A Concept Analysis of Change Fatigue Among Nurses Based on Walker and Avant's Method. — TEI-tagged view

Songmei CaopersName, Jingxi LinpersName, Yiqing LiangpersName, Yuan QinpersName (2024date). “A Concept Analysis of Change Fatigue Among Nurses Based on Walker and Avant's Method..” Journal of Nursing Managementtitle·j.

Object of study — change fatigueterm·dom among nurses

Research question — what the defining attributes, antecedentsterm and consequences of change fatigueterm·dom among nurses are

Contribution — an operational definition of change fatigueterm·dom among nurses with four defining attributes

Full text — tagged

A Concept Analysisterm·key of Change Fatigueterm·dom Among Nurses Based on Walker and Avant's Method.

Abstract Background: Change is prevalent in nursing environments and often leads to change fatigueterm·dom among nurses while aiming to improve service quality and efficiency. Change fatigueterm·dom is a significant stressor affecting nurses' work and psychology, and it is a crucial factor influencing organizational changeterm·key. However, the concept of change fatigueterm·dom among nurses has not yet been clearly defined or analyzed.

Aim: This analysis aims to differentiate, clarify, and clearly identify the specific concept of change fatigueterm·dom among nurses, which will provide nursing administrators and researchers with a comprehensive understanding of the concept of change fatigueterm·dom among nurses, ultimately facilitating relevant measurements and interventions.

Methods: This study employed Walker and Avant's concept analysisterm·key method.

Results: A total of 29 papers were included in the study. The four defining attributes of change fatigueterm·dom among nurses were identified as nurses' exposure to constant change, exhaustionterm·key, decreased agencyterm·dom, and passive acceptance of changeterm·dom. Antecedentsterm were categorized into nurses' personal factors and those related to the organizational environment. The consequences of change fatigueterm·dom were distinguished between individual-level and organizational-level impacts.

Conclusions: This study provides a clearer understanding of the concept of change fatigueterm·dom among nurses by outlining its antecedentsterm, attributes, and consequences. An operational definition and conceptual understanding of change fatigueterm·dom will aid future research in developing effective prevention strategies.

Keywords: change fatigueterm·dom, concept analysisterm·key, nurses, organizational changeterm·key 1. Introduction Organizational changeterm·key occurs frequently in the healthcare industry, encompassing innovations in new technologies, workflow adjustments, and infrastructure improvements [ 1 ]. These rapid and continuous changes aim to enhance health services and meet evolving needs and expectations [ 2 ]. However, such changes can have adverse effects on healthcare providers. They may directly impact employees' work environments, leading to organizational instability, negatively affecting employee health and psychosocial well-being, and contributing to dissatisfaction, burnoutterm·key, and anxiety [ 3 , 4 ]. Additionally, these changes can diminish employees' sense of belonging and loyalty to the organization [ 5 ], resulting in increased rates of sick leave and turnover [ 6 ]. Research on employees' emotional responses to change is crucial. Bernerth's research highlights that sustained change can lead to emotional exhaustionterm·key, also known as change fatigueterm·dom [ 7 ], a concept initially identified in the management discipline [ 8 ] and recognized as a significant factor influencing organizational changeterm·key [ 9 ].

Change fatigueterm·dom is prevalent in healthcare organizations due to the frequent and accelerating pace of change [ 10 ]. Nurses, as key members of the healthcare workforce, experience frequent changes in healthcare settings. Research by Gee et al. indicates that nurses encounter change fatigueterm·dom, making it a common phenomenon [ 11 ]. Recent research has increasingly focused on change fatigueterm·dom within the nursing discipline. Several studies have employed qualitative methods to explore nursing staff perceptions and experiences of rapid and sustained change [ 12 – 14 ]. For instance, McMillan's interviews with 14 nurses revealed that they experience significant change fatigueterm·dom similar to that described in the non-nursing literature [ 15 ]. Quantitative research has also examined change fatigueterm·dom among nurses. Brown et al. reported moderate levels of change fatigueterm·dom among 521 nurses in acute care settings [ 16 ]. Camilleri found that large-scale changes contributed to high levels of change fatigueterm·dom in nurses [ 1 ]. Factors influencing change fatigueterm·dom among nurses have been investigated in several studies, including the frequency of change, hospital size [ 16 ], intensity of nursing work [ 17 ], organizational adaptive reserve [ 18 ], and personal resilience [ 16 ]. Research has shown that increased change fatigueterm·dom among nurses correlates with decreased organizational commitment, job satisfaction, and a higher tendency toward burnoutterm·key and turnover [ 19 , 20 ]. Additionally, nurses' mental health is adversely affected, with higher levels of change fatigueterm·dom significantly increasing anxiety and depression [ 21 ]. Recent reviews have enhanced the understanding of change fatigueterm·dom's impact on nurses and the nursing profession, highlighting the need for strategies to prevent and address change fatigueterm·dom [ 22 ].

