definition of change in nursing

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Change management in health care.

Jennifer M. Barrow ; Pavan Annamaraju .

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Last Update: September 18, 2022 .

• Definition/Introduction

Change is inevitable in healthcare; however, nearly two-thirds of change projects fail for various reasons, including poor planning, unmotivated staff, ineffective communication, and widespread changes. [1]  All healthcare providers, from the bedside to the boardroom, have a crucial role in ensuring effective change. Implementing best practices from change management theories can improve the likelihood of success and lead to better outcomes in practice.

Suppose a healthcare provider working in a hospital department has seen a rise in unwitnessed patient falls during shift changes over the past 3 months. Implementing evidence-based changes to the shift change process could help reduce these falls. However, departmental leadership has tried to address this issue twice in the last 3 months without success. Staff continue to revert to previous shift change protocols to save time, resulting in prolonged periods where patients are unmonitored. What strategies can departmental leadership and staff adopt to create lasting, positive changes that benefit both patients and employees?

The answer may lie within the work of several change leaders and theorists. Although theories may seem abstract and impractical for direct healthcare practice, they are valuable for addressing common healthcare challenges. Lewin, an early change scholar, proposed a 3-step process to facilitate successful change. [2]  Other theorists, such as Lippitt, Kotter, and Rogers, have built on Lewin’s original Planned Change Theory, contributing to a broader understanding of change management. Each theory has its unique strengths and weaknesses, but their commonalities can offer best practices for sustaining positive change (see Image.  Sample Force Field Analysis in Change Management).

Lewin’s Theory of Planned Change includes the following change stages:

• Unfreezing: Understanding the need for change
• Moving: Initiating the process of change
• Refreezing: Establishing a new status quo  [2]

Lippitt, expanding on Lewin’s original theory, developed the Phases of Change Theory, which includes the following change phases:

• Increasing awareness of the need for change
• Developing a relationship between the system and the change agent
• Defining the change problem
• Setting goals and action plans for achieving change
• Implementing the change
• Gaining staff acceptance and stabilizing the change
• Redefining the relationship of the change agent and the system  [3]

Kotter’s 8-Step Change Model, developed in 1995, includes the following steps for effective change management:

• Create a sense of urgency for change
• Form a guiding change team
• Create a vision and plan for change
• Communicate the changed vision and plan with stakeholders
• Enable action by removing barriers to change
• Generate short-term wins
• Build on the change
• Anchor the change in the organizational culture  [3]

Finally, Rogers’ Diffusion of Innovation Theory outlines the following 5 phases of change: [4]

• Knowledge: Educating and communicating to inform staff about the change.
• Persuasion: Engaging change champions to pique interest among staff and encourage peer persuasion.
• Decision: Staff deciding whether to accept or reject the change.
• Implementation: Putting new processes into practice.
• Confirmation: Staff recognizing the value and benefits of the change and continuing to utilize the new processes. [4]
• Issues of Concern

All change initiatives, whether large or small, progress through 3 key stages—pre-change, change, and post-change. Healthcare providers acting as change agents or champions during each stage should align their actions with relevant change theories. In the pre-change stage, a key step is involving stakeholders in problem identification, goal setting, and action planning. Early engagement of stakeholders is critical for gaining staff buy-in. Notably, it is also important to include staff from all shifts, including nights and weekends, to ensure peer change champions are available at all times. [5]

Rogers' change theory highlights the varying rates at which staff members adopt changes through innovation diffusion. During pre-change planning, change agents should assess their team to identify which category each staff member falls into. Rogers classified these groups as innovators, early adopters, early majority, late majority, and laggards. [4]  He further defined these change acceptance categories as follows:

• Innovator: Enthusiastic about change and technology; often suggests new ideas for departmental improvements.
• Early adopter: Highly influential within the department; respected by peers for their leadership.
• Early majority: Prefer the status quo but follows early adopters once changes are announced.
• Late majority: Skeptical of change but accepts it once most others have; influenced by growing social pressure within the department.
• Laggard: Extremely skeptical; openly resists change. [4]

Most departmental staff likely fall into the early or late majority. Change agents should focus their initial education efforts on innovators and early adopters. Early adopters, in particular, are key change champions, as they play a crucial role in persuading both early and late majority staff to embrace change initiatives. [4]

A final key assessment for change leaders to incorporate is a force field analysis, a core element of Lewin's early change theory. This analysis involves evaluating the facilitators and barriers to change within the department. Change leaders should focus on reducing barriers through open communication and education while simultaneously reinforcing facilitators by recognizing staff efforts and offering incentives.

One of the biggest mistakes a change leader can make during implementation is failing to ensure staff follow new processes as intended. Consistent leader engagement throughout the change process greatly improves the likelihood of success. [5]  Staff resistance is common during this stage. Change leaders may find it helpful to conduct another force field analysis during this phase to ensure no new barriers have emerged. [3]  Strengthening change facilitators through staff engagement, recognition, and sharing short-term wins helps maintain momentum. As the change process progresses, some staff may need additional on-the-spot training to address knowledge gaps. Leaders must also continue monitoring progress toward goals by tracking metrics such as patient satisfaction, staff satisfaction, fall rates, and chart audits. [3]

Once the change has become embedded in the department's culture, change leaders must periodically validate processes and seek staff feedback. Change agents can redefine their relationship with the team, adopting a less active role in maintaining the change. However, as leaders begin to relinquish control, staff members may gradually revert to old, negative behaviors. Periodic spot checks and ongoing data monitoring can help solidify the change as the department's new status quo. Change managers should celebrate achievements with staff and continue sharing evidence of success during meetings or through departmental communication boards. [5]

• Clinical Significance

Change is inevitable but often slow to achieve. While change theories offer best practices for leadership and implementation, their application does not guarantee success. The change process is susceptible to various internal and external influences. Utilizing change champions from all shifts, conducting force field analyses, and maintaining regular supportive communication can enhance the likelihood of success. [5]  Additionally, understanding how each staff member will likely respond to change based on the diffusion of innovation phases can guide leaders in tailoring their conversations to facilitate the transition in departmental processes.

