Date of Submission

8-16-2020

Document Type

DiP

Degree

Doctor of Education

Department

Education

Keywords

New Graduate Registered Nurses, Practice readiness, Academic Service Partnership, Kotter’s eight-stage process of major change, Critical Theory, Return-on-Investment (ROI) methodology

Abstract

New Graduate Registered Nurses’ (NGRN) lack of practice readiness is a Problem of Practice (PoP) impacting hospitals. Stemming from the evolving complexity of today’s healthcare environment and the generalist nature of the baccalaureate nursing program, the lack of NGRN practice readiness increases hospital-based orientation costs, patient safety risks, and NGRN attrition. There is currently no formal structure in which key stakeholders can address the NGRN lack of knowledge, skills and judgment and the associated implications for the safety and quality of patient care. This Organizational Improvement Plan (OIP) examines NGRN practice readiness within the organizational context of the Health Centre (HC), a Canadian academic health sciences center, and explores possible solutions. Nadler and Tushman’s (1980) Congruence Model of Organizational Behavior is used to perform a critical analysis of the HC’s current state and determine needed change. Consideration is given to the political, economic, social, cultural and historical influences shaping this PoP

The Change Leader (CL) draws on authentic leadership, collaboration theory, principles of influence and inclusion, and adaptive leadership theory to develop a comprehensive change plan. Viewing the disempowered position of nursing students, NGRN, and patients through a critical theory lens highlights the need to remove structural barriers and enable equitable participation of all stakeholders in the change process. The HC operates as a complex adaptive system (CAS) and, in light of complexity theory, the proposed emergent change is guided by broad, system-level goals. Three possible solutions to this PoP are reviewed. Based on Kotter’s eight-stage process of major change, a plan to establish an Academic-Service Partnership (referred to as the ‘Alliance’) is described. Throughout the change plan attention is given to the empowerment of key stakeholders: nursing students, NGRN, and patients.

The evaluation component of the change plan incorporates a Return-on-Investment (ROI) methodology to identify both the monetary and intangible benefits of the proposed change. A multi-strategy communication plan designed to align with and support the corresponding stages of the planned change is outlined. This OIP proposes a model which provides the structure required to address NGRN practice readiness. In future, this solution has potential application for other healthcare professions and their transition into professional practice.

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