NR 504 Week 6 Discussion – Collaboration Cafe
A case scenario in my current area of practice involves staff clocking in and out appropriately for meal breaks. Our staff is entitled to a 30-minute meal break, and our policy states that if they are interrupted before 28 minutes have passed, they get paid for the full 30-minute meal break. Our new Chief Nursing Officer (CNO) has identified that we have a huge number of staff throughout the hospital who are accruing a significant amount of incremental additional pay in this manner. She is having us run monthly reports for her and has mandated this practice be brought under control. She has tasked us with staff having no more than two incidences of a short meal break per month.
This week’s lesson discussed that Kotter’s Change Model is based on a series of 8 steps (Chamberlain College of Nursing, 2020), and as I learned about them this week, I realized that I am actually going through the steps of this model in my quest to influence a long term change in behavior in my department.
The first step is to identify the need for change and create some excitement about it. I have shared with my staff the position of our CNO, and I’ve also provided the rationale: We all work way too hard and deserve a full, uninterrupted meal break; it is good for our mental and physical health to rest during our shift; and policy requires us to be provided and to take a 30-minute meal break, so going forward, all efforts will be made to be sure that their meal breaks are
NR 504 Week 6 Discussion – Collaboration Cafe
The second step is to align with a group of people who will support the change. Our CNO did this step for us by including her leadership team in her mandate; however, I am focusing on my charge nurses in order to create my own group specific to my department since this is where my change is going to be generated.
The third step is to create a clear, concise vision of what the change is going to create and how we are going to get to that point. I have identified that we will be better rested, we will have a chance to refuel and refocus, put our feet up, handle any personal business we need to, and will be compliant with our policies and mandates from our I have offered to get egg timers or sand timers and suggested staff set reminders on their cell phones.
The fourth step is to communicate the vision and start to work towards convincing people of its importance and benefit. Consistent, clear, positive communication keeps the vision in the forefront of everyone’s mind is a reminder to put forth the effort necessary And by being positive in the communication techniques and pointing out the benefits, eventually, more and more people will buy into the change. I remind staff during our morning huddles we have reminders posted, and the staff has decided to make it a quality improvement goal in our department.
The next step is to identify and correct anything that can hinder the process of change. We have added our timekeeping app to our computers throughout the department so staff don’t have to walk to the timeclock; I have placed the timers in the lounge for staff to use if they choose to remind them when 30 minutes is. We have signs posted to remind staff to punch in/out, and I have encouraged them to tell me if they forget so I can correct their time sheets. I have also tasked my charge nurses to be cognizant of time and to make an intentional effort to get staff their full meal breaks. I myself give breaks if the workload requires this, and I give my charge nurses their breaks when needed, as they often go without a meal break.
The sixth step is to share successes and create momentum with celebrations. I run the report every month for our CNO, and I have started sharing the numbers with the We have steadily reduced the number of short meal breaks on the report. We have a graph on a grease board in our lounge to show how we are doing. If someone has more than two incidences in a particular month, I have a conversation to find out what happened and help with solutions. Staff who have struggled with this in the past and are showing improvement get an email from me congratulating them on their success. Staff who have corrected the problem get a handwritten note and a $5 gift card to thank them for the effort they have put forth. We just had our first month in a year with no instances of short meal breaks, so we celebrated with a snack bar. I brought in a variety of snacks and some decorated cellophane bags, and the staff could make up their own snack bags.
NR 504 Week 6 Discussion – Collaboration Cafe
The seventh step is to encourage and develop the culture so that effort is continuously applied to keep the momentum going. I will do this by using positive, motivational, and encouraging communication, continued small celebrations, continued personal communications, and continued sharing of our trending numbers. I am going to invite our CNO to attend a huddle and congratulate my staff, and I will plan some bigger celebrations; for example, we’ll have pizza for the department if we can do three consecutive months of zero short lunch periods or something similar, something for the staff to work towards so that the behaviors that are rewarded and celebrated become the norm. We also just finished our annual performance evaluations and made this one of the goals for each individual to work on.
The last step is to work to entrench the new behaviors as the new norm, the new culture. This will come as we work through step 7, as well as when we onboard new staff who are oriented in the midst of the new culture as opposed to the old. We will continue to monitor and evaluate what creates a barrier and what helps continue the behavior, and we will continue to recognize and be positive and
I am currently in step 6 of this process. I plan to focus on our successes and continue to recognize and celebrate them. This has been a long process, and it’s exciting to finally see some results and some commitment from my staff. I believe steps 7 and 8 will be part of our long-range vision that will be fueled by the actions we take during step 6. The leadership strategy I plan to intentionally apply to this particular process is effective communication techniques. If I continue to use effective, positive communication techniques, the vision will be shared in a clear and concise manner, staff will feed off the positive message, the reward message will create a sense of accomplishment and inspire continued behaviors to support the change, and this will set the example and send a continued message to new staff who join our team which will create a new culture in our department.
Reference
Chamberlain College of Nursing, (2020). NR 504, Week 6: Leadership and nursing practice [Online lesson]. Downers Grove, IL: Adtalem.
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Question 
Describe a potential case scenario involving an MSN-prepared nurse in your selected area of practice. Within the scenario, identify a specific problem that needs to be addressed. Examples might include a new curriculum, change in the EHR, decreasing patient satisfaction rates, safety risks, or another situation that impacts your future MSN role.
Discuss how Kotter’s Change Model would be applied in your recommended change initiative and its intended potential impact.
Identify one specific leadership strategy to facilitate change, and describe how it is congruent with Kotter’s Change Model and may affect your future role.