Leadership and Change in Nursing

Leadership and Change

• Kym Bell

 

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I have chosen to use Jersey College in Trenton, New Jersey for my leadership change project. Jersey College is an educational nursing program that provides the combination of Licensed Practical nursing (LPN); Bachelor of Science in Nursing (BSN) and bridge programs for Registered Nurses (RN). The college is located in an urban setting with the student body predominantly from lower income families. The college provides, “education for adults through an open curriculum that accommodates diverse lifestyles” (Jersey College, 2014). The school prides itself on being the conduit to provide diverse opportunities for Certified Nursing Assistants (CNA), LPN’s, & RN’s. The program provides the opportunity for LPN’s and RN’s to acquire a BSN. Jersey College was founded in 2003 and was originally called The Center for Allied Health & Nursing Education. In 2004, the LPN program was approved by the New Jersey Board of Nursing. Since opening in 2004, the school has grown to incorporate two New Jersey campuses and two Florida campuses. The school is affiliated with many institutions who provide a variety of other educational opportunities for students (Jersey College, 2014, p. 1).

In the past few years, there has been a decrease in the availability of nursing faculties and training sites for nursing students. This has increased the need for nursing instructors to look at alternative clinical sites. A variety of clinical sites are needed to provide students diverse learning and training opportunities. These practice opportunities are needed to prepare students to become independent professional heath care workers. One solution to this problem is to establish a virtual skills laboratory software program. The stakeholders for this project will be the college, instructors, students, parents, and the future communities that these students will be working in.

Organizational Structure

There is an organizational structure that depicts the framework for running Jersey College (Appendix A). There is a board of directors that hold the governing power. The Chief Executive Officer (CEO) is included in this group. The budget and financial management of the college is overseen by the CEO. The board hires the president of the college. Presently the president of Jersey College is Steven Litvak. He responsible for organizing, constructing, executing, and assessing the financial aspect of the college. The president is responsible for maintaining and establishing the mission, purpose, and policies of the college. The nursing education department is led by the Dean of Students. The education department is split into the Practical Nursing Program and the Professional Nursing Program. The two combined programs have a budget for educational needs. If a large purchase needs to be approved the department must submit a written request to the Dean of Nursing. The request is then submitted to the president who then submits the request to the Board of Directors. The school is accredited by the Council on Occupational Education (COE), New Jersey Higher (NJ) Education, and the New Jersey State Board of Nursing (Jersey College, 2014).

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The department of Health and Human Services (HHS) has supported grants that will sponsor a wide variety of research grants to improve the quality, safety, effectiveness, and efficiency of health care in the use of technology. My plan is to apply for a grant called Faculty development: Integrated technology into nursing education and practice (ITNEP).

The US Department of Health and Human Services (HHS) (2014) offers a grant that provides support to nursing collaboratives for faculty development in the use of information and other technologies in order to expand the capacity of collegiate schools of nursing to educate students for 21st century health care practice. Nursing collaboratives will use health care information systems to enhance nursing education and practice, optimize patient safety, and drive improvements in health care quality (HHS, 2014, para. 1).

Assessment of Readiness

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Jersey College has a very small simulation lab that has very poor ventilation and very few nursing supplies. There are currently two students in my group that have latex allergies and cannot physically work in the skills lab without having allergic reactions. The students often complain that, even though there are many mannequins, there are no simulators that attach to the mannequins. Many of the other machines and supplies are in disrepair. The mannequins’ teaching capabilities are outdated. Many of them have missing limbs or do not have anatomically correct parts. For example, one of the mannequin’s tracheostomy hole is drilled incorrectly so that the student can only put in the tracheostomy tube upside down. The students do not feel that they are truly getting exposure to best practice in the present skills lab. The cost of replacing the lab has been discussed at many meetings and the concept of implementing a virtual lab has been in committee for the past year. The committee has researched many options and has come up with pros and cons of switching to a virtual lab. With the assistance of community and government funding options, the future of a virtual skills lab appears to be on the horizon.

