Unit 5 – Prescribing in Practice

Management of Change

Theories about organisational change abound. Changes are usually introduced either to improve effectiveness or to adapt to external changes. The constant need for change and improvement is what ensures future organisational success.

Changes linked to nurse prescribing have occurred as a result of external forces effected by government legislation. The management of these changes depends on how they are implemented in the team.

Lewin (1951) describes the phases of planned change effort as unfreezing, moving and refreezing.

The unfreezing phase involves identifying a problem that requires change. Those who will provide the impetus to move things forward will accept this need for change. Some people will see the need for change immediately, while others will resist acknowledging it.


Consider the words 'others will accept this need for change'. To whom may this refer? Can you think of anyone who may be resistant to the changes nurse prescribing will bring to your area of practice?

After the first phase, which involves acknowledging the need for change, comes the next step — the exploratory moving phase. People move towards change by exploring options, formulating plans and implementing the change.


How would you involve those unwilling to accept the new changes?

The final phase requires refreezing the changes and re-establishing stability around these. Refreezing keeps others from going back to the old way of working and provides an infrastructure on which to build.

In reality, people in a group tend to vacillate, moving at different speeds and in different directions. Ultimately, they must converge to make the change permanent.

Thus, the theory of change is heavily influenced by the practicalities of change, in that these involve individuals.

Further Reading

Further reading

Ootim, B. (1997) Effective change. Nursing Management 4: 2, 10.

Sheehan, J. (1990) Investigating change in a nursing context. Journal of Advanced Nursing 15: 7, 819-824.

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