IntroductionIn thecurrent context, healthcare industry evolves around change adapting to a changehas become a vital role (Marquis & Huston, 2016).
This paper will discussmy experience on a near miss medication error and how this incident has broughta new change that was unexpected. There will be a discussion on the strategiesimplied to overcome the challenges in adapting to a change. Description of Clinical ExperienceThisis an experience that I encountered as an enrolled nurse in Orange ValleyNursing Home. During my shift, I was assisting the staff nurse to servemedications. The staff nurse was concerned when the prepacked medication forhypertension looked different from the usual.
To clarify her doubts, she calledthe pharmacy to double confirm. That is when the nurse realised that themedication order that was sent to the pharmacy was filled with antidepressantmedication (Topamax) instead of antihypertensive (Toprol-XL). To preventmedication errors in the future, the issue was raised to the nurse manager toexplore ways to find a solution.
The nurse manager called for an urgent meetingwith her team of nurse leaders to identify a solution. There was a change initiated,to include both trade name and generic name in the medication order forms. Additionally,the nurses will need to include the patient’s diagnosis in the medication orderform.
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With immediate effect, the forms were changed with the new implementation.Some nurses perceive this as a good initiative whereas another group of nurses findit as troublesome and time-consuming to include a few additional details. Therewas another group of nurses who felt that this change was unnecessary.
Theoretical Analysis/ApplicationLikehow a coin has two sides to it, Kurt Lewin’s Force Field Model (1947) suggeststhat there are forces that push towards a positive effect and positive perceptionabout change (Sullivan, 2010). These are the driving forces. Whereas on theother hand, there is another aspect that will push towards resistance andmaladaptive to change. These are the restraining forces (Sullivan, 2010).
Figure 1.1. Kurt Lewin’sForce-Field ModelThis model clearly depicts that of anorganisation or an initiative that has driving forces and there will be anopposing force at the same time.
According to the theory, to achieve aproductive change first an inequality will occur between the driving forces andrestraining forces (Hussain, et al., 2016). This will unfreeze the currentbehaviour of the involved participants. Behaviours will change to another levelwhere other opposing forces are brought into a level of equilibrium. Once thenew practices integrate into the involved parties, it becomes part of theirpractice and organisation (Ellis & Hartley, 2012).
The process of meeting the ever-changingdemands of the internal and external client needs in healthcare is vital (Hussain,et al., 2016). Therefore, there are three strategies mentioned in Kurt Lewin’stheory which are (Ellis & Hartley, 2012):1.
Unfreeze the existing equilibrium 2. Move the target system to a new level ofequilibrium 3. Refreeze the system at the new level ofequilibrium As theexperience of a near miss medication error was only encountered by one nurse,it is often taken lightly by the other nurses who are not involved in thatsituation. Often, it is perceived as a careless mistake from the uninvolvednurses. This explains why other nurses feel that it is not important or ahassle to change the medication order form. It was also perceived as anadditional workload for them.
Therefore,it is the duty of the nurse manager to clearly explain to the staff of why achange is required. At the same time, there could be a sharing session from theaffected nurse to the other nurses of how it felt to be in that scenario. Duringthe sharing, there could be an effective participation from the other nurses toparticipate in the generating alternative solutions. According to the theory, thisis to unfreeze the situation by motivating the nurses to get ready for a change by improvising the old practices.Oncethe nurses are motivated to adapt to a change, there is an opportunity for themto be ready for it. In this process, the nurses must internalise that newprocess and effort so that the change will be effective. In this way, newequilibrium could be attained according to the model.Refreezingwould be the last strategy in the model.
Refreezing could be done by, monitoringthe effectiveness of the medication form by receiving feedback from the staff.This will keep the new change incorporated and reinforced on a regular basis tosustain the change.Barriers to ChangeAs mentioned by Hewitt (2013),there are various barriers that would refrain the nurses to accept the change.
