Identification  of a Needed Change
As unit manager in a long term care unit within a larger facility, there are sometimes inequities in terms of staff usage. Sometimes we have a lack of nurses in the long-term unit, while there are plenty of nursing staff available in the skilled nursing units. Unfortunately, the skilled nursing staff are often reluctant to fill in when the long-term care unit needs temporary help.  To address this problem, I would like to try using “floating nurses” who are specifically hired to fill in wherever the need is greatest.  Lewin’s theory of change notes that organizational changes are done in a 3-step process of unfreezing the existing state, making a change, and (if the change worked) making the change permanent (Kritsonis, 2004).

Implementation Steps for that Change
Our facility always has nursing staff openings. The goal would be to begin with one floating nurse per shift.  If after 3 to 4 months, this seems to work well, we would then move toward moving to 2 to 3 floating nurses per shift. The 3-step implementation plan includes:

1. Unfreezing the existing system by
• Gaining approval from the CNO of the organization to try this process.  This also means working with the unit manager of the skilled nursing unit to build a consensus.
• Identifying the necessary skills and requirements for floating nurses.
2. Making the change by:
• Working with HR to use existing nursing reqs to hire 1 floating nurse per shift. This also requires identifying the manager who would determine where the floating nurse would work (i.e., long-term or skilled nursing units) on any given shift.
3. Making the change permanent by:
• Monitoring the usage and effectiveness of the floating nurses to determine where they work most often, how effective they are in each of the units, and so on. If successful, make the change permanent.

Impact of Change on Stakeholders
Working as an evidence-based nurse manager means being willing to try small experiments to see if they work and using the evidence of those trials to determine organizational changes (Pfeiffer & Sutton, 2006).  By doing a small-scale trial, using existing open nursing requisitions, this idea can be tried with no budgetary impact for stakeholders. By hiring nurses who are able and willing to work both long-term care and skilled nursing units we can improve patient care by ensuring capable, talented nursing staff.  This also ensures that staff in both units are not overworked because of a temporary lack of help.  Thus stakeholders of all levels gain, and budget is not impacted.

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