Sample Nursing Paper on Social and Cultural Influences in Global Business


In the recent past, many theorists have come up with models that explain change. Some of the theorisers include Lewin, Havelock, Rogers, Lippitt and Kotter.  According to Clay and Brett (2017), Kotter illustrated an eight-step progression for cultural change. Kotter later changed his idea of structural change from top-down to deliberate bottom-up development. This paper will concentrate on John Kotter’s change model, application of the theory in practical processes, driving and restraining forces during the implementation of change.

Overview of Kotter’s change theory

The escalated rate of technology dictates changes in organizational undertakings. Preparing people to receive and implement fresh methods of working is thus necessary. Henry et al. (2017) expound on John Kotter’s eight basic steps for effective transformation. First, one needs to convince people that the change is urgently needed. Second, a team of influential leaders is to be created to represent the whole organization. The third step is developing a realistic and attainable idea of the change. Fourth, it involves publicizing the vision to the desired audience. Fifth, unravel any obstructions to the change and find their solutions beforehand. In the sixth step, one needs to create rapid successes and overcome resistance. Seventh, keep stirring the change frontward regardless of new opposition along the way. Lastly, infuse the new amendments into the group culture.

Purpose of Kotter’s change theory

Often, unceasing success in any institution demands vital changes. Most change actions fail due to many factors which include; tolerating too much complacency, failing to form a competent coalition, poor choice of a vision, allowing obstacles to choke the change process, inability to get short-term triumphs, declaring success impulsively and lastly, not diffusing the changes in the communal culture. Kotter’s change theory is thus designed to help organizations avoid such errors.

Thesis statement

Kotter’s change theory provides an easy-to-use strategy for implementing change in the nursing profession.

Major components of Kotter’s change theory

Kotter’s change model has eight key steps. Consistent with Kotter, following the exact order of steps is crucial in attaining success. In 2017, Libby and Betsy discussed eight steps in John’s change theory. The first step entails establishing an impression of urgency. A high level of motivation in the target audience is crucial for the change process to succeed. Therefore, people need to be convinced that change is necessary now. This sense of urgency will propel them towards accepting and finally implementing the change. In the second step, one needs to create a team of competent and persuasive leaders from the organization. The team should be well informed about the change. This is because the team is supposed to influence the entire system in embracing and applying the change. The third step ensures that the aim of the change is real. Having precise strategies for attaining the goal is also key. One should explain the means of achieving the change while focusing on the vision.

The fourth step focuses on discussing the vision to win people. All the details of the change are simplified at this stage. It is crucial to create an environment that encourages dialogue with the target audience. Encouragement of others to act occurs in the fifth step. This is achieved by determining barriers to change, such as workers’ skill sets and organizations’ structures and working so hard to find their solutions. The sixth step entails planning on how to create quick wins. These wins help in overcoming obstructions. After that leading the change process to long-term victories. The seventh step ensures that re-emergence of obstructions later in the process does not cause the collapse of the process. This is realized by elevating the earnestness to change among the staff. In the last step, the change is incorporated into the culture.  Present staff should view the change as a benefit over the previous way of working. New employees should clearly see the change as part of the culture. Generally, the change should supersede the former styles in advantage.

In 2017, Donnelly and Lane reported that 70% of change projects fail. This implies that the majority of people are really bad at adopting new ideas. Kotter identifies eight mistakes that stumble to change efforts. To begin, accepting too much contentment causes people to lack a reason for the change. Moreover, failure to come up with a powerful helping coalition and having unclear vision stumbles most change procedures.

Additionally, failure to accurately communicate the details of the vision leaves people with unanswered questions and doubts. Barriers of change that re-emerge along the process can choke the vision. Failure to create quick wins contributes to loss of focus on the objective. Declaring victory at the sight of the first positive victory can crumble the project due to prejudgement. Lastly, neglecting to infuse the change into the organisational culture causes the change to fail due to lack of a firm anchor.

Implementation of Kotter’s change theory in nursing

A need for constant improvement of services in the health care sector necessitates that nurses should embrace changes. This need has led to the application of Kotter’s theory in the nursing field to enhance the value of services. According to Chowthi et al. (2016), Nurse Coaches have played a crucial role in bringing about the needed changes in the nursing profession. Further down is a description of how Kotter’s change model has been used to communicate relevant information at the bedside while changing shifts.

