Implementing Urinary Foley Insertion Education for Novice RN Nurses in the Emergency Room at North Shore Medical Center: A Change Management Perspective

Introduction

In the emergency room (ER), urinary catheterization is a routine practice usually administered by nursing personnel in order to address acute urinary detention, monitor urinary excretion rates, and also to facilitate surgical interventions. Being a major practice, the misapplication of the technique, especially during insertion of the Foley catheter, can lead to adverse outcomes, including urinary tract infections (UTIs), discomfort by the patient, and, at times, urethral trauma (Fakih et al., 2014). The outcomes of the misapplication of this tool call for the need to ensure that essential education is provided to the RN nurses to make it easier for them to effectively insert the Foley catheter in the EM, thereby avoiding the challenges that come with its use. To help facilitate change, this project proposes the implementation of urinary Foley insertion education among the RN nurses at North Shore Medical Center to improve skill sets and confidence over a period of eight weeks.

Description of the Change Model

The implementation of urinary Foley insertion education at North Shore Medical Center will utilize Kotter’s 8-Step Change Model. Kotter’s 8-Step Change Model is a change management model that seeks to empower organizations to ensure organizational change is rapidly adopted to by facilitating effective implementation of the new processes (Laig & Abocejo, 2021). The model provides a systematic approach that, when adopted, will facilitate adherence to the project needs and facilitate change at both personal and organizational levels. The model was developed as a result of Dr. Kotter’s observation of various organizations and leaders in the attempt to transform or execute change strategies and identified the eight most common steps leading to change as follows:

Create a sense of urgency.

Here, the model suggests inspiring people to act with a purpose and passion in order to achieve the intended goal. This would involve instilling a sense of urgency in improving the skills of the insertion of the urinary Foley by providing the RN nurses with education and the strategies that can be adopted to enhance the patient’s safety and also lead to better healthcare outcomes. The implementation of the training will rely on the creation of a sense of urgency among the emergency room managers and the leading nurses in order to enhance support for the project.

Form a guiding coalition.

This step will entail the creation of a coalition among the stakeholders, which will be essential in ensuring the success of the initiative. The key stakeholders who will be involved in the creation of the coalition will be the nurse educators, administrators, and emergency room managers, among other essential hospital stakeholders, to ensure that they are unified and work towards ensuring that the nurses acquire the required training on the insertion of the catheters. Forming guiding coalitions will be essential to ensure that the necessary and required resources are provided by the hospital.

Form a strategic vision. 

The provision of education will change the hospital’s future operations by minimizing infections such as UTIs, urethral trauma, and the discomfort that is associated with the misapplication of the catheter. Here, the possible benefits of the implementation of education among the nurses will be a major and essential aspect of the project.

Enlist a volunteer army.

Here, the model emphasizes the need to identify and enlist the people who want to actively contribute to the project to ensure its success, an aspect that will be achieved by providing room for the stakeholders and other concerned individuals to participate in the project.

Enable Action by Removing Barriers

The barriers to the implementation of the project will be identified and addressed to ensure that the project is implemented without any setbacks.

Generate short-term wins

Celebrating the performance of the nurses will be essential in helping motivate them to continue learning and practicing the techniques or the approaches covered in the education program by establishing the milestones that the nurses are required to cover at particular times.

Build on the Change

Here, the plans for expanding the hands-on education program to other nursing departments within and outside the organization will be established to ensure that the practices provided in the program are adopted throughout the institution. This would involve establishing such programs in other departments other than the ER.

Anchor the Changes in Corporate Culture

The change will be integrated into the hospital’s organizational culture for long-term impact by coming up with a curriculum and ongoing training of the nurses to ensure that all the hospital staff are well trained on handling and administering catheters as a way of providing long-term performance.

