Programme: FOUNDATION DEGREE NURSING ASSOCIATE

APPRENTESHIP/INDEPENDENT ROUTE

Module Title: Enhancing Skills: Developing Leadership

Knowledge and Evidence Based Practice for the Nursing
Associate

Module Tutor: Andrea Mason & Shaun Kershaw

Essay Title: REPORT

Student Number:1915948

Date:10/11/2022

Word Count 4000

Abstract

The title is change and leadership in healthcare, linking the two for a common goal for

development. The report will discuss shift changes in hospitals. It will use effective

leadership frameworks and theories of change management to explore and investigate how

problems with shift changeovers can be improved and how change can be implemented. The

report has focused on the application of individual experiences in the respiratory ward with

patients moving from one ward to another at times like 6am to 8am or 6pm to 8pm. This

aspect has been important to assess recent changes in shifts and management of patients in

wards. The report has developed a detailed discussion on the value of change and its

relevance in the healthcare, keeping the context of day and night shift and emergency patient

admission in consideration. Following this, the research has focused on a detailed evaluation

of shift changes using teamwork amidst the heavy pressures of patient care which could face

problems during change of duties.

Page 1 of 31
Introduction

Shift changeovers and additional care systems are integral to work management in healthcare

centres worldwide (Allan et al., 2021). Transitioning care services for patients during change

of duties requires a proper infrastructural system and experienced teams of nurses and doctors

(Herbst et al., 2018). However, one cannot select any person for such practices as they

require special training and expertise together with proper allocation and classification of

duties staff (Hargreaves et al., 2022). Proper supervision of leaders and schedulers is

necessary to ensure effective care of patients entering hospitals during shift changes. The

report will assess the need for change and leadership development during rotational shifts

between day and night staff. The report will explore different models to assess the needful

skills that leaders and managers in all nursing departments must exhibit during patient

admissions. The paper will try to deliver a seamless understanding and functioning of

healthcare duties and shifts.

Individual Role and Evolution

This report will be focusing on the work of nursing associates within a respiratory ward

during am and pm handovers. Specific attention will be given to identifying the key issues

which are linked to lack of information within a handover and limited understanding of

patient history.A nursing student at work gives the medication under supervision, makes

referrals to certain departments in the hospital depending on what the problems are, checks

the patient's deterioration and reports to the doctor (Kok et al., 2022). Here, I have been on

the respiratory ward. It would be good to mention that in between 6 pm and 8 pm or 6 am and

8 am, transfers from one ward to another are not made since there is an organizational policy

which needs to be adhered to. As in my case, I have joined as normal nursing staff in the

NHS special unit for special care. Since there is not enough staff strength in different

Page 2 of 31
departments and demand for efficient professionals in multiple units, I was assigned with

other responsibilities which I was supposed to deliver in emergency ward. Typically, the

leaders who govern the staffing management and supervise care delivery to the patients

discuss and evaluate the roles and responsibilities of each individual. And they finally decide

how to allocate duty and care approaches to the professional according to the requirements

based on the staff availability (Lodenstein et al., 2017).

Importance and Relevance of Effective Leadership in Healthcare Delivery

Leadership is an integral part of the total system of care and nursing (Dafny and Beccaria,

2020). All healthcare across the United Kingdom appoints departmental heads who are

experienced in tackling teams and guiding them in different patient care situations and

medical conditions staff (Hargreaves et al., 2022). For example:

 Leadership inspires employee efforts

 Enhances the safety and secured application of healthcare practices by the

professionals to cater to the patients with utmost precision and eliminates the potential

risks.

 They supervise and proactively assess the needs and implement strategies to upgrade

and enhance the healthcare delivery to strengthen patient outcome

 Leaders ensure a proper change management and adaptation into the practices

 Leaders assess employee capabilities and channelize their efforts through effective

development and re-skilling approaches

When accurate leadership is not implemented into the healthcare system, the biggest impact

is observed among the employees.

