Resistance to Change literature review

sagepub.com/journalsPermissions.nav DOI: 10.1177/1084822311407292 http://hhc.sagepub.com Psychosocial Perspectives Nurse educators and nursing leaders in home health and other community-based venues, such as hospices, wellness centers, and family shelters are aware that nursing practice is changing. The high unemployment rate has created the need for fewer nurses in hospitals and new graduates are finding their first job is in community settings. It is projected that in the near future, less than 25% of nurses will be employed in the traditional hospital setting but, instead, will be providing nursing care within various community settings (Bureau of Labor Statistics, 2010). In addition, one of the goals of health care reform is to keep people out of hospitals and manage their health and wellness in the community cared for by nurses. The changes brought on by health care reform and employment opportu- nities are forcing nurse educators and nursing leaders to rec- ognize that the traditional trajectory for undergraduate nursing education is not adequately preparing students to enter into practice. Furthermore, nurse educators are finding it more and more difficult to obtain adequate and sufficient clinical placements in hospital settings. The urgent need for nursing education to respond to the changes in health care delivery is particularly evident in pedi- atric nursing. Nursing leaders and educators are struggling with ways in which students can be provided with the neces- sary clinical experiences to care for well and critically or chronically ill children and their families. Hospital pediatric units are not available in sufficient number to provide students with pediatric clinical experiences. This crisis has forced nurs- ing programs to seek alternative community clinical place- ments ranging from home health agencies to family shelters. The change from inpatient pediatric nursing education to working with community partners has dramatically changed the faculty’s role. A hospital environment provides built-in distractions, which guide the faculty toward a care delivery model, which has become increasingly complex and time- consuming focusing primarily on mastery of technical skills.

Ask any experienced expert clinical nursing educator to change their clinical site to home health or another commu- nity setting, particularly for pediatrics, and you will be met with varying degrees of resistance. The role of pediatric clin- ical faculty have historically been very clear and defined by the institution—the rules, routines, culture, and required technical skill sets are so ingrained that the faculty generally have a good idea what to expect before they arrive at the hospital pediatric unit.

In contrast to the acute care setting, home health and other community-based settings require faculty interacting accord- ing to rules, routines, and culture defined by the client, fam- ily, and community. Faculty, client, and student interaction and communication require that each situation be approached with expectation of the unexpected. Faculty must be able to take classroom/laboratory content and effectively demon- strate how to transfer that knowledge to a very unfamiliar and ever changing environment. Facilitation of student suc- cess requires the faculty effectively demonstrate how to transfer classroom content to the home or other community setting to evaluate, plan, and implement health education on both a community and individual level. In addition, faculty must be able to communicate to the students their personal commitment to the development and promotion of a pediatric community health care model as an acceptable venue for pediatric clinical education. Should 407292 HHC XX X 10.1177/1084822311407292Cof feyHome Health Care Management & Practice 1Humboldt State University, Arcata, CA Corresponding Author:

Catherine Coffey, 1 Harpst Street, Humboldt State University, Arcata, CA 95521 Email: [email protected] Faculty and Student Resistance to Change: The Need for Home Health and Other Nursing Community Leaders to Partner With Nurse Educators to Change Nursing Education Catherine Coffey, RN, MSN, CNS, PNP 1 Keywords pediatric nursing, community pediatric nursing, student resistance, faculty roles, community partners 382 Home Health Care Management & Practice 23(5) faculty communicate that they do not value this particular clinical education model, students will experience only frus- tration and disappointment. They must also be successful in developing and maintaining community partners. The nurs- ing leaders in the community partnership must also be com- mitted to continuing relationships with the nursing program and influencing the direction of nursing education to meet the current and projected needs of their clients. There have been limited studies on students’ perceptions of their experiences in pediatric community settings, but the findings to date have consistently noted that students initially experience reticence and confusion regarding the value of a community-based pediatric clinical experience. They are more comfortable in the familiar hospital setting where they feel more in control. The author’s own experiences in changing students’ clini- cal experiences from hospital to the community are that stu- dents are initially very resistant, that they are fearful and unsure of their role, and that they realize that they now must rely heavily on their ability to effectively communicate with clients to gather information needed to develop an optimum plan of care. Frequent student comments include “What does this have to do with nursing?” “This is not real nursing, why do we have to do this?” “How do I talk to these people?” “I \ am really uncomfortable with this lifestyle.” “Why do they live like this?” “Why do they have so many kids when they can’t take care of themselves?” “Someone should take their kids away.” “I am not learning anything.” Studies and personal experience have found that most stu- dents after several weeks into the community experience began to verbalize the importance of the opportunity to care for pediatric clients/families in their homes and other com- munity settings. They recognize that home health and com- munity nursing are essential components to optimum children’s recovery, health maintenance, and prevention.

They begin to internalize how they as nurses can positively assist pediatric clients/families to attain their optimal level of wellness. Comments noted at the culmination of the clinical experience include “I hate to go back to the hospital now . . .

I will miss the families I have worked with . . . I would have missed a lot if I hadn’t been here.” “I was able to really make a difference . . . just me and what I did . . . no medicine or doctors just me.” “It was hard to be here . . . really sad for me . . . much more difficult emotionally than the hospital.” “I can see how important it is to start figuring out where people will go after they get out of the hospital . . . I just didn’t realize.” Even in the face of major paradigm shifts in health care delivery, many faculty and students continue to resist needed changes in the delivery of clinical education, holding fast to the notion that the acute care hospital is the only appropriate clinical education venue. Although it is clear that the development of technical expertise is critical to care for the hospitalized and home- bound pediatric client, technical prowess is far more effec- tive when coupled with an inclusive approach, which demands careful consideration of all aspects of the client’s life. Nurse educators and nursing leaders must work together to make a paradigm shift. Nursing leaders need to become more active on nursing school’s educational advisory com- mittees and influence the direction of nursing education to reflect the changing health care model. If the mounting changes taking place in health care are ignored and nursing education continues on the same trajectory that has been used for the past 30 years, nursing educator and leaders will be part of the problem rather than the solution in adequately preparing nursing students to enter into practice.

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

Reference Bureau of Labor Statistics. (2010). Occupational outlook hand- book, 2010-11 edition. Retrieved from http://www.bls.gov/oco/ ooh_index.htm Bio Catherine Coffey, RN, MSN, CNS, PNP, is currently an assistant professor at Humboldt State University, Arcata, California, and had formerly taught at Oregon Health Science University in the School of Nursing and the Department of Developmental Pediatrics. She has worked as a pediatric nurse practitioner in Oregon and California where she primarily worked with high-risk pediatric clients in rural, urban, and academic settings. She is currently working on her Doctorate of Nursing Practice at University of San Francisco, with particular research interest in community-based care of the high-risk pediatric client.