Change is an everyday reality of nursing. New systems, updated protocols, and evolving patient needs mean nurses are constantly adapting. But knowing how to guide or manage that change can be the difference between frustration and success.

In this guide, you’ll discover change theory in nursing examples that show how theory translates into practice. These frameworks aren’t stuck in textbooks — they give nurses real tools to lead teams, ease resistance, and improve patient outcomes.

Here are the five change theories we’ll cover, each with practical nursing examples:

Lewin’s Unfreeze–Change–Refreeze Model
Kotter’s 8-Step Model
ADKAR Model
Rogers’ Diffusion of Innovations
Transtheoretical Model (TTM)

Change Theories in Nursing (with Examples)

1. Lewin’s Change Theory in Nursing

Lewin’s model is one of the simplest and most practical for nurses. It works in three steps:

Unfreeze – identify the need for change and prepare people for it.
Change – introduce and test the new process or behavior.
Refreeze – reinforce the new way so it becomes the routine.

This model is especially useful for unit-level changes where daily workflows need adjustment.

Example 1 – Bedside Shift Report
A hospital wanted nurses to move shift reports from the nurse’s station to the patient’s bedside. At first, staff resisted, worried about privacy and extra time. Leaders used Lewin’s model:

Unfreeze: Shared survey data showing patients felt excluded from their care.
Change: Piloted bedside reports with volunteer nurses and provided training.
Refreeze: Updated policy, celebrated staff who adapted quickly, and built it into daily routines.

Result: Bedside reporting became standard practice, and patient satisfaction scores improved by 20%.

Example 2 – Fall Prevention Rounds
A hospital wanted to reduce patient falls. Using Lewin’s model:

Unfreeze: Shared fall incident data and patient harm stories.
Change: Piloted hourly rounding to check on mobility and toileting needs.
Refreeze: Built rounding into policy and assigned accountability.
Result: Fall rates decreased by 30% in six months.

Example 3 – Pain Reassessment Policy
Nurses were inconsistent in reassessing pain after medication. Leaders:

Unfreeze: Highlighted patient complaints and Joint Commission requirements.
Change: Implemented standardized reassessment at 30 minutes.
Refreeze: Added prompts to EHR and celebrated compliance.
Result: Pain management scores improved noticeably.

2. Kotter’s 8-Step Change Model in Nursing

Kotter’s model is designed for large-scale organizational change. It breaks transformation into eight steps:

Create urgency
Build a guiding coalition
Develop vision and strategy
Communicate the vision
Empower action
Generate quick wins
Consolidate gains
Anchor new approaches in culture

This structured roadmap makes it easier for hospitals to manage change that cuts across departments or involves major policy updates.

Example 1 – Hospital-Wide Hand Hygiene Campaign
One hospital struggled with hand hygiene compliance, with rates below 60%. Leaders applied Kotter’s steps:

Create urgency: Shared infection data and patient stories.
Build a coalition: Brought together nurse managers, infection control, and unit champions.
Communicate vision: Used the theme “Clean Hands, Safe Patients” in posters and staff meetings.
Quick wins: Recognized units that hit 80% compliance early.
Anchor change: Built hand hygiene audits into performance reviews and orientation.

Result: Compliance climbed to 95%, and hospital-acquired infection rates dropped significantly.

Example 2 – Hospital-Wide Sepsis Bundle Rollout

Create urgency: Shared mortality data from delayed sepsis care.
Coalition: Formed sepsis taskforce with nurses, doctors, pharmacists.
Vision: “Every Minute Counts” campaign.
Quick wins: Units with best compliance recognized weekly.
Result: Sepsis mortality dropped 15% in one year.

Example 3 – Magnet Recognition Preparation

Urgency: Highlighted benefits of Magnet status.
Coalition: Engaged shared governance councils.
Vision: Positioned Magnet as a path to excellence.
Quick wins: Celebrated submission milestones.
Result: Organization achieved Magnet recognition with higher staff engagement.

3. ADKAR Change Model in Nursing

The ADKAR model focuses on the individual nurse’s journey through change. It highlights five key stages:

Awareness – understanding why the change is needed
Desire – wanting to support and engage in the change
Knowledge – learning how to change
Ability – practicing and developing the skills to change
Reinforcement – making sure the change sticks over time

This model is especially effective when rolling out new tools or systems that rely on staff adoption.

