[Sharon]

Think of a time of difficult change in an organization that you were part of or affected you. What was the reason for the change?  Did you resist the change? Where did you see yourself during that change – as an innovator, early adopter, early majority, late majority, laggard or a rejecter?

Using the above questions as a guide, reflect on a change that happened in your work environment.

[Johanna]

I remember years ago when our LTC home first brought in RAI-MDS. I was somewhat familiar with it from working in a hospital environment, and already understood it’s importance from a funding perspective. In this case, I tried to act as an Innovator, and tried to help my colleagues who were struggling to understand the coding. I volunteered to take all the coding shifts I possibly could, and also tried to help correct any misunderstandings amongst the PSWs on how to code particular ADLs.
As time went on, RAI-MDS became a constant in our home and staff became more comfortable with it. It was interesting to see the staff change over time, from initially being suspicious and resistant, to acceptance and understanding.

[Maria]

Thanks for sharing your experience. As an innovator myself I am always happy to see other nurses who are accepting to change and go out of their way to promote change in a positive way. As well all know, healthcare is a continuum of learning and changes occur all the time. Being adaptable to change, seeing its benefits, and setting an example to promote change within the organization is a good leadership skill. Change is always inevitable.

[Loretta]

Being somewhat familiar with what change is coming giver you a better perspective on it and allows you to be more accepting of it. Stepping up and being an innovator probably helped make the transition a little easier for your colleagues.

[Maria]

Working in the ER we’re very prone to changes monthly, however, during the beginning of COVID-19, the whole ER department was going through changes in policy, treatment, location, and PPE use every single day as the entire world studied and dealt with Covid at I am always an innovator when it comes to change since I always saw it as an opportunity for growth, however, during the first wave, and the time when our manager restricted the whole department from using N95 due to scarcity in the entire Country, the manager locked all the PPE in her office and we were required to only use 1 face shield that we needed to clean every day and the only time it gets replaced is when it breaks, and for N95 only the nurses involved with resuscitation with a possible Covid patient can use them. It was too much for all of us as we all collectively became rejectors. It didn’t help that our trust was broken when we found out that the med-surg units of the hospital do not reuse their face shields, and they have an abundance of N95 to use at their disposal. However, what I want to share here is my individual experience along with the very few pregnant nurses during this time who were working in the ER. During our daily meetings with the doctors who were working with the government and WHO regarding COVID-19, one of the doctors said that studies showed Covid is not harmful to pregnant women. During this time, it was evident that since Covid was very premature in everyone’s lives, it was apparent that there were no studies done on how the virus would affect pregnant women and their fetuses. I was a complete rejector at this time and broke the rules of being allowed to work in the Covid area of our emergency department. I advocated for myself and other pregnant nurses to be only allowed to work in the non-Covid area of the ER since we are not allowed to wear N95. This rejection of the proposed change paved the way for the future of pregnant nurses during the pandemic state in the ER. Pregnant women were only scheduled to work in the non-Covid areas of the ED.

[Jay-Ann]

Hi Maria,
Thanks for sharing this experience. Covid-19 first wave was definitely a difficult time to be in health care and working without proper PPE will definitely make the job scarier. I applaud you for standing up for what you believed and rejecting the hospitals imposed policy regarding scarcity of PPE.

[Jessica]

Good for you Maria! It must have been very difficult being pregnant while working in ER. I’m sure your pregnant colleagues appreciated your voice and and strength to fight for your safety.

[Jay-Ann]

The long-term care home where I currently work is integrating a new secure communication system. This new system, as its name implies, will allow nurses to communicate with doctors and the nurse practitioner in a secure manner. The reason for this change was because management believed vital information was being lost and not being communicated effectively. The system will also serve as a form of accountability. Once a concern is identified and communicated through the system, the person who initiates the conversation has to follow through until the concern is resolved by the doctor or the NP. If the concern is not resolved by the end of the shift, the oncoming nurse has to be added to the secure communication and accountability is transferred.

During this change I see myself as an early adopter, I adapt to changes well but approach them carefully before accepting. As time passes, I believe using this system will come easy and will improve communication and in turn improve residents’ care.