 Employee stress increases

Page 3 of 31
  Lack of employee motivation

 Poor task management

 Weak execution of allocated responsibilities

 Quality of healthcare deteriorates

 Safety concerns related to healthcare delivery

 Poor employee retention and increased employee turnover

 Increased cost of healthcare

As for my case, I was the direct contact with the hospital superintendents and NHS board for

duty reliefs between day and night shifts. It is important for a nursing associate to know all

about the patient they are being handed over with which is however the rare case in many

hospitals. The importance and relevance of transparency is however neglected in many

healthcare institutions which hinder the appropriateness of a nursing practices and often leads

to inconsistent decision-making (Milton, 2009). Hence, I have often ended up with the patient

being in my ward or duty during the allotted time without any prior information. It hinders

my conduct and has put me through many issues given that I rarely know what medications

are necessary or what is the patient’s medical history. It is a serious safety compromise in

terms of the patients wellbeing as there is no prior record been provided to me to evaluate the

patient’s healthcare information and history. It is a matter of concern in my area of

professional conduct as well since I might not get adequate understanding of the patients

which might reflect in the patient outcome and the uninformed shift can lead to sever and

fatal consequences. It is necessary for me to know which patients are in my department and

how to provide them with the utmost care and precision of treatment based on their past

treatments and medications. Transparency is required to ensure safe and secured treatment for

every patient.

Page 4 of 31
However, it is important to note that care had not been so effective before the incident in Mid

Staffordshire (Romero et al., 2020). The scandal of poor care services in hospitals of the

location in 2013 has made all healthcare units across the UK focus on training leaders and

employees on modern healthcare processes (Romero et al., 2020). Considering the present

situation, meeting the demands of the population in terms of early care and proper

observations and reporting are some common areas faced by both day and night staff

(Romero et al., 2020).

Another crucial aspect to note here is the impact of leadership on the ward culture.

Strong medical leadership is essential for creating a safe working environment for patients.

Leaders can better ensure the safety of their staff and patients if they create a climate of

psychological safety in which workers and patients feel comfortable raising problems and

addressing concerns. Greater work satisfaction, less stress, reduced healthcare mistakes, and

an enhanced culture of safety are the end results of leaders who foster a healthy

organisational climate (The Anesthesia Patient Safety Foundation, 2020). The ease with

which personnel (whether clinical or support staff, new or veteran) raise concerns about

potential safety issues is a key indicator of a healthy safety culture. Because of the

importance of learning from mistakes, near-misses, and hazardous circumstances, it is crucial

that leaders promote open communication within care teams. One way to achieve this goal is

to promote reporting that is both open and not met with retaliation.

Leaders should not only participate in but actively advocate for initiatives to eliminate

coercive conduct. Patient safety might be jeopardized when employees' lack of

professionalism is overlooked (The Anesthesia Patient Safety Foundation, 2020). If

inappropriate conduct is not addressed in a consistent and open way, it will continue and send

a message to new hires that it will be allowed, which might lead to an increase in such

Page 5 of 31
behaviour. Taking action against disruptive workers' unprofessional behaviour may boost

workplace happiness, engagement, image, quality care, risk assessment, and overall quality of

life. The culture of a company may have a significant impact on both quality and patient

safety. 

The process of shift changeovers between day and night nurses and emergencies have been

challenged by lack of experience in cases (Norrie et al., 2020). Critics state that a need for

upgrades was also felt while the healthcare system was working together, particularly when

handling nurses of day and night in groups (Norrie et al., 2020). It came with an urgency for

external support to patients and families while retaining internal coordination in changing and

retrieving nurse duties (Norrie et al., 2020).

The value of leadership is evident in the mode of conduct of leaders and managers in

different situations as individuals and teams (Nmc. 2022). Following the professional duty of

candour, every healthcare leader and member must maintain transparency and honesty in

their conduct (Nmc. 2022). Thus, the leaders should convey all patient information to the

teams on duty and to retrieve, be it day or night. They should avoid any form of negligence

and aim for coordination between team members with proper motivation (financial or non-

financial) (Kegan, 2018) However, the accountability of all staff should be to the leader

regarding their own responsibilities and how they have considered executing the processes

and tasks\, reporting all their conducts and information regarding the patients and constant

updates are important to keep in mind (Kegan, 2018). Thus, ideally, a leader should guide all

staff about professional codes. The code of candour also suggests that all healthcare staff and

leaders are responsible to patients and the organisations they work under ( NMC, 2022). As a

leader, it is therefore important to follow an inclusive leadership style that helps teams to

understand and appreciate the value of services with their contributions, particularly when

handling new patient entries (Kegan, 2018).

Page 6 of 31
According to Kegan (2018) leadership helps to develop a sense of accountability and

acknowledgment of personal and cultural differences in hospitals. Automatically, nurses can

improve their coordination and teamwork in handling duties and handovers respectively I

have also experienced that nurses in my hospital are facing new patients after their resting

hours. Like they are discharged from duties of one patient and moved to another patient in the

wards without their own notice. As a result, the new patients admitted between either 6am

and 8am or 6pm and 8pm are rarely getting the care they expect from us, the lack of

transparency regarding nurses’ duties of newly admitted or shifted patients to their own unit

reduces proper care possibilities, sometimes there is no handover report as well making it

difficult and unsafe for any professional conduct (Fealy et al., 2019).