Example 1 – Bar-Code Medication Administration (BCMA)
When a hospital introduced bar-code medication scanners, many nurses worried the process would slow them down. Leaders applied ADKAR:

Awareness: Shared safety data showing BCMA prevents errors.
Desire: Peer champions explained how scanners caught near-miss mistakes.
Knowledge: Provided workshops and tip sheets.
Ability: Superusers shadowed nurses to give real-time support.
Reinforcement: Recognized teams that reached zero med errors.

Result: Nurses adopted BCMA fully, and medication errors declined across the hospital.

Example 2 – Electronic Health Record (EHR) Upgrade

Awareness: Explained why old EHR caused errors and inefficiencies.
Desire: Showed how upgrade reduced clicks and improved patient safety.
Knowledge: Provided online training and simulations.
Ability: Supported staff with on-site “superuser” nurses.
Reinforcement: Gave badges for staff who completed all modules.
Result: Nurses adopted system faster with fewer complaints.

Example 3 – Fall Risk Assessment Tool

Awareness: Shared fall data and risk factors.
Desire: Nurses engaged after hearing patient stories.
Knowledge: Taught how to use screening tool.
Ability: Piloted tool with mentoring from senior nurses.
Reinforcement: Monthly unit-level fall reduction celebrations.
Result: Risk assessments reached >95% compliance.

4. Rogers’ Diffusion of Innovations in Nursing

Rogers’ theory explains how new ideas and practices spread across a team or organization. Adoption happens in stages:

Innovators – the first to try something new
Early adopters – influential staff who model success
Early majority – those who follow once they see results
Late majority – adopt after the majority is on board
Laggards – last to adopt, often needing extra support

This model is most useful when introducing clinical innovations or technology that benefits from peer influence.

Example 1 – Early Sepsis Detection Alerts
A unit piloted automated EHR alerts for sepsis. Adoption followed Rogers’ stages:

Innovators: Tech-friendly nurses tested the system.
Early adopters: Shared positive outcomes in rounds.
Early majority: Began using alerts after seeing patient improvements.
Late majority: Adopted as usage became routine.
Laggards: Came on board once benefits were clear and training addressed concerns.

Result: Faster sepsis recognition and treatment led to lower mortality rates and better patient outcomes.

Example 2 – Telehealth Post-Discharge Follow-Up

Innovators: Tech-savvy nurses piloted telehealth check-ins.
Early adopters: Shared patient stories about reduced ER visits.
Early majority: Joined after seeing lower readmissions.
Late majority/laggards: Adopted as evidence grew and workflows simplified.
Result: Readmission rates fell, and patient satisfaction improved.

Example 3 – Mobility Programs in ICU

Innovators: Physical therapists and a few nurses trialed early mobility protocols.
Early adopters: Showed success with shorter ICU stays.
Majority: Adopted once benefits were evident.
Result: Reduced ventilator days and improved patient outcomes.

5. Transtheoretical Model (TTM) in Nursing

The Transtheoretical Model, or Stages of Change, is often used in patient education and behavior change counseling. It recognizes that people move through stages at their own pace:

Precontemplation – not yet considering change
Contemplation – thinking about change
Preparation – getting ready to act
Action – making the change
Maintenance – sustaining the new behavior

This model helps nurses tailor their approach to each patient’s readiness, making interventions more effective.

Example 1 – Smoking Cessation Counseling
A nurse in primary care applied TTM with patients who smoked:

Precontemplation: Provided education on health risks.
Contemplation: Discussed pros and cons of quitting.
Preparation: Helped patients set quit dates and find resources.
Action: Supported them with follow-ups during the first weeks.
Maintenance: Checked in regularly to prevent relapse.

Result: Patients felt supported at every stage, and quit rates improved as counseling matched readiness levels.

Example 2 – Diabetes Lifestyle Support

Precontemplation: Educated patients on long-term risks.
Contemplation: Helped them weigh pros/cons of diet change.
Preparation: Set small, achievable nutrition goals.
Action: Provided meal planning support.
Maintenance: Follow-ups reinforced progress.
Result: Patients reported better blood sugar control and confidence.

Example 3 – Vaccine Uptake in Hesitant Patients

Precontemplation: Addressed myths and misinformation.
Contemplation: Shared peer success stories.
Preparation: Helped patients schedule convenient appointments.
Action: Provided supportive environment on vaccination day.
Maintenance: Checked in post-vaccine to ensure follow-up doses.
Result: Increased vaccination rates in the clinic.

Measuring Success in Nursing Change Projects

Change only matters if it lasts. For nurses and leaders, that means tracking outcomes that prove the effort was worth it. The right metrics show whether a new process has truly improved patient care and staff performance.

