NURS 489 Week 7 Discussion Board Forum 5 Example

Discussion Board Forum 5: Leading Change on a Nursing Unit

NURS 489 Leadership in Nursing, Discussion Board Forum 5

Thread by [Student Name]

The unit, the change project and the classmates are composites; the textbook, Scripture and journal articles cited are real.

When our manager asked me, as one of the charge nurses, to lead the move from shift report at the nurses' station to report at the bedside, I expected some grumbling. I got more than that. The night nurses said report would take twice as long. Several nurses said they could not speak freely about a difficult family or a sensitive diagnosis in front of the patient. One of our most experienced nurses said, "We tried this in 2017 and it didn't work." All of these were fair concerns, and this week's reading helped me see them as part of change rather than obstacles to it.

Finkelman (2016) presents Lewin's model, in which change moves through unfreezing, moving and refreezing, and notes that staff resist most when they do not understand why a change is needed or have no part in shaping it. Our first attempt in 2017 had skipped the first stage entirely: a memo announced the new process, and within months everyone was back at the station.

This time, I want to start by unfreezing, which means giving the staff a reason they can accept. Cho et al. (2022) reviewed 22 quality improvement projects on intershift handover and found that standardized tools and bedside handover with patient participation reduced adverse events and handover time and improved the satisfaction of both patients and nurses. Rihari-Thomas et al. (2026) went further with a stepped-wedge trial on nine wards in three hospitals covering 13,753 admissions. Nurses performed a structured assessment at the start of every shift, gave a patient-centered handover at the bedside and joined medical rounds. Stage 2 to 4 pressure injuries fell by 41%, nurses rated the safety culture higher and their perceived barriers to physical assessment dropped, although falls, emergency team calls and unplanned ICU admissions did not change. I plan to share both findings honestly, including what did not improve, at our next huddle.

For the moving stage, I will ask two night nurses who raised concerns to help write our script, including a rule that sensitive information is passed privately outside the room. For refreezing, we will audit ten reports a week for three months, post the results in the break room and ask patients at discharge whether they felt included in report. A change that is announced but never followed up is only a suggestion with a deadline.

Reply to Hannah

Hannah, your unit's experience is so close to ours: bedside report started with enthusiasm and faded within three months. I think the reason may lie in refreezing. Finkelman (2016) explains that new practices hold only when they are reinforced until they become the normal way of working, through feedback, visible support from leaders and attention to the problems staff run into. When managers stop checking and staff never hear whether the change made any difference, the old habit wins on the first busy night. If your unit tries again, you might suggest short audits shared at huddles and a quick way for nurses to report what gets in the way, such as rooms with a confused roommate. The Bible describes this same kind of persistence: "let us not grow weary of doing good, for in due season we will reap, if we do not give up" (English Standard Version Bible, 2001/2016, Galatians 6:9). Sustaining change takes a leader who keeps showing up after the launch, when the excitement is gone and the unit is tired. Did anyone on your unit ever collect data on whether the first attempt helped patients? Even a little local data might persuade staff that a second attempt is worth the effort it will take.

Reply to Kevin

Kevin, you asked how to bring along senior nurses who tell you they have "seen this before." I am facing the same thing, and I wonder whether their experience is an asset we have been treating as a barrier. Senior nurses often remember exactly why earlier attempts failed. In the ACCELERATE trial, Rihari-Thomas et al. (2026) found that ratings of leadership behavior and leader culture improved on the wards after the intervention, which suggests that how a change is led shapes how staff receive it. Rather than presenting the plan to your senior nurses, you might ask one or two of them to help design it and to act as the people others go to with questions. Asking them for advice shows respect for what they know. Paul told the Philippians to act in humility and count others as more significant than themselves (English Standard Version Bible, 2001/2016, Philippians 2:3), and a charge nurse who gives experienced colleagues real influence over a change is practicing that humility on a unit. Their buy-in also carries weight with newer nurses, who watch how senior staff respond. Have you considered asking your most skeptical nurse to be a champion? I am going to try that with ours next month.

References

Cho, S., Lee, J. L., Kim, K. S., & Kim, E. M. (2022). Systematic review of quality improvement projects related to intershift nursing handover. Journal of Nursing Care Quality, 37(1), E8-E14. https://doi.org/10.1097/NCQ.0000000000000576

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). Pearson.

Rihari-Thomas, J., Whittam, S., Thornton, A., Goncharov, L., Slade, D., McMahon, J., Coventry, A., Coughlan, K., Steadward, Y., Taylor, J., Liu, M., Walsh, S., Riddell, K., Tuqiri, K., Olesen, K., Dahm, M. R., Chien, L., Kelly, P., Ball, J., . . . Middleton, S. (2026). Assessment and communication excellence for safe patient outcomes (ACCELERATE): A stepped-wedge cluster randomised trial evaluating the effectiveness of a nurse-led assessment and handover communication intervention on patient adverse events. International Journal of Nursing Studies, 183, 105652. https://doi.org/10.1016/j.ijnurstu.2026.105652