Applying the participating style, leaders like matrons or nursing associates guide staff on the

duties allocated and changes in day and night shifts from time to time (Vafaei et al., 2018). In

most cases, such allocations involve a team-based discussion to understand any problem. The

participating leadership style is principled on proactive engagement of nurses and attendants

(Vafaei et al., 2018). Thus, this style of leadership helps nurses to find the appropriate

guidance in patient care and history of medical information. They can acquire proper training

and learning to convey the same to others. Thus, it is opined that a nursing associate can plan

an agreeable routine that gives team members time to relieve each other timely and discharge

duties with information exchange (Vafaei et al., 2018). Similarly, any change is conveyed

through general meetings in linking day and night staff particularly when facing an

emergency patient admission.

However, authoritative or assertive leadership styles are never ideal for healthcare standards

and change (Rofuth and Piepenbring, 2019). They create a pressured work-environment and

they try to micro-manage tasks which can decrease employee satisfaction and morale. They

do not believe in giving feedback and restricts the potential of skilled workers. These involve

Page 7 of 31
a heavy stimulation of forced approvals which minimise the performance of teams and

internal efficiencies. Rather, coach leadership is believed to positively influence teams. It

allows the staff to learn from leaders on care in special cases like shift change and care,

easing regular activities (Rofuth and Piepenbring, 2019).

Change management and Introduction of New Change to the Existing

Approaches

Skills and Approaches to Execute Change Successfully

Every nurse or doctor in the UK healthcare centres must submit a report at the end of the

shift, listing their current medical status of the patients under their supervision and daily

activities (Syrek et al., 2022). There should be a proper update on every treatment or care

output so when the shift ends and patients are transferred to other words, they get the

information properly compiled to continue the treatment without any error. The report is of

high value as it helps to verify the pressures that staff face individually and their

contributions. The healthcare institutions’ allocation of duties and shift changes are complex

due to lack of transparency and shift handover and employee management. It is because

routines tend to clash for several staff, creating conflicts within the appointed staff. The need

for shift changeovers has become more essential as workloads for healthcare professionals

have increased since the rising patient admissions since the covid-19 pandemic (Syrek et al.,

2022).

Evidence during recent services shows that several staff could not handle the sudden

admission of new patients during shift changes (Ko and Chou, 2020). I have also faced many

conflicts in the process of managing duties and allocations. Therefore, it was vital in handling

duty discharges between day and night staff. The pressure on the limited staff has risen with a

Page 8 of 31
shortage of people to work in all departments of the NHS (Ko and Chou, 2020). Thus,

creating an effective team to rescue appointed staff duties is vital to ease the pressures of

observations, especially for critical patients (Ko and Chou, 2020). These includes reflection

of core values like coordination, mutual respect and inclusivity, tram building and problem-

solving skills, and most importantly, proactive leadership with a participating mindset to

engage other nurses and associates (Papachristou, 2019).

Based on work practices in the last few years, an interesting observation in UK healthcare is

the acceptance of duties and shift schedules (Kok et al., 2022). Like others, nurses have been

working tirelessly, day and night, to serve new and existing patients in hospitals (Ko and

Chou, 2020). Members of both the shifts have also been stressed because of mismanagement

and lack of effective leadership to guide teams (Ko and Chou, 2020). However, other leaders

and managers have constantly faced issues aligning a proper routine for all nurses working in

the NHS hospitals. Thus, the shift change is now being motivated by nurses’ health and

wellness (Kok et al., 2022). Following the shift pattern change law, no nurse can work

continuously for over 48 hours in the hospitals (Group, 2022). However, there have been

incidents when staff have served for over three consecutive days in the hospitals to attend to

special patients (Group, 2022). Such stressful shifts in departments, both general and private,

made it difficult to discuss and discharge duties from my part while running beyond 24 hours

at a stretch. Thus, in between the entire day and night staff, additional rescue staff are

mandatory in departments to retain effective patient care (Group, 2022).

Leaders' contribution and understanding of employee issues are undeniable in any situation.

A leader's efficiency in hospitals has allowed staff to retain their patience even under stressful

conditions. However, effective staff training is also vital considering the limitations of

staffing and rushes in hospitals. Thus, the report identifies a plan via effective change

management and leadership styles to improve communication between day and night staff via

Page 9 of 31
internal training throughout different wards. These can help to improve the efficiency of all

staff (Hargreaves et al., 2022).

