You are a day shift charge nurse of a 25-bed medical-surgical unit in a 350-bed urban hospital. The hospital opened its doors in 1988 as a community hospital serving a rural county. Both the county and the hospital have become urbanized with the influx of high-tech industries, a military base expansion, and tourism.
Recently your hospital spent millions of dollars to implement bar-coded medication administration (BCMA) to reduce medication errors, improve documentation, facilitate a culture of safety, and capture more accurate medication administration charges. In this system, the nurse uses a handheld device to scan the drug to be given, the patient’s identification band, and the medication administration record. If any data do not match, the nurse is alerted to the discrepancy.
It has come to your attention that some nurses on your shift are overriding the safety features built into the system. For example, some nurses are reluctant to wake sleeping patients to scan the bar code before they administer IV medications; instead, these nurses simply scan the chart label. Some nurses have overridden the bar code warning, assuming it was some kind of technical glitch. Some nurses have administered drugs to patients despite having identification bands that are smudged, torn, or no longer scan properly. One nurse in particular states that she cannot read the text on the device. Still, other nurses are carrying multiple pre-scanned pills on one tray or charting that drugs have been given, even though they were left at the bedside. Finally, you learned that one nurse even affixed extra copies of the patient’s bar codes to her clipboard so that they could be scanned more quickly. At the time the decision was made to utilize the particular hand-held BCMA, the nursing unit staffs were very vocal that enough nurses were involved in the decision making and the testing on the use of this particular device.
Regardless of a thorough orientation and training regarding barcoding, it is clear that some staff have developed workarounds to the system, increasing the risk of medication errors and patient harm. The staffs state that they understand BCMA reduces risks to patients; however, it is their perception that the equipment is not convenient and that performing the additional safety checks inherent in BCMA takes them more time than how they did it in the past, ultimately delaying medications to patients. One highly experienced and strong staff nurse has voiced discontent over the new BCMA. She has said she would rather quit than use the device, and she sees little reason to change. The staffs say they will “try to do better” and will “try to be more careful in implementing the BCMA procedures.” You continue to sense resistance on their part.
Overall, the staff on the nursing unit has been stable for the past three years. The nursing unit is staffed using 12-hour shifts. There is a ward clerk/unit manager on duty 8 am – 8 pm. The registered nurses work traditional 7 am – 7 pm shifts working three days on and four days off, then four days on, three days off. The nursing staffs consist of 1 newly graduated nurse still on orientation and eleven registered nurses that are either full or part-time. Sixty percent of the registered nurses on 7 am – 7 pm are baccalaureate educated, and forty percent are diploma or associate degree educated.
The Nursing Director for Medical-Surgical Services has requested that you prepare a plan to reduce the resistance behaviors of the staff.
Prepare a four to six-page plan to address the resistance on your shift to the BCMA change. The paper should include a title page, a plan, and references. The plan should be evidence-based. The text should be one reference. Include a minimum of three additional references from the literature. Refer to the BSN Handbook and to the course syllabus to identify the acceptable sources for references. The rubric can be viewed in Introduction to Written Assignments. Save your paper as LastNameFirstInitital_Communication.
Include Introduction, Discussion, and Conclusion sections. Using the Level One Heading (bolded, centered), for the Discussion and Conclusion sections.
To better organize the paper, use Level Two Headings (flush with the left margin, bolded) for the topics included in the discussion. So, the sections in the paper would look something like this:
Identification of the Problem
Driving and Restraining Forces
Strategies to Handle Resistance
Include all of the following components:
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