INTRODUCTION Today almost all nurses are educated in either two year or four programs in community colleges, comprehensive

colleges and universities where they exchange tuition for instruction, which, among other things, leads to examination for registration as a professional nurse. More than half of all those now studying nursing are in associate degree (two-year) programs; these students are preparing to practice as generalists. Others are enrolled in baccalaureate or masters programs to earn their first nursing credentials. This background of widely different and changing educational routes to the practice of nursing makes the story of nursing education and practice much more complex. TERMINOLOGIES lanning preliminary thoughts. refers to thinking ahead of time and formulation of

designed to promote movement towards a desired goal. Planned change is a change that results from a well thought out and deliberates effort to make something happen. It is the deliberate application of knowledge and skills by a leader to bring about a change. Tappen, 1995 innovation, and works to bring about the desired change. VENTURE PLANNING Venture Planning is a personal assessment of your feelings and the feasibility of a venture. Venture Planning answers the question, should I be doing this and why? The Venture Feasibility process examines seven key factors in any venture. It is not about writing a Business Plan. Sometimes a business plan is not needed. Venture Planning does not require detailed funding, source analysis, professional opinions, entity formation or detailed market analysis. Venture Planning is development of a means of comparing various business models, usually through financial modeling to answer the following questions: Which venture concept produces the most sales, the best margins, the highest net profit and the lowest breakeven? Which model requires the least investment by entrepreneurs and others? Which concept requires equity as opposed to debt financing? Which produces the highest "Return on Investment" and the best liquidity? Which model requires the entrepreneur to give up the least equity? Identify and quantify the risks involved with execution of each model.

VENTURE FORMATION INVOLVES ALL OF THE FOLLOWING STAGES: Idea - Concept Development - Venture Development - Monitoring Progress Initiating New Changes - Venture Feasibility Analysis - Business or Operational Plan - Budget vs. Actual - New Plans.

THERE ARE FOUR KEYS TO GOOD VENTURE PLANNING: 1. 2. 3. 4. Focus on one venture at a time in one business area at a time. Discover the opportunity first, and then evaluate how to exploit it. Develop three cases good, bad & likely for each scenario of a venture concept. Identify what type of venture you want. Each type has an entirely different model, implementation and end result. Each demands a different entrepreneurial approach and each requires different management and style.

THERE ARE 11 KEYS TO A GOOD FIRST VENTURE 1) Founder's alignment with the mission. 2) Guaranteed or qualified customers. 3) Lifestyle of High Profit smaller business. 4) Routine concept. 5) Available product. 6) Advantageous Cash Flow. 7) Supportive local environment. 8) Neutral State and Federal Environment. 9) Equity Control. 10) Relevant Experience. 11) Low Overhead. EMERGING VENTURE AREAS IN NURSING THAT NEEDS PLANNING There often occurs a crisis situation in the healthcare set- up when nurses try to defend existing models of practice instead of embracing change. In order to gain successful planning of good ventures, we should examine the existing realities (traditional), and analyze and adapt to the changing context of nursing practice. Some of the traditional realities are; Institution based care

Process oriented Procedure driven Based on mechanical and manual intervention Provider driven Treatment based Reflective of late stage intervention Based on vertical clinical relationships

According to Porter-O Grady (2003), the emerging realities for nursing practice for this century will be; Mobility based on multiple settings Outcome driven Best- practice oriented Emphasized by technology and minimally invasive intervention User driven Health based Geared for early intervention Based on horizontal clinical relationships

FUNCTIONS OF GOOD NURSE MANAGER A nurse managers functions include the following; The nurse administrator needs to know the plans and programs of the health facility administrator and of other departments in which personnel contribute to the joint effort of providing health care services. Should be a participatory , voting member of all committees of the institution including those dealing with budgeting, planning, credentialing, auditing, utilization, infection control, patient care improvement, library or any other committees concerned with nursing services, nursing activities and nursing personnel. Should develop a marketing operational plan based on the overall view of the agency problems and activities. Marketing plan should include gathering and analysis of data related to product or service Operational plan consist of pinpointing possible strengths, weaknesses, problems and opportunities. Before launching a venture, a control plan is made to measure performance of implementation of venture within a time frame. Selected and trained personnel will be assigned to compare expected results with actual results for making corrections in all elements of plan and its implementation in future.

