Describe at least three evolving issues that are internal or external to your practicum setting that could affect the implementation and sustainability of your proposed change.

Multiple systems can be influenced by evidence-based, systemic change


As an advance practice nurse, it is essential to be aware of the multiple factors that influence one’s work and the changes proposed as a nurse leader. The practice environment changes constantly and is fluid. It’s important to stay current with developments in order to adapt or maintain a change. This essay will discuss three issues, both internal and external to the context of practice that may impact implementation and sustainability. We will discuss the origins of these problems and how proposed changes may affect other levels.

There are many factors that can affect the implementation and sustainability of the proposed change.

Staffing shortage is one of many issues that may impact the sustainability and implementation of the change. Hoyle (2015) states that staff shortages can lead to low morale, lower productivity and increased staff turnover. They are more likely to have difficulty implementing and maintaining change because of a lack of resources. Regulators are another emerging issue that can impact implementation and sustainability. Regulations, such as policy changes, can significantly affect the practicum setting’s ability to implement and sustain change. If a regulation change is complex or requires more resources, it could pose challenges for the practicum setting in implementing the change and maintaining its sustainability. Supply is another issue that can impact the sustainability and implementation of the change. It could be difficult for the practice setting to sustain the proposed change if it lacks sufficient resources.

These Issues are at the Systems Level and other Systems involved in response to the Factors

Organizational systems are a part of the wider healthcare system and can cause staff shortages. To address staffing problems, the healthcare system can develop programs such as workforce development initiatives. This will increase the quantity and quality of health care professionals. Similar to regulations, they originate at the national system level. In response, other systems such as state, local and organizational can take actions to resolve these problems. In response to changes in policy at the national levels, some healthcare providers may have to modify their procedures to meet the requirements of the regulations. Supply issues can also arise at the national or local level. In response to these changes, it may be necessary for other systems to adapt. In the case of a local shortage, resources may be required to supplement the supply system.

What the proposed Change might do to other levels beyond the Initial Focus

Changes to the proposed policy and practice may be made at higher levels than what was initially planned. For instance, if the proposed change is related to the implementation of a new technology in the practicum setting, the success of this change could influence the adoption of similar technologies in other organizations, ultimately leading to a shift in the national or global healthcare system’s practices. Furthermore, the proposed change may lead to the development of new policies or regulations aimed at improving healthcare practices, leading to a shift in the healthcare system’s practices at the national or global level.


This essay explains that staffing shortages and regulations are evolving problems which could impact the sustainability and implementation of proposed changes. This issue can be triggered at multiple levels such as the national, local, or organizational systems. Other systems could then respond to this problem. Additionally, the change proposed may cause shifts at different levels than the original focus. For example, it could influence policy changes or practice adjustments. To be a leading healthcare professional, it is important to understand the possible effects of a change.

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