The first skill critics have used to execute the change in nursing culture is communication

(Godfrey et al., 2020). Effective communication between healthcare providers and their

patients is essential to provide safe and effective care that meets the needs of each individual

patient while also protecting the safety of the carers delivering that care (Lotfi et al., 2019).

The communication skills include listening and active participation skills to educate one and

all about new schedules and processes. The next skill in use is the research skills that allowed

leaders to assess staff workloads daily in the last two years (Godfrey et al., 2020). Unlike

other skills, these have been used extensively to locate the problems that healthcare staff like

us face. It has also given updates on further improvisations. Expert nurses also think proper

information exchange between matrons and general nurses can help to negotiate and retain

positive work environment in the hospitals during shift transitions (Godfrey et al., 2020).

The first skill that nurses critically acclaim to have is empathy. The display of empathy is a

major trait to motivate and support teams in any situation . Professor Michael West done lots

of compassionate leadership research in NHS where he is spoke about issues and underlying

issues where it’s keeping the NHS leaders very busy. He is supporting the health education

and developed on improvements on leadership development (Michael West et al, 2020)). In

this case, empathy exhibition can be applied to setting the routines for individual staff in

different departments (Research Gate. 2022). Interestingly, the time reduction for shift

changes and allocations in all wards is intended with empathy for limited employees serving

since the pandemic's beginning.

The next attribute that healthcare leaders must inherit is logical decision-making and strategic

planning (Mardani et al., 2019). It is of high value considering the need to attend patients in

Page 10 of 31
different units through proper care and supervision. The report believes division of the

timetables for staff requires intense research that the leaders have accommodated in the

healthcare facilities at different points (Mardani et al., 2019). In this case, the critics have

shown the efficiency of communication, particularly interpersonal engagement to support

each other and patients coming in regularly (Mardani et al., 2019). Communication has also

helped to plan which ease out the experience with new patient who are admitted with severe

medical conditions.

The change management could have been more effective if nurses had used additional skills.

Self-awareness is one of these skills that all individuals should be trained in the process of

development (Estacio et al., 2017). It would have helped staff manage their mental and

physical stress levels at different levels in shifts. Leaders also needed to educate the staff to

be more patient and perseverant toward patients (Estacio et al., 2017). It could help them to

retain good communication within themselves also in discharging nursing duties and

attending newly admitted patients. When a patient moves from one ward to another, they call

and fill out a form that informs them of questions about the patient. Consequently, many of

the nursing associates don't know anything about the patient or what medications or

supervisory care is necessary for the concerned case (Estacio et al., 2017).

Proposed Change Initiative

Considering my own experience regarding shift management and handover, it is necessary to

have a strategy present in the institution that enable the leaders to effectively manage the

patients while properly allocating duties to the nurses and other supporting staffs according to

staff availability. The implementation of an online staff registering system can be considered

to properly oversee the staff availability and accordingly allocate the tasks based on that. It

will allow the manager and leaders to see who is available and how many patients are being

Page 11 of 31
allocated for each nurse or supporting staff. Virtual teams can also be formed using advanced

software to promote coordination and allow flow of information so that errors can be

avoided.

I. Kotter's Change Model

Kotter's change model involves eight distinct steps aimed at empowering organisations in

handling innovation and transformation (Healthknowledge, 2022). Kotter's model is also

based on evolving the needs to accommodate developments and speed transformations by

fulfilling needs as per urgencies (Healthknowledge, 2022).

The eight steps being discussed in the model are the core elements that nurses should opt to

create team engagement in any hour of the day. The urgency here is patient care for which

detailed information and history of patients being handed over is necessary (Crayne and

Medeiros, 2021). Applying this model, nursing leaders can guide the associates on the right

vision and values which help care practices (Crayne and Medeiros, 2021). That way, the

nursing associates can acquire short-term wins like timely medication and emotional support

to the handed patients irrespective of the wards being transferred to (Crayne and Medeiros,

2021). Additionally, the nursing associates could learn to generate team values and

cooperation which is ethical and crucial in the healthcare profession.

II. NHS Change Model

It is clear from the above figure that change model of the NHS is focused on a systematic

process that supports management and measurement of performances (NHS England, n.d)).

Applying it to the contexts of the problem, sharing of purposes is crucial in making nurses

capable of understanding why patient information is crucial. It means that the nursing

associates will be educated about the system of adoption with agility ideologies like lean

services. Focus needs to be laid on motivation of the nurses with adequate and prior notices

Page 12 of 31
on new patients being handed over to them (NHS England, n.d). The model should be

effective in creating interests among nurses to learn about patients based on financial or non-

financial motivation. Thus, applying this model, the nursing associates can stabilise their

internal communication to make clear discussion on patients being admitted or handed over.

