NURSING DEPARTMENT DOWNSIZING WHILE MAINTAINING CARE QUALITY
This research describes a planned change for the nursing department in an acute care hospital in a small city located in a major metropolitan region. The planned change involves downsizing the nursing department.
An increasing number of hospitals, in the pursuit of goals related to both efficiency and effectiveness, are implementing reorganization schemes that frequently involve downsizing, decentralization, or some combination of downsizing and decentralization (Barrett, 1995, p. 24). Among health care professionals, nurses tend to be those most frequently displaced by the contemporary downsizing and decentralization strategies (Suderman, 1995, p. 7). While the size of the nursing staff in the acute care hospital that is the setting for the planned change must be reduced, the major nursing problem involves the need to preserve the quality of patient care while accomplishing the downsizing objectives.
Downsizing of the nursing department will occur is so directed by the hospital administration. The objective of the nursing administrators in this situation is to develop a change strategy for the nursing department, gain hospital administration approval for the strategy, gain nursing staff support for the strategy, and implement a strategy that will serve the interests of patient care, the nursing staff, and the hospital to the maximum extent feasible given the constraints of downsizing.
Literature is reviewed that is relevant to changes in the health care environment in the United States that affect such strategies as downsizing. Literature also is reviewed in relation to theory to support and facilitate organizational change. Two such theoretical models are reviewed: Kurt Lewin's "Field Theory" as it applies to change; and Shirley Ziegler's "Nursing Process Model."
Changes in the Health Care Environment
The American hospital is being reinvented in a wa...