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PLANNING FOR CHANGE Change occurs over time, often fluctuating between intervals of change then a time of settling and stability. Change management entails thoughtful planning and sensitive implementation, and above all, consultation with, and involvement of, the people affected by the changes. If you force change on people normally problems arise. Change must be realistic, achievable and measurable. These aspects are especially relevant to managing personal change. CHANGE AGENT A change agent is someone who deliberately tries to bring about a change or innovation, often associated with facilitating change in an organization or institution. To some degree, change always involves the exercise of power, politics, and interpersonal influence. It is critical to understand the existing power structure when change is being contemplated. A change agent must understand the social, organizational, and political identities and interests of those involved; must focus on what really matters; assess the agenda of all involved parties; and plan for action. The change agent should have the following qualities; The ability to combine ideas The ability to energize others Skills in human relations Integrative thinking Flexibility modify ideas Persistent, confident and has realistic thinking Trustworthy Ability to articulate a vision, and Ability to handle resistance.

ASSUMPTIONS REGARDING CHANGE Change represents loss. Even if the change is positive, there is a loss of stability. The leader of change must be sensitive to the loss experienced by others. The more consistent the change goal is with the individuals personal values and beliefs, the more likely the change is to be accepted. Likewise the more difficult the goal is from the individuals personal values; the more likely it is to be rejected. Those who actively participate in change process feel accountable for the outcome. Timing is important in change. With each successive change in a series of changes, individuals psychological adjustment to the change occurs more slowly. And for this reason the leader of change must avoid initiating too many changes at once.

THE KEY PRINCIPLES DRIVING THE ELEMENTS OF THE CHANGE MANAGEMENT ARE:

1. Targeted Commitment Levels 2. Executive Ownership 3. Visible, sustained sponsorship 4. Deployment/Implementation Support and Monitoring 5. Employee Support 6. Post Deployment Preparation

STRATEGIES FOR PLANNED CHANGE In general, three categories of change models exist: empiricalrationale, power-coercive, and normative-educative model. (Bennis, Benne and Chin [1969], The planning of change) Rationale- empirical: This strategy emphasizes reason and knowledge. People are considered rational beings and will adopta change if it is justified and in their self- interest. Here the change agents role is communicating the merit of the change to the group. If the change is understood by the group to be justified and in the best interest of the organization, it is likely to be accepted. This strategy is useful when little resistance to change is expected. It is assumed that once if the knowledge and rationales are given, people will internalize the need for change and value the result. Normative- re-educative: This is based on the assumption that group norms are used to socialize individuals. The success of this approach often requires a change in attitude, values, and/ or relationships. This strategy is most used when the change is based on culture and relationships within the organization. The power of the change agent, both positional and informal, becomes integral to the change process. Power- coercive: This approach is based on power, authority, and control. Desired change is brought about by political or economic power. It requires that the change agent have the positional power to mandate the change. The outcome of change is often based either on followers desire to please the leader or fear of the consequences for not complying with the change. This strategy is effective for legislated changes, but other changes using this strategy are often short- lived. BARRIERS TO CHANGE AND STRATEGIES TO OVERCOME It is important to identify all potential barriers to change, to examine them contextually with those affected by proposed change, and to develop strategies.