Preferred Model

Based on above inputs, the NHS model is considered a better choice or Kotter’s or Lewin’s

models. The reason is that this model focuses on the shared vision and measurement of

individual performances alongside teamwork. Critics opine the idea tends to be highly

utilitarian among nursing associates aspiring for evolving work cultures (Healthknowledge,

2022). It will assist the shift handovers to make processes smoother with positive engagement

between nurses dealing with a concerned patient.

Enablers

Among enablers, mention should be made about the interest that nurses can inherit based on

proper motivation from the change traits. It can be financial or non-financial with a focus on

workplace training which could enhance their contributions in shift handovers by improving

information exchange on patients between am and pm nurses (Research Gate. 2022).

Barriers

Resistance to change is the only barrier that nurses could offer. However, the lack of insights

on the model could be a reason leading to misinterpretation of the NHS change model and its

ideologies to shift management and patient care during handovers (Research Gate. 2022).

Based on the Appendix 3, it is deduced that communication is a needed process that promotes

the performance of nurses (Change-management-coach.com. 2022). However, the lack of

leadership and effective control on nursing teams and associates could hinder the process of

Page 13 of 31
change being planned in shift handovers or information transfer on patients (Gbadamosi and

Gbadamosi, 2022).

On the one hand, barriers like the rising cases and patient ailments issued problems in

allocating nurses to respective cabins and wards. Following the Gantt Chart in Appendix 2, I

think these delayed the process of care for patients during shift changes. On the other hand,

the professionals were prompt in attending critical patients throughout the day.

Creating a change team has been mandated across the healthcare unit to solve scheduling

problems (Zarzaur et al., 2020). However, a new team has to include a directorial board with

at least two members with an experience of over five years. Also experienced people should

come from both doctors and nurse groups. It is because they have the knowledge and

experience to educate other hospital staff on problems to come further (Zarzaur et al., 2020).

They are also good advisors on change policies and can execute the command necessary.

Other members of the team should also be participating in different meetings.

According to Zarzaur et al (2020) believe process of leading the new team requires the

alignment of specific practices. Communication is the first aspect that the new team would

incorporate . Effective communication is essential to retain good terms between the

healthcare professionals, patients and families. Alongside, the nurses need to get trained on

impulse control and self-awareness to ensure utmost professionalism while handling urgency

cases. Team coordination and group development are also critical for the success of nurses

during shift changes. Following the goals from Appendix 1, extensive implementation of

motivation, financial and non-financial, is necessary among all staff to ensure a sense of

value and belonging. Motivation has been noted to positively impact the mind-set of doctors

and nurses in the care process. However, individual and team accountability will be

prioritised here to retain a sense of responsibility in conduct and behaviours.

Page 14 of 31
Specific theories can also be aligned for advanced learning and practice in teams. For

example, Maslow's needs theory is valuable in tracing the needs of healthcare workers based

on their daily shift end reports (Hopper, 2020). Similarly, coach leadership can help leaders

communicate and guide team.

Evidence supporting the value of these methods lies in the current situation. Healthcare

centres of all sizes have relied heavily on teamwork for which both day and night staff have

co-operated and understood the needs clearly. Nurses have successfully tackled patients in

multiple wards in the last few weeks. Again, they have also worked overtime with effective

communication between day and night nurses. The change is therefore expected to ease staff

experience by lowering healthcare pressures. Following the inhibitors in Appendix 3,

effective implementation of communication and team building skills can help authorities to

teach nurses about ward care and attendance during emergencies.

As a change leader, my responsibility would be to ensure that the nurses have access to all

resources and communication. For this, need to interact personally with the nurse teams on

their ease in delivering duties. As in Appendix 1, it is the responsibility of all staff to discuss

the issues and assist in special cases whenever necessary. Thus, shift changes can be made

negotiable wherein one nurse could do overtime in case of urgencies also ensure that

overtime pay are increased to appreciate the hard work which day and night nurses offer in

emergencies (Zarzaur et al, 2020)

There are many ways to measure the effectiveness of changes being issued to ease hospital

work experiences. The first and most important tool I have understood is the handover report

of doctors, nurses and other staff at the end of their shifts. Details fed here could help to

assess the level of implementation of change in shifts and recovery staffing in the hospital.

