1. Effective Change Strategy: Nursing Retention
Part Four: Leading Change in a Professional Environment
Nina Favor, Jody French-Sroka, Mary Hefferan, & Amy Herrington
In this part of the presentation, I will discuss leading change in the professional environment and leadership qualities that promote commitment to change.

2. Objectives Outline the attributes of the nursing profession
Understanding the profession to enable change
Transformational leadership traits
Who are we accountable to?
What drives leaders in professional
health care organizations
In order to initiate organizational change towards the retention of nurses, the attributes of a profession and traits of leaders should be outlined to guide understanding and better facilitate change. In this section of the group presentation, the objectives are to outline the attributes of a profession, including understanding the profession to enable change and describe transformational leadership and desired traits. Also, in order to answer the question “who are we accountable to” I will describe accountability and what drives leaders in professional health care organizations.

3. Objectives Explain how credibility contributes to a change process
Nursing roles contributing to change
Using leaders’ strengths to promote change
Credibility will be explained and how it contributes to the change process when a leader possesses it. I will discuss how the nursing roles we’ve assumed for this presentation will contribute to our change process of the retention of nurses. Jody will maintain the role of the nurse administrator, Nina will continue to be a nurse educator, Amy will now be a nurse practitioner in the organization, and I, Mary, will be a charge nurse in the intensive care unit for the organization. I will describe how each of these nursing leaders’ strength will be utilized in order to help our change process and obtain “buy in” for members of the organization.

4. Hoffart and Woods (1996) Professional Practice Model for Nursing
Professional Nursing
Hoffart and Woods (1996) Professional Practice Model for Nursing
To better enable the adoption change process that will promote nursing retention, it is important to describe the characteristics of professional nursing. Hoffart and Woods (1996) professional practice model for nursing represents the subsystems of professional nursing and how woven together, they create a strong professional nursing practice. The subsystems they describe are: the management approach, professional relationships, compensation and rewards, patient care delivery system, and professional values.
The subsystem, management approach, addresses the “structure and processes used to make decisions related to unit and organizational operations” (Hoffart & Woods, 1996, p. 356). It is important to identify the management approach in organizations when attempting to implement change. Doing this will assure proper adherence the each unique organizational management structure and how each organization approaches change.
The professional relationship subsystem relates to the interactions within the organization and its workplace culture (Hoffart & Woods, 1996). Marshall (2011) states that “no proposed mission, vision, or strategy for change that is not consistent with the organizational culture has a chance of success” (p. 184). Therefore, in order to impart change, understanding the professional relationships is essential to guiding change.
Source: / Edited by M. Hefferan

5. Hoffart and Woods (1996) Professional Practice Model for Nursing
Professional Nursing
Hoffart and Woods (1996) Professional Practice Model for Nursing
The next subsystem described is compensation and rewards. This, as the title implies, refers to how the organization compensates staff for their work (Hoffart & Woods, 1996). Besides hourly or salary pay, organizations can reward staff through recognition of achievements, funded educational opportunities, and bonuses for certifications. These rewards show that the organization is invested in their members. When instituting change, keeping this subsystem in mind will be beneficial because the organization can utilize these rewards to motivate change. Marshall (2011) states that “people who are valued, encouraged, supported, and provided with the environment and resources to succeed will take initiative and perform creatively and effectively” (p. 118). Motivation should be fostered within the employees; in order to provide meaning and value to their profession as well. This should promote nursing retention efforts by providing a level of commitment and spirituality within their work.
The subsystem patient care delivery system defines how patient care is delivered and how responsibilities are assigned regarding the delivery of patient care (Hoffart & Woods, 1996). This element pertains to role division and clarity of nursing functions. This will be important to understand if initiating a new graduate RN residency program because the mentor/mentee relationship will function differently than that of a staff RN. Role division and clarity will ensure that all staff will recognize each of their unique function and the differing responsibilities associated with each.
Source: / Edited by M. Hefferan

6. Hoffart and Woods (1996) Professional Practice Model for Nursing
Professional Nursing
Hoffart and Woods (1996) Professional Practice Model for Nursing
And lastly, the subsystem of professional values incorporates the beliefs and values that inspires the nursing practice (Hoffart & Woods, 1996). This subsystem is the ethical backbone of nursing that is required to guide the nursing practice and “act consistently with what is moral, right, and true” (Marshall, 2011, p. 146). Values are “reinforced through the American Nurses Association Code of Ethics, professional standards of nursing practice, and professional and institutional norms” (Hoffart & Woods, 1996, p. 355). Leaders of change should understand and model ethical professional values to truly inspire and motivate those in their team.
Source: / Edited by M. Hefferan

