to persuade organizational actors to understand the need to change their approach. Taking a positive approach is often helpful. Rather than stressing the negative incidents which happened in the past, focusing on positive and proactive ways that the mentorship program will enable new nurses to better transition into their new roles is far more helpful, as well as the benefits of an improved workplace atmosphere. Providing active training for nurses in the mentorship program will increase buy-in.
The third step of refreezing is to ensure that there is no backsliding and the change is maintained throughout the future. “This means making sure that the changes are used all the time, and that they are incorporated into everyday business. With a new sense of stability, employees feel confident and comfortable with the new ways of working” (“Lewin’s Change Model,” 2017, par.18). This means that once the mentorship program is actually put into place at the organization, both mentors and mentees are monitored to ensure both groups are participating and honoring their obligations to one another.
Possible components of the program to keep track of include the following: if mentors follow up to check in on how new nurses are doing, if they use respectful language to new nurses, and if they make efforts to actively supervise and teach younger nurses. Both quantitative surveys and qualitative interviews can be used to assess and monitor the program and to address any problems when needed. Periodic unfreezing and refreezing may be needed to tweak the program.
Who Is Involved
Ideally, nurse managers themselves would be involved in supervising and implementing the program. These nurses would need to be committed to reducing bullying in the workplace yet have the skills and knowledge to know what new nurses needed to learn and the best ways for mentors to educate others. Change agents must have technical knowledge of the field but must also have broader personal qualities of resilience and fortitude to change an entrenched and negative culture of bullying.
Organizational and administrative skills are also necessary to ensure that the program’s success is being monitored correctly. Hospital administrators are needed to keep track of data as well as to reevaluate the performance review process of the mentoring program. Finally, HR may must be able to offer assistance with mediation to prevent potential conflicts between mentors and mentees from escalating and defeating the purpose of the program.

References
Introduction to mentoring. (2012). AMSN. Retrieved from:
https://www.amsn.org/sites/default/files/documents/professional- development/mentoring/AMSN-Mentoring-Introduction-Article.pdf
Katz, K. (2014). Bullying in nursing: Why nurses ‘eat their young’ and what to do about it.
Rasmussen Nursing. Retrieved from: http://www.rasmussen.edu/degrees/nursing/blog/bullying-in- nursing-nurses-eat- their-young/
Lewin’s change model. (2017). Changing Minds. Retrieved from:
https://www.mindtools.com/pages/article/newPPM_94.htm