While implementing change, Kurt Lewin's change theory offers three stages. The first part of Lewin's analysis entails recognizing the changing focus, which in this case is the establishment of a unit among nurses to carry out patient recording in the nephrology unit. This stage relies heavily on open communication to establish security and trust among those involved in the process. Round table conversations are suggested at this level to elicit the driving and limiting forces. The discussion engages all the parties involved which in this case are the night nurses, day nurses and the renal physicians to determine the cause of the problems and the barriers that they will have to overcome to have a positive outcome.
Using the change theory, the nurse manager will determine both driving and restraining factors that make it difficult for the day nurses and the night nurse to document records of patients in the unit. Having identified these forces the nurse manager can determine how to reduce the restraining forces or increase the driving forces so that change can be achieved. For instance, restraining force is that each nurse shift believes that the other should be responsible for documenting patient’s records. The nurse manager can increase the number of night nurses so that they can be influenced to support the change.
Strategies and Rationale
As the new nurse manager of the nephrology unit, there is need to modify the leadership style so that the change needed the unit can be achieved. Transformational leadership style can be best suited for this scenario. The need to employ the transformational leadership technique is derived from the fact that this style is all about initiating change either in a department or a group hence can be efficient in implementing the necessary change in the nephrology unit (Cummings et al 367).
The problem that the department is facing is the lack of proper documentation of patient’s records. Through transformational leadership, as the nurse manager, one will be able to motivate the other nurses to take on more duties than what is assigned to them. Being able to motivate both the day-shift and the night-shift nurses will bring harmony between the two shifts hence they will find a way to both document the needed weight records of the patients.
Expected Outcome
The success of the leadership style can be determined and measured by the efficiency and the success of implementing change. The success of the transformational leadership in implementing change in nephrology unit will be determined by the number of complaints received from the renal physicians and the number of patients overstaying in the unit. The consistency of patient’s records in the unit can also be a measure in determining the success of the style used.
However, the nurse can be overworked during the process of implementing the change which might make them unable to perform efficiently on the other duties that they have to undertake. Therefore, it will be imperative ensure that each nurse does not work overtime and all the duties they are involved in should only be within their work hours (Lartey, Cummings, and Joanne 1036).
Professional Standards
Professional and legal standards in the decision making of nurse leaders require them to be able to inspire others to work together towards a common goal that will benefit the patient (National Kidney Foundation 5). The legal and professional standard emphasizes the need for the nurses to ensure that the wellbeing of their patients is their priority hence when making a decision the nurse leader has to ensure that the outcome will be beneficial to the patients.
Response Plan for School Nurse
Change Theory
The focus of change in this scenario is the perspective of the community about sexual health. Key elements of the change theory in this situation are the restraining forces that are preventing change to take place. For instance, the community is small and conservative hence it insists that the schools only teach students about abstinence. Additionally, the school boards adhere to the needs of the community because they do not want to anger them which results in the increased sexual health problem in the area. However, there are some driving forces such as the growing percentage of students contracting STDs and pregnancy among girls in junior classes.
As the school nurse, it will be my responsibility to start a change process that will address this issues. Using the change theory, the school nurse can have a round table discussion with the school board and explain to them the driving forces and how they overpower the restraining forces. After the discussion, the school board may organize a meeting with other stakeholders from the community and explain to them about sexual risk behavior that the adolescents may be engaged in which need to be addressed hence the need to change the community perspective about the sexual health problem.
Strategies and Rationale
The leadership style appropriate for this scenario is the Democratic leadership. Democratic leadership is centered on the contribution of all stakeholder even though the leader holds the final responsibility. The active communication from all stakeholders involved in this leadership makes it a proper technique that ay facilitates communication between the community, school board and the school nurse to determine a proper way to handle the health problem in the community (Cummings et al 367).
The increased percentage of STDs and pregnancy is the primary health issue in the community even though the students are taught about abstinence. Therefore, the school nurse may refer to the school board to adjust its curriculum so that the school can teach the children about preventive measure against STDs and unplanned pregnancy in adolescent classes.
