Raising the costs of treatment might be necessary to hire new nurses. Dialysis clinics, because of their small size, often have fewer resources than large hospitals and the increased cost of wages of new hires would place a an additional stress on the unit's already limited budget, perhaps if estimates by the American Hospital Association are correct, as much as $270 million dollars a year. Elaborate on potential negatives that individuals or groups might bring up in discussions and how you would counteract this.

Some nurses, despite their generally strong feelings in favor of the proposal because of their workload, may fear having to take a pay cut, or have overtime hours cut, because of the increased costs and influx of new nurses. Administrators may adopt a different type of change-resistance technique, and simply assert that it cannot be done, given the current nursing shortage, although effective recruiting techniques could be deployed, like tuition assistance, for example, flexible hours, as well as sign-in bonuses, to attract current students looking for jobs upon graduation as well as career nurses.

Based on change theory, how long do you anticipate that it would take to socialize the idea, propose the specific change, and initiate implementation?

The difficulty with persuading others to adopt the change is that it requires a long-range view. Trying to save on costs by increasing nursing workloads is a classic example of being 'pennywise but pound foolish.' Although there may be initial cost savings on nurses' salaries, the costs that will be incurred because of increased rates of patient ailments, increased duration of hospital stays because of complications, and even the costs of potential lawsuits because of the deaths that arise in a clinic with a less-than-desirable staff to patient ratio will far outweigh the initial costs of hiring more nurses.

Nurses already overburdened and overstressed in terms of the demands made upon their time, will likely welcome this initiative, even after initial temporary resistance to possible pay and overtime cuts. Introducing new people...

Socializing the idea to the current healthcare employees will likely be relatively easier than persuading managers who do not have to shoulder an increased workload and who are resistant the costs of implementation.
Budgeting for the cost of the plan will itself take time. Many of the patients receive Medicaid or Medicare but those who have health insurance from private providers may balk at the increased cost. However, the personal as well as the financial cost of medical errors that will result from not implementing the plan would be far greater. Additionally, patients that have better outcomes from dialysis treatments spend less time in the hospital -- patients want to go home as soon as possible, and be healthy as possible, and from the dialysis clinic's perspective, when patients are in the hospital it does not get paid for patient treatments, thus increased ailments and hospital stays result in a loss of revenue for the clinic.

Feasibly, overcoming organizational resistance could take several years, as could approach and lobbying dialysis organizations, to implement the proposal. However, if efforts are made to recruit new nurses throughout this time, this will not be time wasted, and hopefully a new graduating class of nurses will be open and willing to consider employment at the clinic.