When Change Happens…

or why must life keep throwing curveballs at us?

Jun 05, 2026

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The first time I recall really seeing how difficult a change in routine was for some people was in my first nursing job. Our hospital was going through an expansion project. They decided to also renovate all the old units before opening the new units to new patients. This happened one old unit at a time, with most of their staff, along with all their patients being transferred to the new units while the old unit was refurbished.

The new units had been established for “Total Patient Care” style of nursing. Each room had built in “Nurse server,” which was like having both a “clean” and “dirty” utility cabinet. The upper half was the “Clean” utility area with its own door access only from the hall.

The upper portion had all the linen supplies and treatment supplies needed for the patient. There was a pocket on the inside of the door that held the patient’s chart. Yes, this was before electronic charts—I’m that old, folks. There, also, was a locked built-in drug box, which the pharmacy tech would place the exact needed medications for your shift at the start of every shift.

The lower half was the “dirty” area and could be accessed from either in the patient’s room, or from out in the hall. There was a “sharps receptacle along with a medical waste receptacle and a laundry bag for dirty linens in this area. There was an area for any reusable equipment to be placed for cleaning and/or sterilizing.

We were leaving team nursing behind, where one nurse was “charge nurse” and did all the rounding with doctors. Another nurse did all meds for every patient, and any other nurses did assessments, vital signs, treatments, and hung IVs. On crazy busy shifts, we all tried to pitch in wherever needed.

Our unit was the last to be renovated. Since I was interested in doing Pediatric nursing, I had already worked on the renovated Peds unit with the new “Total Patient Care” concept. I loved it and looked forward to the change. When we received notification, we were to report to the new unit, it immediately set up a bit of consternation for our part-time nurses.

Some nurses embraced the new concept, but others resented it. Also since the old units were 36-39 bed units and the new units were about 30 beds, it meant a nurse would have to “float” to a completely different unit every night. This created a great deal of distress for the nurses that resisted change.

I was working the 3-11 shift. A nursing supervisor broke the news that part-time nurses would be floated elsewhere, and the chatter, protests and tears started. I slid over to the supervisor and suggested since I wanted Peds and was used to floating there, why not just use me as the float nurse and let our part-timers stay where they were more comfortable.

Change was happening, whether we liked it or not. Not only were our staff in an unfamiliar environment, they were also having to get used to an entirely different way of doing nursing care. For the one doing the most protesting… she was nearing retirement. She had been doing Team Nursing for forty years. This was a double whammy change for her, the new environment, and a new system of nursing.

I was the relative new girl on the block. I had graduated less than six-months before this unit move. I didn’t have any longtime friends amongst staff, to me floating was no big deal. It was a win-win solution for our “team”.

Total Patient Care vs. Team Nursing

Primary Nursing or Total Patient Care was different than what I learned about in nursing school, but I was young and eager to learn. I could see the benefits to a more holistic, comprehensive approach to nursing care that task-oriented nursing does not have. This type of nursing requires a larger number of skilled nurses to do well, but it is a far more patient centered approach.

Task-oriented nursing has nurses assigned to a specific task (charge, meds, treatments) and ancillary staff used to support the treatment nurse(s). The problem with this type of nursing is it comes from a scarcity mindset and leads to fragmented, piecemeal and can feel impersonal.

What I saw in terms of nursing care when Sheila was hospitalized several times was a weird combination of Primary and task-oriented care, neither of which was terribly effective. It had all the drawbacks of task-oriented nursing and none of the benefits of Primary nursing.

The nursing unit was divided up into 4 zones, with 4 RNs doing charge and med duties and some more complex treatments for her group of patients and ancillary staff doing (or not doing, the actual bedside care, VS, observations, simple treatments.

As a whole in-hospital patients seem much sicker, with many more issues and there are simply not enough nurses to really get to know their patients and provide them with the standard of care all patients deserve.

Either this means I’ve gotten older and far more resistant to change or medical care in the US is less concerned about the patient and more driven by the bottom line. However, it is the patient that gets the short end of the stick.

Change is something I was thrown into in the first few months of my first nursing job. What this did for me was it taught me that there are effective and ineffective ways of adapting to change.

One observation I made had to do with Resistance to Change.

Instead of sitting down with part-timers and listening to their concerns, they brushed their concerns aside. This led to a lot of negative chatter about the upcoming changes, which fed fears and anxieties in staff members.

Their fears could have been combatted by sitting down with staff and listening to them. Communicating the new nursing vision clearly and often might have helped mitigate the stress, along with addressing fears and concerns through discussions. Taking time to provide some training might also have eased the fears.

Another observation I made had to do with Leadership.

Was there clarity of vision? If not, why not. If the barrier is right at the top of the leadership hierarchy it creates problems downstream. Since I know our DON had a clear vision of what she wanted and she communicated it to me clearly when I was hired, the Leadership Block occurred at a lower level in the chain of command. That should have been addressed.

A third compounding issue I observed this hospital to great stock in a “just do as your told” Culture.

Communication is a great mitigator, but the communication needs to be open and non-judgmental to be effective in making changes. Making sure everyone is invested in the process of change will make the change easier to accept. Making sure all voices are heard, clarifying roles and responsibilities are other effective means of creating a healthy working environment.

When I arrived on my first unit, I was one of two full-time nurses that had replaced two other nurses, one of whom stayed on in a part-time role. There was another full-time nurse that had also recently been hired. We had one three full-time RNs, one full-time LPN, at least four part-time RNs and a few aides. There had already been a lot of upheaval on our shift and now we were going to a new unit with a new style patient care delivery style in a hospital that had hiccoughs in how they communicated the change.

For me it was a golden opportunity to learn more nursing in general, and as it turned out, specifically in Pediatrics, ICU and the ER. I used it as a time of growth and discovery. I was the lucky one. I learned change did not have to be a bad thing; it could be mean growth.

Oh, sure, I was as nervous as could be the first time I was floated to the ER. However, my positive attitude helped me acclimate quickly and I found staff were eager to support me until I was comfortable with the pace.

My first time floating to ICU was much the same. Staff welcomed the extra set of hands, and they eased me into their routines which benefitted all of us.

Throughout life we face changes. Some will be changes we expect, we want, we might even run towards them as we embrace the change. Examples might include longed for relationships or babies.

Other changes we may resist, such as the dissolution of a relationship, or death. But no matter what… we will all face change throughout life.

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