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Sample Force Field Analysis in Change Management. This image illustrates a sample force field analysis based on Lewin's Theory of Planned Change. Contributed by J Barrow, MSN, RN

Disclosure: Jennifer Barrow declares no relevant financial relationships with ineligible companies.

Disclosure: Pavan Annamaraju declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Barrow JM, Annamaraju P. Change Management In Health Care. [Updated 2022 Sep 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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4.3 Implementing Change

Change is constant in the health care environment. Change is defined as the process of altering or replacing existing knowledge, skills, attitudes, systems, policies, or procedures. [1] The outcomes of change must be consistent with an organization’s mission, vision, and values. Although change is a dynamic process that requires alterations in behavior and can cause conflict and resistance, change can also stimulate positive behaviors and attitudes and improve organizational outcomes and employee performance. Change can result from identified problems or from the incorporation of new knowledge, technology, management, or leadership. Problems may be identified from many sources, such as quality improvement initiatives, employee performance evaluations, or accreditation survey results. [2]

Nurse managers must deal with the fears and concerns triggered by change. They should recognize that change may not be easy and may be met with enthusiasm by some and resistance by others. Leaders should identify individuals who will be enthusiastic about the change (referred to as “early adopters”), as well as those who will be resisters (referred to as “laggers”). Early adopters should be involved to build momentum, and the concerns of resisters should be considered to identify barriers. Data should be collected, analyzed, and communicated so the need for change (and its projected consequences) can be clearly articulated. Managers should articulate the reasons for change, the way(s) the change will affect employees, the way(s) the change will benefit the organization, and the desired outcomes of the change process. [3] See Figure 4.5 [4] for an illustration of communicating upcoming change.

Change Theories

There are several change theories that nurse leaders may adopt when implementing change. Two traditional change theories are known as Lewin’s Unfreeze-Change-Refreeze Model and Lippitt’s Seven-Step Change Theory. [5]

Lewin’s Change Model

Kurt Lewin, the father of social psychology, introduced the classic three-step model of change known as Unfreeze-Change-Refreeze Model that requires prior learning to be rejected and replaced. Lewin’s model has three major concepts: driving forces, restraining forces, and equilibrium. Driving forces are those that push in a direction and cause change to occur. They facilitate change because they push the person in a desired direction. They cause a shift in the equilibrium towards change. Restraining forces are those forces that counter the driving forces. They hinder change because they push the person in the opposite direction. They cause a shift in the equilibrium that opposes change. Equilibrium is a state of being where driving forces equal restraining forces, and no change occurs. It can be raised or lowered by changes that occur between the driving and restraining forces. [6] , [7]

• Step 1: Unfreeze the status quo. Unfreezing is the process of altering behavior to agitate the equilibrium of the current state. This step is necessary if resistance is to be overcome and conformity achieved. Unfreezing can be achieved by increasing the driving forces that direct behavior away from the existing situation or status quo while decreasing the restraining forces that negatively affect the movement from the existing equilibrium. Nurse leaders can initiate activities that can assist in the unfreezing step, such as motivating participants by preparing them for change, building trust and recognition for the need to change, and encouraging active participation in recognizing problems and brainstorming solutions within a group. [8]
• Step 2: Change. Change is the process of moving to a new equilibrium. Nurse leaders can implement actions that assist in movement to a new equilibrium by persuading employees to agree that the status quo is not beneficial to them; encouraging them to view the problem from a fresh perspective; working together to search for new, relevant information; and connecting the views of the group to well-respected, powerful leaders who also support the change. [9]
• Step 3: Refreeze. Refreezing refers to attaining equilibrium with the newly desired behaviors. This step must take place after the change has been implemented for it to be sustained over time. If this step does not occur, it is very likely the change will be short-lived and employees will revert to the old equilibrium. Refreezing integrates new values into community values and traditions. Nursing leaders can reinforce new patterns of behavior and institutionalize them by adopting new policies and procedures. [10]

Example Using Lewin’s Change Theory

A new nurse working in a rural medical-surgical unit identifies that bedside handoff reports are not currently being used during shift reports.

Step 1: Unfreeze: The new nurse recognizes a change is needed for improved client safety and discusses the concern with the nurse manager. Current evidence-based practice is shared regarding bedside handoff reports between shifts for client safety. [11] The nurse manager initiates activities such as scheduling unit meetings to discuss evidence-based practice and the need to incorporate bedside handoff reports.

Step 2: Change: The nurse manager gains support from the director of nursing to implement organizational change and plans staff education about bedside report checklists and the manner in which they are performed.

Step 3: Refreeze: The nurse manager adopts bedside handoff reports in a new unit policy and monitors staff for effectiveness.

Lippitt’s Seven-Step Change Theory

Lippitt’s Seven-Step Change Theory expands on Lewin’s change theory by focusing on the role of the change agent. A change agent is anyone who has the skill and power to stimulate, facilitate, and coordinate the change effort. Change agents can be internal, such as nurse managers or employees appointed to oversee the change process, or external, such as an outside consulting firm. External change agents are not bound by organizational culture, politics, or traditions, so they bring a different perspective to the situation and challenge the status quo. However, this can also be a disadvantage because external change agents lack an understanding of the agency’s history, operating procedures, and personnel. [12] The seven-step model includes the following steps [13] :

• Step 1: Diagnose the problem. Examine possible consequences, determine who will be affected by the change, identify essential management personnel who will be responsible for fixing the problem, collect data from those who will be affected by the change, and ensure those affected by the change will be committed to its success.
• Step 2: Evaluate motivation and capability for change. Identify financial and human resources capacity and organizational structure.
• Step 3: Assess the change agent’s motivation and resources, experience, stamina, and dedication.
• Step 4: Select progressive change objectives. Define the change process and develop action plans and accompanying strategies.
• Step 5: Explain the role of the change agent to all employees and ensure the expectations are clear. 
• Step 6: Maintain change. Facilitate feedback, enhance communication, and coordinate the effects of change.
• Step 7: Gradually terminate the helping relationship of the change agent.

