Implementation of Change in Nursing at Westmount Hospital


Most hospitals suffer due to poor feedback given by patients as they leave. Majority of the feedback is usually focused on poor quality of service offered by nurses. As a result of this, management may end up firing employees frequently as the underlying cause has not been addressed. The Westmount Hospital has been featuring the same trend of firing and hiring for many years, before it finally decided to look deeper into the problem. During the review of the system used by the hospital, many factors that are beyond nurse control were identified, and most of these directly linked to the poor performance of nurses. This paper features a plan of the proposed changes within the organization, how they will be implemented, and the resources that will be required.

Description of Current Problem

The Westmount Hospital is presently being challenged by poor health care delivery to patients mainly because of poor resource allocation. For a long time, nurses have been forced to work under stressful situations due to workforce shortages, and their daily tasks around the hospitals are also difficult due to lack of needed medical equipment. These two factors are the major reasons why patients are endlessly complaining of poor quality of care provided by the nurses available. As a result of workforce shortage, nurses are overwhelmed with having to cover a big number of patients on time. Their rounds are often delayed, with some patients being given little attention (Farquharson et al, 2013). This results into patient frustration, as medications need to be taken on time, just as other medical assessments should be done. The absence of required medical equipment used by nurses also contribute further to the situation. In this hospital, not all nurses are provided with basic equipments. For this reason, a lot of time is wasted when they use old school methods a task that is also tiresome and complicated. For instance, without a stethoscope and blood pressure monitor, a nurse in charge will not be capable of properly analyzing a patient’s condition when doing rounds.

Proposed Solution

To ensure that the Westmount Hospital improves its services to patients, it is important to offer support to the nurses. The main reason why nurses are providing poor quality services is because of work overload, and absence of medical equipment (Kar & Suar, 2014). Therefore, this hospital needs to increase its workforce and also purchase more medical equipment. It should be handled in such a way that a single nurse will only care for 10 patients a day. This will be an improved from the previous case where a single nurse would care for up to 30 patients a day. The fewer the number of patients a nurse is caring for per round, the better the quality of care will be. This will mean being served on time for all patients. Aside from offering medication and checking on the basic factors such as pulse and blood pressure, the nurse can also have time to connect with patients and better communicate with them. This is also a very important role of the nurse, besides the obvious factors. Medical equipment should be available in high numbers so that each nurse on duty will have a complete set of equipment. Offering patient care will, therefore, be easy and time saving.

Literature Review

Over the past decades, many researchers have taken it upon themselves to determine the reasons as to why nurses seem to perform poorly at their tasks. Underlying causes were determined, as it was identified that sometimes nurses do the best they can to ensure patient satisfaction. This meant that some of the reasons for low quality services may have been beyond their control. Farquharson et al (2013) state that nurses who perform poorly commonly complain of occupational stress. Occupational stress generally occurs when an individual is overloaded with tasks to handle at the same time. In nursing, this may happen when there is a workforce shortage, and a single nurse is expected to compensate for other 5 to 10 nurses. When faced with a such a situation, the nurse will commonly start experiencing a deterioration in physical and psychological health due to the trauma being caused to the body and also to the mind (Farquharson et al, 2013). As a result, the individual will start feeling less satisfied with the job, hence will perform poorly or lead to turnover.

Kar & Suar (2014) argue that the performance of a nurse is directly linked to a number of factor such as workload, job complexity and role conflicts. When a nurse is overloaded with tasks in the healthcare facility, the result is emotional exhaustion. The latter paves way for reduced personal accomplishment, a factor that eventually leads to decreased commitment and intentions to turnover. Job complexity may result due to the absence of required medical equipment that make things easier and more effective for nurses. As a result, nurses may be forced to use complicated methods to obtain measurements and carry out other roles that have been assigned to them. Role conflicts, on the other hand, is quite common in situations whereby there is workforce shortage. Hence, nurses may be expected to carry out tasks that they are not supposed to handle in the first place. As a result of such factors, nurses are also affected physically and psychologically, leaving them unfit to offer high quality patient care.