Next, the handover sheet has also helped to examine the different departments that healthcare

Page 15 of 31
staffs have been a part of or attended in specific tenures (Research Gate. 2022). These come

along with their feedback on the report which helps to locate problems and improvements in

duties and discharges of nurses from their shifts. Another tool to evaluate the efficiency in my

opinion is ethics feedback. It is an ideal tool allowing every staff in the hospital to approach

the authorities anonymously, stating their issues and responses at work. As sustained from the

goals stated in Appendix 1, the leaders and directors could personally handle any problem in

the shifts when admitting a new patient. Even the efficiency of leadership in the change team

must be reported timely using feedback forms that the hospital administration hands over to

all employees. Similarly, patients can share a feedback on the staff and care given. Clinical

audits can be tallied regularly to enhance patient services (Granger, 2019). Care providers

and patients both benefit from clinical audit, since it reveals whether or not their service is

meeting standards and highlights areas for development. 

SMART Analysis of Changes Suggested

Changes Specific Measurable Achievable Relevant Time Bound

Avoiding ✓ ✓ ✓ ✓ Around 6
entry of new months
patients
during shift
change in
hospital
Proper ✓ ✓ ✓ ✓ At least 8
Training of months
the day and
night staff on
patient duties
and
emergency
care

Page 16 of 31
 Analysis of ✓ ✓ ✓ ✓ One year
Teams using
Leaders
capable of
Coach
Leadership
Merging ✓ × ✓ ✓ One year
Practices and 3
with months
Consultations
to Hospital
Authority
Table 1: SMART Analysis

(Source: Self-created)

Following the contexts of Appendix 1 and Appendix 2, the SMART goals involve specific

changes which can help my team to evolve individual practices in care. These would focus on

completing all tasks within a year and a half. Also, measuring the progress is likely to focus

in records and comparison of previous and future reports. That way, we can keep trace of

efficiency in patient attendance and entries during shift change.

Conclusion

It is conclusive from the discussions that change shifts and rotation duties for staff have

become prominent concerns at present. The report highlights that limitation of staff and lack

of skilled professionals have been some crucial reasons that complicated the situations. The

limited workforce finds it difficult to handle the pressures and rotations from special to

normal wards as I have already observed as a staff. Using the change models, it has been

easier to list the pros and cons of change and stages that can improve team engagement,

communication, and motivation.

Page 17 of 31
Page 18 of 31
References

Allan, J., Webster, E., Chambers, B. and Nott, S., 2021. “This is streets ahead of what we
used to do”: staff perceptions of virtual clinical pharmacy services in rural and remote
Australian hospitals. BMC Health Services Research, 21(1), pp.1-11.

Change-management-coach.com. 2022. [online] Available at: <https://www.change-

management-coach.com/force-field-analysis.html> [Accessed 30 June 2022].

Crayne, M.P. and Medeiros, K.E., 2021. Making sense of crisis: Charismatic, ideological, and
pragmatic leadership in response to COVID-19. American Psychologist, 76(3), p.462.

Dafny, H.A. and Beccaria, G., 2020. I do not even tell my partner: Nurses’ perceptions of
verbal and physical violence against nurses working in a regional hospital. Journal of clinical
nursing, 29(17-18),pp.3336-3348.
Estacio, E.V., Oliver, M., Downing, B., Kurth, J. and Protheroe, J., 2017. Effective
partnership in community-based health promotion: lessons from the health literacy
partnership. International journal of environmental research and public health, 14(12),
p.1550.

Gbadamosi, N. and Gbadamosi, N., 2022. What are the barriers to implementing change in
the NHS? | Nursing Times. [online] Nursing Times. Available at:
<https://www.nursingtimes.net/opinion/what-are-the-barriers-to-implementing-change-in-
the-nhs-11-02-2015/> [Accessed 30 June 2022].

Gensleron.com. 2022. Six Key Drivers Transforming Healthcare Business - Urban Planning
and Design - architecture and design. [online] Available at:
<http://www.gensleron.com/cities/2016/7/14/six-key-drivers-transforming-healthcare-
business.html> [Accessed 30 June 2022].

Godfrey, M., Green, J., Smith, J., Cheater, F., Inouye, S.K., Hurst, K. and Young, J., 2020.

Process of implementing and delivering the prevention of delirium system of care: a mixed

method preliminary study. BMC geriatrics, 20(1), pp.1-15.

Page 19 of 31
Group, C., 2022. Shift Pattern Change Laws | Croner. [online] Croner. Available at:

<https://croner.co.uk/resources/employment-law/shift-pattern-change-laws/> [Accessed 30

June 2022].

Hargreaves, C., Clarke, A.P. and Lester, K.R., 2022. Microsoft Teams and team performance

in the COVID-19 pandemic within an NHS trust community service in North-West

Healthknowledge.org.uk. 2022. Critical evaluation of various principles and frameworks for

managing change | Health Knowledge. [online] Available at:
<https://www.healthknowledge.org.uk/public-health-textbook/organisation-management/5c-
management-change/critical-evaluation> [Accessed 30 June 2022].