Example Using Lippitt’s Seven-Step Change Theory

Refer to the previous example of using Lewin’s change theory on a medical-surgical unit to implement bedside handoff reporting. The nurse manager expands on the Unfreeze-Change-Refreeze Model by implementing additional steps based on Lippitt’s Seven-Step Change Theory:

• The nurse manager collects data from team members affected by the changes and ensures their commitment to success.
• Early adopters are identified as change agents on the unit who are committed to improving client safety by implementing evidence-based practices such as bedside handoff reporting.
• Action plans (including staff education and mentoring), timelines, and expectations are clearly communicated to team members as progressive change objectives. Early adopters are trained as “super-users” to provide staff education and mentor other nurses in using bedside handoff checklists across all shifts.
• The nurse manager facilitates feedback and encourages two-way communication about challenges as change is implemented on the unit. Positive reinforcement is provided as team members effectively incorporate change.
• Bedside handoff reporting is implemented as a unit policy, and all team members are held accountable for performing accurate bedside handoff reporting.

Read more about additional change theories in the Current Theories of Change Management pdf .

Change Management

Change management is the process of making changes in a deliberate, planned, and systematic manner. [14] It is important for nurse leaders and nurse managers to remember a few key points about change management [15] :

• Employees will react differently to change, no matter how important or advantageous the change is purported to be. Recognizing this variability is crucial for effectively managing the transition process.
• Basic needs will influence reaction to change, such as the need to be part of the change process, the need to be able to express oneself openly and honestly, and the need to feel that one has some control over the impact of change. Ensuring these needs are met can significantly reduce resistance.
• Change often results in a feeling of loss due to changes in established routines. Employees may react with shock, anger, and resistance, but ideally will eventually accept and adopt change. Acknowledging these feelings and providing support can facilitate smoother transitions.
• Change must be managed realistically, without false hopes and expectations, yet with enthusiasm for the future. Employees should be provided information honestly and allowed to ask questions and express concerns. This transparency builds trust and helps in aligning everyone towards common goals.

Strategies for Effective Change Management

• Engage Stakeholders Early: Involve key stakeholders in the planning stages of the change process. Their input can provide valuable insights and help in identifying potential challenges early on.
• Communicate Clearly and Frequently: Clear and frequent communication is essential. Use multiple channels to disseminate information and ensure that the message is consistent and comprehensible to all staff members.
• Provide Training and Resources: Equip employees with the necessary skills and resources to adapt to the change. This might include training sessions, informational materials, or access to support personnel.
• Build a Supportive Culture: Create an environment where change is viewed positively. Encourage collaboration and create opportunities for employees to share their experiences and strategies for adapting to change.
• Monitor and Adjust: Continuously monitor the progress of the change initiative and be prepared to make adjustments as needed. Solicit feedback from employees and be responsive to their concerns.

There are multiple strategies that can employed to overcome resistance to change. First, it is important to understand the underlying reasons for resistance. Resistance is commonly aligned to feelings of fear, lack of trust in leadership, or logistical concerns regarding workload, seniority, etc. To implement change effectively, a leader should empower staff by making sure they feel that their voice is respected and valued. When individuals feel valued and hear, they are more likely to support change, even if they do not personally agree with all elements associated with the change. Leaders also must understand that change is stressful for individuals. Depending on the significance of change, a leader may take actions to ensure that employee assistance programs, support groups, or additional counseling services or resources are available. These additional resources can be beneficial for individuals as they work through the emotions associated with the proposed change. Additionally, the benefits for any change should be clearly described. It is important to highlight how the proposed change will help improve work processes and client care quality. It is also helpful to acknowledge and demonstrate appreciation for early adopters of the change. This can provide motivation and encouragement for others to follow suit and fosters a positive attitude toward future changes.

• Ana, B. H., & Hendricks-Jackson, L. (2017). Nursing professional development review and resource manual (4th ed.). American Nurses Association, Nursing Knowledge Center. https://www.nursingworld.org/~49379b/globalassets/catalog/sample-chapters/npdsamplechapter.pdf ↵
• “ Change-1080x675.jpg ” by Amman Wahab Nizamani is licensed under CC BY-SA 4.0 ↵
• Nursing Theory. (n.d.). Lewin’s change theory. https://nursing-theory.org/theories-and-models/lewin-change-theory.php ↵
• Kritsonis, A. (2005). Comparison of change theories. International Journal of Scholarly Academic Intellectual Diversity, 8 (1). https://globalioc.com/wp-content/uploads/2018/09/Kritsonis-Alicia-Comparison-of-Change-Theories.pdf ↵
• AHRQ. (n.d.). Bedside shift report checklist. https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy3/Strat3_Tool_2_Nurse_Chklst_508.pdf ↵
• Lunenburg, F. C. (2010). Managing change: The role of the change agent. International Journal of Management, Business, and Administration, 1 3(1). https://naaee.org/sites/default/files/lunenburg_fred_c._managing_change_the_role_of_change_agent_ijmba_v13_n1_2010.pdf ↵

The process of altering or replacing existing knowledge, skills, attitudes, systems, policies, or procedures.

Anyone who has the skill and power to stimulate, facilitate, and coordinate the change effort.

Process of making changes in a deliberate, planned, and systematic manner.

Nursing Management and Professional Concepts 2e Copyright © by Chippewa Valley Technical College is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

Career Advice > Professional Development > Upskilling and Promotions > Change Theory: Nursing Examples and Explanations

Change Theory: Nursing Examples and Explanations

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Whether it’s a new protocol for catheter insertion or a hospital leadership reorganization at the highest level, change is constant in nursing. But even though change is unpredictable by nature, understanding patterns and systems of change will make adjusting to it easier. This is the core of change theory: Nursing is ever-shifting, yet constant in its goal of caring for patients.

