Nurses hate change…or do they?

Posted on September 25, 2011

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Whenever a project fails one will inevitably hear a comment about how the nurses, especially older ones, never want to change.  While this may provide some momentary comfort to the leaders of the initiative, it’s an untruth.  If we look at the hospital environment today, it is full of complexity. Those who do not like change would never survive in this type of environment that is used to functioning on the edge of chaos.  I am sure most nurses would tell us that they are doing very little the same as they were a decade ago: different drugs, different treatments, different diseases, patients with different challenging circumstances.  Take a basic nursing function: medication administration. My first job out of college in 1985 had me sticking little cards in slots on a tray to pass our meds which were poured from stock bulk bottles; now I am scanning bar-codes of individually packaged pills.  This requires a totally different set of cognitive functions and physical skill than the process did back in 1985.

Why are some target behaviors not sustainable?  Quality and Safety in Healthcare published a revealing article about a safety intervention and policy for anesthesiologists which was accepted by all as needed but which basically disappeared from practice in a year (de Saint Maurice, et al., 2010). How often does this happen? Do we routinely monitor policy compliance or just shake our heads when something happens about our bad luck to employ rogue or lazy staff  who don’t follow policies?

BJ Fogg is a researcher who runs the persuasion lab at Stanford University.  His main focus is in using technology to create healthy behaviors, the most difficult behavior change there is.  He was taken many psychological theories and combined them into a formula:

For a behavior to occur you need all three: motivation, ability and trigger.  The trigger needs to be actionable whenever possible not just a reminder. This behavior model provides a nice framework for nursing leadership as we devise projects for behavior changes we would like to see whether related to productivity, safety or clinical practice.  Technology can be used in a persuasive manner to enhance sustainable of the target behaviors in employees.   Fogg has developed an interventional approach based on properties of the behavior such as how different it is from current behavior and how often we need it to occur.

To read a paper on this model click here and go to the behavior change website for more explanation.

Most failed initiatives are the fault of the process and triggers, not the employee.