How Do We Manage Change?

1. Change Management in Nursing Leadership: A Strategic Approach

In the ever-evolving healthcare landscape, change management is a critical skill for nurse leaders at all levels. Change is necessary to improve patient outcomes, streamline workflows, integrate new technologies, and adapt to shifting policies and regulations. However, resistance to change is common among nursing staff, and poorly managed transitions can lead to stress, disengagement, and decreased morale.

Effective change management requires visionary thinking, structured approaches, and leadership support at all levels. While the C-suite drives large-scale transformations, nurse leaders play a pivotal role in translating those changes into practical, sustainable improvements at the unit level.

key concept

By understanding change theories and strategies, nurse leaders can empower their teams, reduce resistance, and create an environment where continuous improvement is embraced rather than feared.

2. Lewin’s Change Management Model in Healthcare

One of the most widely recognized and effective models for navigating change in healthcare is Kurt Lewin’s Change Management Model. Known as the father of social psychology, Lewin proposed a three-stage model that provides a structured, evidence-based approach to managing transitions in any organization.

The three stages of Lewin’s Change Model are:

1. Unfreezing – Preparing staff to let go of outdated processes and mindsets.
2. Changing (Movement) – Implementing the transition and guiding staff through new processes.
3. Refreezing – Reinforcing and stabilizing the change as the new standard practice.

3. Stage 1: Unfreezing: Overcoming Resistance to Change

The first stage of change requires nurse leaders to help staff break free from established routines and old patterns of thinking that may no longer serve the best interests of patient care. This stage is crucial for minimizing resistance and fostering openness to innovation.

Key barriers to change in nursing include:

• Fear of the unknown – Concerns about competence, workload, or job security.
• Comfort with the status quo – “We’ve always done it this way.”
• Lack of understanding – Unclear purpose or rationale for the change.
• Inadequate support – Perceived lack of leadership involvement.

3a. Strategies for Effective Unfreezing

To prepare staff for change, nurse leaders must:

• Communicate the "Why" Behind the Change – Explain the need for change, how it will improve patient outcomes, enhance workflow efficiency, and align with the organization’s mission.
• Identify and Engage Key Influencers – Recognize formal and informal leaders within the unit and involve them early in the change process. These individuals can champion the change and serve as role models.
• Increase Driving Forces – Reinforce the benefits of the change and provide real-world examples of success.
• Reduce Restraining Forces – Address fears, dispel myths, and offer training and resources to bridge knowledge gaps.
• Encourage a Growth Mindset – Promote the idea that change leads to professional growth and improved nursing practice.

Real-World Application: Unfreezing Stage
When a hospital transitions to a new electronic health record (EHR) system, nurse leaders should:
✓ Provide early notice of the change.
✓Conduct training sessions before implementation.
✓Offer hands-on practice environments for staff to get comfortable with the system.
✓ Assign super-user mentors to assist those struggling with the transition.

4. Stage 2: Changing (Movement): Implementing the Transition

Once resistance has been reduced, the next stage involves executing the change while providing support and reinforcement. Staff must internalize new behaviors, workflows, and thought processes to make the transition successful.

Key Challenges in the Changing Stage:

• Uncertainty and anxiety about new processes.
• Lack of immediate competence in new systems or workflows.
• Misalignment between leadership expectations and frontline reality.

4a. Strategies for Successful Changing Implementation

• Provide Clear, Step-by-Step Guidance – Offer structured training programs, simulation exercises, and real-time coaching.
• Encourage Two-Way Communication – Allow staff to ask questions, share concerns, and provide feedback on implementation challenges.
• Implement Change in Phases – Where possible, introduce changes incrementally rather than all at once.
• Offer Emotional and Psychological Support – Recognize that change can be stressful; encourage peer support, wellness initiatives, and leadership check-ins.
• Emphasize Alignment with Institutional Goals – Reinforce how the change improves patient safety, quality care, and professional development.

Real-World Application: Changing Stage
When introducing bedside shift reporting, nurse leaders should:
✓ Conduct interactive training sessions on best practices.
✓ Allow nurses to observe successful implementations in other units.
✓ Provide scripted templates to ease the transition.
✓ Collect feedback and make adjustments based on staff concerns.

5. Stage 3: Refreezing: Reinforcing the New Normal

The final stage of Lewin’s model is Refreezing, in which the new processes become standard operating procedures. Without reinforcement, staff may revert to old habits, diminishing the effectiveness of the change.

Key Challenges in Refreezing:

• Lack of ongoing reinforcement – Once the initial change excitement fades, staff may drift back to old practices.
• Inconsistent application of new processes – Some staff members may adopt the change fully, while others do not.
• Failure to recognize and reward success – Without positive reinforcement, staff may feel unmotivated to sustain the change.

5a. Strategies for Long-Term Change Sustainability

• Conduct Regular Check-Ins and Rounding – Nurse leaders should monitor adoption rates, provide on-the-spot coaching, and reinforce correct behaviors.
• Establish Accountability Measures – Use performance metrics and compliance tracking to ensure that changes are being maintained.
• Celebrate Successes and Recognize Staff Efforts – Highlight positive outcomes and recognize staff members who have adapted well.
• Provide Ongoing Education – Conduct refresher courses and mentorship programs to maintain competency.
• Adjust and Improve as Needed – Change is not static; refine processes based on feedback and new insights.

Real-World Application: Refreezing Stage
When implementing a new patient safety protocol, nurse leaders should:
✓ Conduct regular audits to ensure compliance.
✓ Recognize and reward staff who successfully integrate the new practice.
✓ Provide refresher training if adherence begins to decline.
✓ Adapt the protocol based on frontline feedback and new evidence-based guidelines.

6. Change Management as a Leadership Imperative

Change in healthcare is inevitable, but it does not have to be disruptive or stressful. By applying Lewin’s Change Management Model, nurse leaders can:

✓ Reduce resistance to change.
✓ Empower staff to embrace new processes.
✓ Ensure long-term success and sustainability.
✓ Enhance patient care and clinical outcomes.

Mastering change management is an essential leadership skill, enabling nurses at all levels to drive positive transformations that benefit both staff and patients.

reflect

Consider the following reflection questions for nurse leaders:

• What changes are currently happening in your unit or organization?
• How can you apply the Unfreezing, Changing, and Refreezing model to lead more effectively?
• What strategies do you use to reduce resistance and promote a culture of innovation?

big idea

By developing strong change leadership skills, nurses can transform challenges into opportunities, fostering a healthcare environment where continuous improvement is embraced, rather than resisted.