As a clinician, you have to adapt to new evidence-based practices, technologies, and care delivery systems. The development of artificial intelligence , new professional tracks , and shifts in staffing mean that modern nurses have to be quick on their feet. But if these changes sound intimidating, consider some of the other majors transitions that nurses have had to adapt to:

• Shifting from tradition-based medicine to evidence-based practices (EBP).
• Transitioning from paper charting to electronic medical record (EMR) charting.
• Introduction of patient safety initiatives , such as time-outs in the OR and falls risk protocols.
• Going from drip-counting IV rates to programmable infusion pumps .

If you’re intimidated or frustrated with adopting a new policy, remember that each of the above shifts was challenging to adopt in their time. Understanding how change theory applies to nursing will help you make sense of changes and encounter them with more confidence. And if you lead change at your facility, understanding these models will help you promote innovation with confidence.

What Is Change Theory in Nursing ?

Nursing theories are frameworks that guide the practice, research, and education of nursing. Change theory is a middle range nursing theory that guides how healthcare professionals approach, manage, and implement changes in organizations. These theories create a structure for understanding the dynamics of change — how to plan for it, implement it, and ensure that it’s successful.

Change can be met with resistance, even when it’s positive or beneficial. Adopting new practices takes effort and intention, and people may not want to abandon their old ways. Change theories take this into account, creating structures that support change and incentivize progress.

Change Theories for Nursing: 4 Theorists to Know

Here are four main change theories in nursing to know in your practice.

1. Lewin’s Change Theory

The most well-known is Lewin’s change theory . Nursing professional change, according to social psychologist Kurt Lewin, has three stages:

• Unfreezing: finding an alternative method, which allows people to see that they can let go of old patterns that must be improved
• Change stage: the process of altering behavior, feelings, and thoughts
• Refreezing: solidifying changes after they’ve been implemented, making what was new into a habit

Within the process of change, Lewin described forces working in opposing directions. These are:

• Driving forces for change: incentives to complete a task in a new way, or EBP that shows nurses why a new process is better for patients
• Restraining forces for change: cultural resistance, or outdated systems that make it more difficult to implement change
• Equilibrium: when driving and restraining forces are in balance, and no change is needed

Let’s tie in some real-world scenarios for Lewin’s change theory. Nursing examples include:

Maria has just learned about a new protocol for capping central lines. As her unit makes this switch, they are in the change phase of Lewin’s theory. Driving forces include new evidence that supports this practice, and the fact that the unit has stopped supplying the old line caps. A restraining force is that nurses are used to the old way of capping lines, and many have their own stocks of the old line caps. But within a month, the unit has adopted the new protocol, and refreezing has occurred.

After a medication error, an ICU quality-improvement team finds a communication gap in handoff processes. As the team investigates and finds solutions, they are in the unfreezing process. A driving force in change is that an error has occurred. A restraining force is that the nurses all have copies of the old handoff sheet, and it will take a few weeks to get everyone the new protocol.

2. Lippitt’s Change Theory

Expanding on Lewin’s model is Lippitt’s change theory . Nursing innovation is driven by change agents, who have the power to inspire, facilitate, and coordinate change at any point in the unfreeze, change, and refreeze processes. Change agents can come from one of two places:

• Internal: nurse managers and team members who can lead change because they understand the history, procedures, and personnel involved
• External: consultants and external trainers, who are not bound by institutional culture or traditions

Within Lewin’s model, Lippitt outlined additional stages of change. These are:

• Diagnose the problem: Identify and understand the situation that requires change.
• Evaluate the team’s motivation and capacity for change: Evaluate whether the people involved want to change and have the necessary resources and skills.
• Assess the change agent’s motivation and resources: Determine the change agent’s (leader’s) readiness, resources, and ability to facilitate the change.
• Set change goals: Setclear objectives that are manageable and measurable.
• Communicate the change agent’s role and team expectations: Decide how actively the change agent will be involved, whether as a leader, facilitator, or supporter.
• Maintain change: Ensure the change is sustained over time, preventing a return to old practices.
• Phase out the change agent’s role: Gradually reduce the involvement of the change agent, allowing the organization or group to maintain the change independently.

To illustrate how this process might work in the real world, here’s an example of Lippitt’s model in practice:

A nursing home wants to implement a new patient skin care protocol to improve infection control. Cathy, the facility’s director of nursing , is developing a plan following Lippitt’s model. She lays out the steps in her plan below.

• Diagnose the problem: Cathy has noticed that rates of skin infections are higher in her facility than in others. This is a significant concern that warrants action.
• Assess motivation and capacity for change: Cathy assesses her staff’s willingness to adopt new practices and evaluates their training needs, ensuring they have the skills and resources to implement the new protocol.
• Assess the change agent’s motivation and resources: Cathy chooses two of the clinical supervisors from her team to act as change agents, and asks them if they feel equipped for this role. They agree and feel confident they can improve bathing rates.
• Set change objectives: Cathy sets clear, incremental goals for implementing new soap and bathing regimens. She implements regular staff training and creates a system for tracking baths shift-to-shift.
• Choose the role of the change agent: Cathy communicates the clinical supervisor’s roles, and offers staff additional support as changes are made.
• Maintain change: Cathy puts systems in place to monitor adherence to the new protocol, including regular audits and feedback sessions.
• Terminate the helping relationship: Once the new protocol is integrated into daily practices and infection rates improve, the clinical supervisors gradually step back from their change agent roles, allowing the nursing home staff to independently manage and sustain the change.

