Nursing Leadership Quality Improvement Project

Correctional nursing is a specific sphere of clinical practice that is associated with different issues and challenges for its stakeholders. On the one hand, a part of the problems is ethical because some people, such as inmates, find it difficult to work under constant corrections, while others, such as nurses, find the level of a material reward offered to them insufficient. On the other hand, the whole system of correctional nursing is endangered by the perspective of having no appropriate financial support due to the irrelevance of the level of financing from the state and federal budget programs. For this reason, the analysis of the situation demonstrates that correctional nurses should initiate the process of change of the principles of financing care and make it inmate-dependent. In order to achieve the established goal, the nursing leaders should implement the guidelines of Lewin’s Three-Step Change theory and the principles of transformational leadership. If the proposed methodology is validated, prison inmates would accept the proposed change and assist correctional nurses in improving the quality of medical care in their facilities.

The Problem Statement

The Problem

The modern state of correctional nursing in the US is far from good due to different issues, including financial ones. In 2014, there were 2.3 prisoners in the US, and many of them who had chronic illnesses failed to receive the required level of care for their conditions (Mahoney, 2015). In the major part of these cases, only 9-30% of the corrections costs were directed toward addressing healthcare issues in inmates, which places a limitation on the level of care provided to them (Mahoney, 2015). In such situation, the traditional system of state budgeting and using the taxpayers’ money for treating prisoners requires improvement as the level of financing of health care issues is drastically insufficient. The reason for this includes the reduction of the number of qualified medical personnel, the level of their payment, the availability of different medications, supplies, and equipment as a consequence of inadequate financing (Mahoney, 2015). Therefore, it is suggested that the nursing leaders of a correctional institution introduce a quality improvement project directed toward establishing a new system of financing.

A Change Theory Model

In order for the quality improvement project to be effectively validated, it has to follow the steps of Lewin’s Three-Step Change theory as it considers the critical stages of validation of any project. According to the change management model developed by Kurt Lewin, the three stages, “unfreezing”, “changing”, and “refreezing” allow maintaining any change regardless of its complexity and the diversity of the environment (Cummings, Bridgman & Brown, 2016). Although some scholars criticize it for being too simple, it embraces the most critical concepts for changing specific communities, working environments, behaviors, and other (Cummings et al., 2016). According to it, the stage of unfreezing is associated with destabilizing the existing situation or environment and transiting to the process of adopting new ideas, communicating, training, and implementing changes for making them permanent at the final stage. Experts argue that the efficacy of the Three-Step Change theory is possible because Lewin has developed it after analyzing behavioral and gestalt theories in psychology (Burnes & Cooke, 2013). Thus, the analysis of specific thought patterns and behaviors led the scholar toward developing a change model that is valuable for leaders and managers in any sphere as it uses the fundamental principles of human psychology.

The Proposed Change and the Rationale

The proposed change initiative is directed toward decreasing the financial burden of the state’s taxpayers and introducing an internal fee system for inmates to finance their health care expenditures. The reason for this burden is the increase of the imprisonment rate in the US caused by the introduction of longer prison sentences for men and women together with overall sentencing guideline changes (Kintz, 2013). These days, almost all categories of inmates have specific health care needs that require the assistance of correctional nurses. For example, about 85% of the inmates of the age of 50 years and older have three or more chronic diseases whereas 79% of the individuals of the age of 65 years and older have a risk for developing a disability (Kintz, 2013). Moreover, some of the prisoners intentionally harm themselves in order to visit a doctor or initiate fights that lead to various traumas and injuries (Mahoney, 2015). For these reasons, the increase of the number of inmates leads to the increase of the burden on the medical staff in prisons along with the traditional financing programs that remain unchanged. Consequently, in case prisoners would have to cover the major part of financial expenditures associated with their health conditions, the financial pressure on the state’s programs would decrease.

Action Plan

Staff Compliance

The need for addressing staff compliance in order to introduce the change is critical due to the fact that the failure to address it may lead to the failure to validate the required change. For this reason, experts advise introducing different forms of regulations, such as executive orders and agency directives issued in order to establish and maintain specific corporate policies (Tucker, 2017). Since correctional nursing staff works in specific conditions, the issued directives should have not a recommended, but an obligatory role. For example, nurses should be prohibited from initiating discussions of the financial issues with their patients in case psychically non-stable patients are dissatisfied with the introduced changes. Likewise, the nursing rooms should have announcement boards with the code of appropriate conduct written on them for maintaining the efficacy of the introduced policies. Finally, nurses should participate in weekly surveys that assess the level of individuals’ satisfaction with the newly introduced change. The survey should have open-ended questions for possible improvement of the effect of the introduced policy.

The Communication of the Plan

The aspects of communication of the proposed plan to the staff and the inmates should represent a combination of obligatory agency directives and communication with staff and prisoners. The latter aspect requires consideration due to the fact that the scholars highlight the need for interpersonal communication needed for introducing institutional changes and generating specific cultural structures on the basis of the change of institutional logic (Ocasio, Loewenstein & Nigam, 2015). The reason for having communications and debriefings devoted to the explanation of the problem and the way of solving it is based on the risk of provoking dissatisfaction with the change among the inmates and their resistance to using health care services of the prisons. In particular, despite initiating strikes, inmates may refuse to take their regular medications or food, which would have an adverse impact on their health. For instance, in 2005, Charles R. McNabb refused food for an extended period that endangered his health, whereas a Californian prisoner, Andrews, refused eating and taking medication even though he was quadriplegic (Faiver, 2017). Therefore, adequate communication of the plan supported by relevant argumentation is critical for bypassing different negative ethical and healthcare issues associated with prisoners’ possible resistance to the change.