Clinical Outcomes

Infection rates (e.g., CLABSI, CAUTI, HAI trends)
Patient safety incidents (falls, medication errors)
Readmission rates for common conditions

Process Outcomes

Compliance data (hand hygiene audits, checklist completion, documentation rates)
Protocol adherence (turning schedules, pain reassessment, sepsis bundles)
Response times for urgent protocols (like sepsis alerts)

Patient Outcomes

Patient satisfaction scores (HCAHPS or local surveys)
Patient trust and engagement in care plans
Measurable health behavior changes (quitting smoking, vaccination uptake)

Staff Outcomes

Adoption rates of new systems and tools
Staff satisfaction and engagement scores
Nurse retention and reduced burnout after implementation

Tip: Always connect these metrics back to your original goal. If you launched a new bedside report, don’t just track compliance — measure whether patient satisfaction actually improved. Linking outcomes to intent keeps teams motivated and shows real impact.

Barriers to Change in Nursing (and How to Overcome Them)

Even the best plan hits roadblocks. Nurses juggle heavy workloads, and change can feel like “one more thing.” Knowing the most common barriers — and how to address them — helps you keep momentum.

1. Resistance to Change

Why it happens: Fear of losing control, comfort with old habits, or doubt about benefits.
How to overcome it: Use Lewin’s Unfreeze stage or ADKAR’s Awareness + Desire. Involve staff early, listen to concerns, and show how the change benefits patients.

2. Lack of Time or Resources

Why it happens: Nurses already feel stretched thin, so new processes seem like extra work.
How to overcome it: Apply Kotter’s Empower Action step. Remove barriers, streamline workflows, and provide hands-on support so change feels like a time-saver, not a burden.

3. Poor Communication

Why it happens: Staff hear mixed messages or don’t fully understand the “why.”
How to overcome it: Use Kotter’s Communicate the Vision. Share updates in huddles, emails, posters, and through peer champions to keep messaging consistent.

4. Leadership Gaps

Why it happens: Without visible support, staff doubt how serious the change really is.
How to overcome it: Leaders need to model the new behaviors, attend training, and celebrate wins. Recognition tied to progress builds trust.

5. Sustainability Challenges

Why it happens: Initial energy fades once audits stop or leadership changes.
How to overcome it: Use Lewin’s Refreeze or ADKAR’s Reinforcement. Build the change into policy, orientation, and daily routines so it sticks long term.

Quick Comparison: Nursing Change Models

Model	Best For	Key Strength	Common Use in Nursing
Lewin	Unit-level workflow changes	Simple, easy to follow	Bedside shift reports, infection prevention
Kotter	Hospital-wide or large-scale initiatives	Structured 8-step roadmap	Hand hygiene campaigns, Magnet prep
ADKAR	Staff adoption of new tools	Focus on individuals	BCMA, EHR modules, fall risk tools
Rogers	Spreading new innovations	Explains adoption stages	Sepsis alerts, mobility programs, telehealth
TTM	Patient education & counseling	Meets patients where they are	Smoking cessation, vaccine uptake, diabetes lifestyle support

This table makes it easy to match your challenge with the right theory.

Frequently Asked Questions (FAQs)

Q: Which change theory is most common in nursing?
Lewin’s model is often the first choice because it’s straightforward and works well at the unit level.

Q: Can I combine different models?
Yes. For example, Kotter’s 8-Step Model can guide a hospital-wide change, while ADKAR helps ensure individual nurses adopt the new practice.

Q: How do I know if a change really worked?
Track outcomes like compliance rates, patient satisfaction, and staff adoption. Sustainability is the key — the change should last beyond the rollout.

Q: Which model works best for patient-focused change?
The Transtheoretical Model (TTM) is best for guiding patient education and lifestyle counseling.

Conclusion

Change is part of everyday nursing — whether it’s adopting a new bedside routine, implementing a safety protocol, or supporting patients through lifestyle changes. Having the right framework turns uncertainty into progress.

Lewin helps teams break old habits and lock in new ones.
Kotter rallies organizations for large-scale transformation.
ADKAR builds step-by-step adoption at the individual level.
Rogers shows how innovations spread through groups.
TTM meets patients at their stage of readiness.

By using the right model for the right situation, nurses can make change less stressful and more effective — leading to safer care, stronger teams, and patients who feel supported.

Change Theories in Nursing Explained: Lewin, Kotter, ADKAR, Rogers & TTM