Change Theory in Nursing: How It Is Evolving the Profession                                                  

The health care industry is constantly evolving. Technical innovations, medical breakthroughs, legal compliance shifts, and new patient care theories can quickly reshape care delivery. For facilities that strive to provide quality care on an optimal level, keeping up with the rapid pace of change requires strict adherence to effectively manage the process of adapting and adjusting. Without such a plan, implementing changes can be less effective.

Effectively managing change is crucial in the nursing field, since nurses are often the first line of patient care. 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. Having this understanding can help them interpret the short- and long-term ramifications of each change accurately. This can allow them to make the decisions that can lead to guiding changes that can potentially lead to the highest quality of care delivery possible. 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.

What Is Change Theory? 

Change theory is a viewpoint that aims to manage health care changes in its many forms so that quality patient care remains constant and is not disrupted. These changes come from many directions, including organizational practice, patient care models, care policies, and legal compliance. Using the theory allows health care leaders to govern change management in health care more deliberately, which can lead to cleaner change implementation.

Modern change theory encompasses different principles that can help nurses shape their approach to change management more pragmatically. However, its origins stem from German-American psychologist Kurt Lewin. A pioneer in the field of group dynamics — so much so that he coined the term — Lewin developed change theory as a means to examine how people adapt and adjust to changes within an organization. The principles of change theory can set the framework for nurse leaders to develop strategies to implement change that cause minimal workforce issues.

Breakdown of Lewin’s Change Theory               

Lewin’s Change Theory comprises three distinct stages:

• Unfreeze. At the unfreeze stage, an organization decides to make changes that impact employee responsibilities. These changes can disrupt an employee’s routines and methodologies. Some workers may prefer not to have their routines disturbed. To prevent resistance, it is critical to present changes in a way that allows them to mentally prepare themselves for the change.
• Change. At the change stage, most employees have accepted the changes to come. They also display a willingness to learn how to integrate the changes within their daily tasks. This stage is when operational slowdowns may occur, as people may have to get used to the changes. Organizational leaders may keep watch on employee progress at this stage.
• Refreeze. At the refreeze stage, work gets back to normal speed as employees gain familiarity with the changes. When this occurs, organizational leaders develop strategies to enforce and fortify these changes through their various policies and procedures.

Lewin’s Change Theory is vital because it breaks down any change into distinctive sections that can be analyzed and streamlined. 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 that may minimize pushback. It can also help organizations set key performance indicators (KPIs) or benchmarks to chart the progress of each employee impacted. Additionally, it can provide organizations with the vision needed to make changes permanent.

Lewin’s Force Field Analysis: Driving and Restraining Forces

Lewin also developed a sister theory that can help organizations determine whether implementing change makes any sense. This theory, known as the force field analysis, focuses on driving and restraining forces: internal and external influencers surrounding a potential need for change.

Driving forces are the productive factors that can potentially spur development, growth, and progress. These factors ultimately aim to streamline an organization’s progress toward a positive goal. Common driving forces 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. These can compel an organization to maintain the status quo and keep the current pace toward goals stable. Common restraining forces include the following:

• Company culture
• Employee unions
• Comfort
• Concerns about the future
• Past unsuccessful change initiatives

According to Lewin’s theory, when these forces are in balance, an organization is in equilibrium and does not need to engage in change. On the other hand, if there is instability between these forces, changes may be inevitable to restore balance.

These different theories can help an organization make more assured decisions on when it may be 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.

The Uniqueness and Importance of Change Theory in Nursing

The framework of Lewin’s theory applies to a wide range of industries. It has a unique application in nursing because of the field’s purpose. In other organizations, a slowdown in operations due to change adaptation correlates to goods and services. In nursing, it correlates to patient care. This makes it particularly important for nurse leaders to understand change theory. 

A lack of understanding of change theory in nursing can leave a nurse leader unprepared for the resistance to change that may come from staff. It can also cause the implementation and permanency of changes to occur more slowly, which can cause a greater disruption to operational processes. This can reduce the efficiency of patient care and make it harder for facilities to achieve their goal of providing care that improves patient outcomes.

The need to engage in change management can come from many different elements. It can come from a new piece of technology that can improve operational efficiency, such as electronic health records (EHRs). It can come from the need to adjust specific procedural elements to comply with new federal or state regulations regarding patient care. It can also be the result of an internal philosophical switch, such as a transition to an evidence-based practice model to improve cost efficiency. These elements can cause different forms of change; addressing and managing these changes in a way that minimizes disruption is essential.

Applying the Stages of Change Theory in Nursing

The application of Lewin’s three stages of change theory is a popular strategy for nurses to use because health care tends to be in constant flux. With each innovation, breakthrough, or new care delivery philosophy, nurse leaders must evaluate the impact of bringing a change into their facility’s environment and ultimately determine if it is needed. This is where the force field analysis can come into play. 

A nurse leader can determine whether their facility is in a state of homeostasis, in which patients are consistently receiving optimal care and the facility’s operations and budgets are strong. If it is determined that the facility is out of balance, then change may likely be needed.

