Research paper

from selecting a clinical team who share similar concepts of effective nursing care. A shared philosophy of patient care and the ability to remain focused on patient and program outcomes indicate a workable fit. Visible support of one an- other is a critical key to success. A cohesive, collaborative team can improve staff morale, maximize staff involvement in unit decisions and tiltimately improve patient outcomes.

Anne Roberts, RN, MSN .\'urse Mtiruiger, Umg-Term Psychiatric Unit

Anna McMahan, RN, MSN, CS Psychiatric Clinical Nurse Specialist Veterans AdminLstration Medical Center—Leestown

Lexington. Kentucky

PLANNED CHANGE: A CASE IN POINT When implementing mother-baby nursing, the key words are attitude and flexibility. Together with Lewin s change theory, the strategies we used tor facilitating the change were norma- tive-reeducative, power-coercive and empirical-rational: • Linfreeze the existing equilibrium; motivate participants by getting them read>' for change. • Mo\e the target system to a new level of equilibrium; get participants to ̂ ^ e that the status quo is not beneficial to them.

• Refreeze the system at the new level of equilibritxm; rein- force the new patterns of behavior

The normative-reeducative strategies of change assume that people act in accoalance with social norms and values. In this mode.tlie power ingredient is not authority and knowl- edge, but skill in interpersonal relationships. Power-coercive strategies apply power by legitimate authority, economic sanction or political clout. In the empirical-rational model of change strategies, the power uigredient is knowledge. It is as- sumed that people are rational and will follow tlieir rational seU-interest if that self-interest is made clear to them.

During the first stage of the change, nurses were given ar- ticles and workshops on mother-baby care.To begin the nor- mative-reeducat ive process, a steering committee was estab- lished to identify needs. Cross-orientation included maternal- infant care course, newborn physical assessment, change workshop and a mother-baby basic course. Unit orientation with a preceptor lasted 4 weeks.

M;uiagement decided to start the program using the entire unit, thus beginning the moving phase of the cliai^e theor\'. Both nurses and physicians resisted the change. Nurses seemed to have entered a constant state of panic. Staff mem- bers were calling in sick, often leaving the unit short of help. During this stage, managers used power-coercive strategies, setting specific guidelines and disciplinary rules.

Because of fmancial reasons, the units were divided. The new FTEs were based on the average daily census (ADC) for newborn nurser>' and postpartum.The normal postpartum unit was separated from high-risk antepartum/postpartum. Staff were to indicate their preference of unit and shift, which would be determined by seniority. At this time, staff's morale was low; all they saw was more change. Our first priority was to build morale and to enhance patient care standards.

As management talked with the staff after the division, the refreezing phase of the change process began. The division consisted of the mother-baby unit, normal postpartum pa- tients and the newborn nursery. A high-risk antenatal and postpartum floor also was established. gi\ing nurses a home base ;md reducing the chances of rotating between floors.

The empirical-rational strategy- addressing patient care fo- cused on p«)\'iding knowledge necessary for making a ratio- nal choice. Nursing care conferences were held weekl), pa- tient care classes with the perinatologist each month and fe- tal monitoring classes for nonstress testing were initiated. Education is an ongoing process.

In retrospect, some things could have been done differ- ently. All staff (except new employees) should have been oriented completely. The amount of change should have been monitored: the charting method was changed, tele- phone system changed, JCAHO was due to visit and new computer systems were added. Communication with the physicians would have promoted "buy in" and reduced stress.

Although change will continue to occur, quality care re- mains a primary goal. Managing tension during change, with- out undue stress, leads to greater intemalization. CS

Dorothy S. May, RNC MSN, CNA Nurse Manager, OB High-Risk Antenalal/Postpurtum Unit University of South Alabama Medical Center

Mohiie, Alabama

-f uihenhealtlicare mas all about people? It still is at Appalachian Regional Healthcare.

OPERATING ROOM SUPERVISORS

Appalachian Regional Healthcare, a not-for-profit sys- tem of hospitals, ciinics and home heaith agencies, serv- ing KY, WV and VA, is seeking candidates for Operating Room Supervisor opportunities currently available with our BECKLEY, WV and HAZARD, KY hospitals.

Requirements include appropriate RN iicensure or eligibility, O.R. certification and experience, prefer- ably with several years experience in management/ administration.

ARH offers an excellent salary (new pay schedule implemented) and benefits package. For additional information, please send resume with salary range requirement to: Marilyn Hamblin, ARH Corporate Personnel Dept., P.O. Box 8086,1220 Harrodsburg Road, Lexington, KY 40533.1-800-888-7045 or FAX to: 606-226-2586. EOE.

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