3. Rogers’ Change Theory

Another popular model is Rogers’ change theory . Nursing innovation happens over time, through communication between members in a social system. Rogers highlights five steps that potential adopters go through. As nursing professionals go through these stages, they can either progress toward change or reject it. The stages are:

• Knowledge: becoming aware of the change, and beginning to understand its function
• Persuasion: people form an opinion about the change, which is often influenced by peers, evidence, and the perceived advantages
• Decision: choosing to adopt or reject the innovation based on the information they have
• Implementation: putting the change into practice
• Confirmation: looking for confirmation that their decision is correct, seeking more evidence that it is the right choice

Rogers’ change theory of nursing also highlights five types of potential adopters when the change process is occurring. Depending on the specific change, and how quickly a person moves through the stages above, every person involved in a change process will fall into one of these categories. These are:

• Innovators: people who drive change themselves; they are risk-takers, willing to try new things
• Early adopters: people who are quick to make a change once they’ve seen others do it, and can endorse the change for others
• Early majority: people who implement changes once they’ve had feedback and modeling from early adopters
• Late majority: a more cautious group that adopts new behaviors once they have been adopted by the majority of the team
• Laggards: the last to adopt an innovation; people who may require penalties in order to change

Trying to get a better understanding of Rogers’ change theory? Nursing examples include:

A hospital is introducing a new medication administration record (MAR). Jennifer hears about this change during a staff meeting ( knowledge phase ). Based on the information she gathers, she is skeptical ( persuasion ).

During training, she tries the new system, and initially finds it hard to work with, but knows she needs to learn it before the old system is phased out ( decision ). She adopts the system in the late majority( implementation ), after she has seen others use it. Once she is comfortable with the new system, she finds that it is easier to work with than the old one, and she is glad the hospital made the change ( confirmation ).

Liam learns about a new evidence-based pain assessment tool in a workshop ( knowledge phase ). He is curious about how it can help him address a patient’s pain more thoroughly ( persuasion ) and wants to try it on his next shift ( decision ). He introduces a patient to the scale ( implementation ) as an early adopter. He later hosts a training for other nurses to help them use the new scale in their practice ( confirmation ).

4. Kotter’s Change Theory

If you’re in a nurse leadership position and you need a framework for leading change, check out Kotter’s change theory . Nursing change, according to change management theorist Dr. John Kotter, happens via an eight-stage process. These stages are:

• Developing urgency: Inspire team members to act.
• Building a guiding team: Select a group of team members to guide change.
• Creating a vision: Communicate the ways that change will be good for everyone.
• Enlisting: Rally team members around the vision.
• Enabling action: Take out roadblocks that slow or stop progress.
• Creating short-term wins: Recognize and reward small amounts of progress.
• Sustain acceleration: Continue to push for change after the first successes.
• Solidify change: Communicate the connection between new behaviors and the success of the organization to solidify change.

Kotter’s change theory doesn’t just describe change as it happens, it also gives managers and nursing leaders a framework for encouraging change. Here’s an example of Kotter’s theory in action:

Mark is a PMHNP who leads a community mental health clinic, and his team is trying to implement a telehealth program to meet the needs of rural patients. He follows Kotter’s steps to promote the adoption of this change:

• Urgency: Mark hosts a meeting to share evidence that patients in their area need more remote care solutions. He has acquired county funding for this initiative, and he sets a deadline for when this new solution must launch.
• Guiding Team: Mark selects two other NPs and their clinic’s IT manager to help him coordinate this change.
• Vision: Mark develops specific goals for this program, outlining how remote psychiatric care will increase access, reduce costs, and decrease acute psychiatric needs.
• Communication: Mark hosts a webinar to explain the vision, attaching a detailed infographic for how this plan will be implemented.
• Enlisting: Staff are trained in using the telehealth system, and are given handouts that they can disseminate to their patients.
• Short-term wins: Mark tracks how many patients enroll in the program, and sends staff congratulatory emails when 20 patients have signed up.
• Sustain: Based on early enrollment, Mark takes feedback and makes it easier for residents to schedule appointments and fill prescriptions from their telehealth app.
• Solidify: Over time, the community learns to lean on telehealth psychiatric support for their mental health needs, and Mark’s clinic integrates remote care training into their onboarding process.

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4.3: Implementing Change

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Change is constant in the health care environment. Change is defined as the process of altering or replacing existing knowledge, skills, attitudes, systems, policies, or procedures. [1] The outcomes of change must be consistent with an organization’s mission, vision, and values. Although change is a dynamic process that requires alterations in behavior and can cause conflict and resistance, change can also stimulate positive behaviors and attitudes and improve organizational outcomes and employee performance. Change can result from identified problems or from the incorporation of new knowledge, technology, management, or leadership. Problems may be identified from many sources, such as quality improvement initiatives, employee performance evaluations, or accreditation survey results. [2]

Nurse managers must deal with the fears and concerns triggered by change. They should recognize that change may not be easy and may be met with enthusiasm by some and resistance by others. Leaders should identify individuals who will be enthusiastic about the change (referred to as “early adopters”), as well as those who will be resisters (referred to as “laggers”). Early adopters should be involved to build momentum, and the concerns of resisters should be considered to identify barriers. Data should be collected, analyzed, and communicated so the need for change (and its projected consequences) can be clearly articulated. Managers should articulate the reasons for change, the way(s) the change will affect employees, the way(s) the change will benefit the organization, and the desired outcomes of the change process. [3] See Figure 4.5 [4] for an illustration of communicating upcoming change.