Facilitators of Implementation

Implementing hands-on education at North Shore Medical Center can be facilitated by clear communication of the benefits of the educational programs, the timelines, and the responsibilities of the stakeholders, as well as any challenges and changes that are implemented in the process of the project. Clear communication is also essential to ensure that the nurses have attained competence in the training process (Engle et al., 2017). Support from the hospital leadership is also essential in that it determines the perception of the nurses and their willingness to participate actively in the educational program. Programs without the support of the leadership tend to be challenging to implement effectively, as the leaders are supposed to be on the frontlines, motivating and guiding the nurses to participate and implement the change. The staff members will buy into ideas and programs that the leadership supports. Besides, identifying the key champions among the nursing staff who are concerned with the challenges that catheters present to patients and those who want change in order to minimize the impacts is an essential aspect that can help deal with the resistance that could come with the implementation of the program.

Barriers to Implementation

The most significant barrier to implementation that the project could face is resistance to change among nurses who are used to using traditional educational methods as well as practice methods. Resistance to change in organizations is sometimes facilitated by the lack of insights into the benefits that come with the adoption of a specific practice, and in an event when the introduced change is more likely to result in increased workload. Besides, limited resources are also a major barrier to the implementation of the programs (Yazdani & Wells, 2018). Such resources may be human resources such as trainers, finances, learning resources, and technological resources essential in the implementation of the suggested practices. The competing priorities of the available resources can make it difficult for resources to be allocated to the emergency room when they might be needed in other departments within the hospital, thereby minimizing the resources available for the emergency room. Proper management of these barriers will be prioritized to enhance the success of the program.

Resources Required

1. Educational materials such as educational videos, simulation models, hands-on training kits, and instrumental guides for inserting the urinary Foley.
2. Facilitators will mostly consist of nurse educators who will be responsible for conducting the educational sessions and providing the required guidance and learning support to the RN nurses.
3. Audiovisual equipment such as screens, projectors, and audio systems facilitate effective learning sessions by enabling the display of educational videos.
4. Evaluation tools such as competency assessment tools to evaluate the effectiveness of the intervention.

Budget

Project Evaluation Plan

The participants in this project will consist of the nurses working in the emergency room at North Shore Medical Center. The recruitment process will be voluntary, although the administration may make it compulsory for every employee in the department. The evaluation will use a mixed method approach where qualitative and quantitative data collection methods will be used to provide a deep understanding of the effectiveness of the interventions. For the comparison group, the primary data, such as nurses who did not participate in the program, will be utilized, and such data will be collected using surveys and competency assessments. A formative evaluation criterion will assess the implementation of the educational program as it happens, while the summative criteria will be used to assess the impact of the intervention. Evaluations will be made at the onset of the educational interventions to assess the nurses’ skills and knowledge on the issue and at the end of the 8-week intervention period to analyze how the training has benefited the nurses.

To control the extraneous variables, strategies such as randomization, standardization of the intervention delivery, use of a controlled environment, and monitoring and documentation would be essential practices to ensure that the project is successful. The collected quantitative data will be analyzed using descriptive and inferential statistics to measure changes and compare the outcomes of the interventions. The qualitative data will be analyzed using thematic analysis, and the data will be integrated to provide a deeper understanding of the outcomes. Notably, throughout the project, human rights will be protected by ensuring informed consent in data collection, confidentiality, anonymity, and data security measures are put into place.

References

Engle, R. L., Tyler, D. A., Gormley, K. E., Afable, M. K., Curyto, K., Adjognon, O. L., … & Sullivan, J. L. (2017). Identifying barriers to culture change: A qualitative analysis of the obstacles to delivering resident-centered care. Psychological services, 14(3), 316.

Fakih, M. G., Heavens, M., Grotemeyer, J., Szpunar, S. M., Groves, C., & Hendrich, A. (2014). Avoiding potential harm by improving the appropriateness of urinary catheter use in 18 emergency departments. Annals of Emergency Medicine, 63(6), 761-768.

Laig, R. B. D., & Abocejo, F. T. (2021). Change management process in a mining company: Kotter’s 8-Step change model. Journal of Management, Economics, and Industrial Organization, 5(3), 31-50.

Yazdani, A., & Wells, R. (2018). Barriers to implementation of successful change to prevent musculoskeletal disorders and how to systematically address them. Applied ergonomics, 73, 122-140.