Someof those are as follows:CommunicationCommunicationis the key to any problem resolution. It could also be a barrier to accept achange. In the clinical situation, if the nurse manager is not clearlycommunicating with the staff about the change could lead to unnecessarymisunderstanding. At the same time, if the staff is not willing to understand thepurpose; communication becomes ineffective.ParticipationIt isessential to involve the staff during a brainstorming process for a solution.In the clinical situation, this was not the case.
As it was perceived as notimportant by the nurse manager and she only involved the nurse leaders in theprocess. If the other staff are involved during the brainstorming, there willbe minimal resistance to change during that phase. The feeling among the staffthat change is unnecessary or it will not help the current situation could beavoided. Implications for Professional Practice and ManagementThroughthis experience I understood the challenge being faced by a nurse manager whenimplementing a change. It is not easy to convince every staff to follow thedirection that might serve the best for all. It is an art that could be masteredthrough experience. This does not only allow me to understand the dilemma of anurse manager, also to understand how a staff could be receptive towardschange. Most of the time as nurses, we will be overwhelmed with the paperwork.
Ifthere was a new implementation of documentation, we might perceive it as anadditional workload. This is what I witnessed in the clinical experience. As nurses,we must always be open to new initiatives that could improve patient safety.
Thisis the mindset that I would like to adopt when I join the workforce as a full-timestaff. With this mindset, I could apply the Code of Ethics Value Statement 5and 6 which are; “To Provide Care in a Responsible and Accountable Manner” and “MaintainCompetency in the Care of Clients” (Singapore Nursing Board, 2018). If I encounterthe same incident in the future, I will approach the new initiatives receptivelyand follow the code of ethics. I will remain vigilant when serving medications topreserve the patient safety. If there was an opportunity for me climb up thecareer ladder to be a nurse manager, I will apply the principles of managingchange within the organisation and bear in mind that not all staff will bereceptive towards a change. It also balls down to how I will manage if therewas a resistance towards change happens using the strategies mentioned by Kurt Lewin(1947). IntroductionIn thecurrent context, healthcare industry evolves around change adapting to a changehas become a vital role (Marquis & Huston, 2016). This paper will discussmy experience on a near miss medication error and how this incident has broughta new change that was unexpected.
There will be a discussion on the strategiesimplied to overcome the challenges in adapting to a change. Description of Clinical ExperienceThisis an experience that I encountered as an enrolled nurse in Orange ValleyNursing Home. During my shift, I was assisting the staff nurse to servemedications. The staff nurse was concerned when the prepacked medication forhypertension looked different from the usual. To clarify her doubts, she calledthe pharmacy to double confirm. That is when the nurse realised that themedication order that was sent to the pharmacy was filled with antidepressantmedication (Topamax) instead of antihypertensive (Toprol-XL). To preventmedication errors in the future, the issue was raised to the nurse manager toexplore ways to find a solution.
The nurse manager called for an urgent meetingwith her team of nurse leaders to identify a solution. There was a change initiated,to include both trade name and generic name in the medication order forms. Additionally,the nurses will need to include the patient’s diagnosis in the medication orderform. With immediate effect, the forms were changed with the new implementation.Some nurses perceive this as a good initiative whereas another group of nurses findit as troublesome and time-consuming to include a few additional details. Therewas another group of nurses who felt that this change was unnecessary.Theoretical Analysis/ApplicationLikehow a coin has two sides to it, Kurt Lewin’s Force Field Model (1947) suggeststhat there are forces that push towards a positive effect and positive perceptionabout change (Sullivan, 2010).
These are the driving forces. Whereas on theother hand, there is another aspect that will push towards resistance andmaladaptive to change. These are the restraining forces (Sullivan, 2010). This model clearly depicts that of anorganisation or an initiative that has driving forces and there will be anopposing force at the same time. According to the theory, to achieve aproductive change first an inequality will occur between the driving forces andrestraining forces (Hussain, et al., 2016).
This will unfreeze the currentbehaviour of the involved participants. Behaviours will change to another levelwhere other opposing forces are brought into a level of equilibrium. Once thenew practices integrate into the involved parties, it becomes part of theirpractice and organisation (Ellis & Hartley, 2012).The process of meeting the ever-changingdemands of the internal and external client needs in healthcare is vital (Hussain,et al.