Herbst, L.A., Desai, S., Benscoter, D., Jerardi, K., Meier, K.A., Statile, A.M. and White,
C.M., 2018. Going back to the ward—transitioning care back to the ward team. Translational
pediatrics, 7(4), p.314.

Kegan, R., 2018. What “form” transforms?: A constructive-developmental approach to

transformative learning. In Contemporary theories of learning (pp. 29-45). Routledge.

Ko, C.H. and Chou, C.M., 2020, April. Apply the SERVQUAL instrument to measure

service quality for the adaptation of ICT technologies: A case study of nursing homes in

Taiwan. In Healthcare (Vol. 8, No. 2, p. 108). MDPI.

Kok, E.D., Weggelaar, A.M., Reede, C., Schoonhoven, L. and Lalleman, P., 2022. Beyond

transformational leadership in nursing: A qualitative study on rebel nurse leadership‐as‐

practice. Nursing Inquiry, p.e12525.

Lodenstein, E., Mafuta, E., Kpatchavi, A.C., Servais, J., Dieleman, M., Broerse, J.E.,
Mambu, T. and Toonen, J., 2017. Social accountability in primary health care in West and
Central Africa: exploring the role of health facility committees. BMC health services
research, 17(1), pp.1-15.

Mardani, A., Hooker, R.E., Ozkul, S., Yifan, S., Nilashi, M., Sabzi, H.Z. and Fei, G.C., 2019.
Application of decision making and fuzzy sets theory to evaluate the healthcare and medical

Page 20 of 31
problems: a review of three decades of research with recent developments. Expert Systems
with Applications, 137, pp.202-231.

Nmc.org.uk. 2022. Read the professional duty of candour - The Nursing and Midwifery
Council. [online] Available at: <https://www.nmc.org.uk/standards/guidance/the-
professional-duty-of-candour/read-the-professional-duty-of-candour/#:~:text=1%20All
%20healthcare%20professionals%20have,who%20are%20in%20your%20care.> [Accessed
30 June 2022].

Papachristou, T., 2019. Finding the'Sweet Spot'Between Centralization and Independence in

Interprofessional Education. California State University, Long Beach.

Research Gate. 2022. [online] Available at:

<https://www.researchgate.net/publication/43351381_Quality_improvement_of_doctors
%27_shift-change_handover_in_neuro-critical_care> [Accessed 30 June 2022].

Rofuth, T.W. and Piepenbring, J., 2019. Management and leadership in social work: A

competency-based approach. Springer Publishing Company.

Romero, E., López-Romero, L., Domínguez-Álvarez, B., Villar, P. and Gómez-Fraguela,

J.A., 2020. Testing the effects of COVID-19 confinement in Spanish children: The role of
parents’ distress, emotional problems and specific parenting. International journal of
environmental research and public health, 17(19), p.6975.

Syrek, C., Kühnel, J., Vahle‐Hinz, T. and de Bloom, J., 2022. Being an accountant, cook,
entertainer and teacher—all simultaneously: Changes in employees' work and work‐related
well‐being during the coronavirus (COVID‐19) pandemic. International Journal of
Psychology, 57(1), pp.20-32.

Vafaei, S.M., Manzari, Z.S., Heydari, A., Froutan, R. and Farahani, L.A., 2018. Improving
nursing care documentation in emergency department: A participatory action research study
in Iran. Open Access Macedonian Journal of Medical Sciences, 6(8), p.1527.

Zarzaur, B.L., Stahl, C.C., Greenberg, J.A., Savage, S.A. and Minter, R.M., 2020. Blueprint

for restructuring a department of surgery in concert with the health care system during a

pandemic: the University of Wisconsin experience. JAMA surgery, 155(7), pp.628-635.

Page 21 of 31
Milton, C.L., 2009. Transparency in nursing leadership: A chosen ethic. Nursing science

quarterly, 22(1), pp.23-26.

The Anesthesia Patient Safety Foundation, 2020. Effective Leadership and Patient Safety

Culture. [Online]. Available at: https://www.apsf.org/article/effective-leadership-and-patient-

safety-culture/ [Accessed on 10th February].

Norrie, C., Moriarty, J., Lipman, V., Elaswarapu, R. and Manthorpe, J., 2020. A qualitative

study of handovers at shift changeovers in five care homes for older people in

Fealy, G., Donnelly, S., Doyle, G., Brenner, M., Hughes, M., Mylotte, E., Nicholson, E. and

Zaki, M., 2019. Clinical handover practices among healthcare practitioners in acute care

services: a qualitative study. Journal of clinical nursing, 28(1-2), pp.80-88.