7. Transformational Leadership
To lead the intended change towards the retention of nurses, nursing leaders must not only understand the profession, but should understand what is required of them to become a true transformational leader and lead change. A study conducted by Herold, Fedor, Caldwell, and Yi (2008) showed that “transformational leadership and individuals’ commitment to change were significantly positively related” (p. 353). They found that the transformational leaders “get more ‘buy in’ to an organizational change” (Herold et al., 2008, p. 353). This graphic is a representation of the interacting traits that transformational leaders possess. At the core of a transformational leader is the personal qualities and core values of being honest, consistent, and acting with integrity. Marshall (2011) also discusses this as being important to being an authentic leader; “to be real, to possess sincerity, honesty, and integrity” (p. 33).
During change, transformational leaders must also engage individuals, showing concern and encourage questions. They must engage the organization and inspire others by supporting a developmental culture and focusing team effort. To continue progress and move forward together, they must build a shared vision, network, resolve conflict; to be sensitive when facilitating change.
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8. Accountability, Credibility and Change
Personal and team accountability
Leading by example
Credible and honest
Ethical and moral values
Driving force for leaders
Personal mission statement
Commitment to a goal
To inspire change for an entire organization, transformational leaders must also represent personal and team accountability. Leading by example will promote personal accountability for the team. Accountability represents trustworthiness and credibility. Leaders are accountable to themselves, their followers, and their organization. “Followers want to know that the leader is ‘truthful, ethical, and principled’ with integrity and character synonymous with honesty” (Carroll, 2005, p. 149). Leading this way must be grounded “to a foundation of ethical/moral values that includes the self discipline to stick to your job” (Marshall, 2011, p. 34). And when a change such as this may take time, being grounded in authenticity and accountability will drive long term results (Marshall, 2011).
When initiating organizational change towards nursing retention, leaders should be driven by a personal mission statement to ensure focus towards a goal. This is the driving force behind a change and should carry through all stages of change. Leaders should also be accountable to their goals and their commitment to a goal. According to Marshall (2011), “the goal-focused leader…enables conscientious workers to perform their own jobs more effectively, because they have a better understanding of how their jobs fit with organizational priorities” (p. 30).

9. Nursing Leaders Nurse Administrator (Jody) Nurse Educator (Nina)
Financial incentive
Conflict resolution skills
Balancing staffing concerns
Nurse Educator (Nina)
Commitment to education
Skills of curriculum development and evaluation
In order to create a commitment to change towards nursing retention, the integration and commitment of nursing leaders within the organization is essential to success. In this change strategy scenario, we have assumed the following nursing leadership roles: Jody is a Nurse Administrator for the organization, Nina is a Nurse Educator, Amy is a Nurse Practitioner, and I Mary am Charge Nurse on the intensive care unit for the organization.
“Successful organizations owe their success to the ‘dedication and inventiveness’ of their people” (Marshall, 2011, p. 92). Utilizing the strengths of other nursing leaders will in turn strengthen the mission. First, nursing leaders in the organization should be given incentive towards promoting nursing retention. After explaining the cost of replacing a nurse (up to $64,000 per nurse) Jody, as a nurse administrator would have the financial incentive to promote retention of nurses (Jones & Gates, 2007). Her strengths of conflict resolution and balancing staffing concerns as a nursing administrator would be incorporated into the team.
Nina, as a nurse educator, has a commitment to advocating for nursing education and are responsible “for helping students develop as nurses and…facilitate learner development” (National League for Nursing, 2012, p. 16). With this ongoing incentive for facilitating learning, Nina is motivated to participate in the RN residency program that will help facilitate new nurses transition into practice and further education of experienced nurses. Her strengths of education curriculum development and student evaluation as a nurse educator would be utilized within the team.

10. Nursing Leaders Nurse Practitioner (Amy) Charge Nurse (Mary)
Committed to patient safety and quality patient
care
Advanced knowledge
Education and confidence building
Charge Nurse (Mary)
Workplace environment associate with trust, good communication and quality patient care
Matching preceptor personalities
Remain visible as a leader
Further engaging the nursing leaders, Amy, a nurse practitioner is committed to patient safety and quality patient care. When stressing that high nursing turnover rates “can negatively affect the ability of hospitals to meet patient needs and provide quality care” Amy would be motivated to commit to a change towards the retention of nurses (Chiu, Chung, Wu, & Ho, 2009, para. 1). Her advanced knowledge of patient care and experience could be utilized during the education of new nurses and experienced nurses. She could also integrate new nurses into decision making in inter-disciplinary rounds; giving them valuable decision making practice and confidence building activities.
As a charge nurse, especially in an intensive care unit, I would be motivated to produce a workplace environment associated with trust, good communication, and quality patient care. To ensure this environment, I would want to ensure new and experienced nurses have the confidence to ask questions, trust their coworkers, and feel they have adequate training to perform their job effectively. With the information presented in part one regarding nurses leaving due to inadequate support, I would utilize my strengths as a charge nurse to support the integration of the RN residency program and promotion the retention of experienced nurses. Having experience with the staff of the unit, I could match appropriate preceptor personalities of experienced nurses with the new nurse graduate to ensure compatibility (Twibell et al., 2012). I would remain available and visible to the all staff nurses and evaluate how staff relationships are being built and foster a team work environment.