, 2016). Therefore, there are three strategies mentioned in Kurt Lewin’stheory which are (Ellis & Hartley, 2012):1. Unfreeze the existing equilibrium 2. Move the target system to a new level ofequilibrium 3. Refreeze the system at the new level ofequilibrium As theexperience of a near miss medication error was only encountered by one nurse,it is often taken lightly by the other nurses who are not involved in thatsituation. Often, it is perceived as a careless mistake from the uninvolvednurses. This explains why other nurses feel that it is not important or ahassle to change the medication order form. It was also perceived as anadditional workload for them.
Therefore,it is the duty of the nurse manager to clearly explain to the staff of why achange is required. At the same time, there could be a sharing session from theaffected nurse to the other nurses of how it felt to be in that scenario. Duringthe sharing, there could be an effective participation from the other nurses toparticipate in the generating alternative solutions. According to the theory, thisis to unfreeze the situation by motivating the nurses to get ready for a change by improvising the old practices.Oncethe nurses are motivated to adapt to a change, there is an opportunity for themto be ready for it. In this process, the nurses must internalise that newprocess and effort so that the change will be effective.
In this way, newequilibrium could be attained according to the model.Refreezingwould be the last strategy in the model. Refreezing could be done by, monitoringthe effectiveness of the medication form by receiving feedback from the staff.This will keep the new change incorporated and reinforced on a regular basis tosustain the change.Barriers to ChangeAs mentioned by Hewitt (2013),there are various barriers that would refrain the nurses to accept the change.
Someof those are as follows:CommunicationCommunicationis the key to any problem resolution. It could also be a barrier to accept achange. In the clinical situation, if the nurse manager is not clearlycommunicating with the staff about the change could lead to unnecessarymisunderstanding. At the same time, if the staff is not willing to understand thepurpose; communication becomes ineffective.ParticipationIt isessential to involve the staff during a brainstorming process for a solution.
In the clinical situation, this was not the case. As it was perceived as notimportant by the nurse manager and she only involved the nurse leaders in theprocess. If the other staff are involved during the brainstorming, there willbe minimal resistance to change during that phase. The feeling among the staffthat change is unnecessary or it will not help the current situation could beavoided. Implications for Professional Practice and ManagementThroughthis experience I understood the challenge being faced by a nurse manager whenimplementing a change. It is not easy to convince every staff to follow thedirection that might serve the best for all. It is an art that could be masteredthrough experience.
This does not only allow me to understand the dilemma of anurse manager, also to understand how a staff could be receptive towardschange. Most of the time as nurses, we will be overwhelmed with the paperwork. Ifthere was a new implementation of documentation, we might perceive it as anadditional workload. This is what I witnessed in the clinical experience. As nurses,we must always be open to new initiatives that could improve patient safety. Thisis the mindset that I would like to adopt when I join the workforce as a full-timestaff.
With this mindset, I could apply the Code of Ethics Value Statement 5and 6 which are; “To Provide Care in a Responsible and Accountable Manner” and “MaintainCompetency in the Care of Clients” (Singapore Nursing Board, 2018). If I encounterthe same incident in the future, I will approach the new initiatives receptivelyand follow the code of ethics. I will remain vigilant when serving medications topreserve the patient safety. If there was an opportunity for me climb up thecareer ladder to be a nurse manager, I will apply the principles of managingchange within the organisation and bear in mind that not all staff will bereceptive towards a change. It also balls down to how I will manage if therewas a resistance towards change happens using the strategies mentioned by Kurt Lewin(1947). ConclusionIn conclusion,patient safety is not only important at a clinical level but also in anorganisational level.
Using change management strategies mentioned by KurtLewin (1947), patient safety initiatives could sustain and be incorporatedeffectively in the organisation (Sullivan, 2010). To institutionalise aninitiative it is important for staff not to be sceptical towards a change andbe receptive to it.
