Change Proposal 1

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Running Head: CHANGE PROPOSAL

Change Proposal

Jessica E. Valdes

Nova Southeastern University

NUR 4020

Linda Strommen

October 7, 2007
 Change Proposal 2

Change Proposal

A nursing problem that currently exists is the amount of documentation nurses must

endure. Nurses continually document on patients and although documenting is a very important

aspect of nursing care often times [spelling error -- the preceding two words should be

spelled as one word] nurses are left overwhelmed and with the feeling that [Use a form of

"believe," which is more accurate (and not a cliché)] most of the day was spent charting.

According to Gugerty, et al. (2007), “Nurses routinely spend 15-25% of their workday

documenting patient care, and in some cases considerably more.” The article also stated that

often times [spelling error -- the preceding two words should be spelled as one word] much

of the documentation is unneeded and repetitive.

Changing the amount of time nurses take to document would affect many aspects of the

organization. First and foremost [Redundancy, consider "first."] [Eliminate clichés (tired,

overused phrases) and colloquial (informal) language for more effective academic writing.

(See page 37 in the APA Publication Manual.) ] patient satisfaction would increase

because nurses would have more time to provide direct patient care and better quality of care.

There would be less stress on the nurse; since there is [Expletive construction--"there is,"

"there are," "there was," "there were," "it is," or "it was" are phrases that mean nothing.
 Change Proposal 3

Unless "there" or "it" is a place or a thing, the composition will be much more concise if

rewritten to eliminate such phrases.] less to document, work would be done in a timelier

manner.

Additionally, it would decrease costs in the organization. In the Report by Maryland

Nursing Documentation Work Group, Gugerty, et al. (2007), “more than 1/3 of the nurses

reported routinely staying beyond their scheduled work hours to complete documentation and

almost 2/3 of these were paid for the “stay over period.” Decreasing documentation time would

decrease the amount of time nurses spent charting by 25 percent [Use the % sign with

numerals.] and would cut cost by approximately $94,000,000 per year in the state of Maryland

this would not only allow nurses to provide more direct care but would improve nurse

satisfaction and result in retention of nurses (Gugerty, et al. 2007).

Using the Havelock six step change model to implement change would help overcome

change resistance in the planning stage (Kelley, 2003). First it is [Expletive

construction--"there is," "there are," "there was," "there were," "it is," or "it was" are

phrases that mean nothing. Unless "there" or "it" is a place or a thing, the composition will

be much more concise if rewritten to eliminate such phrases.] ["It" must refer to a specific

word in the sentence or the reader can become confused by the vague pronoun reference.

Example – It demonstrated his recent achievement. (This usage is incorrect because "it"

does not refer to a specific element in the sentence.) When Victoria received her diploma,

she put it in a frame. ("It" clearly refers to the diploma.)] important to execute a

documentation reduction committee. According to Gugerty, et al. (2007), the committee should

include nurses and nursing superiors, “nurse informaticians, nurse executives, nurse managers

and direct care nurses can dialog about the issues identified.” This can be compared to the
 Change Proposal 4

assessment portion of the nursing process. First you [Word choice—using the second-person

pronoun "you" is inappropriate in academic writing. Except within a direct quote, rewrite

with third-person pronouns (he, she, it, they).] gather a committee of nurses build a trusting

relationship and diagnose/assess the problem. What are the current problems that exist regarding

the documentation process and what can be done to reduce documentation the process? During

this time it is [Expletive construction--"there is," "there are," "there was," "there were,"

"it is," or "it was" are phrases that mean nothing. Unless "there" or "it" is a place or a

thing, the composition will be much more concise if rewritten to eliminate such phrases.]

important to address the current documentation process and the changes that can be implemented

to reduce documentation time. This can be achieved by reducing sections of the nursing notes

that are repetitive, charting by exception and moving to computer charting.

After the assessment is complete and the problems are identified changes need to be

made there maybe more than one solution to the problem using trial and error and allowing the

nursing staff to be part of the research can aid in finding the best solution. It is [Expletive

construction--"there is," "there are," "there was," "there were," "it is," or "it was" are

phrases that mean nothing. Unless "there" or "it" is a place or a thing, the composition will

be much more concise if rewritten to eliminate such phrases.] important to allow the nurses

to give feedback in order to decide what the best approach is. As Gugerty, et al. (2007) states

“encourage the involvement of nurse executives and direct care nurses in the formulation of

documentation policies, selection of software, planning, and implementation.” This will assist

gaining acceptance to the change because everyone is involved in improving the nursing process

of documentation. Havelock emphasized that the change agent needs to support involvement of
 Change Proposal 5

the people participating the more the people affected by the change participate the more they are

likely to make the change a successful one (Kelley, 2003).

In order to implement this change the leader involved in making the change needs to be

honest and trustworthy. The leaders must take the initiative to implement positive changes and

not hesitate to the show the way. The leader must be an authority figure implementing a median

between autocratic leadership and democratic leadership it is [Expletive construction--"there

is," "there are," "there was," "there were," "it is," or "it was" are phrases that mean

nothing. Unless "there" or "it" is a place or a thing, the composition will be much more

concise if rewritten to eliminate such phrases.] important for the leader to use centralized

decision making without using power to command others but the leader needs to be influential

and have a personal relationship with those involved (Kelley, 2003).

In order to mentor others to the change it is [Expletive construction--"there is," "there

are," "there was," "there were," "it is," or "it was" are phrases that mean nothing. Unless

"there" or "it" is a place or a thing, the composition will be much more concise if rewritten

to eliminate such phrases.] important to show the benefits of decreasing documentation. This

can be achieved by presenting statistical information regarding the decrease of documentation

and how it improves nursing and patient care overall. Emphasize that this is a project that can not

work without their participation and it’s a change that needs to be executed with their assistance,

they are in the frontline of the change.

The change would have a positive affect on the organization and on nursing in general.

Increase in patient satisfaction would improve the hospital. “Increasing patient satisfaction is a

critical goal for healthcare organizations of all types, especially in these times of increased

competition, scrutiny and demand for services” (Waneless, 2007). Moreover it would help
 Change Proposal 6

decrease the nursing shortage because nurses would have weight lifted off their shoulders.

“Nurses working in most healthcare settings have identified the excessive burden of

documentation as a source of dissatisfaction in their practice (Gugerty, et al. 2007).

In order to gain support allowing the nurses to voice their opinion is an essential

component. Allowing the committee to not only feel involved but be involved is of topmost

importance especially since they are the key component to making recommendations.