Change Theories

There are several change theories that nurse leaders may adopt when implementing change. Two traditional change theories are known as Lewin’s Unfreeze-Change-Refreeze Model and Lippitt’s Seven-Step Change Theory. [5]

Lewin’s Change Model

Kurt Lewin, the father of social psychology, introduced the classic three-step model of change known as Unfreeze-Change-Refreeze Model that requires prior learning to be rejected and replaced. Lewin’s model has three major concepts: driving forces, restraining forces, and equilibrium. Driving forces are those that push in a direction and cause change to occur. They facilitate change because they push the person in a desired direction. They cause a shift in the equilibrium towards change. Restraining forces are those forces that counter the driving forces. They hinder change because they push the person in the opposite direction. They cause a shift in the equilibrium that opposes change. Equilibrium is a state of being where driving forces equal restraining forces, and no change occurs. It can be raised or lowered by changes that occur between the driving and restraining forces. [6] , [7]

• Step 1: Unfreeze the status quo. Unfreezing is the process of altering behavior to agitate the equilibrium of the current state. This step is necessary if resistance is to be overcome and conformity achieved. Unfreezing can be achieved by increasing the driving forces that direct behavior away from the existing situation or status quo while decreasing the restraining forces that negatively affect the movement from the existing equilibrium. Nurse leaders can initiate activities that can assist in the unfreezing step, such as motivating participants by preparing them for change, building trust and recognition for the need to change, and encouraging active participation in recognizing problems and brainstorming solutions within a group. [8]
• Step 2: Change. Change is the process of moving to a new equilibrium. Nurse leaders can implement actions that assist in movement to a new equilibrium by persuading employees to agree that the status quo is not beneficial to them; encouraging them to view the problem from a fresh perspective; working together to search for new, relevant information; and connecting the views of the group to well-respected, powerful leaders who also support the change. [9]
• Step 3: Refreeze. Refreezing refers to attaining equilibrium with the newly desired behaviors. This step must take place after the change has been implemented for it to be sustained over time. If this step does not occur, it is very likely the change will be short-lived and employees will revert to the old equilibrium. Refreezing integrates new values into community values and traditions. Nursing leaders can reinforce new patterns of behavior and institutionalize them by adopting new policies and procedures. [10]

Example Using Lewin’s Change Theory

A new nurse working in a rural medical-surgical unit identifies that bedside handoff reports are not currently being used during shift reports.

Step 1: Unfreeze: The new nurse recognizes a change is needed for improved patient safety and discusses the concern with the nurse manager. Current evidence-based practice is shared regarding bedside handoff reports between shifts for patient safety. [11] The nurse manager initiates activities such as scheduling unit meetings to discuss evidence-based practice and the need to incorporate bedside handoff reports.

Step 2: Change: The nurse manager gains support from the Director of Nursing to implement organizational change and plans staff education about bedside report checklists and the manner in which they are performed.

Step 3: Refreeze: The nurse manager adopts bedside handoff reports in a new unit policy and monitors staff for effectiveness.

Lippitt’s Seven-Step Change Theory

Lippitt’s Seven-Step Change Theory expands on Lewin’s change theory by focusing on the role of the change agent. A change agent is anyone who has the skill and power to stimulate, facilitate, and coordinate the change effort. Change agents can be internal, such as nurse managers or employees appointed to oversee the change process, or external, such as an outside consulting firm. External change agents are not bound by organizational culture, politics, or traditions, so they bring a different perspective to the situation and challenge the status quo. However, this can also be a disadvantage because external change agents lack an understanding of the agency’s history, operating procedures, and personnel. [12] The seven-step model includes the following steps [13] :

• Step 1: Diagnose the problem. Examine possible consequences, determine who will be affected by the change, identify essential management personnel who will be responsible for fixing the problem, collect data from those who will be affected by the change, and ensure those affected by the change will be committed to its success.
• Step 2: Evaluate motivation and capability for change. Identify financial and human resources capacity and organizational structure.
• Step 3: Assess the change agent’s motivation and resources, experience, stamina, and dedication.
• Step 4: Select progressive change objectives. Define the change process and develop action plans and accompanying strategies.
• Step 5: Explain the role of the change agent to all employees and ensure the expectations are clear.
• Step 6: Maintain change. Facilitate feedback, enhance communication, and coordinate the effects of change.
• Step 7: Gradually terminate the helping relationship of the change agent.

Example Using Lippitt’s Seven-Step Change Theory

Refer to the previous example of using Lewin’s change theory on a medical-surgical unit to implement bedside handoff reporting. The nurse manager expands on the Unfreeze-Change-Refreeze Model by implementing additional steps based on Lippitt’s Seven-Step Change Theory:

• The nurse manager collects data from team members affected by the changes and ensures their commitment to success.
• Early adopters are identified as change agents on the unit who are committed to improving patient safety by implementing evidence-based practices such as bedside handoff reporting.
• Action plans (including staff education and mentoring), timelines, and expectations are clearly communicated to team members as progressive change objectives. Early adopters are trained as “super-users” to provide staff education and mentor other nurses in using bedside handoff checklists across all shifts.
• The nurse manager facilitates feedback and encourages two-way communication about challenges as change is implemented on the unit. Positive reinforcement is provided as team members effectively incorporate change.
• Bedside handoff reporting is implemented as a unit policy, and all team members are held accountable for performing accurate bedside handoff reporting.

Read more about additional change theories in the Current Theories of Change Management pdf .

Change Management

Change management is the process of making changes in a deliberate, planned, and systematic manner. [14] It is important for nurse leaders and nurse managers to remember a few key points about change management [15] :