[Blair]

We are currently rolling out this program at my work place as well. I see the benefits of it as I have worked in environments were Dr and staff are using their personal phones to communicate. As we all know this is such a breach of confidentiality. Many of our homes have stated the Drs are not on board and they are no interested in communicating this way. Education was giving out that this is an option and not mandatory and that our organization needed and wanted to provided a platform for the physicians that do. With the changes times and advancement in technology we have to do everything in our power to keep information confidential.

[Johanna]

Hi Jay-Ann,
I know from previous experience that the secure conversations will be a positive for our home. In this respect I feel like an early adopter as well. It allows a concern to be communicated securely to the appropriate practitioner, so we don’t have to go through the RNs. It will also save some work as well, as it can be used to generate progress notes, and will eliminate double-charting.
I also feel some resistance about this new technology, as it is a newer version than what I am used to. I am concerned that I will forget to hand over a conversation to a new staff member, and that the system will fail the resident.
However, ultimately, it is a positive for our residents and once we have used it for a while, it will become another tool we can use to improve our care.

[Blair]

One of the challenges I am currently facing in my role is technology. I am finding that we are trying to push out new programing and modules and forgetting that we are still in a recovery phase. We are currently rolling out many new modules that involve a lot of training and changing process . I am finding that we have so many new staff and the turn over rate that we are unable to keep up with current expectations and the actual day to day of running a success home. As we continue to recover and find a new norm in LTC we need to step back and remember what need to be done to stay compliant and keep residents safe and happy. Just this past week we pulled in all administrators, HR and our corporate team and discussed a new strategic plan. Being part of this process help me feel like I was apart of the solution and that my voice matter. We often need to remind ourselves that we need a realist snap shot from each home of were they are at. not were we think they are at. We keep putting new technology demands on homes until they have mastered the technology/programing. As with rolling out many programs we are also coming across many “bug” on the software side that they correct but delays us with our programing and technology advancements.

[Jessica]

One of the biggest changes in the hospital in recent years was the introduction to computer charting. My hospital was one of the last hospitals to convert. I personally did not have any issues moving forward with the changes outside of the learning curve. For most of my colleagues, it was easy to make this change. For some of the more senior staff this was not an easy change. There were definitely some that if they could reject the change they would. I would fall in the category of early adopter. In general I adopt well to change. I would take my enthusiasm to help those resistant to the changed to learn and grow. The message was clear for the majority that this was a good changed but the process was difficult none the less.

[Loretta]

A change that occurred within my organization was the change of our EMR system. Our physicians were not very open to the change and we lost a couple of them when the change was implemented and they were required to use the EMR instead of paper charts. The nurses that used the previous EMR system were essentially double charting because we did our notes in the paper chart and in the EMR. I was one that used the EMR once I became familiar with it, as they were already using it when I started working there. I feel like I was an early adopter because I felt the traditions was a bit easier for me because I was already used to using technology and find it easy to learn and figure things out when it comes to technology. I’ve learned new things from my coworkers and they have also come to me when they had difficulty figuring things out. Our younger physicians also learned to use it. I think it makes it easier for the providers within our organizations to consult one another because we have 2 locations for our clinics. Paper charts made it difficult for providers to treat patients because they didn’t have access to other providers notes as our patients will utilize both clinics and whichever provider they can get an appointment with.

[Rebecca]

I am an early majority. I don’t tend to resist change, but I don’t take part in it. Through experience I have learned it can be better to take a moment to reflect before reacting. Everyone can get caught up in change and get upset/resist, but it can be important to take a step back and look at why you are reacting that way. Is the change actually a bad thing? Sometimes people can get caught up in heightened emotions and opinions that might not even be theirs. If everyone around me is upset with the change, that can sometimes affect how I feel about it, even if I don’t mind the change. In the past I have disagreed with change just because everyone around me was against it. Looking back, I don’t think I would feel the same way today.

[Marilyn]

Great conversation it shows how each layer of leadership has room for change and growth!

[Author]

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