TYPES OF CHANGES TYPES OFCHANGES

TYPES OF CHANGES: Hohn (1998) identified four different types of change: Change by exception, Incremental Change, Pendulum Change and Paradigm Change.

existing belief system. For instance, if a client believes that all nurses are bossy, but then experiences nursing care from a much modulated nurse, they may change their belief about that particular nurse, but not all nurses in general.

of it. changes of points of view.

and involve a changing of beliefs, values and assumptions about how the world works. CHANGE THEORIES IN NURSING Change theories are used in nursing to bring about planned change. Planned change involves, recognizing a problem and creating a plan to address it. There are various change theories that can be applied to change projects in nursing. Choosing the right change theory is important as all change theories do not fit every change project. Some change theories used in nursing are Lewins, Lippitts, and Havelocks theories of change. The characteristics of change theories are;

Kurt Lewins change theory: The theoretical foundations of change theory are robust: several theories now exist, many coming from the disciplines of sociology, psychology, education, and organizational management. Kurt Lewin (1890 1947) has been acknowledged as the father of social change theories and presents a simple yet powerful model to begin the study of change theory and processes. He is also lauded as the originator of social psychology, action research, as well as organizational development. "Unfreezing" involves finding a method of making it possible for people to let go of an old pattern that was counterproductive in some way. In this stage, the need

for change is recognized, the process of creating awareness for change is begun and acceptance of the proposed change is developed. "Moving to a new level" involves a process of change--in thoughts, feelings, behavior, or all three, that is in some way more liberating or more productive. The need for change is accepted and implemented in this stage. "Refreezing" is establishing the change as a new habit, so that it now becomes the "standard operating procedure." Without some process of refreezing, it is easy to backslide into the old ways.The new change is made permanent here. Lewin also created a model called force field analysis which offers direction for diagnosing situations and managing change within organizations and communities. According to Lewins theories, human behavior is caused by forces beliefs, expectations, cultural norms, and the like within the "life space" of an individual or society. These forces can be positive, urging us toward a behavior, or negative, propelling us away from a behavior. Driving Forces- Driving forces are those forces affecting a situation that are pushing in a particular direction; they tend to initiate a change and keep it going. In terms of improving productivity in a work group, pressure from a supervisor, incentive earnings, and competition may be examples of driving forces. Restraining Forces- Restraining forces are forces acting to restrain or decrease the driving forces. Apathy, hostility, and poor maintenance of equipment may be examples of restraining forces against increased production. Equilibrium - This equilibrium, or present level of productivity, can be raised or lowered by changes in the relationship between the driving and the restraining forces. Equilibrium is reached when the sum of the driving forces equals the sum of the restraining forces. LIPPITTS PHASES OF CHANGE THEORY: Lippitts theory is based on bringing in an external change agent to put a plan in place to effect change. There are seven stages in this theory. The first three stages correspond to Lewin's unfreezing stage, the next two to his moving stage and the final two to his freezing change. In this theory, there is a lot of focus on the change agent. The third stage assesses the change agents stamina, commitment to change and power to make change happen. The fifth stage describes what the change agents role will be so that it is understood by all the parties involved and everyone will know what to expect from him. At the last stage, the change agent separates himself from the change project. By this time, the change has become permanent.

The seven phases shift the change process to include the role of a change agent through the evolution of the change. Phase 1:Diagnose the problem Phase 2:Assess the motivation and capacity for change Phase 3:Assess the resources and motivation of the change agent(commitment the change, power, and stamina) Phase 4:Define progressive stages of change Phase 5: Ensure the role and responsibility of the change agent is clear and understood (communicator, facilitator, and subject matter expert. Phase 6:Maintain the change through communication, feedback, and group coordination Phase 7:Gradually remove the change agent from the relationship, as the change becomes part of an organizational culture. Havelock's change model: Havelock's change theory has six stages and is a modification of the Lewin's theory of change. The six stages are building a relationship, diagnosing the problem, gathering resources, choosing the solution, gaining acceptance and self renewal. In this theory, there is a lot of information gathering in the initial stages of change during which staff nurses may realize the need for change and be willing to accept any changes that are implemented. The first three stages are described by Lewin's unfreezing stage the next two by his moving stage and the last by the freezing stage. John P Kotter's 'eight steps to successful change' John Kotter's highly regarded books 'Leading Change' (1995) and the follow-up 'The Heart Of Change' (2002) describes a helpful model for understanding and managing change. Each stage acknowledges a key principle identified by Kotter relating to people's response and approach to change, in which people see, feel and then change: Kotter's eight step change model can be summarized as: Increase urgency - inspire people to move, make objectives real and relevant. Build the guiding team - get the right people in place with the right emotional commitment, and the right mix of skills and levels. Get the vision right - get the team to establish a simple vision and strategy focus on emotional and creative aspects necessary to drive service and efficiency.

