Nursing Department Downsizing

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 down

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come is not being attained under existing operational conditions. The specific outcomes that are not occurring are defined in change theory as the non-accomplishment of a desired job, a non-obtaining of wants and needs, and the non-achievement of growth or maturation (Goad & Hough, 1993, p. 187). Three stages are structured into change theory (Goad & Hough, 1993, p. 187). The first stage, "unfreezing," is defined as the period wherein "change agents create dissatisfaction," while "inspiring the motivation to accept some type of change" (goad & Hough, 1993, p. 187). The second stage, "moving," is defined as participant attitude and behavior changes in relation to the planned change (Goad & Hough, 1993, p. 187). The third stage, "refreezing," is defined as the period within which "new behaviors are practiced and reinforced" (Goad & Hough, 1993, p. 187). The change agent referred to in change Theory is defined as an "individual who is skilled in change theory and the practice of planned change" (Goad & Hough, 1993, p. 187). While the change agent is not a component of change theory, the change agent is necessary for the effective functioning of planned change. Change theory assumes that a change agent will identify sources o

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