Nurse leaders must act as a role model and change agent to staff during the change process. A transformational leader must attempt to view change in a positive manner and share his/her views with their staff. A team leader embraces change and views it as a new opportunity to be innovative and try something new in order to make a difference. (Marquis & Huston, 2017) Over the past two years, Roxburo Medical Center has lost 25% of its market share. This current fiscal year, Roxburo had an additional 15% decline in its market share resulting in large budget cuts in personnel across the organization. Due to mandates staffing ratios, The CEO and CFO of the organization have mandated a reduction in the management workforce.
Changes will occur over a 6 month period. As the CNO over the largest department in the hospital, I am the primary person responsible for the entire nursing operation including staffing, policies, quality, finances, and productivity. In order to restructure the department to reduce 30% of the workforce, the Kotter change model will be implemented. The purpose of this paper is to create an evidenced based plan for system-wide change, engage in the decision making process of a nurse executive, and use reflective practice knowledge and skills to influence strong decision making during the change process. Kotter’s change model will be applied in order to address all stages of the change process efficiently and appropriately.
Potential challenges may present during the change process. The mandated change may meet heavy resistance from the staff. Therefore a plan to address resistance to the change will be implemented. Implications to this change will cause an increased workload for the management team that was chosen to stay. Culture and climate will potentially shift into a negative light. Therefore it is essential to use the Kotter model to address all stages of the change process appropriately with energy, enthusiasm, and positivity.
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Reduction of Workforce-Deciding
Using Human Resources (HR) metrics a reduction in workforce will be determined through the elimination of ten positions. Using the information provided, I decided to reduce HS1, UM 2, UM 3, and CN1 through CN7. My approach to the reduction process was through analyzing the importance of each position. After analyzing each position, I analyzed their average and latest performance review followed by their years of service. When analyzing the HS, I will be reducing HS1 due to their years of service in management.
Due to big changes coming from the mandate, I will need the experience of HS2 and HS3. HS3 will have to be talked to 1:1 for recent performance. HS3’s average performance review is high, so I feel with motivation and coaching that HS3 can fix his/her recent performance and help me lead through the changes. 2 Unit managers will be cut. I feel that 4 managers can run a 200 bed hospital given occupancy fluctuations. All charge nurses will be relieved. The charge nurse role is shared among all RN’s of the unit in today’s modern era of healthcare. Sharing and rotating charge duties increases the expectations of all subordinates, fostering accountability, development, and an increased awareness of unit duties.
Nurse leaders play a significant role in ethical decisions. Therefore, it is essential for a nurse leader to use a structured approach when making decisions that affect people and the organization in which they serve. Although protecting the organization is a responsibility of the nurse leader, outcomes should not be the only criteria when making decisions that are based on maximizing or minimizing human capital. Due to the mandate for a reduction in workforce, ethical challenges will be presented. Eliminating ten positions brings ethical dilemmas due to the individuals and their families that are involved. The decision to lay off HS 1, UM2, UM3, and CN1 through CN7 was a challenge due to not knowing who these individuals are and the intangibles that they bring to the table.
In order to make an informed decision, I need to know their leadership abilities and political network within the organization in order to more accurately anticipate the impact on the organization after laying them off. Understanding leadership style and level of engagement are two important factors of an individual’s job performance. Therefore the most challenging part of deciding whom will be laid off is due to the lack of the information provided. Due to the lack of information of the individual’s engagement level of committees, family and personal information, and leadership style, the role of ethics will be deeply challenged using the sole information.
More information was provided by adding relative information on the individuals that are being considered to be included in the reduction of the workforce. Gathering data from the relative information columns, the reduced positions will be changed with specific focus on the Unit Managers. HS1 did not change due to only needing two House Supervisors during this change. The rationale for this decision lies within HS1’s experience level. HS1 had the least amount of experience of the House Supervisors.
Experience and skill mix will be needed through this transition leading to the decision to keep HS2 and HS 3. In regards to the Unit Managers, UM3 and UM 6 were selected to be reduced. UM 3 was chosen due to only 2 years of management experience with a low performance review. UM3 will be chosen to be laid off due to performance and unit size that can be covered by the remaining managers. UM6 will be included in the reduction due to low performance and negative attitude toward change. This will remove barriers to the change process as it gains momentum in the later stages. CN1 through CN7 will be reduced due to position elimination.
Reducing 30% of the management workforce may present serious challenges leading to conflict. Conflict may arise from UM3 due to being on FMLA for the past four months. HR and risk mangement will have to be consulted in this case to assess the legal risk of this decision. An ethical dilemma may arise with UM6 due to being a single parent with a one income household. This should be evaluated with HR in order to see if there are potential reallocation options. Regarding CN1 through CN7, the position will be entirely eliminated, causing a change in the organization’s structure. This will be felt on all units. Internal conflict of this decision may occur due to the shift in culture and climate of all nursing units of the organization.
Due to the conflict that may arise, negotiation will take place with the Chief Executive Officer and the Chief Financial Officer about the implications of reducing 30% of the management workforce and the ethical dilemmas surrounding those who will be affected. Many of the individuals chosen are current or future leaders of the organization which will impact the organization’s growth and development in the long term. Due to the vast implications of the mandate, negotiation will be used in an attempt to create a win-win situation for the organization as well as the individuals that are affected. Negotiation can be highly emotional with these types of circumstances at stake.
Therefore it is essential for the nurse leader to be prepared with factual statements and gathered research. A presentation consisting of workplace stress of nurse managers will be presented during the negotiation process. Nurse managers have an essential role in maintaining a healthy work environment that delivers high quality nursing care. Workplace stress through an increased workload will result in negative effects of nurse managers as well as their staff members. The increased workload will increase burnout, leading to retention issues for the organization’s leaders. (Dunnham-Taylor, 2013)
