Resistance to change

[kmaryniak]

I've just recently become a unit based educator, and one of my main tasks in educating the nurses, is updating the policies and procedures. I am a great believer in evidence-based nursing, so I quite enjoy this. I am very surprised, however, at the resistance to change I've been getting. I don't know if it's because it's a smaller hospital/community, or if it's because some of the nurses have been working the past 5-10years here, or what. I have previously been an instructor at a college, and the nursing students were very different. They were so eager to learn everything, and took the rationale I gave them to heart. I always have research and rationale to back up whatever I try to teach. Any thoughts as to why this group might be so resistant??

[indie]

You know already that it's related to power and threat and autonomy and being afraid that really they might not be all that knowlegable.

A couple of suggestions from my own experience in this sort of position. Try a very short questionnaire to try and identify the most time consuming, ineffective, inefficient, troublesome (whatever . . . ) issue in the working day of the nurses, stating that you are going to try to do something about it.

When items are identified, then ask for ideas for improvement. Set up a small committee and get the buy in of these RNs. You might feel that's stretching yr. job description, but I think you can be creative about wording.

The truly seasoned RNs will feel you are another new broom and try to ignore you, but you have to get their involvement. Ask on the questionnaire (anonymous if you must) for areas they truly feel in which they have some expertise and might wish to present a short session. Or areas in which they'd appreciate some re-education.

Sometimes it's as simple as not really understanding how pharmacy restocks and procedures to get meds. not in the cart or Pyxis - new grads often come up with this one in my experience.

For the more seasoned RNs it can be lengthy discharge procedures and outdated paperwork.

When you have yr. topic ideas, try presenting very, very short update sessions at multiple times of day, especially around shift change, or put up education boards in the nurses' stations and keep them up to date or ask for a volunteer on each floor etc. etc.

The message is that you have to find a way to get their input or I don't think anything you do will be successful. Try not to come over as the academic with 'rationale based' issues. Let them see your expertise in action; this always wins RNs.

If there is a time consuming procedure often ordered that you do not feel is evidence based - try mounting a well-orchestrated challenge - that means taking on the medical staff too, but would win you brownie points.

Teaching students in school on a schedule is one thing; getting busy RNs to address their education, possibly in their own time is another. Try lobbying HR for 'education time'. Make sure you can offer CEUs and not just tiny one hour ones either.

Off to work, sorry it's so choppy, but I hope you get the general idea I'm trying to put over. I wish you luck and a few good colleagues.

[kmaryniak]

Thanks for your input! I have tried a questionairre when I first started, but I think I do need to look more towards the staff on a continual basis, for their thoughts, feelings, and needs. I'm not ready to give up yet!!!