11. Conclusion Nursing Profession Transformational Leadership
Many aspects to understand to facilitate change
Transformational Leadership
Better commitment to change
Accountability, Credibility, and Change
Required to drive long term results
Nursing Leaders
Utilize strengths of nursing leaders within the organization
Leading change within a professional environment requires understanding of the profession itself. The nursing profession has many aspects to understand including: the management approach, professional relationships, compensation and rewards, patient care delivery system, and professional values. Each must be considered when approaching organizational change.
Transformational leadership in healthcare environments is important to professional organizational change because it has shown to be positively related to individual’s commitment to change (Herold et al., 2008). Included in transformational leadership traits is accountability and credibility. To drive long term results towards change, these traits must be represented and led by example.
Finally, the nursing leaders in this group scenario of nurse administrator, nurse educator, nurse practitioner, and charge nurse would be given the incentive to commit to the retention of nurses and their various strengths would be utilized during the process. Because “effective change does not happen within the purview of a solitary leader” but with the knowledge, expertise, and strengths of a team (Marshall, 2011, p. 92).

12. Conclusion of Group Presentation
Nursing shortage as a healthcare issue
Nursing turnover
Inadequate support, emotional/physical stresses, and role adjustment
High costs associated with turnover
Nursing retention
Lewin’s Change Theory: Unfreezing, change, refreeze
In conclusion of the group presentation, the growing nursing shortage has been identified as a major health care issue that could be mitigated by instituting major organizational change towards the retention of all nurses; new graduates and experienced nurses alike. Causes of nursing turnover include inadequate support from preceptors, management, and nurse educators, emotional and physical stresses associated with understaffing and unhealthy work environments, and trouble transitioning to a new role. The high costs of nursing turnover has been outlined to support the need to address this issue.
We propose a change strategy to promote the retention of new graduate and experienced nurses that incorporates the three stages of Kurt Lewins Change Theory: unfreezing, moving to a new level or changing, and refreezing. Details of how this theory could be applied towards the retention of nurses has been outline including unfreezing old beliefs, changing to new innovative ideas, and refreezing towards improvement.

13. Conclusion of Group Presentation
Theory-informed behavior change
Evidence based practice, identify barriers, include key stakeholders, identify measureable goals
Leading in a professional environment
Professional Practice Model for Nursing
Transformational leadership
Accountability and credibility
Nursing leadership roles
We have outlined steps towards a change process based on this theory including identifying evidenced based practice that aids our change process, identify barriers to this change process, include key stakeholders who will contribute to the behavior change, and identify measureable goals after initiating change.
Also, in order to lead in a professional environment, the nursing profession must be understood in its various components. We have used Hoffart and Woods professional practice model to identify the subsystems of nursing to better facilitate change based on the unique needs of the nursing profession and the organization we intend to change. Transformational leadership traits are important to obtaining ‘buy in’ for members towards organization change and the core of transformational leadership is rooted in values of accountability and credibility.
Nursing leadership roles that we have assumed during the presentation have been discussed and their strengths that could aid in this change have been outlined. Each nursing leader must be invested to aid in the issue of nursing retention to ensure this change strategy succeeds.

14. References
Carroll, L. T. (2005). Leadership skills and attributes of women and nurse executives: Challenges for the 21st century. Nursing Administration Quarterly, 29(2), Chiu, L. Y., Chung, G. R., Wu, S. C., & Ho, H. C. (2009). The effects of job demands, control, and social support on hospital clinical nurses’ intention to turn over. Applied Nursing Research, 22, Retrieved from: Herold, M. D., Fedor, B. D., Caldwell, S., & Liu, Y. (2008). The effects of transformational and change leadership on employees’ commitment to change: A multilevel study. Journal of Applied Psychology, 93(2), p doi: / Hoffart, N. & Woods, Q. C. (1996). Elements of a nursing professional practice model. Journal of Professional Nursing, 12(6), Retrieved from: Jones, B. C. & Gates, M. (2007). The costs and benefits of nurse turnover: A business case for nurse retention. The Online Journal of Issues in Nursing, 12(3). doi: /OJIN.Vol12No03Man04 Marshall, E. S. (2011). Transformational leadership in nursing: From expert clinician to influential leader. New York, NY: Springer. National League for Nursing. (2012). The scope of practice for academic nurse educators. New York, NY: National League for Nursing. Twibell, R., St. Pierre, J., Johnson, D., Barton, D., Davis, C., Kidd, M., & Rook, G. (2012). Tripping over the welcome mat: Why new nurses don’t stay and what the evidence says we can do about it. American Nurse Today, 7(6). Retrieved from: