NURS 524 Week 6 Reflective Exercise 2 on Leading Change Example

Reflective Exercise 2: Why Bedside Shift Report Failed the First Time and Worked the Second, a Reflection on Leading Change

The First Attempt

Two years ago, our medical-surgical unit was told to begin bedside shift report. The hospital had adopted it as a patient experience initiative, and our manager announced it in a staff meeting and an email, with a start date two weeks away. As a charge nurse, I was asked to "make sure it happens." I did what I thought a good charge nurse should do: I reminded people at the start of each shift, I walked the hall at 0700 to see who was reporting at the bedside, and I wrote down names. Within a week, nurses were reporting at the bedside when I was in the hall and at the station when I was not. Within a month, almost no one was doing it. When I asked why, the answers were consistent: report took longer, patients were asleep, roommates could overhear, and nobody had asked us. I privately blamed the staff for resisting. Looking back, I had become an enforcer of a change I did not understand myself.

Interpreting the First Attempt

Kelly and Tazbir (2014) describe Lewin's model of change in three stages: unfreezing, in which people come to see why the current way of doing things must change and are ready to let it go; moving, in which the new practice is introduced and learned; and refreezing, in which the new practice is stabilized as the norm. Our first attempt skipped unfreezing entirely. Nobody explained what problem bedside report was meant to solve on our unit, and nobody addressed the nurses' legitimate concerns about privacy, sleep and time. We went straight to moving, and my hallway monitoring tried to refreeze a practice that had never been accepted. I was trying to hold in place something that had never actually moved.

The Second Attempt

Six months later, after two handoff-related errors on the unit, our manager tried again differently. This time the manager asked for volunteers to form a small group of day and night nurses, including two of the most vocal critics of the first attempt, and gave us protected time to design our own version. We reviewed our two errors together, which did more to explain the need for change than any memo. We visited a unit in our system that used bedside report successfully, adapted their script, and solved the problems nurses had raised: a quiet voice and a whiteboard note for sensitive information, a quick look without waking sleeping patients, and a two-minute target per patient. We piloted it on one hallway for two weeks, adjusted it, and then rolled it out. During the pilot, members of the design group worked the hallway and coached colleagues through their first bedside reports, which made the new practice feel like something nurses were teaching one another rather than something leaders were checking. Patients on the pilot hallway were asked what they thought, and several said they liked meeting the next nurse before the old one left, which gave the staff a reason of their own to continue. This time it held, and a year later it is simply how our unit gives report.

Interpreting the Second Attempt

Porter-O'Grady and Malloch (2016) argue that innovation in health care succeeds when it emerges from the people closest to the work and when leaders create the conditions for staff to experiment and adapt rather than imposing finished solutions. The second attempt did exactly that. The design group did the unfreezing for the unit by connecting the change to errors everyone knew about, and the nurses who had resisted became its strongest advocates because the version we adopted answered their concerns.

Recent research helps explain why leadership style made the difference. Waseem et al. (2026) surveyed 269 nurses in two cities and found that servant leadership was positively associated with nurses' innovative work behavior, both directly and through a chain in which servant leadership built trust in the leader, which encouraged knowledge sharing, which in turn supported innovation. In the second attempt, our manager served the group by protecting our time and trusting our judgment, and we shared what we knew because we trusted that our ideas would be used. A systematic review of 14 studies with more than 7,000 participants found servant leadership positively associated with nurses' behavior and attitudes, the quality of leader-nurse relationships and psychological safety (Saavedra et al., 2025). Both studies are cross-sectional or synthesize cross-sectional work, so they cannot prove that servant leadership causes innovation, but they match my experience closely.

What I Learned About My Own Leadership

The hardest lesson is that in the first attempt, I chose control because it was easier than understanding. Walking the hall with a clipboard required less of me than asking nurses why they resisted and taking their answers seriously. I also learned that resistance often carries information. Each objection the nurses raised in the first month pointed to a real flaw in the plan as the hospital had designed it, and if I had collected those objections instead of counting compliance, I could have brought them to the manager as a list of problems to solve. That would have shortened the six months between the two attempts and spared the unit two handoff errors. It also would have kept me on the same side as my colleagues, rather than positioning me as the hall monitor for an initiative none of us owned. The nurses' objections about privacy and sleep were valid design problems, and solving them made the practice better than the hospital's original version.

Lessons for the Next Change

I will carry three lessons into the next change I lead. First, I will begin by helping staff see the problem in their own unit's terms, using our own data or events, before proposing a solution. Second, I will invite the strongest critics into the design work, because their objections usually point to real problems. Third, I will plan for refreezing with support rather than surveillance, because a practice that is watched into place tends to slip as soon as the watching stops, such as peer coaching and celebrating early adopters, instead of monitoring who complies. When the disciples argued about rank, Jesus answered that the great among them would be the ones who served (English Standard Version Bible, 2001/2016, Matthew 20:26). Our manager's second approach showed me what that looks like in leading change: serving the people who will carry the change, rather than standing over them.

References

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

Kelly, P., & Tazbir, J. (2014). Essentials of nursing leadership and management (3rd ed.). Delmar Cengage Learning.

Porter-O'Grady, T., & Malloch, K. (2016). Leadership in nursing practice (2nd ed.). Jones & Bartlett Learning.

Saavedra, S., Ruiz-Palomino, P., Pérez-Contreras, R., & Gonzalez-Sanz, J. D. (2025). Impact of servant leadership on the work environment and the attitudes and behavior of nursing professionals as a function of gender: A systematic review. Journal of Nursing Management, 2025, Article 8825138. https://doi.org/10.1155/jonm/8825138

Waseem, M., Hassan, R., Habiba, U., Khan, K., & Malik, M. H. (2026). Servant leadership and nurses' innovative work behavior: The serial mediation role of trust-in leadership and knowledge sharing. Journal of Nursing Scholarship, 58(2), Article e70081. https://doi.org/10.1111/jnu.70081