Practice Change and Culture Change in Implementing Geriatric Care Initiatives

Geriatric acute/critical care units regularly implement initiatives to improve safety and care quality for hospitalized older adults. But how can those changes in practice routines, care systems and clinicians’ attitudes be sustained over time?

The nurse manager, in addition to communicating that the practice change is important, can take other actions to keep staff engaged in changing practice and may include:

  • Developing and rewarding “awesome” staff, a practice that becomes a self-fulfilling prophecy.
  • Choosing champions of the cause carefully. Including a mix of experienced and newer nurses.
  • Playing to individual team members’ motivation, such as their personal experience, desire to advance their education or aspiration for promotion.
  • Using rewards that are meaningful and targeted specifically to those who contributed to desired results.
  • Providing individual and collective feedback emphasizing positive achievement toward the goal behavior or practice change, as well as plans for improved performance.
  • Using multiple vehicles of communication and repeating essential messages.
  • Engaging interdisciplinary partners—physicians, pharmacy, nutrition, speech and rehabilitation therapies, and social work—early and often.

Nurse managers, along with clinical nurse specialists and administrative support, together can change unit culture and institute practice improvements in the care of older adults.