Implementing a Practice Change - Case for Chapters 2, 3, and 13 Jodie Bell The Nurse Manager of a 40-bed Newborn Nursery unit attended the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) national conference. One of the conference sessions introduced the buccal administration of glucose gel as a means to treat neonatal hypoglycemia. The glucose gel treatment had been shown to decrease transfers to the Neonatal Intensive Care Unit (NICU) for intravenous glucose. It also decreased the need for formula supplements to normalize blood sugar levels, leading to improved success with breastfeeding. The Nurse Manager was very excited to implement this practice change in the Newborn Nursery unit. A decrease in transfers to NICU would improve patient satisfaction as mothers would not be separated from their babies. The lower cost of nursery care compared to care in the NICU would create a financial benefit for the hospital. By reducing formula use, the glucose gel initiative fit right in with previous projects the Newborn Nursery had successfully completed to promote exclusive breastfeeding. The Nurse Manager thought the introduction of glucose gel would be a win all around. Resources were tight because of a high census and staff vacations. In addition, two nurses were out on prolonged medical leaves. Several staff nurses were already working on a project to address employee engagement scores, which were declining from their previously high levels. All of the nurses were scheduled for multiple educational sessions about upcoming changes to the electronic medical record system. Because of these competing priorities, the Nurse Manager began to work through the details of the glucose gel project alone. She sought approval from the Medical Director for the practice change and partnered with the pharmacy to create a protocol for specific dosing instructions. The Nurse Manager developed a policy and discussed the project details with the unit leadership team. When it was time to implement the change, the Manager presented the policy and instructions to the staff. The buccal administration of glucose gel was demonstrated through a train-the-trainer approach managed by the unit educator The project got off to a rocky start, with many texts flying back and forth between the nurses and the unit leadership team. The nurses complained about their unfamiliarity of the buccal administration of the gel, despite the education provided. They questioned the dosage amounts and the safety of administering the glucose product to a newborn. The administration of glucose gel caused additional work for the nurses, who said that they would rather the babies were just transferred to the NICU instead. As the project continued, individual interpretations of the protocol caused confusion, and some nurses only gave the gel if they had time. Many complaints were brought to a staff meeting held the second week of the project. Although the glucose gel project was eventually fully implemented, it continued to be a topic of discussion at subsequent staff meetings, and the overall project was perceived as a negative change that just made more work for the nurses. 5. WHAT COULD THE NURSE MANAGER HAVE DONE TO PREPARE THE STAFF FOR CHANGE? The Nurse Manager The other nurses THEORIES Maslow's Hierarchy of Needs Alderfer's ERG Theory Herzberg's Two Factor Theory McClelland's Acquired Needs Theory Skinner's Reinforcement Theory I Adam's Equity Theory Vroom's Expectancy Theory Locke's Goal Setting Theory Taylor's Scientific Management McGregor's Theory X and Theory Y Quiche Theory z