By: Peggy Pilon, BSN, MS, RN, VP of Clinical Success
In my last two articles, I shared the fantastic innovations by Florence Nightingale that the nursing profession arose from and some of the transformational changes by 21st century nurse leaders. However, accepting change can still be difficult to achieve today in healthcare.
Why is Change so Hard
The reason change is hard for all human beings is because we are hardwired to resist change. The study of neuroscience has shown that our brains are made up of approximately 100 billion neurons, which are continually storing and transmitting information. Every time we learn a new behavior or process, our brains capture it, store it and a new pattern is created. Each time that pattern is repeated, a neural pathway is created and it deepens. Repeating these neural pathways over time becomes easier and does not require us to use our prefrontal cortex (part of the brain used for higher level skills). Our bodies are always looking for ways to conserve energy and “brain power”, so our brains naturally look for the established neural pathways to use, i.e. the path of least resistance. The basal ganglia (located in the temporal lobe of the brain) are activated by familiar and repetitive activities that are more automatic in nature. In addition, the amygdala (also located in the temporal lobe of the brain) interprets a new neural pathway as a threat and reacts with a “Fight or Flight” response. The body then releases adrenaline, norepinephrine and cortisol into the bloodstream, which causes an increase in temperature, heart rate, respiratory rate and blood pressure. This is of course why people feel anxious, due our bodies are sensing danger. So our brains will naturally resist change in the pursuit of homeostasis. This is why so many people all across the world, when presented with an innovative solution, will resist it.
Why is Change Even More Challenging for Nurses?
1) Nature of Nursing Work:
Nursing is a highly demanding profession that involves long hours, physical and emotional fatigue and complex detailed-oriented work. Any changes to the nurse workflow, can disrupt the finely-tuned nurse workflows that could adversely affect patient care.
2) Fear of the Unknown:
Nurses can fear the uncertainty that accompanies new procedures, technologies or protocols, which can lead to resistance.
3) Lack of Involvement in Decision Making:
Nurses may resist changes that they feel have been imposed upon them without their input or the understanding of their daily challenges.
4) Inadequate Training or Resources:
Nurses who feel that they haven’t received sufficient training or resources to adapt to the change, may resist the change. If they have a work history where they were not given enough training to implement a change, they may automatically put up barriers to the change.
5) Hospital Culture:
If the hospital culture is one where change is not encouraged or readily accepted, nurses could resist making changes.
6) Patient Care and Safety Concerns:
Nurses will resist changes if they believe it will compromise patient care or patient safety.
7) Organizational Communication:
Ineffective communication can lead to nurses not understanding the rationale for the change and result in not supporting the change initiative.
Implementing new technologies that involve nursing and affect patient care requires a comprehensive approach that addresses all aspects of the change.
Top ten recommendations:
1) Engagement and Participation:
Engaging nurses in the change process ensures they feel valued and understood. Their participation allows them to provide insights and feedback that can be crucial for refining the change process. It is also important to obtain nurses’ feedback during the building phase of new technology.
2) Effective Communication:
Clear, transparent and frequent communication about the change, why it is happening, how it will affect nurses and patients and the benefits of implementing the change, can alleviate concerns and resistance.
3) Proper Training and Education:
Providing adequate hands-on training and enough time for repeat demonstrations, ensures that staff will be well equipped to use new procedures, technologies and protocols. Like the old adage goes…”practice makes perfect.”
4) Supportive Leadership:
Leaders who support, guide and model the new changes are a critical part in a successful implementation. Their active involvement can inspire trust and commitment from the bedside team.
5) Peer Champions and Super Users
Involving and training peer champions and super users can make or break an implementation. These individuals advocate and model the change within their units. They also serve as resources long after “Go-Live day.”
6) Feedback Mechanisms:
Embedded regularly collected feedback allows leaders to identify challenges and make adjustments in real time. The feedback collection needs to continue to make sure the implementation is sustained.
7) Adequate Resources:
Leadership has to ensure that there are enough resources (time, personnel and/or materials) to support the change. Insufficient resources can lead to frustration on the part of staff and lead to an unsuccessful implementation.
8) Cultural Sensitivity:
In order to have a successful implementation, the change needs to be integrated into the existing culture. It is also important to recognize that there will always be unexpected obstacles as changes are rolled out. Understanding the organizational culture makes it easier to work through any unexpected issues.
9) Regular Evaluation:
Continual monitoring and evaluating the implementation, allows hospital systems to measure the effectiveness of the changes and understand the opportunities for improvement. It also allows time to capture the “Lessons Learned.”
10) Recognition and Reward:
Recognizing and rewarding nurses for their efforts and support of the implementation can boost morale and increase commitment and engagement. Plus, it is just the right thing to do to recognize staff for their work.
At CalmWave, we understand how hard change can be and how change can positively impact both the patient and nurses’ environment. We know first hand how technology can be used to solve healthcare issues and the importance of clinician involvement. At CalmWave we are leveraging our success from managing alarm fatigue in Fortune 100 Enterprise IT companies and bringing that success to hospitals to decrease the “noise”.
CalmWave implements Transparent AI solutions with clinical expertise. CalmWave™ is an operations-based artificial intelligence (AI) platform that captures, analyzes, and synthesizes real-time data from dozens of data sources (monitors, labs, orders, findings, etc.) to empower hospitals with the intelligence critical to improving patient outcomes, optimizing operations, and retaining staff. The AI technology from CalmWave™ presents objective solutions that reduce non-actionable alarms by providing proper alarm management insight to the caregiver, thereby decreasing alarm fatigue, excessive cognitive load, and burnout. At CalmWave, we are interested in supporting clinician workflow so they spend less time responding to non-actionable alarms, and more time caring for patients.
At CalmWave, we are data-driven, patient-focused and clinician-centric. Florence Nightingale along with other Nurse Innovators from the 21st century made it safe to be a “disruptor”. All of these previously discussed highly accomplished nurses have modeled for us to not fear change…that change is needed to be innovative. We need to override our brains’ hardwiring to readily accept the help we need today to decrease nurse burnout. As Dr. Vonda Wright, accomplished orthopedic surgeon, writer and speaker says …”We do not function in fear, but we surround ourselves in science”. Words to live by! Come join us and all the other nurse leaders on this innovative journey in improving healthcare.