| Course | NUR-4280 Leadership and Management In Nursing |
|---|---|
| Module | Module 5 |
| Paper type | Change theory application |
| Length | About 1,038 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | Bachelor of Science in Nursing |
| Updated | October 2026 |
Free sample paper for NUR 4280 Module 5
Unfreezing the Morning: Applying Lewin's Planned Change Theory to a Discharge-Readiness Huddle on an Observation Unit
Student Name
Bachelor of Science in Nursing, Thomas Edison State University
NUR-4280: Leadership and Management In Nursing
Mentor Name
Month Day, Year
Unfreezing the Morning: Applying Lewin's Planned Change Theory to a Discharge-Readiness Huddle on an Observation Unit
Most of our observation unit's patients are medically ready to leave well before they actually leave. The pathway tasks are done, the results are back, and the patient is waiting for a discharge order, a ride or a last piece of information that nobody has asked for. Earlier in this course I proposed a dashboard whose first two lines are how long patients stay and how many stay beyond two days. This paper applies Kurt Lewin's theory of planned change to a change I am leading to improve those numbers: a ten-minute discharge-readiness huddle at 0630, attended by the charge nurse, the observation physician and the case manager, that reviews every patient expected to leave that day.
Lewin's Theory and Why It Fits
Lewin described organizational change as a movement between states held in balance by opposing forces. Driving forces push toward change and restraining forces resist it, and a stable situation persists because the two are balanced. He named three stages. Unfreezing loosens the old balance by making the case that things cannot stay as they are. Moving is the period of trying the new behavior and adjusting it. Refreezing locks the new behavior into routines until it becomes the normal state of the unit. Shirey (2013) argues that the theory remains useful to nurse leaders because it is simple enough to explain to staff and because its force field analysis turns vague resistance into named factors a leader can address.
The theory fits this change for two reasons. First, the huddle requires a change in routine from people who do not report to me, the physician and the case manager, so success depends on shifting the balance of forces rather than on authority. Second, morning routines on our unit are firmly frozen. Physicians round in the order they arrive, case managers start with inpatient units, and nurses prepare discharges only after an order is written. None of those habits is wrong individually; together they delay discharges by hours.
Force Field Analysis
Before planning the change I listed the forces on each side, rating each from one, weak, to five, strong, with input from two staff nurses and the case manager.
The analysis showed that the strongest restraining force was not opposition to the idea but the physicians' existing rounding order, which no one had ever been asked to change. That changed my strategy. Instead of persuading people that earlier discharge was good, which they already agreed with, I needed to make the huddle the easiest place for a physician to start the morning.
| Driving forces | Rating | Restraining forces | Rating |
|---|---|---|---|
| Median stay above the unit target for three straight months | 4 | Physicians round in arrival order, not discharge order | 5 |
| Emergency department boarding when beds do not open by noon | 5 | Case managers start with inpatient units | 3 |
| Patients and families frustrated by waiting after results return | 3 | Night shift handoff at 0700 competes for the same time | 3 |
| Nurse manager support and dashboard visibility | 4 | Belief that huddles are another meeting | 2 |
Unfreezing
Unfreezing began with data. At the monthly staff meeting I showed the median time from the last pathway result to the discharge order, which in the previous quarter was three hours and forty minutes. I also shared the emergency department's count of patients who waited more than two hours for an observation bed that was occupied by someone already cleared to leave. Neither figure blamed a person. Together they showed that the delay was a gap between roles, not a failure within any one role. I then met separately with the medical director of the observation unit, who agreed to ask physicians to try starting rounds at the huddle for one month.
Evidence helped too. Wertheimer et al. (2014) reported that a multidisciplinary intervention including a morning discharge planning process moved the proportion of patients leaving before noon on academic medicine units from about one in nine to well over one in three, and readmissions did not rise meaningfully. That was an inpatient setting, not observation, but it showed that morning planning across roles can move discharge times substantially. Sharing a published result made the change feel less like the idea of one charge nurse.
Moving
The huddle started on a Monday with a one-page list printed at 0615 showing every patient whose pathway could be complete by noon, the tasks still outstanding, and the expected ride home. The charge nurse leads the huddle, the physician states which patients can be discharged once results return, and the case manager names any barrier such as transport or a pharmacy authorization. It lasts ten minutes and ends with each person repeating the tasks they own. Goldenhar et al. (2013) found in a qualitative study that huddles improve the efficiency and quality of information sharing and increase accountability and a shared awareness of risk, and the teach-back at the end of ours was designed to build exactly that accountability.
Two problems appeared in the first week. Physicians arriving after 0630 missed the huddle, so we added a two-line summary on the whiteboard for late arrivals. The night charge nurse found that preparing the list at 0615 collided with end-of-shift tasks, so the list is now generated automatically from the electronic record. Adjusting the change while it is moving, rather than defending the original design, is part of what Lewin's middle stage requires.