 Communicate for buy-in - Involve as many people as possible, communicate the essentials, simply, and to appeal and respond to people's needs. De-clutter communications - make technology work for you rather than against. Empower action - Remove obstacles, enable constructive feedback and lots of support from leaders - reward and recognize progress and achievements. Create short-term wins - Set aims that are easy to achieve - in bite-size chunks. Manageable numbers of initiatives. Finish current stages before starting new ones. Don't let up - Foster and encourage determination and persistence - ongoing change - encourage ongoing progress reporting - highlight achieved and future milestones. Make change stick - Reinforce the value of successful change via recruitment, promotion, and new change leaders. Weave change into culture. GENERAL CONSIDERATIONS FOR PLANNING CHANGE Secure and maintain commitment to change Define and communicate desired end state Identify critical success factors Establish targets and prioritize activities Develop a theme Understand why the change is desired/ required General considerations for planning change Secure and maintain commitment to change Define and communicate desired end state Identify critical success factors Establish targets and prioritize activities Develop a theme Understand why the change is desired/ required

NURSE LEADER (MANAGER) AS ROLE MODEL FOR PLANNED CHANGE Implement a comprehensive and coordinated change management program: Discover, develop, detect. Identify change agents and engage people at all levels in the organization. Ensure the message comes from the top, and executives and line managers are walking the talk. Make change visible with new tools and/or environment. Ensure clear, concise, and compelling communication. Integrate change goals with day-to-day activities, e.g., recruiting, performance management, and budgeting. Address short-term performance while setting high expectations about long-term performance.

Help management avoid attempts to short circuit the change management process. Foster change in peoples attitudes first, then focus on change in processes, then change in the formal structure. Manage both supporters and champions, as well opponents and possible detractors. Accept that all people go through the same steps some faster, some slower and it is not possible to skip steps. Build a safe environment that enables people to express feelings, acknowledge fears, and use support systems. Acknowledge and celebrate successes regularly and publicly!

MISTAKES BY A LEADER MANAGER

Fail to provide visible support and reinforce the change with other managers. Do not take the time to understand how current business processes would be affected by change. Delayed decision-making, which leads to low morale and slow project progress. Are not directly or actively involved with change project. Fail to anticipate the impact on employees. Underestimate the time and resources needed Abdicate ownership of the project to another manager. Fail to communicate both the business reasons for the change and the expected outcome to employees and other managers Change the project direction mid-stream Do not set clear boundaries and objectives for the project

PLANNING FOR CHANGES IN NURSING EDUCATION SECTORS Move from teacher-centered to student-centered with Focus on Educational Outcomes : Move from teacher-centered to student-centered with Focus on Educational Outcomes professionals capable of evaluating knowledge, thinking critically and demonstrating creativity in managing care and health services. Educators principle function is to manage the learning environment rather than be the main conduit of information to students. Increase Demand for More Advanced Educational Preparation : Increase Demand for More Advanced Educational Preparation Pressure to raise the level of basic nursing/midwifery education. Heightened interest in post graduate studies, especially at the master level. Practice-focused doctorate More Flexible Educational Systems :

