Nursing Leadership and change: CLABSI reduction in the oncology unit
Title: Nursing Leadership and change: CLABSI reduction in the oncology unit
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Introduction
The nursing landscape has seen dramatic changes in the last 30 years, as the nursing profession embraces technology, changed financial pressures and new realities, as well as increased emphasis on evidence-based practice. All these changes are supposed to ensure that patients have the best possible clinical outcomes, as well as ensure the long-term survival of healthcare institutions. Nurses are at the forefront of these changes. As this paper discusses, nursing leadership in improving the quality of the nursing practice is key to the success of such endeavors.
Central Line-Associated Blood Stream Infections (CLABSI)
Central lines are common with long-term care patients. The central lines are needed for long-term venous access so that clinical staff can easily administer medicine and offer other care as needed. Oncology units regularly use central lines for long-term cancer patients. Some patients develop CLABSI due to poor nutrition, advanced age, and the presence of other illnesses such as diabetes, lengthy hospitalization, and the positioning of the central line (Taveira, 2017). While they are treatable, CLABSI can also present serious health complications for patients, leading to poor patient outcomes, prolonged health stays, and even fatalities.
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Effective nursing leadership
In the oncology unit discussed here, the nursing leader aimed to reduce the occurrence of CLABSI by effective collaboration with the nursing personnel. The leader also believed that by connecting with, and self-awareness by the oncology unit’s nursing team, there would be a marked change in how central lines were used and monitored, and therefore, fewer cases of CLABSI. The nursing leader’s priority was to transform the way nurses in the unit viewed and handled central lines, with regard to CLABSI. The nurses needed to better understand the infections, and how they could be minimized.
As a major transformative initiative, all nurses were expected to observe proper hand hygiene before and after interacting with patients. This would reduce the chances of transmitting pathogens to the patients. Before placing central lines, chlorhexidine would be used for skin preparation, thereby sterilizing the area where the line would be placed. All unnecessary catheters would be removed, and none introduced where other means were available. To see the changes in behavior and practice through, the nursing leader challenged nurses to take ownership of patients’ health, and do what they could to ensure the best client outcomes.
Leadership and change theories applied
In effecting the changes, the nursing leader aimed to transform the nursing personnel so that they could adopt a new attitude towards their work in general, and specifically, towards the reduction or eventual elimination of CLABSI in the oncology unit. The nursing leader aimed to change the way the unit went about its duties, expecting the changed behavior and mode of operation would lead to better patient outcomes. To achieve this, the leader wanted to motivate the nurses more and make them feel like important parts of the changes in motion. By co-opting the team in the process, the leader expected, and got, minimal resistance to change, a factor that enhanced the chances of success. This theory can be referred to as the transformational Theory of Leadership. Instead of transacting behavior change with rewards and benefits, the leader wanted to make the nurses partners in effecting the change (Molony, 2020).
Another theory that could be used to explain the actions of the nursing leader is the theory of Planned Change, conceptualized by Lippitt, Watson and Westley. The change started with an acknowledgement by the nurse leader that the present late of CLABSI was unacceptable. Having done this, the leader then performed a readiness assessment on the existing protocols to minimize CLABSI, and how they could be remedied. Having established that the systems were favorable to the proposed change, the leader then examined the readiness of the nurses to effect the change, through a highly interactive exercise to ensure no one was left behind. Participation was seen as a way of minimizing any resistance to the new methods. The nurses were then fully briefed on what was required, and the expected results. Different strategies were proposed, and some implemented to achieve the change. In the change, the nurses would be expected to internalize the need to wash hands regularly, use chlorhexidine, and other methods to minimize infection of patients. Nurses would be expected to widely consult before placing catheters, to establish the medical necessity of such procedures. Having become familiar with the change, the nurses would be expected to maintain the change, and over time, view the changes as part of standard professional practice, rather than a short-term change.
Effective communication and feedback
Throughout the process, the nursing leader was keen to communicate what was expected and provide feedback on the progress and deviations so far. The nursing leader understood a few facts about effective communication. Communication was regular, through various channels – one-0ne-one meetings, webinars, and general unit meetings. The channels were interactive, with the leader expecting feedback, and communicating sincerely and honestly.
The nursing leader was ever-present in the unit, constantly checking, commending, and advising. This meant that there was always quick feedback on progress and that the team felt more confident about their work. The leader was also able to affirm the desired position through action and showing the way, thereby presenting others with a ready template. By being a listening partner, the leader provided others with a reference point, and a role model to emulate (Kash, 2014).
Overcoming barriers to change
Resistance to change is a natural occurrence when people are being told to stop doing one thing and doing another, or modifying the way they are used to doing things. To curb resistance to change, a useful tool is clear and regular information. Another important tool is involving employees in all stages of change. The nursing team was well informed of the impending changes. To make it clearer, champions of the new way of doing things were chosen from among the nursing personnel, with little reference to seniority in the department.
Effective leadership is crucial in overcoming any barriers to change. In the initial stages of change, the expected progress or results may not be clear for all to see. As a result, many members of the team may lose their motivation or question the necessity of such a change in the first place. This was evident in the first few days of the quality improvement exercise. To ensure that change progressed as expected, the leader rallied the personnel, making them believe in the result, and clearly explaining how the change was expected to work (Molony, 2020).
Leading a similar initiative
I would lead a similar initiative using more or less the same strategy that the nursing leader used. I would prioritize employee participation and handling resistance as amicably as possible. There would be effective leadership since it is a key element in any envisaged change that eventually succeeds. One area that I would revise is training. Through training, it is possible to have the team understand the reasons for the change better. By being trained, they also understand why the change is important to the patients as well as their own professional lives. The training was sparingly used in this instance, meaning that change did not move as smoothly as it could have with better-equipped employees.
References
Iacono, L., Altman, M. (2016). Nurses emerge as change leaders. Nursing, 46(8), 50-53.
Kash, B. (2014). Success Factors for Strategic Change Initiatives: A Qualitative Study of Healthcare Administrators' Perspectives. Journal of Healthcare Management, 59(1), 65-81.
Molony, S. (2020). Clinical Scholarship & Inquiry in Nursing. Hamden: Quinnipiac University Press.
Taveira, M. (2017). Risk Factors for Central Line-Associated Bloodstream Infection in Pediatric Oncology Patients with a Totally Implantable Venous Access Port: A Cohort Study. Pediatr Blood Cancer, 64(2):336-342
