NR 451 Week 6: Implementing Change Despite Resistance

NR 451 Week 6: Implementing Change Despite Resistance

NR 451 Week 6: Implementing Change Despite Resistance

We all encounter change at some point in our careers. As nurses along with other healthcare professionals  we have a highly important role when working to improve and maintain the safety and quality of patient care (CCN,2017). This includes implementing evidence-based practices that improve patient outcomes which entails change. The changes that are sometimes introduced come with great resistance while other don’t and are gladly accepted. I think the difference between change that is accepted and change that is rejected includes multiple factors. Three factors that I believe increase resistance to change is lack of knowledge, lack of involvement and lack of support. If the person being affected by the change is not educated in why the change is made there will be difficulty for the person to accept the change. When people are involved in the process of finding new changes they will accept the change more often and have knowledge of why the change is being made. Many times there isn’t support from management and other coworkers about the new change so it isn’t taken seriously and is rejected. 

In terms of my change project of educating patients to reduce readmission rates I believe resistance would be met at having a more primary focus on education and utilizing the teach-back method only to educate patients. If staff were involved in implementing the change I believe there would be less resistance.  The ANA states that we have a responsibility to educate. This includes assessing individual’s readiness to change and use non-judgmental approaches (American Nurses Association, 2015).  Also if staff were shown statistics on the improvement the teach-back method makes for readmission rates they would be more inclined to use the method because they had knowledge of it. 

American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author. Chamberlain College of Nursing. (2017). NR-451. Week 6 Lesson: Strategies for Effective Change [Online lesson].  Downers Grove, IL: DeVry Education Group. Retrieved from

Change in any setting is difficult, we go through changes every day, new laws, new way of doing things, new technology and so forth.  Some embrace change as inevitable and others just refuse to change.  My mother is an avid reader and has literally hundreds of books, trust me I know I have moved her twice in the past 10 years and know all the books she has.  I bought my mother a nook several years ago and taught her how to use it.  Instead of embracing this new-found way of reading thousands of books that are stored in one place, she chose to hide the nook and claim it was lost.  Recently she started having trouble with her eye site and could not read regular print books so I searched her apartment and found the nook, I charged it and set the font to large type and re-oriented her to its use.  Again, she stashed it away saying it would not charge.  Now I know that was not true, she just will not change to use of new technology, she will not learn to use a computer or tablet, she has no interest in doing that.  Change scares her and that is the bottom line. As nurses, we are a lot like my mother, afraid of change, and this fear holds us back in our practice and in safe quality care and positive outcomes for our patients.  

There are several major barriers to the advancement of EBP which would bring about change in nursing.  These include:

  • Lack of knowledge and skill
    • Low comfort level with search techniques
    • Perceived lack of time-REAL LACK OF TIME
    • Challenges with critically appraising research
    • Lack of organizational/administrative support
    • Educational programs that continue to teach research the “traditional way” with focus on producing instead of using evidence
    • Negative attitudes-skeptics and fear

I had one negative encounter with implementation of change early after I earned my masters’ degree.  My barrier with leadership and their lack of knowledge and insecurity with staff effecting change.  I was basically told after my presentation of my idea for change that I was hired as a staff nurse and nothing more.  Their insecurity with staff effecting change that could improve patient outcomes along with their lack of knowledge in nursing research became the barriers to positive patient outcomes.  In the past year, the culture at that facility has changed and nursing research that includes the staff has been implemented. 

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Tell the class about the barriers you may encounter in your practice if you were to attempt to implement a change?  It could be from staff or leadership or both.  

Feeg, D. V., Suny Downstate Medical Center Department of Nursing , Nursing Research and Evidence-Based Practice 
     ConferenceMay 26, 2010; Strategies for Overcoming Barriers in Implementing Evidence-Based Practice; retrieved from

It’s been said that “ changes are inevitable,” but clearly they have not work with some of my coworkers.I was assigned a project to create flowcharts for a department at my job. The goals were to create a new process that would be easy to use and decrease the time and help eliminate some of the problems that exist with the current process.  This assignment was given to me three months ago with a timeline for completion in six weeks.  
 I have created and revised the flowcharts four times following the specific narratives the department presented to me.  During my research, I offered several prime solutions.  One of the solutions was to revise the process from manual to an electronic.  The newer staff were excited and ready to proceed, however, the staff who used the manual process did not feel the need to change to electronic.  
In my presentations, I was able to demonstrate how the new process would be faster and easy to use.  The department director and the older staff push back when the electronic solution was presented. I have no doubt that the fear of something new lies within the staff who are familiar with the manual process, and no matter what I said or did their response were the same.   According to our reading assignment for this week states that I need the endorsement of the participants and those impacted by the change in order to ensure that the innovation is implemented successfully.  The current process has several problems that prevent easy flow and delay the transition from one step to another in a timely manner. Because of the support of the program director, I haven’t been able to transition the process to electronic, but it is still on the table for further discussion.



Agency for Healthcare Research and Quality (AHRQ). (2008). Patient safety and quality: An evidence-based handbook for nurses. Retrieved from