More Flexible Educational Systems Allow progression to higher qualifications e. g. diploma to degree, practical to registered nurse. Have different entry points e.g. through the vocational training system. Take account of prior learning. Using multiple providers, public and private. Diverse delivery modes traditional, distance or combination. Full-time, parttime or at own pace basis. Competency Based Curriculum: Competency Based Curriculum Trend to greater accountability nursing education Educators need to demonstrate graduates can perform in accordance with a level of competence set by the profession. Curricula designed around competency statements or performance-based abilities necessary for contemporary practice. National and international work to identify competencies for entry into practice and for other categories of nursing . Shared Competencies: Shared Competencies No one provider owns any set of skills. Within accepted scopes of practice, discipline roles change as client needs and context of practice change. Central to the notions of flexibility and adaptability -use of diverse mix of healthcare providers, promotes interprofessional collaboration. Claimed benefits include promote more integrated, co- ordinated care, improved outcomes, more effective and efficient services. Changes in Teaching-Learning Methods/ Technologies of Instruction : Changes in Teaching-Learning Methods/ Technologies of Instruction Promotion of self-directed/active learning. More creative and interactive models e.g. problem/case based, project work, role play, developing clinical portfolios. Use of open-ended problems based on real life situations that actively engage students. Assessment of learning is multiple and diverse focus on demonstrating mastery of learning outcomes. Integration of educational technology and the use of distance learning e.g. email , electronic presentation, virtual libraries, online conferencing , web-based courseware, computer assisted simulation. Life-Long Learning: Life-Long Learning Traditional model of concentrated selective learning over a limited period of time no longer meets todays needs. Continuing competence is receiving considerable attention as the public and funders demand accountability from healthcare providers. Why learning through work life? Rapidly altering practice; daily advances in health sciences and technology; and reforms in professional regulation. Responsibility of the individual practitioner, profession, regulators, and employers. Challenges : Challenges Challenges for Education Becoming comfortable in working in primary health care, homecare and other forms of community-based care. Providing a broad and integrated knowledge base. Developing a relevant range of clinical, communication and interpersonal skills. Having the ability to navigate ethical issues arising daily and in exceptional situations. Learning to work co- operatively and collaboratively. Options for Action : 1. Define categories (levels) of nursing/midwifery personnel and how they relate to each other. - Scope of practice, role, function, competencies expected of each level ,within the broader tasks of human resources planning, development and management.- Clear career pathways linked to competency levels, education preparation and experience.

2. Multiple points of entry and educational pathways which draw on existing resources, strengths, and increase the range of potential recruits. - Open-ended educational systems defining routes for educational progress, - Specific upgrade programmes, - Shorter programmes for graduates

3 . Establish a system for recognition of prior learning and experience, and credit transfer. 4. Explore alternative modes of programme delivery Part-time, distance and e-learning options 5. Upgrade quality of faculty, clinical teachers/preceptors Standards for faculty. Upgraded competencies in heath professions education. Research skills. Academic qualifications in educational sciences, Improved incentives and Rewards. 6. Establish and maintain relevance in curricula Orienting curricula toward national priority health problems. Prepare for new/emerging roles, keeping pace rapid expansion and change in knowledge technology, and practice. Linking theory to practice. Building in periodic evaluation and revision . 7. Establish plan for improving the quality of education Setting standards institutions, programmes clinical learning sites. Developing accreditation/quality processes. Developing expertise to establish, implement, maintain and improve the quality system. 8. Establish partnerships (national and international) Assistance with programme development, implementation and evaluation. Faculty development. Faculty and student exchange. 9. Explore different types of educational providers public and private, national and international : Collaborate with diverse education providers Public & private; National & international. Outreach campuses of national/international institutions. Partnering in joint educational ventures. Creating special overseas programmes to meet needs of international clients. Assisting with capacity and institutional building. Challenges -- relevance & quality; recognition of qualifications. THE FUTURE OF NURSING EDUCATION Ten Trends to Watch : 1. Changing Demographics and Increasing Diversity 2. The Technological Explosion 3. Globalization of the World's Economy and Society 4. The Era of the Educated Consumer, Alternative Therapies and Genomics, and Palliative Care. 5. Shift to Population-Based Care and the Increasing Complexity of Patient Car 6. The Cost of Health Care and the Challenge of Managed Care 7. Impact of Health Policy and Regulation 8. The Growing Need for Interdisciplinary Education for Collaborative Practice 9. The Current Nursing Shortage/Opportunities for Lifelong Learning and Workforce Development