 Creating a sense of urgency entails motivating the workers to embrace change as a way of solving current problems. The staff is encouraged to view a problem as an opportunity to change and addressing it assures positive results and a more supportive environment to implement the change. For instance, administration in the nursing field realized the need for precise communication at the bedside. Implementation of Kotter’s first step was effected by exposing the demerits of poor communication during the handoff process. By discussing risk for harming patients, nurses were willing to foster bedside communication. Competent leaders are required to persuade others to adopt a change. In the infusion of this step in the nursing field, nurse leaders (nurse manager, nurse educator, senior bedside nurse) were educated about the eight steps of Kotter’s change theory by a nurse director. Additionally, leaders used literature on safety initiatives from the institute of medicine. With all the relevant information at hand, the cohesive leaders were equipped to create a vision for change.

Shaping the vision and coming up with strategies to achieve it is vital.  This step was implemented in nursing by coming up with a 3-step process that included explaining the roles of incoming and outgoing nurses and officiating communication structure for the handoff procedure at the bedside. The results were better communication among nurses, patients, and relatives at the bedside. After establishing the vision, it is important to share it with the execution team. In the nursing field, articles explaining the significance of bedside handoffs and implementation of change concurrent with Kotter’s model were availed to the staff. Thorough education of the staff on the vision of change was conducted during staff meetings and other educational sessions.

Effective communication and direct assistance from others are critical during the adoption of a concept. To implement this step in nursing, the staff was empowered to embrace the vision by reinforcing the home-grown system. Nursing groups were convened daily to assess the efficacy of countermeasures until full adoption was achieved. Nursing leadership provided relevant support to employees who were unpleased with change. This was a continuous process until all setbacks to change in staff fraternity were resolved.

Additionally, to sustain change processes, a team is encouraged to create immediate and visible wins. During the application of this step in the nursing practice, two examples of instant wins were identified. First, the staff was able to identify missed prescriptions on the electronic medication record at the start of the shift. Second, the staff realized an improvement in efficiency in work completion and that they were able to leave on time. By emphasizing such wins, the motion of the project was strengthened.

In 2016, Small et al. explained how the nurse leaders trained and supported the staff while maintaining the change. Moreover, the leaders emphasized the need to uphold critical thinking, which resulted in the emergence of new procedures. Implementation of this step in the daily management system improved patient care services. For instance, by revising the assignments of the staff, patients were organized according to bed location, leading to reduced walking and moving nurses near their patients. Lastly, full compliance with the change requires a cultural initiative to enable the vision to become a norm.  This step was applied in the nursing practise by integrating bedside handoff change into new nurse orientations and education of nurses.

Consequently, bedside handoff became a cultural practice in the unit. Acceptance from the majority propelled the change regardless of a few opposition from a few resistant nurses. Eventually, the new practice enhanced communication and patient satisfaction, making a nursing field a better working place.

Potential driving forces in Kotter’s change theory.

The potential driving forces in Kotter’s model includes change agents and the nature of the model. According to Salam et al. (2016), Change agents are essential in supporting the process of change. In the nursing field, the change agents are the leaders of various departments and units. First, the agents play a critical character in the consultant. They provide nurses with relevant data from both internal and external sources. This data is essential in building predictive models by the management and employees. Agents can also answer any questions from employees hence clearing all doubts concerning the change. Second, the agents are trainers. The nurse leaders educate employees on a new skill set to enable the staff to solve various problems in their units. Lastly, agents are researchers. As researchers, the nurse leaders develop evaluation systems that asses the efficiency of the change process in their respective staff members

The implementation process of the model is an easy step-by-step procedure. Kotter provided clear steps that are easy to understand and apply. The model focuses on preparing and embracing the change while allowing for an easy transition. The focus of the model is on the buy-in of employees leading to success. The flexibility of the model ensured ease incorporation into various structures.

