20Jan 2022 by
One change that was implemented at my hospital was the move from using a non-smart phone to using iphones as the primary way to get a hold of each other. I was told by the older staff (nurses who have been working there for decades) that when this change was announced, many people were against the idea. Their main arguments was that it would take them a long time to learn how to get around using a smartphone, and that most were comfortable with how things were. The hospital made the change because they believed it was safer for the patients to be able to communicate with the rest of the healthcare team in more ways than just a phone call. You had access to real time chats, were able to pull up patients information right on the phone, and best of all you could send images straight to the person you were talking to in regards to patient care. This was especially favored with wound care nurses, who could chart their findings without having to get a camera, upload the image on the computer and wait to document it.
This change, as wonderful and useful as it is, has brought about another issue which needs to be addressed and that is privacy. These iphones are not password protected, meaning if you lose your phone, anyone who picks it up has access to the records of your patients, and can search for any patient admitted to the hospital. The floor I work on is a locked unit, so this issue isnt something we deal with, but speaking to other nurses that are in the same nurse residency program and work on other floors have dealt with this. They are so scared of losing their phones that sometimes they forget and accidentally take the phone home with them. This can violate major HIPPA regulations if they were to lose the phone out on the street! In one journal I read, they stated Even if mobile devices are secured, there is considerable potential for the users of those devices to violate HIPAA rules or company policies and not necessarily on purpose. There have been many recorded HIPAA violations in which the authorized exposure of PHI was accidental, (HIPPA Journal, 2019, p.1).
I believe that Lewins Force-Field Model is one of the better models to use to make some sort of change happen. According to Murray (2017) Successful change requires the driving forces to be greater than the restraining forces, (p.297). This model takes into account the side who might be opposed to changes by having the nurse leaders help them understand the need for change. There was a lot of resistance the first time around when the iphones were introduced, so I believe it would be easier to be available to answer peoples concern over whatever change might be implemented. What some units have been trying out is having everyone sign off on a phone before they take the phone with them (something we do not do on our unit). The charge nurse is responsible for making sure every phone is accounted for at shift change by going down the roster and seeing who signed their phones back in. The Lewis model is very straightforward and easy to understand, with it containing only three major steps. This extra step in having to sign your phone back in (instead of just being able to drop it off at its charging station) is time consuming. It is also time consuming for charge who has to go an extra step to ensure this is happening. I believe the other theories have too many steps in them and would discourage nurse leaders from following things all the way through. They already have so much on their plate.
If I were a nurse leader, I would follow Lewiss model because I think its important to get both sides when trying to implement change. Its more frustrating for someone to have to do something without an explanation as to why we are doing it. Change could be snoother if the majority is on board with the change. My opinion about how leaders and managers are different at addressing change relies on what I believe to be true about each one. Leaders inspire and motivate those around them. They dont necessarily have to be in a position of management to influence the people around them. This is important when trying to enforce change. A manager on the other hand, has the authority to reinforce the change by including it in policies and standards of care, holding people responsible for when this is not followed. Both parts are equally important and a manager can play the role of a leader if they have the qualities to do so. Lewiss model includes both roles, ensuring that the change could be sustained in the long run.
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