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The health care industry is constantly evolving. Technical innovations, medical breakthroughs, legal compliance shifts, and new patient care theories quickly reshape care delivery. To maintain high-quality care, facilities must rigorously manage change and adapt quickly.

Effectively managing change is crucial in the nursing field, especially for front-line medical workers. For nurse leaders, the first step in deploying impactful change management within a facility’s nursing team is to have a full understanding of change theory in nursing. This can help them accurately interpret the short- and long-term ramifications of each change. This also lets them make decisions that guide improvements toward top-quality care.

For nurses seeking to use their nursing degrees to advance their careers, demonstrating an understanding of change theory may also allow them to stand out in a competitive job market.

What Is Change Theory?

Change theory focuses on managing health care changes so that quality patient care remains constant. These changes come from many sources, including organizational practice, patient care models, care policies, and legal compliance. Applying the theory allows health care leaders to govern change management more deliberately with cleaner implementation.

Modern change theory encompasses different principles that can help nurses pragmatically shape their approach to change management. Its origins stem from German-American psychologist Kurt Lewin, a pioneer in the field of group dynamics. Lewin developed change theory as a means to examine how people adapt and adjust to changes within an organization.

Breakdown of Lewin’s Change Theory

Lewin’s Change Theory comprises three distinct stages:

• Unfreeze. Preparing for change to minimize resistance.

• Change. Implementing the change.

• Refreeze. Stabilizing the organization after the change.

Lewin’s Change Theory breaks down any change into distinctive sections to drive efficiency. For example, the theory compels leaders to think about the level of pushback they may receive from a change; this can help them incorporate ideas to minimize that pushback.

It can also help organizations set key performance indicators (KPIs) or benchmarks to chart the progress of each impacted employee. This can help make changes lasting and sustainable.

Lewin’s Force Field Analysis: Driving and Restraining Forces

Lewin also developed a sister theory that helps organizations determine whether implementing change will be beneficial. This theory, known as the force field analysis, focuses on driving and restraining forces: internal and external influences surrounding a potential need for change.

Driving forces are the productive factors that can spur development, growth, and progress. They include the following:

• Increased demand

• New federal or state laws

• Managerial pressure

• Public perception

• Field competition

Restraining forces are the factors that can inhibit progress and innovation, maintaining the status quo. They include the following:

• Company culture

• Employee unions

• Comfort

• Concerns about the future

• Past unsuccessful change initiatives

These theories can help inform an organization’s decisions on how and when it’s time to make a change. It can also equip them with the preparedness needed to brace for resistance, provide appropriate guidance, and turn a new idea into a new standard without causing much disruption.

Applying the Stages of Change Theory in Nursing

The application of Lewin’s three stages of change theory is a popular strategy for nurses because health care is constantly changing. With each innovation, breakthrough, or new care delivery philosophy, nurse leaders must evaluate the impact of implementing a change into their facilities’ environment and determine if it is needed.

Nurse leaders who apply Lewin’s Change Theory can use the health system’s penchant for constant change and progress to their advantage.

• At the unfreeze stage, they can prepare staff members for any change by reminding them of the field’s ebb and flow. This can help staff members acknowledge that changes to various processes or the implementation of new technologies help care delivery move forward. This step can also involve breaking down how the issues can be fixed or what processes can be improved with the proposed changes.

• At the change stage, nurse leaders can implement strategies to allow their staff members to actively engage in the process. For example, leaders can use a transition to an electronic health record (EHR) model as an opportunity to help their staff members improve their technical skills. They can also encourage staff to take an active role in the implementation through group coaching and training. This can lower resistance to change and showcase its benefits.

• At the refreeze stage, nurse leaders assess the effect that the changes have on the staff members and care delivery. This allows leaders to fine-tune their strategies to improve integration. This can induce additional training to strengthen weak points and measure KPIs to monitor appropriate progress.

Using change theory in nursing can allow nurse leaders to include staff in changes. This can make it easier for them to function more cohesively, which can improve care efficiency and lead to a more streamlined clinical experience for patients.

Other Nursing Change Theories

Lewin’s Change Theory represents the gold standard of change theory in nursing; however, other theories can help nurses effectively deploy change management in health care while mitigating the potential for impairing the patient care process. Nurse leaders should familiarize themselves with these theories, as they may help them develop their own pragmatic change management strategy.

Lippitt’s Seven-Step Change Theory

Psychologist Ronald Lippitt augmented Lewin’s original change theory, placing greater emphasis on the individual promoting the change.

1. Identify the need for change after examining all angles of a particular problem.

2. Evaluate resources needed to conduct proper change implementation, such as financial and human capital.

3. Assess the motivation behind the change.

4. Set goals and create action plans to meet goals.

5. Implement the change, working with staff to ensure a clear understanding of the plan’s parameters.

6. Gather feedback on the change from affected parties.

7. Transition from implementation to permanency.

Lippitt’s Seven-Step Change Theory in Action

1. A medical‑surgical unit tracks rising patient fall rates and recognizes the need to reduce falls.

2. Leaders take resource inventory.

3. Leadership and staff discuss why fall reduction matters, such as patient safety, accreditation risk, and staff morale.