Restraining forces in Kotter’s change theory

Restraining forces are barriers to change. Resistance comes in mainly at the transition level. In the nursing practice, the personnel is not flexible enough to abandon the old practices. According to research conducted by Tang and Ngang in 2019, competent nurses tend to be rigid as they cherish their long term experience in their routine procedures. Sometimes this leads to professional negligence, such as negligence in double-checking of high alert medications. Such nurses believe that they don’t need to change; experience in old ways is more important to them. Nurses are often hesitant to change their old practices due to various reasons.

To begin with, failure to appreciate the need to change creates resistance toward change. The aim of modernization might have been misunderstood or considered irrelevant and incapable of solving current problems. Second, some nurses might be against the tactics of applying the amendments rather than the change itself. Additionally, some nurses perceive the change as an embarrassment and threat to their self-esteem or interest, thus becoming intolerant to change. Furthermore, a lack of trust in the nurse educators and other change agents based on past failures in implementing changes. The nature of Kotter’s model, such as the strict following of steps, long implementation time, and lack of room for co-creation, can lead to frustration among the nurses if their needs are overlooked. Lastly, change agents in the nursing practice have reported a lack of resources as one of the major restraining force.

Ways of overcoming resistance to change

In 2016, Salam et al. explained strategies that can be adopted to overcome resistance. First, the empirical-rational approach, which assumes that the behaviour of nurses is driven by rational self-interest, explains the resistance to change among nurses. Nurses can embrace a change if its benefits are well explained and justified. Proper communication and enticements are necessary for this strategy. Research has revealed that some nurses are usually convinced of the change. Nurse educators are thus advised to target such converts and use them as influencers. Second, we have the normative re-educative strategy, which banks on the assumption that nurses act in line with socio-cultural norms. Nurse educators are expected to focus on the impact of alteration in the already existing cultural activities of the staff. The strategy should not distort the skills, attitudes, values, and relationships among the nurses. Since culture does not evolve quickly, this strategy is effective for middle and long term projects such as the establishment of a Magnet Recognition Program, which takes up to five years to achieve.

Third, educators can use a power-coercive policy whereby changes are imposed on nurses by the management. Defiant nurses are often subject to disciplinary actions. This strategy is considered effective, especially for the changes that are urgent and must-do nursing policies that explain the standards of care. Changes in policies such as patient identification before administering medicine should use this approach too. The fourth strategy is called an adaptive environmental scheme. This involves the construction of a new organization and, after that, transferring staff from old buildings to a new one. This strategy is, therefore, considered impractical for the nurse educator.

The need for change in nursing practice

In 2017, Joseph and Joyce revealed that changes in nursing practice are inevitable and paramount. This is due to the ever-evolving techniques in the field that are aimed at improving the quality of services and enhance efficiency at work. Regulations in the nursing practice are constantly evolving to improve the quality and safety of health care services. The old methods are prone to errors; thus, nurses are instructed to embrace modifications to evade such errors. Any nursing system that is reluctant to adjust is considered obsolete and with a limited chance to advance. Just like any other business, nursing practices should aim at satisfying its clients (patients). Therefore, any beneficial and justified change in nursing practise should be embraced.

The implication of change in nursing practice

Changes that have been introduced in the nursing practice have improved the quality of health care services and elevated the standards of hospitals. This is according to the research that was conducted by Baloh et al. (2018). For instance, the introduction of clear communication at the bedside while changing shifts have increased the level of accuracy while handling patients. Additionally, safety for the patients has improved. This is evidenced by the prior identification of patients by the nurse on duty before the administration of medicine.

Furthermore, the transition of a shift has been made easier by clearly defining the roles of each nurse, thus eliminating the possibilities of role mix-ups or exchange. The nurses have also been relieved of too much walking as they are stationed closer to their respective patients. The education of nurses on the new skillsets has also improved their level of expertise, thus equipping them to handle problems in their field of operation. Generally, the adoption of new procedures in the nursing practice has steered growth in the profession.


Change theory is essential when anticipating modifications in nursing practice. Selecting a model that effectively fits the needs of administration, staff, and patients are crucial for sustainability. The chief causes of failure in most change progressions in nursing practice are reluctance to support and empower the nurses to adopt the new procedures. Embracing planned changes in nursing practice is necessary, but it can be demanding due to resistance. Therefore one needs to have in place proper strategies to aid in dealing with the barriers to revolution. Kotter’s 8-step model is easy to understand and can be easily applied for effective change.



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