10. Significant Advances in Nursing Science and Research REVIEW OF LITERATURE 1.Towards a team-based, collaborative approach to embedding e-learning within undergraduatenursing programmes. Kiteley RJ, Ormrod G. Source Department of Behavioural and Social Sciences, University of Huddersfield, Queensgate, Huddersfield, UK. r.kiteley@hud.ac.uk Abstract E-learning approaches are incorporated in many undergraduate nursing programmes but there is evidence to suggest that these are often piecemeal and have little impact on the wider, nurse education curriculum. This is consistent with a broader view of e-learning within the higher education (HE)sector, which suggests that higher education institutions (HEIs) are struggling to make e-learning a part of their mainstream delivery [HEFCE, 2005. HEFCE Strategy for E-Learning 2005/12. Bristol, UK, Higher Education Funding Council for England (HEFCE). [online] Available at: <http://www.hefce.ac.uk/pubs/hefce/2005/05_12/> Accessed: 30 May 07]. This article discusses some of the challenges that face contemporary nurse education and seeks to account for reasons as to why e-learning may not be fully embedded within the undergraduate curriculum. These issues are considered within a wider debate about the need to align e-learning approaches with a shift towards a more student focused learning and teaching paradigm. The article goes on to consider broader issues in the literature on the adoption, embedding and diffusion of innovations, particularly in relation to the value of collaboration. A collaborative, team-based approach to e-learning development is considered as a way of facilitating sustainable, responsive and multidisciplinary developments within a field which is constantly changing and evolving. 2. The role of the public health nurse in a changing society. Nic Philibin CA, Griffiths C, Byrne G, Horan P, Brady AM, Begley C. Source School of Nursing & Midwifery, Trinity College Dublin, Ireland. Abstract AIM: This study is a report of a study to clarify the role of the public health nurse in one Irish community care area in the light of acknowledged problems in defining boundaries of the role. BACKGROUND: Demographic developments and planned reorientation towards primary care of the health service in Ireland have changed the workload of public health nurses, which is unique compared with other countries. However, there is a lack of clarity and consequent problems in defining the role of the Irish public health nurse. METHOD: A descriptive qualitative study was conducted with 25 representatives of community nursing from one county in Ireland with a population of 209,077 and a

complement of 65 full-time equivalent public health nurses. Purposive sampling was used and 21 public health nurses, two registered general nurses, one assistant director and one school nurse participated. Tape-recorded, individual semi-structured interviews were conducted over a 15-month period from 2002 to 2004. The constant comparative method was used for analysis. FINDINGS: Four themes emerged: 'Jack of all trades: the role of the public health nurse defined and described', 'the essence of the role', 'challenges to the role of the public health nurse' and 'communication'. The first theme is discussed in this paper. CONCLUSION OF THE STUDY Public health nurses need to define and redesign their role so that they no longer think that they are the catch-all service in the community. This will enable them to deal with the rapid demographic, sociological and cultural changes in the population, a change that has international resonance.

CONCLUSION The investment society is willing to make in educating nurses depends on the expectations placed on them. Nurses have been very important to society for a long time, but in the last half century people rather quickly turned to nurses to know and do more. Equally important is the change in self-expectation on the part of nurses. Nurses in the latter part of the twentieth century began, to an extent not found in previous generations, to see themselves as knowledge workers. More and more nurses came to believe that education was a good investment for them and came to expect life- long careers. The education they sought offered knowledge and expertise to recognize and solve patient care problems.

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