The one time that the force field analysis does not potentially factor into this situation is in legal compliance situations. For example, if the federal government were to make a change to its privacy laws, health care facilities would need to adhere to these changes. In these cases, nurse leaders would move directly to applying change theory strategies without needing to analyze whether change is necessary.

Nurse leaders who apply Lewin’s Change Theory can use health care’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 come from a place of moving care delivery 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 various strategies that can allow their staff members to actively engage in the process. For example, leaders can use a transition to an EHR model as an opportunity to help their staff members improve the technical skills associated with using the program. They can also engage them in a way that allows them to take an active role in the implementation. This can involve using group activities, such as coaching and training, to get them comfortable with new processes. This can lower resistance to change and provide an opportunity to showcase the benefits of change. 
• At the refreeze stage, nurse leaders must assess the effect that the changes have on the staff members and its ability to deliver optimal patient care. This assessment allows leaders to tweak their strategies to improve integration. Some of these strategies can induce additional training to strengthen weak points and measure KPIs to monitor appropriate progress.

Successfully using change theory to govern care delivery fluctuations can allow nurse leaders to build a strong, trusted rapport with their staff members. 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. This rapport can also make them better prepared to roll with the constant changes associated with the health care industry, which can also help change integration occur with minimal disruption to care delivery strategies.

Other Nursing Change Theories 

While Lewin’s Change Theory represents the gold standard of change theory in nursing, other theories can help nurses effectively deploy change management in health care while mitigating the potential for jumbling up the patient care process. Most of these theories build off Lewin’s original theory, expanding on its principles to emphasize different areas of change management. Nurse leaders need to also be cognizant of these theories, as they may be able to draw on their philosophies to develop their own pragmatic change management strategy.

Lippitt’s Seven-Step Change Theory             

Psychologist Ronald Lippitt augmented Lewin’s original change theory with a few steps. The steps intend to place greater emphasis on the individual promoting the change. 

• Step 1: Becoming aware of the need for change after examining all angles of a particular problem
• Step 2: Evaluating resources needed to conduct proper change implementation, such as financial and human capital
• Step 3: Assessing the motivation behind the change
• Step 4: Setting goals and creating action plans to meet goals
• Step 5: Implementing the change, working with staff to ensure a clear understanding of a plan’s parameters
• Step 6: Gathering feedback on change from affected parties
• Step 7: Transitioning from implementation to permanency

Spradley’s Change Theory               

Spradley’s Change Theory is also based on Lewin’s original theory but breaks it down into eight steps. This theory emphasizes evaluating the change during the implementation phase to ensure its effectiveness.

• Step 1: Recognize the symptoms that spur the need for change.
• Step 2: Diagnose the issue to build a targeted change strategy.
• Step 3: Analyze change-based solutions.
• Step 4: Select the change solution that works best.
• Step 5: Create a plan to implement the change.
• Step 6: Implement the change.
• Step 7: Assess the change to determine what works.
• Step 8: Stabilize the change before it is made permanent.

Rogers’ Diffusion of Innovation Theory       

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

• Stage 1: Inform affected parties about the reason for the change, the process of change implementation, and who will be involved with making these changes.
• Stage 2: Persuade affected parties to accept the change, noting the negative and positive attitudes of those impacted by the change.
• Stage 3: Deploy a pilot program or trial study to determine whether the change should be used.
• Stage 4: Implement change on an established or a permanent basis.
• Stage 5: Confirm change adaptation via feedback from those implementing and impacted by the change.

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’ theory, it gauges the affected party’s reaction, but it emphasizes how the change transforms the individual during and after the change.

• Step 1: Discussing the end goal to signify the change
• Step 2: Gauging the transition between the old ways and new ways of doing things
• Step 3: Acknowledging the new direction via adaptation

Whatever theory a nurse leader uses, they must do so by bringing the Theory of Human Caring into the mix as a supporting player. Developed by registered nurse Jean Wilson, the theory emphasizes the need to ensure that every change is done with the patient’s healing journey at the forefront; this is ultimately established by protecting a caring environment. By incorporating this theory with other change theories, nurse leaders can ensure that their strategies ultimately revolve around caring for the patient. If this suffers, the implemented change ultimately fails. 

Become an Impactful Leader of Change

Change theory in nursing carries extra weight compared with change theories in other industries because patient health is involved. Nurse leaders who know how to effectively build change management strategies around these theories can help a health care facility maintain steady quality care while changes occur. In an industry known for its constant change, having this knowledge is key to success in the industry.

The University of Tulsa’s nursing programs can help you develop into 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 we can help you shape your path in this essential field.

Recommended Readings

The Importance of Evidence-Based Practice in Nursing

The Most Important Leadership Skills for Nurses

3 Reasons to Expand Your Nursing Scope of Practice

Sources:

American Nurses Association, “Current Theories of Change Management”

Indeed, Lewin’s Force Field Analysis (With How to Conduct One)

Indeed, What Is Lewin’s Change Theory? 3-Stage Change Management

Journal of Healthcare Leadership, “Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare”

Practical Psychology, Lewin’s Change Theory (Definition + Examples)

Securiti, A Guide to Healthcare Compliance Regulations

SimpleNursing, What Is Change Theory?

StatPearls, “Change Management”