According to the Joint Commission (2014), one of the major causes of a sentinel event in the United States is the lack of communication. This means miscommunication is usually demonstrated in the form of “wrong patient, wrong site, and wrong procedure”. A sentinel event is a recurring medical issue within a facility that causes patient harm. The Joint Commission has recognized that many of these errors can be avoided by taking a “time out”. The “time out” procedure requires a consensus of all healthcare individuals that are involved with the patient. Everyone must stop what they are doing to verify that they have the correct patient; the correct site being assessed; and the correct paperwork/lab results must be verified. Nursing students need to recognize how important it is to verbally and nonverbally communicate with each other to avoid potential medical mistakes. The use of a virtual nursing skills lab can mimic medical situations in a safe and consistent environment. This type of laboratory will provide multiple opportunities for students to interact and communicate with a variety of cyber patients. Nursing students can utilize a virtual environment to learn clinical skills and to practice communication techniques. These skills will be useful when students are interacting with patients, families and other healthcare team members.

Currently, the students do not have ample opportunities to access a computer during their class time. Many of the students, over ninety percent, have computers of their own. The nursing program is not currently set up to allow access to class information or other learning materials online. The Dean of Nursing is a very forward thinking person and has petitioned the president to acquire a working virtual laboratory. The Dean and instructors would like to update the school’s equipment and keep the facilities modern and technologically savvy. The new program will keep current students up to date and a new virtual laboratory would be a great way to entice new students into the program.

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There are many different types of leadership theories, I chose to use Lippett’s Theory of change. This type of theory decrees that a leader is needed to promote the need for change. Lippitt, Watson, & Westley (1958) utilized the basics of Lewin’s Theory of Change which included the concept of freeze, unfreezing and refreezing. Lippitt expanded on Lewin’s theory by adding four more steps.

Lippitt et al. (1958) discovered that: Maintaining a favorable balance of

forces is a continuous job for the change agent and client system, beginning

with the initial decision to undertake a change project or helping relationship

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and continuing until the project has been completed (p. 73).

Lippitt’s Theory of change has seven phases.

Phase 1: Recognize there is a problem

The problem is that the current hands-on skills laboratory is out of date and in need of a massive facelift. The cost of this renovation would be staggering to the institution.

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Phase 2: Assess the motivation and capacity for change

The students, as well as faculty, have voiced their opinions that either a new skills hands on laboratory or virtual laboratory needs to be added to enhance the teaching/learning capability of the school.

Phase 3: Assess the resources and motivation of the change

There is a grant and government funding for the school to replace the current lab with a virtual one. Many of the faculty have gone back to school and have been exposed to new technological advances. Virtual software can provide nursing students with a multitude of learning opportunities that cannot always be accessed in the “real” world. The faculty is eager to learn how to work within an online environment. They have stated that they are willing to be instructed in how to run this type of lab. Upper management is willing to put in the time and energy that is necessary to make this change.

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Phase 4-Design the progressive stages of change

The stages that will take place will be:

1. Have a representative, from the selected virtual laboratory software company to come and speak to those staff members that have volunteered to be “Super Users”.
2. Implement a training sessions for “Super Users”. These are fellow colleagues that that are given extensive training to assist others in transitioning to a new product or service.
3. Meet with the nurse managers to provide training using the new laboratory software.
4. Answer all questions and concerns that may affect each individual instructor’s educational needs for each specific laboratory classroom.
5. Provide training sessions for educators to provide each instructor guidelines for the new software.
6. Go “live” with the virtual laboratory software with students.

Phase 5: Ensure the role and responsibility of the change agent is clearly understood

1. Clearly identify as many of the problems as possible to fix prior to going “live” with the program.
2. Ensure that everyone that works with this change will have technical backup and support.
3. Confirm that there will be a representative from the company to answer any and all questions.

Phase 6: Maintain the change through communication, feedback, and group coordination

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1. There will be evaluation forms for managers and students to provide feedback. Users will be surveyed to evaluate any changes that may be needed to support their teaching/learning needs.
2. The evaluation will be an ongoing process. As problems arise, there will be a representative available on site or by telephone to assist any users.

