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Nurses as a Change Agent

Change in today’s health care landscape is a daily, if not hourly, reality. The historical term for those leading change is “change agent.” The job of the change agent is to assist people (including both health care professionals and consumers), organizations (hospitals, skilled nursing facilities, physician offices, home health agencies) and other stakeholders in understanding why change is needed and, more importantly, understand how it benefits them. For transformational change to happen, all parties must understand what benefits are available to them as a result of changing. Judgment and finger pointing are not effective weapons for the change agent. Rather, a change agent must be an active listener and a persistent messenger, and provide tools, assistance and resources to enable change to occur.

Nurses comprise the largest sector of the health care workforce worldwide. The each and every nurse must have strong leadership skills to navigate through change with a focus on the patient and the provision of safe and reliable care. Nursing has a critical contribution in healthcare reform and the demands for a safe, quality, patient-centered, accessible, and affordable healthcare system. To deliver these outcomes, nurses, from the chief nursing officer to the staff nurse, must understand how nursing practice must be dramatically different to deliver the expected level of quality care and proactively and passionately become involved in the change.

We can play a critical role in shaping the health care system of the future. There are transformative changes occurring in healthcare for which nurses, because of their role, their education, and the respect they have earned, are well positioned to contribute to and lead. To be a major player in shaping these changes, nurses must understand the factors driving the change, the mandates for practice change, and the competencies (knowledge, skills, and attitudes) that will be needed for personal and system wide success. These changes will require a new or enhanced skill set on wellness and population care, with a renewed focus on patient-centered care, care coordination, data analytics, and quality improvement.

Being a change agent is a major function for nurses. Nurses are on the floor seeing the effects medicine and the health care system is having on the patient. We know that some things are getting better for the patient and other things are not. We must be vocal about the changes that are working and those that aren’t, and about what still needs to change. It is critical for nursing to play a significant role in how our health care system is shaped and changed going forward. As a change agent the nurse should use his/her behaviours including guidance, facilitation, and inspiration to inspire others toward change, altering human capabilities, and supporting and influencing others toward change.

Nurses must continue to look for ways to impact change within the health care system. You don’t have to be a nurse manager to be a change agent. Any nurse can have a significant impact on needed change within nursing. If you see a change that could occur that you think would have an impact, discuss it with someone who can help to champion your idea and get it implemented. It will need to be tested to see if it does result in a positive outcome and is cost effective. Nurses have what is needed to be successful in identifying and implementing change.

Transformation and the changes required will not be easy—at the individual or systems level. Individually, it requires an examination of one’s own knowledge, skills, and attitudes and whether that places you as ready to contribute or resist the coming change. At an organizational level, it requires an analysis of mission, goals, partnerships, processes, leadership, and other essential elements of the organization and then overhauling them, thus disrupting things as we know it. The reality is that everyone’s role is changing—the patients’, physicians’, nurses’, and other healthcare professionals’—across the entire continuum of care. Success will come if all healthcare professionals work together to transform and leverage the contribution of each provider working at full scope of practice. Achieving patient-centered, coordinated care requires inter-professional collaboration, and it is an opportunity for nursing to shine.

One example of nurses being involved in facilitating change is in decreasing hospital readmissions. When nurses are assigned to elderly, high risk patients that are likely to relapse, readmissions go down. This was demonstrated at the University of Pennsylvania in Philadelphia with the Transitional Care Model program. In this program the nurse follows the patient up to three months after discharge, attending their medical appointments, and collaborating with physicians, caregivers, and family. This program demonstrated a significant reduction in the number of hospital readmission and costs dropped by as much as $5,000 per patient. Unfortunately, many third-party-payers and institutions are not willing or not structured in a way to pay for nurse-directed programs.

There are barriers keeping nurses from being effective change agents in the ever evolving health care system. These barriers need to be fully identified, recognized, and overcome for nurses to be in the position to lead change and demonstrate the ability to be change agents.

Some of the barriers for nurses to be a major leader in change are that nurses need to be allowed to practice to the full level of their education and training. Nurses also need to be recognized as a fully functioning discipline in health care delivery and be a full partner in health care decision making.

There is no doubt that nurses are poised to assume roles to advance health, improve care, and increase value. However, it will require new ways of thinking and practicing. Shifting your practice from a focus on the disease episode of care to promoting health and care across the continuum is essential. Tracking outcomes as a measure of effectiveness and leading and participating in ongoing improvement to ensure excellence will require exquisite teamwork as excellence crosses departments, roles, and responsibilities. “Nurses can no longer take a back seat—the time has come for nursing, at the heart of patient care, to take the lead in the revolution to making healthcare more patient-centered and quality-driven”. The question you must ask to self always is “Are you ready?”

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