Medical professionals strive day and night to offer error free performance. This standard, however, can be difficult to attain when there are some factors that may limit performance. A research conducted by Valiee, Peyrovi & Nasrabadi (2014) identified five categories of causes of nursing errors when offering health care services. These include individual reasons, work pressure, not giving accurate care, the challenge of a unique caring environment, and also poor coordination among team members. The management is majorly responsible for the prevention of such errors as they can control nurses and their activities. For instance, work pressure may be avoided by ensuring that the organization has enough workforce. This means that each nurse will be given a manageable number of patients to handle, and not too many. Having a big number of patients will lead to working faster and less effectively to get the work done, instead of focusing on individual patient needs.

For many years, the nursing profession has been on the spotlight due to the issues of labor shortages and care quality. According to Wright, Bretthauer & Côt (2006), nurses commonly state unattractive schedules and excessive workloads as the two reasons why they are not content. This is why many countries have already started taking the issue seriously. This is being addressed by having a mandatory nurse-to-patient ratio (Wright, Bretthauer & Côt, 2006). This implementation of such laws shows that workload is indeed affecting the quality of work done by nurses. This is because, once the nurse feels overworked and dissatisfied with the job, he will not be in a position to offer patients the best care that is needed. There are other roles of nurses, such as being there when a patient needs to talk, that will be affected when a nurse is hurriedly moving from one patient to the next. Communication with patients helps the nurse to determine the unique needs of the patient, and thus will be able to implement them.

Malloch (2015) argues that it is important to make accurate determinations of the time required for handling patient care needs and aligning the findings with the appropriate nurse competencies and also the available time. Such an alignment is what will prevent work overload and being forced to work on areas of no competency, thus the quality of patient care and nurse satisfaction will both be improved.

Implementation Logistics

The proposed change will be integrated into the organization in a specific manner to ensure the maximum benefits are reaped. Due to the urgency of the matter, it is necessary that this changes be implemented as soon as possible. All the required preparations may take around a month, while purchasing the medical equipment may take up to three months. The latter is expected to take longer as the hospital will need to gather enough funds to cater for the expense. Therefore, the changes should be implemented within five months. Integrating these into the current organizational structure and culture will take place is stages. All the proposed changes cannot be implemented at once, as this may create confusion. Therefore, the first change to be implemented will feature introduction of new nurses to compensate for the shortage being experienced.

Since there will be more than five new nurses, the management will need to reconsider its approach on how these staff are handled. The proposed method will be to make use of smaller teams, whereby each one of them will have a leader nurse. This makes it easier to manage new personnel, and also to ensure that they are blending well with other previous nurses. The leader nurse will be responsible of task assignment so as to ensure all nurses get equal work loads. During this stage, the new nurses will be educated on how the organization functions.

The next stage will feature the introduction of medical equipment for all nurses. All nurses do not need to have their own equipment as they work in shifts. However, it is important to ensure that all nurses working in a specific shift will have all the required medical equipment to make their work easier. The human resource department will be responsible for ensuring that there is enough medical equipment for nurses during the shift. Nurses may need to be educated on how to use these equipment to achieve the best results. The management will be responsible for organizing a one month workshop, whereby all nurses will be expected to attended when they are not on duty.

Resources Required for Implementation of Change


As the organization will first need to recruit more workforce, posters will be required to help with the advertisements of job vacancy. These will be posted all over town to ensure a maximum number of people get the message. This is important as it will enable the hospital to choose from many applicants.


These resources will come in handy during the job vacancy advertisement and also during the education process of new nurses. The pamphlets may be designed to feature some of the most important information about the organization such as the organization culture, mission and vision statements.

Power-Point Presentations

These presentations will be essential during workshops as the speaker will need this for demonstrations. During the positioning of individuals into teams, the management may need the power-point presentation to show the staff where each one of them belongs.


These will be needed throughout the implementation process. They will be important when it comes to assessing whether the nurses are noting any changes, and the patients feedbacks may also be collected through the same. New nurses may need questionnaires to help determine their competencies and weak areas that need polishing.


Workforce shortage and lack of enough medical equipment may prevent nurses from carrying out their tasks effectively. This is because individual patients will not be given the amount of attention they need, and the nurse will not be able to identify each patient’s unique needs. This is why this plan is very important. It features an introduction of proposed changes that will ensure these issues facing the Westmount Hospital are addressed right from the roots. The result will be a long term change, compared to what may have been achieved by firing and hiring new nurses.

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