Phase 7: Gradually remove the change agent

At the initial phase of the project, there will be a representative on site to help anyone who is having trouble accessing or understanding how to navigate the new laboratory software. After the first six or eight weeks, the physical presence of the software company will no longer be on site but, there will always be twenty-four hour telephone support

(Lippitt, Watson, & Westley, 1958).

Plan for Change

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After careful research, by a chosen committee, a specific software program will be bought by the college. The college is currently looking into the software called “The Digital Clinical Experience™” made by Shadow Health. Farmer (2014) states that there are over four hundred colleges and universities that are currently using this type of software in their nursing programs. The article goes on to state that the Shadow Health’s program “is broken down into ten modules, each of which correlate with a body system students study in class” (Farmer, 2014, para. 10). The acquisition committee has a chairwomen that will contact the software developer and set up a demonstration of the product. The committee members will have the opportunity to talk to one of the four hundred present user sites and observe the software in action. Once the decision has been made to purchase this program, the training will begin.

• Phase I will be the technical part of installing and updating any computer equipment that the school has.
• Phase II will be educating and training the instructors and “Super Users”.
• Phase III will be educating the students and remaining faculty.
• Phase IV Take the program “live” and start assigning lessons within the software website.

There will be follow up meetings and suggestion boxes to evaluate the staff and students feedback in using this new system. The staff and students need to feel like their suggestions and feedback will make a difference in promoting advanced learning. The amount of money it will take to update, install, and train faculty and students will be added into the cost of tuition. The research committee has evaluated the cost and have estimated that the increase in semester cost will be two-hundred and fifty dollars per student. There will be opportunities for students to reduce this cost by applying for grants and/or financial aid.

Evaluation

As with any change, it will take time and dedication for staff and students to get used to the new software and work within an online environment. There will be an initial survey for students and faculty prior to starting the online learning lab project. After the software has been up and running for six months, a follow up survey will be given to evaluate the student’s and staff’s perception of the learning quality provided by the software.

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The students should be aware that there will always be technical support available to them and that instructors will be reasonable regarding grades and assignment within this initial new setting. The students should be contacted, by the instructor, via email numerous times throughout the semester and asked if they are experiencing any issues or concerns with the new software (O’Neil, Fisher, & Rietschel, 2014, p. 134). The continuous evaluation process will allow the college to work with the software developers to custom fit the needs of the college.

References

Farmer, R. (October, 2014) Virtual patient teaches nursing students lessons in real-life care. Nurse.com. Retrieved from

http://news.nurse.com/apps/pbcs.dll/article?AID=2014141009007#.VFvjrvnF8mvAssets/ 092014_SpaceCoastBusinessMagazine_FlCTWWinners.pdf

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Jersey College. (2014). About us: Accreditation and licensing. Retrieved from

http://www.jerseycollege.edu/about/accreditation-licensing/

Joint Commission. (2014) Sentinel event data: root causes by event type 1995–2Q2014. Retrieved from

http://www.jointcommission.org/assets/1/18/General_Information_1995-2Q_2014.pdf

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Lippitt, R., Watson, J. & Westley, B. (1958). The dynamics of planned change. New York: Harcourt Brace.

O’Neil, C., Fisher, C., & Rietschel, M. (2014). Developing online learning environments in nursing education (3rd Ed.). New York: Springer.

Shadow Health. (2014). Health assessment software. Retrieved from

http://www.shadowhealth.com/health-assessment.html

The Center for Allied Health & Nursing Education. (January, 2012). Faculty guidelines for practicum experiences.

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United States Department of Health and Human Resources (HHS). (2014). Faculty development: Integrated technology into nursing education and practice (INTEP). Retrieved from

http://bhpr.hrsa.gov/nursing/grants/itnep.html

Appendix A

ORGANIZATIONAL STRUCTURE OF JERSEY COLLEGE

Admission Advisors

`Education Coordinator

Financial Aid Planner

Career Services AdvisorProgram Administrator

Media Services and LibrarianNursing Faculty

Administrative AssistantProgram Administrator Registrar Nursing Faculty

Academic Affairs Coordinator

The Center for Allied Health & Nursing Education. (January, 2012, p. 14)

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