4. They set measurable goals (50% fewer falls in 6 months) and create an action plan with protocols and training dates.

5. The team pilots hourly rounding, bed alarms, and standardized risk assessments, with daily staff briefings.

6. Nurses, patients, and aides provide feedback via brief surveys and huddles; data on falls is reviewed weekly.

7. After sustained improvement, the unit formalizes the protocols into policy and adds ongoing training to orientation.

Spradley’s Change Theory

Spradley’s Change Theory is also based on Lewin’s original theory, emphasizing the evaluation of the change during the implementation phase to ensure its effectiveness.

1. Recognize the symptoms that spur the need for change.

2. Diagnose the issue to build a targeted change strategy.

3. Analyze change-based solutions.

4. Select the change solution that works best.

5. Create a plan to implement the change.

6. Implement the change.

7. Assess the change to determine what works.

8. Stabilize the change before it is made permanent.

Spradley’s Change Theory in Action

1. A med‑surgical unit notices increased medication administration errors, signaling a need for change.

2. Nurse managers audit workflows and identify inconsistent double‑check procedures as the root cause.

3. The team reviews options: computerized bar‑coding, standardized checklists, or targeted staff training.

4. They choose bar‑coding plus a simplified checklist as the most feasible, high‑impact solution.

5. Leaders develop an implementation plan with timelines, training sessions, and IT support.

6. The solution is rolled out in a pilot pod with hands‑on staff training and IT troubleshooting onsite.

7. Medication error rates and staff feedback are tracked weekly to evaluate effectiveness.

8. After sustained improvement, the system is standardized across the unit and added to orientation.

Rogers’ Diffusion of Innovation Theory

Everette Rogers’ Diffusion of Innovation theory, a variation of Lewin’s original theory, focuses on the reaction of the parties affected by the change, emphasizing the notion that not all individuals involved with the change will simultaneously adapt to it.

1. Inform affected parties about the reason for the change, the process of change implementation, and who will be involved with making changes.

2. Persuade affected parties to accept the change, noting the negative and positive attitudes of those impacted.

3. Deploy a pilot program or trial study to determine whether the change should be made.

4. Implement change on an established or permanent basis.

5. Confirm change adaptation via feedback from those implementing and impacted by the change.

Rogers’ Diffusion of Innovation Theory in Action

1. Leaders announce a new bedside electronic handoff tool, explaining purpose, timeline, and team leads.

2. Nurse champions meet skeptics and early adopters, highlighting improved safety and addressing workflow concerns.

3. A two‑week pilot runs on one unit to test usability, collect timing data, and refine templates.

4. With positive pilot results, the hospital rolls the tool out across units with standardized training.

5. Post‑implementation surveys and shift‑level audits confirm adoption and identify small workflow tweaks.

Bridges’ Theory into Transition

The Bridges Transition Model is a three-step process that approaches change theory from the affected party’s perspective rather than the change agent’s. Like Rogers’s theory, it gauges the affected party’s reaction, but it emphasizes how the change transforms the individual during and after the change.

1. Discuss the end goal to signify the change.

2. Gauge the transition between the old ways and new ways of doing things.

3. Acknowledge the new direction via adaptation.

Bridges’ Theory Into Transition in Action

1. End goal: Leadership announces unitwide shift from paper to electronic charting, explaining the purpose and expected outcomes.

2. Transition: Nurses pilot the system while running dual charting, attending focused training, and sharing frustrations and fixes in daily huddles.

3. New direction: Staff adopt electronic workflows, celebrate reduced documentation time, and integrate the process into orientation and policy.

Centering Change on Care: The Theory of Human Caring as the Guiding Principle

Nurse leaders implementing change should also consider the Theory of Human Caring as a supporting guideline. Developed by registered nurse Jean Wilson, the theory prioritizes the patient’s healing journey and creating a caring environment. By incorporating this theory with other change theories, nurse leaders can ensure that their strategies work toward optimal care. If patient care suffers, the implemented change ultimately fails.

Become an Impactful Leader of Change

Change theory in nursing is integral to the nursing field because patient health is involved. Nurse leaders who know how to build change management strategies around these theories can maintain steady quality care during change.

The University of Tulsa’s online nursing programs can help you become a trusted nursing professional who can provide care with the utmost confidence. Our programs are designed to help you advance your nursing career at every phase, whether you’re just starting on your nursing journey or ready to make the bold step into nursing leadership.

Learn how TU can help you shape your path in this essential field.

Recommended Readings

Everything You Need to Know About the Oklahoma Board of Nursing

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Rural vs. Urban Health in OK: The Role of Nurse Leaders

Sources:

Hospital Pharmacy, “Leading Through Rapid Change Management”

Implementation Science Communications, “Roger’s Diffusion of Innovations Theory and the Adoption of a Patient Portal’s Digital Anamnesis Collection Tool: Study Protocol for the MAiBest Project”

IntelyCare, “Change Theory: Nursing Examples and Explanations”

LibreTexts Health, “Implementing Change”

American Nurses Association, “Current Theories of Change Management”

The Online Journal of Issues in Nursing, “A Case Review: Integrating Lewin’s Theory with Lean’s System Approach for Change”

Six Sigma, “Lewin’s Force Field Analysis in Change Management. What, Why, and How”

StudyingNurse, “Kurt Lewin’s Change Model in Nursing”

William Bridges Associates, “Bridges Transition Model”