Change Process

The chosen change process should follow the model of Lewin’s Three-Step Change theory as it has been approved due to the fact that it allows implementing different changes regardless of different barriers. The value of this model is that it identifies fundamental factors that require the focus of the change and empowers change agents to achieve their goals. Moreover, this model was selected because it has been successfully implemented in different environments when introducing different organizational changes in healthcare institutions (Batras, Duff & Smith, 2016). Its outcomes included not only the achievement of the desired effect for a short term, but for a long-term perspective (Batras et al., 2016). A possible limitation to the application of the selected theory is that it has been used in healthcare not in correctional settings, though the primary stakeholders affected by the change are similar.

The used theory was selected after comparing and contrasting its complexity and scalability with the ones of other theories, such as McKinsey 7-S Model, Kotter’s theory, and others. In particular, the main strength of Lewin’s model is that it uses communication as one of the most critical facilitators of the change in its different forms. For instance, the agents of the change may use direct communication and official statements to dispel rumors, involve other stakeholders in the discussions related to the change, and introduce the change as a new part of the existing culture (Mulholland, 2017). Similarly, a communicative approach may be easier for the nurses to validate due to the fact that they should provide an information support to the prisoners, thus preventing their negative reactions associated with new policies. Therefore, the change policy should be based on such stages as unfreezing, changing, and refreezing, validated by institutional policies and sustained by communicative methods.

The Leadership Style and Management Functions

In order to introduce the proposed change, nurse leaders would have to utilize the transformational leadership style as it offers effective strategies for introducing and maintaining different systemic and organizational changes. For instance, Weng, Huang, Chen, and Chang (2015) claim that transformational leadership style allows transforming local and organizational cultures, thus improving organizational climate through innovations and other methods. Moreover, their research is relevant regarding analyzed setting as the validation of the transformational leadership style allows nurses to increase patient safety outcomes (Weng et al., 2015). Other reasons for the implementation of this model of leadership to be effective in the presented context include the presence of attributes required for an individual to resist the pressuring conditions of a correctional institution. For instance, experts indicate that transformational leading nurses benefited from such attributes as “dynamism, self-confidence, inspiration, emotional intelligence and symbolism” that allowed them to assist different stakeholders and avoid various problems (Hutchinson & Jackson, 2013). Moreover, the expected positive effect of the selected leadership model is possible to achieve due to the fact that the founder of Three-Step Change theory claimed that democratic styles of leadership were more effective than autocratic (Burnes & Cooke, 2013). Consequently, correction nurses should use transformational leadership style in order to validate the change and ensure its acceptance by different stakeholders.

According to the proposed plan, correctional nurses should perform different functions that allow them to sustain the change and avoid possible negative healthcare issues. Thus, the main functions of nursing practitioners in the created situation would be coordination of distribution of information and resources for them to ensure a positive effect on the patients. Therefore, the nurses would implement standard control functions that include planning, organizing, directing, foreseeing, and others (Marquis & Huston, 2017). The performance of the indicated functions would not only play a critical role in bypassing interpersonal conflicts with the colleagues and patients, but also allow directing additional financial resources strictly toward solving healthcare issues.

The Expected Outcomes

The expected outcomes of the proposed change include the increase of the financing of different healthcare programs in correctional institutions. Likewise, the increase in the budget of correctional facilities would allow modernizing equipment, training the staff, and buying critically important medications for prisoners. Finally, some correctional facilities may use saved financial resources to collaborate with different clinics for them to offer inmate treatment programs in order to enhance the level of affordable care to those with chronic diseases and disabilities.

Evaluation of the Proposed Change and Solving Possible Problems

The main method for the evaluation of the effects of the change is eliciting the statistic information with its further analysis. Thus, it is advisable to introduce weekly surveys and monthly interviews in order to collect different subjective estimates regarding the introduced change since the initiation of the project. Moreover, a collection of the financial data and information regarding the available budget, the number of medications, equipment, and inmates’ health status is required for objective analysis. The comparison and contrast of these data would allow assessing the efficacy of the program overall and in specific domains, such as management of tuberculosis or diabetes.

The staff’s noncompliance and rejection of change are ones of the possible issues that may prevent the implementation of the project. However, the chances of this are low due to the fact that nursing staff is the primary stakeholders who would benefit from having an additional budget. Their benefits range from the increase of the wages to the improvement of the working climate because of their ability to solve different healthcare issues and therefore, stimulate the satisfaction of the inmates. Consequently, the plan presumes that it is possible to avoid the option of having agents who refuse to comply with change as they would recognize its necessity for the achievement of the abovementioned benefits.


The goal of the suggested nursing leadership quality improvement project is to establish a new way of expanding the healthcare budget for the correctional nurses to improve healthcare outcomes in prisons. The need for this change is critical as the wide range of healthcare-related issues in correctional facilities is the result of insufficient financing. According to the proposed plan, nursing leaders should follow Lewin’s Three-Step Change theory and utilize transformational leadership model in order to succeed. The need for these methods is important in order to communicate the need for change to the inmate population and ensure that they would not resist it. The outcomes of the proposed change include the increase of financing of correctional nursing departments that would allow buying new equipment and medications, training nursing staff, and other. Consequently, the proposed change would allow solving different critical healthcare problems in prisons, which correctional nurses fail to address these days.