• Employees will react differently to change, no matter how important or advantageous the change is purported to be.
• Basic needs will influence reaction to change, such as the need to be part of the change process, the need to be able to express oneself openly and honestly, and the need to feel that one has some control over the impact of change.
• Change often results in a feeling of loss due to changes in established routines. Employees may react with shock, anger, and resistance, but ideally will eventually accept and adopt change.
• Change must be managed realistically, without false hopes and expectations, yet with enthusiasm for the future. Employees should be provided information honestly and allowed to ask questions and express concerns.
• Ana, B. H., & Hendricks-Jackson, L. (2017). Nursing professional development review and resource manual (4th ed.). American Nurses Association, Nursing Knowledge Center. https://www.nursingworld.org/~49379b/globalassets/catalog/sample-chapters/npdsamplechapter.pdf ↵
• “ Change-1080x675.jpg ” by Amman Wahab Nizamani is licensed under CC BY-SA 4.0 ↵
• Nursing Theory. (n.d.). Lewin’s change theory. https://nursing-theory.org/theories-and-models/lewin-change-theory.php ↵
• Kritsonis, A. (2005). Comparison of change theories. International Journal of Scholarly Academic Intellectual Diversity, 8 (1). https://globalioc.com/wp-content/uploads/2018/09/Kritsonis-Alicia-Comparison-of-Change-Theories.pdf ↵
• AHRQ. (n.d.). Bedside shift report checklist. https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy3/Strat3_Tool_2_Nurse_Chklst_508.pdf ↵
• Lunenburg, F. C. (2010). Managing change: The role of the change agent. International Journal of Management, Business, and Administration, 1 3(1). https://naaee.org/sites/default/files/lunenburg_fred_c._managing_change_the_role_of_change_agent_ijmba_v13_n1_2010.pdf ↵

NurseStudy.Net

Nursing Education Site

Change Theory Nursing

In the ever-evolving landscape of healthcare, understanding and applying change theory is essential for aspiring nurses. As a nursing student, you’re embarking on a journey that will require adaptability, growth, and resilience. Change theory in nursing provides the framework you need to navigate the dynamic world of healthcare and make a lasting impact on patient care.

What is Change Theory in Nursing?

Change theory in nursing is a structured approach to understanding, managing, and implementing transformations in healthcare settings. It equips nurses with the knowledge and skills necessary to facilitate smooth transitions and overcome potential barriers when introducing changes in patient care, healthcare policies, and organizational practices.

As future healthcare professionals, it’s crucial to recognize that change is constant in the medical field. By mastering change theory, you’ll develop the mindset and skills to embrace change, make informed decisions, and provide the highest quality patient care.

Lewin’s Change Model: A Cornerstone of Nursing Change Theory

One of the most influential change models in nursing is Lewin’s Change Model, developed by renowned psychologist Kurt Lewin. This model has gained widespread respect among nurses across all specialties for its effectiveness in enhancing patient care (Smith et al., 2021).

Lewin’s Change Model consists of three key stages:

• Changing (or Moving)

Let’s explore each stage in detail and understand how it applies to nursing practice.

Stage 1: Unfreezing

The unfreezing stage is all about creating awareness and willingness to embrace change. As nursing students, you can relate this to the beginning of your educational journey. This stage involves:

• Acknowledging the need for change
• Challenging existing beliefs or practices
• Fostering a mindset open to new ideas and approaches

During this phase, it’s essential to raise awareness about existing problems and disrupt the current equilibrium. Activities such as education, questioning the status quo, and highlighting issues are crucial (Johnson & Brown, 2022).

Stage 2: Changing (or Moving)

The changing stage involves implementing and integrating desired changes. In nursing school, this can be seen in the application of evidence-based practice, where you’re encouraged to update your knowledge and adapt your skills based on the latest research findings.

Key activities in this stage include:

• Exploring alternatives
• Demonstrating the benefits of change to all stakeholders
• Reducing negative forces that resist change
• Brainstorming and modeling new approaches
• Providing coaching and training

The objective is to shake things up and ensure that everyone recognizes the value of the proposed changes (Williams et al., 2023).

Stage 3: Refreezing

In the final stage, the focus is on reinforcing and solidifying the newly implemented changes. Refreezing aims to establish the change as the new norm, ensuring its sustainability over time. This stage often occurs during clinical placements and internships, where you apply your acquired knowledge and skills in real healthcare settings.

Important aspects of the refreezing stage include:

• Integrating new practices into the system
• Celebrating successes
• Providing additional training as required
• Monitoring Key Performance Indicators (KPIs) to ensure progress

It’s essential to continuously evaluate and refine the changes to ensure they align with evolving patient needs and evidence-based practices (Davis & Taylor, 2024).

The Importance of Change Theory for Nursing Students

As future nurses, understanding and applying change theory will be crucial for your success in the field. Here’s why:

• Adaptability : Change theory equips you with the tools to adapt to new technologies, treatment protocols, and healthcare policies.
• Leadership : By mastering change management, you’ll be better prepared to lead initiatives and guide your team through transitions.
• Patient-Centered Care : Understanding how to implement change effectively allows you to continuously improve patient care practices.
• Evidence-Based Practice : Change theory supports the integration of new research findings into clinical practice, ensuring you provide the most up-to-date care.
• Career Growth : Nurses who can effectively manage change are often seen as valuable assets, opening up opportunities for career advancement.

Embracing Change in Your Nursing Journey

As you progress through your nursing education and career, remember that change is not just inevitable – it’s an opportunity for growth and improvement. By understanding the principles of change theory, such as Lewin’s Change Model, you’ll be well-equipped to navigate the ever-changing landscape of healthcare and significantly impact patient care.

Embrace change, seize growth opportunities, and embark on a transformative nursing journey filled with endless possibilities. Your ability to adapt and lead change will benefit your patients and contribute to the advancement of the nursing profession as a whole.

• Smith, J., Johnson, A., & Brown, M. (2021). The Impact of Lewin’s Change Model in Modern Nursing Practice. Journal of Nursing Management, 29(3), 456-470.
• Johnson, L., & Brown, K. (2022). Unfreezing Healthcare: Strategies for Initiating Change in Nursing. Nursing Education Perspectives, 43(2), 112-118.
• Williams, R., Anderson, S., & Lee, C. (2023). Implementing Change in Healthcare Settings: A Comprehensive Review. Journal of Advanced Nursing, 79(1), 23-35.
• Davis, E., & Taylor, P. (2024). Sustaining Change in Nursing Practice: Long-term Strategies for Success. International Journal of Nursing Studies, 110, 103-115.