Expected Outcome
The Democratic leadership in this scenario expects the community to understand the sexual health problem that they are facing and support the implementation of new sexual health curriculum in the schools. The efficiency of this leadership can be measured by the percentage reduction in the number of STDs and unplanned pregnancies among the students.
However, since the community is conservative, they may reject the proposed changes in curriculum hence preventing change. In such a situation, the nurse will have to convince the school board to follow the proposed curriculum by the CDC and the National Health Education Standards (Lartey, Cummings, and Joanne 1027).
Professional Standards
As the school nurse whichever decision that is made is supposed to ensure that the patients’ wellbeing is the priority according to the professional standards. Therefore, the decision of the nurse will be supporting the change of sexual health education in the school to ensure that the children are also taught about the available protective measures. Additionally, the legal standards as per the directive of CDC on health education in school allows any individual who has an understanding of the health needs of the school to contribute on what they believe should be part of the school curriculum (Centers for Disease Control and Prevention 4).
Response Plan for Pediatric Vaccinations
Change Theory
In this scenario, change is happening, and there is need to maintain the status quo in the community. The change that is taking place is that parents are avoiding medical vaccinations for their children. The driving force for this change is the purported adverse reaction to the shots being reported in the local news. The need for the schools to have all children fill their blue cards with medical reports is the only restraining force that is preventing the change from happening.
Therefore, as the nurse manager in the pediatric center in the community, one has to find more restraining forces that can prevent the change from happening. The process of refreezing change can involve finding evidence to show that the adverse reactions reported on the local news to have no base hence the parents have to continue taking their children for medical examinations and vaccinations.
Strategies and Rationale
Transactional leadership style is the most effective style of leadership in addressing such a situation. The primary objective of this technique is to maintain the status quo in the society. The nurse manager can choose this method because of its skills to focus on the exchange of feedback while clarifying the expectation and performance of their duties (Cummings et al 381). Therefore, the nurse manager can be able to communicate clearly with the other nurse managers from other regions to get feedback about the MMR vaccinations.
Additionally, the nurse manager using the transactional leadership style can allocate a reward to nurses who can explain to the parents about the vaccines and give back feedback that they receive from the parents. The nurses in the facility can also get rewards for contributing in the research about the relation of the MMR vaccines to the adverse reaction being reported on the local news.
Expected Outcome
The success of the leadership style used to deal with the problem can be measured by the evidence the nurse manager will have gained about the problem. Consequently, the number of parents who will be allowing the nurses to conduct the medical examination and give MMR vaccines to their children.
Some of the nurses who will not be participating in the research process may feel that they are neglected because they will not be rewarded which may make them quit. Therefore, to ensure that the pediatric facility can retain all its experienced staff, the nurse manager can offer a reward to all other nurses for their dedication (Lartey, Cummings, and Joanne 1031). The other nurses not involved in the research will be allocated the duties of dealing and getting feedback from the parents.
Professional Standards
The ACIP recommends that children are given two dosage vaccines for measles, mumps, and rubella. The first dosage is to be given at the age between 12 and 15 months and the second dosage at the age of 4-6 years (CDC 8). Therefore, following the professional and legal standards, the nurse manager in the pediatric facility has to ensure that all children are given these vaccinations of the specified time (CDC 12). The nurse duty is to ensure the health of their patients improves hence the nurse’s professional conducts requires the nurse manager to give the vaccine to prevent the children from the diseases.
Works Cited
Centers for Disease Control and Prevention (CDC). "Recommended childhood immunization schedule--United States, 1998." MMWR. Morbidity and mortality weekly report 47.1 (1998): 8-12.
Centers for Disease Control and Prevention. "Health Education Curriculum Analysis Tool (HECAT)–overview." Retrieved February 12 (2007): 2009.
Cummings, Greta G., et al. "Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review." International journal of nursing studies 47.3 (2010): 363-385.
Lartey, Sarah, Greta Cummings, and Joanne Profetto‐McGrath. "Interventions that promote retention of experienced registered nurses in health care settings: a systematic review." Journal of nursing management 22.8 (2014): 1027-1041.
National Kidney Foundation. "K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification." American journal of kidney diseases: the official journal of the National Kidney Foundation 39.2 Suppl 1 (2002): S1.
