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T H E J O U R N A L O F N U R S I N G A D M I N I S T R A T I O N

MAGNET A PERSPECTIVES

Moving Forward Lessons From Unplanned Change

Cole Edmonson, DNP, RN, FACHE, NEA-BC

The article focuses on the concept of unplanned change in a large tertiary facility in Texas related to the 1st Ebola patient to be diagnosed in the United States. The chief nurse executive relates the general reactions, im-pacts, and challenges faced in this unprecedented event.

Much like the Aspen tree, we may appear as individuals, but in truth we are all connected as one great organization, profession, community, and world. Our connectedness is our strength, allowing us to weather the storms that are brought upon us.

VCole Edmonson

As a 2-time MagnetA-designated facility, 1 of ap-proximately 400 worldwide, Texas Health Presbyterian Hospital Dallas for many years has been extremely proud of its innovations in clinical nursing care and leadership. Our focus on professional practice environ-ments and clinical leadership has been unwavering, as has our commitment to be leaders in our community.

Author Affiliation: Chief Nursing Officer, Texas Health Presbyterian Hospital Dallas, and Robert Wood Johnson Foundation Executive Nurse Fellow.

The author declares no conflicts of interest. Correspondence: Dr Edmonson,

Texas Health Presbyterian Hospital, 8200 Walnut Hill Ln, Dallas, TX 75231 (Coleedmonson@ texashealth.org).

DOI: 10.1097/NNA.0000000000000158

Being Magnet means being on the frontlines of change with the ability to embrace complexity and demonstrate plasticity, while remaining focused on humanity. Over the years, we have demonstrated this with programs and research including our Sexual Assault Nurse Examiners care and training program, international research on maternal-infant bonding, and the resuscitation quality improvement programV all firsts in the world and our community.

Planned Versus Unplanned Change

Innovation, research, and sharing are part of the DNA of this hospital. These examples, however, rep-resent outcome-focused change based on careful plan-ning and evaluation. Preparing for, and learning from, unplanned change is a completely different experience that challenges organizations in unique ways including their resilience and hardiness.

In an unplanned change scenario, it is important to keep the elements of planned change front of mind: planning, testing, evaluating, revising, implementing, refining, and ultimately deploying in a more controlled environment.

With the luxury of time and calm gone, un-planned change can take on a dizzying pace. But in that time, the amount of learning that occurs can be tremendous if captured properly for later review, processed for key lessons, and disseminated.

Recently, we were presented with an extremely challenging situation where all that our clinical nurses and leaders had learned and prepared themselves for was tried and tested on an international and public stage.

JONA � Vol. 45, No. 2 � February 2015

The Situation

While Ebola has been on the healthcare radar for years, it remained a true exotic, having been treated in this country only a few times and always with the foreknowledge of those providing care that their pa-tient was infected with this highly morbid disease.

When we became the 1st hospital to diagnose and treat a nonhealthcare worker as an Ebola patient in the United States, a series of events were set in play that has changed forever how patients with infec-tious diseases will be cared for in our hospital and hospitals around the country.

As with any large, urban hospital where frontline nurses routinely encounter infectious diseases, we had infection prevention plans in place, and our nurses were well trained. We believed we were well prepared for most known scenarios. A truly novel presentation, such as Ebola, represented unique challenges for the preparation of nurses and the entire organization to deliver effective, safe, and compassionate care at new levels.

Unlike planned change, this situation had some very unique elements that required us to adapt and change rapidly while actively learning. It is the ability to adapt, adopt, or abort practices that ultimately determines the usefulness and applicability of those changes. A hallmark of nursing is flexibility, agility, and creativity, which we relied on heavily during the evolving situation

What and How We Learned

From the moment we suspected we had an Ebola case, we were in constant communication with experts from Emory University Medical Center, the Centers for Disease Control and Prevention, the Dallas County Health Department, and the Texas Department of State Health Services, among others.

During this time, clinical and nursing leadership, in fact, our entire organization and our outside part-ners, worked extremely well together given the un-precedented circumstances, despite media reports to the contrary.

As a team with a unified goal of better treatment and protection, we were able to

� improve the donning and doffing of personal protective equipment,

� determine which equipment and supplies would provide the best protection,

� reduce risk of exposure based on operational realities,

� refine the designation of zones for treatment and decontamination,

� provide well-being support throughout the im-mediate experience and beyond for clinicians,

� assist in educating our entire health system, our community, and beyond on Ebola facts, and

� understand and help minimize the effects on colleagues who care for patients with Ebola.

All of these adaptations were done expeditiously and systematically. They were captured and catalogued along the way to share what we learned with others. Demonstrating flexibility, agility, adaptability, and humility in the face of extreme challenges is per-haps more valuable than seeking the illusive perfect response.

Sharing Our Learnings

Even before our 2 brave and courageous nurses were cured and returned safely home to us, we had begun disseminating what we learned. We did this primarily through actively consulting with other hospitals and presenting our learnings through webinars sponsored by national nursing and healthcare organizations. We will continue to disseminate lessons learned through additional venues and publications in honor of our commitment to patients and caregivers across the globe.

Reflections

Our nurses are committed to learning and continu-ally improving in a never-ending journey to excel-lence. In the end, it is our Magnet culture, anchored on our values and our promise that have sustained us. We have a deeper appreciation and understanding of connectedness to our colleagues, community, nation, and humanity. As we move forward with courage, strength, compassion, and resolve, we want to thank all of those who have supported us and kept us in their positive thoughts and prayers. Perhaps most of all, thank you to the heroes at Texas Health Presbyterian Hospital Dallas.

JONA � Vol. 45, No. 2 � February 2015