Refreezing and Evaluation
Refreezing means building the huddle into structures that do not depend on my enthusiasm. Three steps are planned: adding the huddle to the charge nurse role description, adding the list to the automated morning reports, and reporting median time from last result to discharge order on the unit dashboard each month. After the first month, that interval fell from three hours and forty minutes to two hours and fifty minutes, a promising but early result from a single month. The real test will be whether the huddle survives the next change of medical director and the next busy flu season. Lewin's model reminds me that a change is not finished when it works once; it is finished when stopping it would feel like a change.
References
Goldenhar, L. M., Brady, P. W., Sutcliffe, K. M., & Muething, S. E. (2013). Huddling for high reliability and situation awareness. BMJ Quality & Safety, 22(11), 899-906. https://doi.org/10.1136/bmjqs-2012-001467
Shirey, M. R. (2013). Lewin's theory of planned change as a strategic resource. Journal of Nursing Administration, 43(2), 69-72. https://doi.org/10.1097/NNA.0b013e31827f20a9
Wertheimer, B., Jacobs, R. E. A., Bailey, M., Holstein, S., Chatfield, S., Ohta, B., Horrocks, A., & Hochman, K. (2014). Discharge before noon: An achievable hospital goal. Journal of Hospital Medicine, 9(4), 210-214. https://doi.org/10.1002/jhm.2154
NUR 4280 Module 5 instructions, in plain terms
The fifth module of NUR-4280 commonly asks you to apply a change theory to a change you would like to make, or have made, in your workplace. You will normally set out the problem and the change you want, explain one change model (Lewin's is the most common pick, with Kotter, Rogers and Lippitt as alternatives), apply each stage of the theory to the change, identify driving and restraining forces or sources of resistance, and explain how you would sustain and evaluate the change. Thomas Edison State University keeps the full directions in Moodle, so check whether your section names a particular theory, wants a force field diagram, or asks you to describe a change that has already happened rather than one you are proposing.
How this NUR 4280 Module 5 example is built
The paper opens by naming the gap between being medically ready and actually leaving, then states the change in one sentence. A theory section explains Lewin briefly and gives two reasons it fits a change that depends on people outside the writer's authority. A rated force field table follows, and the writer uses it to change strategy. The unfreezing section relies on two neutral numbers and one published study. The moving section describes the huddle's structure and the two problems that surfaced in week one, with the adjustments made. The refreezing section lists three structural steps and an early result, and ends with a test for when a change is truly finished.
NUR 4280 Module 5 rubric: what earns full marks
In a change theory paper, the mentor typically scores how well the problem and change are described, accuracy of the change theory, application of each stage to the specific change, analysis of resistance or forces, plans for sustaining and evaluating the change, and writing. Application carries the most weight in most rubrics: each stage of the theory should be matched to concrete actions, not described in general terms. A force field analysis or similar tool tends to earn credit in the resistance row, especially when it influences the strategy. Mentors look for evaluation measures and a realistic plan for keeping the change in place. Evidence supporting the change itself, not only the theory, often separates the top two bands.
NUR 4280 Module 5 help: mistakes that cost marks
A typical draft spends a page on Lewin or Kotter and a single sentence on each stage of the actual change. Reverse that balance and spend your words on what you did or would do at each stage. Another frequent issue is choosing a change too large for one unit, such as a new care delivery model for the hospital. Pick something you can influence. Students also treat resistance as people who need convincing; look instead for structural forces such as schedules and workloads that hold the old way in place. Plan the refreezing stage specifically, with a role, a report or a policy. If you want a change theory paper drafted around a change on your own unit, send your directions and the desk will prepare it.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 4280 Module 5 questions, answered
Where can I find a free NUR 4280 Module 5 sample paper?
Read it on this page: a Lewin change theory application for the TESU nursing leadership course with a force field table, references and margin notes. Its change is a morning discharge huddle; use the structure for a change on your own unit.
Which change theory is best for NUR-4280?
Lewin's model is the most common because its three stages and force field analysis are easy to apply to a unit-level change. Kotter's eight steps suit larger organizational changes, and Rogers' diffusion of innovations suits the spread of a new practice. Use the one your directions name, or the one that fits the scale of your change.
Do I need a force field analysis?
Mentors rarely demand one outright, yet the force-field table is the most practical piece of Lewin's model and it tends to earn credit. List the driving and restraining forces, rate their strength, and explain how the analysis shaped your plan.
Can I write about a change that has not happened yet?
Yes. Many sections accept a proposed change. Lay out the actions planned for every stage, the people who must take part, the pushback you anticipate, and how the result will be measured and kept. Write it in future tense and keep the plan realistic.
How do I show the refreezing stage?
Name the structures that will hold the change in place, such as a policy, a role description, an automated report, a checklist or a dashboard measure. Mentors look for these concrete anchors rather than general statements that staff will continue the change.