Lotfi, M., Zamanzadeh, V., Valizadeh, L. and Khajehgoodari, M., 2019. Assessment of

nurse–patient communication and patient satisfaction from nursing care. Nursing open, 6(3),

pp.1189-1196.

NHS England, n.d, Change Model. [Online]. Available at:

https://www.england.nhs.uk/sustainableimprovement/change-model/#:~:text=The

%20Change%20Model%20is%20a,for%20patients%20and%20the%20public. [Accessed on:

10th February]

Hopper, E., 2020. Maslow’s hierarchy of needs explained. ThoughtCo, ThoughtCo, 24, pp.1-

3.

Granger, G., 2019. Communication in the Health Care Setting. Community Medicine, Public

Health & Education [Internet], 2(1).

Page 22 of 31
Appendices

Appendix 1: Short and Long-term Goals in healthcare and shifting duties

Short-term Goals

Within the first ten weeks, healthcare goals will include proper training of day and night staff

to improve communication and coordination for duty discharges and other ward care

services.

Mid-term Goals

Within the first two years, the goal is to acquire coach leadership in all teams to guide day

and night staff particularly for new patient entries during shift change.

Long-term Goals

In the coming six to seven years, the goal is to acquire at least 50 per cent efficiency in

appointing individual staff from day and night shifts to patients. Focus will be on special

wards and recruiting more staff to handle duty transformations with trained communication

and values.

Appendix 2: Gantt Chart for Short-term Goals

Activit Week Week Week Week Week Week Week Week Week
ies 1 2 3 4 5 6 7 8 9

Resear
ch and
identifi
cation
of
individ

Page 23 of 31
ual
potenti
als of
healthc
are
staff
(both
day
and
night)

Sched
uling
of
duties
for
trainin
g and
practic
es of
new
entrant
s

Proper
researc
h on
existin
g and
new
patient
s and
their
duties

Page 24 of 31
in day
and
night
shifts

Comm
unicati
ng
health
reports
and
other
update
s
timely
betwee
n all
staff
with
individ
ual
staffin
g for
special
patient
s

Team
engage
ment
and
coordi
nation
of

Page 25 of 31
memb
ers to
improv
e value
service
s

Retaini
ng a
positiv
e
enviro
nment
with
interna
l
conflic
t
manag
ement
to
attain
50 per
cent
efficie
ncy

Table 2: Gantt Chart

(Source: Self-created)

Page 26 of 31
Appendix 3: Lewin's Force Field Analysis (LO2)

Figure 3: Force Field Model of Change by Kurt Lewin

(Source: Change-management-coach.com. 2022)

Lewin's model of change helps to understand the forces driving and inhibiting the change

agenda in shift allocation and classification among staff (Change-management-coach.com.

2022). It is understood that shifting duties in care is often robust and scalable given the

emergencies in a hospital. However, in this case, supporting and inhibiting factors coexist in

the healthcare centres affecting execution of plans.

The most prominent factors that support the change idea is financial construct. I have faced a

lack of training and remodelling of staff and their interpersonal skills. It is always ideal to

save finances for other functions. Thus, care training should be developed with more

engagement and evaluation of the patient issues during admission in hospitals. Again, the

Page 27 of 31
staff need to evolve their skills in special care for certain wards (Gensleron.com. 2022).

Technological growth in the healthcare system is another driving factor, offering the scope to

employees to learn about new medical infrastructures for faster and convenient care. As for

my case, I have noted several aspects that affect the change of duties and patient entries. For

instance, a major driver that can enhance the implementation is the coordination between

staff that I can generate using motivation and team engagement. I should also use observation

skills to assess the progressions teams have obtained to reflect on the utilities of appointment

to critical patients.

However, some prominent inhibitors also work here. Resistance to change from the staff is

one negative influence in healthcare (Gbadamosi and Gbadamosi, 2022). Thus, staff need to

learn the need of any change for the all-around well-being in hospitals. However, I am also

going to face problems like lack of support from the senior staff in my hospital. They are also

likely to challenge the approach of appointing special staff for critical cases with lack of

members.

Appendix 4: Kotters Eight Step of Change

Page 28 of 31
 Figure 4: Kotter's Model of Change in 8 Steps

(Source: Healthknowledge.org.uk. 2022)

Appendix 5: NHS Change Model

Page 29 of 31
Figure 5: Change Model by the NHS

(Source: NHS England, n.d)

Page 30 of 31