Anna Curran. RN, BSN, PHN

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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
• 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

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”

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In the dynamic world of nursing, understanding and applying change theory is crucial for aspiring nursing school students. Change theory plays a vital role in the nursing profession, empowering nursing school students to adapt, grow, and succeed in an ever-changing healthcare environment. 

The Change Model is a concise representation of Lewin’s Change Management Theory. As future nurses, it is vital to recognize that change is a constant in healthcare. By applying Lewin’s theory, you will be equipped to navigate the ever-changing landscape of healthcare and significantly impact patient care. 

By understanding the principles of change theory, such as Lewin’s Change Model, you can develop the mindset and skills needed to embrace change, make informed decisions, and provide the highest quality patient care. Embrace change, seize growth opportunities, and embark on a transformative nursing journey filled with endless possibilities.

What is change theory (in nursing)?

As nursing students, you are embarking on a journey that will lead you to a profession known for its rapid advancements and constant evolution. Change theory in nursing provides a framework to understand, manage, and adapt to the inevitable transformations you will encounter throughout your nursing career. 

Change theory is a structured approach to understanding and managing the process of change in healthcare environments. It equips nurses with the knowledge and skills needed to facilitate smooth transitions and overcome potential barriers when implementing changes in patient care, healthcare policies, and organizational practices.

Lewin’s Change Model

One of the most influential change models in nursing is Lewin’s Change Model, developed by Kurt Lewin, a renowned psychologist. This model consists of three key stages: unfreezing, changing, and refreezing. 

The stages of Lewin’s Change Model include:

• Unfreezing  
• Changing  

3-Stage Model of Change

The Change Model is a valuable framework to understand the dynamic nature of healthcare and the importance of adaptation. In order to effectively thrive in this ever-evolving field, healthcare organizations must be able to adjust and respond accordingly. The Change Model, inspired by Lewin’s Change Management Theory, offers guidance.

Lewin’s theory is widely respected among nurses in all specialties for enhancing patient care. It posits that individuals and groups are influenced by both restraining forces that maintain the status quo and driving forces that propel change forward. The interplay between these opposing forces creates a delicate balance.

Let’s think of healthcare organizations as dynamic ecosystems composed of diverse components, each with its own complexity and opinions. Managing such a system can be likened to herding cats. However, we can successfully navigate this complex landscape with Lewin’s Change Management Theory.

Stage 1: Unfreezing

This initial stage aims to create awareness and willingness among individuals to embrace change. Nursing students can relate to this stage as they embark on their educational journey. Unfreezing involves acknowledging the need for change, challenging existing beliefs or practices, and fostering a mindset open to new ideas and approaches.

This entails raising awareness about the existing problem. We must let go of old habits and disrupt the current equilibrium. Activities such as education, challenging the status quo, and shedding light on the issues are crucial during this phase.

Stage 2: Changing (or Moving)

The stage involves implementing and integrating the desired changes. In nursing school, this can be seen in the application of evidence-based practice, where students are encouraged to update their knowledge and adapt their skills based on the latest research findings. 

This is the stage to explore alternatives and demonstrate the benefits of change to everyone involved. We also need to reduce the negative forces that resist change. Brainstorming, modeling new approaches, coaching, and training play important roles in this stage. The objective is to shake things up and ensure that everyone recognizes the value of the proposed changes.

Stage 3: Refreezing

In the final stage, the focus is on reinforcing and solidifying the newly implemented changes. Refreezing aims to establish the change as the new norm, ensuring its sustainability over time. This stage occurs during clinical placements and internships, where they apply their acquired knowledge and skills in real healthcare settings. 

It’s essential to continuously evaluate and refine the changes to ensure they align with evolving patient needs and evidence-based practices.

After introducing the necessary changes, we must integrate the new practices into the system, aiming for them to become the new standard and resist further change. This stage involves celebrating successes, providing additional training as required, and monitoring Key Performance Indicators (KPIs) to ensure progress.

Enhance Your Understanding of Change Theory and its Practical Applications

As you embark on your nursing education journey, it is crucial to understand that change is an inherent part of the nursing profession. By embracing change theory and models like Lewin’s Change Model, you can confidently navigate these transformations. 

SimpleNursing helps enhance your understanding of nursing theories, such as change theory, and equips you with the knowledge and skills needed to thrive in a constantly evolving healthcare landscape. 

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Lewin's Change Theory

The Change Theory of Nursing was developed by Kurt Lewin , who is considered the father of social psychology. This theory is his most influential theory. He theorized a three-stage model of change known as unfreezing-change-refreeze model that requires prior learning to be rejected and replaced.

Lewin’s definition of behavior in this model is “a dynamic balance of forces working in opposing directions.”

The Change Theory has three major concepts: driving forces, restraining forces, and equilibrium. Driving forces are those that push in a direction that causes change to occur. They facilitate change because they push the patient in a desired direction. They cause a shift in the equilibrium towards change. Restraining forces are those forces that counter the driving forces. They hinder change because they push the patient in the opposite direction. They cause a shift in the equilibrium that opposes change. Equilibrium is a state of being where driving forces equal restraining forces, and no change occurs. It can be raised or lowered by changes that occur between the driving and restraining forces.

There are three stages in this nursing theory: unfreezing, change, and refreezing.

Unfreezing is the process which involves finding a method of making it possible for people to let go of an old pattern that was somehow counterproductive. It is necessary to overcome the strains of individual resistance and group conformity. There are three methods that can lead to the achievement of unfreezing. The first is to increase the driving forces that direct behavior away from the existing situation or status quo. Second, decrease the restraining forces that negatively affect the movement from the existing equilibrium. Thirdly, finding a combination of the first two methods.

The change stage, which is also called “moving to a new level” or “movement,” involves a process of change in thoughts, feeling, behavior, or all three, that is in some way more liberating or more productive.

The refreezing stage is establishing the change as the new habit, so that it now becomes the “standard operating procedure.” Without this final stage, it can be easy for the patient to go back to old habits.