Fatigueterm·dom is a psychological state commonly experienced by individuals in healthcare settings. This sense of fatigueterm·dom affects both physical and mental well-being, disrupting work performance and emotional health. Various types of fatigueterm·dom have specific causes and effects. For instance, alarm fatigueterm·dom results from prolonged exposure to numerous clinical alarms, leading to sensory overload and desensitization [ 23 ]. Compassion fatigueterm·dom arises from prolonged empathy and assistance to others, resulting in emotional numbness due to the negative emotions of those being helped [ 24 ]. Occupational fatigueterm·dom is caused by excessive demands and pressures related to work tasks, environment, and scheduling [ 25 ]. Change fatigueterm·dom refers to the fatigueterm·dom and resistance experienced by individuals or groups due to continuous changes [ 7 , 9 ]. Change fatigueterm·dom and other types of fatigueterm·dom constitute the fatigueterm·dom phenomena individuals may experience in healthcare settings. However, unlike other types of fatigueterm·dom, it primarily stems from the uncertainty and pressure associated with organizational changeterm·key.

Although “change fatigueterm·dom” is prevalent among nurses and has been researched, it originates from the management discipline [ 21 ]. Research on change fatigueterm·dom within the healthcare field is still relatively scarce, with many ambiguities regarding its defining attributes, antecedentsterm, and consequences. As a relatively new concept in the healthcare industry, there is no universally accepted definition within the nursing discipline [ 22 ]. Studying change fatigueterm·dom is crucial not only for theoretical advancements but also for informing organizational changeterm·key practices, facilitating the smooth implementation of changes, and supporting long-term organizational development. Therefore, exploring this concept is essential for enhancing researchers' understanding of change fatigueterm·dom among nurses and addressing the ongoing challenges posed by change.

2. Methods 2.1. Concept Analysisterm·key Method Walker and Avant's concept analysisterm·key method is widely used in research to address concepts that suffer from ambiguity and lack of clear definitions. This method provides precise operational definitions that contribute to a fundamental understanding of a concept's core characteristics and enhances its application [ 26 ].

The eight-step process of Walker and Avant's method includes the following: (1) selecting a concept; (2) determining the purpose of the analysis; (3) identifying all uses of the concept; (4) determining the defining attributes; (5) constructing a model case; (6) constructing other cases; (7) identifying antecedentsterm and consequences; and (8) identifying empirical references [ 26 ].

2.2. Data Source Along with consulting dictionary resources for common definitions, we also searched empirical literature to better understand the concept of change fatigueterm·dom among nurses. Keywords such as “change fatigueterm·dom,” “organizational changeterm·key,” and “nurs⁣ ∗ ” were identified based on the literature review. A Boolean search strategy combining “and” and “or” was used to search the CINAHL, Embase, ProQuest, PubMed, Scopus, Web of Science, China National Knowledge Infrastructure (CNKI), and Wan Fang Database for studies from inception to June 2023, and relevant references were tracked ( Table 1 ).

Search strategy.

2.3. Screening Method Primary literature was independently and rigorously screened by two researchers according to inclusion and exclusion criteria, removing duplicates, articles not in English or Chinese, and irrelevant articles based on titles or abstracts. All studies contributing to the understanding of the concept of change fatigueterm·dom, regardless of research methodology quality, were included. Studies were included if they referred to at least one of the following aspects of change fatigueterm·dom: definition, attributes, antecedentsterm, consequences, and empirical references.

3. Results This search yielded a total of 2700 articles, and 14 relevant references were tracked. After removing 533 duplicates, 2181 records remained. A total of 104 articles were retained after the initial screening of titles and abstracts ( n = 2077). Seventy-five records were excluded for the following reasons: unavailability of full text ( n = 7), not focus on change fatigueterm·dom ( n = 67), and population not being nurses ( n = 1). Ultimately, 29 studies in nursing or health sciences were included and analyzed ( Figure 1 ). All studies were published between 2002 and 2023. Of these, 21 studies were from North America (USA and Canada), 5 from Europe, 2 from Australia, and 1 from Türkiye. Regarding study types, eight were quantitative, four were qualitative, four were mixed methods, three were literature reviews, and the remaining were text and opinion pieces. Notably, Kim McMillan was the first author in four studies, and Robin Brown was involved in three studies.

Flow diagram of the study selection process.

3.1. Uses of Concept Change fatigueterm·dom comprises the terms “change” and “fatigueterm·dom.” According to the Cambridge Dictionary and Oxford English Dictionary, “change” is defined as “The action or process of making or becoming different.” In the nursing field, change primarily arises from organizational needs, new evidence-based practices, or requirements from governing bodies [ 19 ]. Such change often involves organizational adjustments, alterations, or transformations in response to internal and external environmental factors [ 27 ]. “Fatigueterm·dom” is defined in Webster's Dictionary as “weariness or exhaustionterm·key from labor, exertion, or stress,” encompassing both physical and emotional fatigueterm·dom. Various fatigueterm·dom issues frequently associated with clinical work include alarm fatigueterm·dom, compassion fatigueterm·dom, and working time fatigueterm·dom, all of which impact care safety and practice. Change fatigueterm·dom has also been recognized as a potential influencing factor [ 10 ].

The topic of change fatigueterm·dom is repeatedly mentioned among employees, manifesting as passive acceptance of changeterm·dom, which depletes adaptive resources and leads to exhaustionterm·key and other negative outcomes [ 13 ]. There are different definitions of change fatigueterm·dom. Kapping [ 19 ], citing Bernerth et al. [ 7 ], defines change fatigueterm·dom as “a feeling of apathy toward the organization, passive acceptance of initiatives, powerlessness, and emotional exhaustionterm·key with limited resources such as energy, personal control, or time due to excessive organizational changeterm·key.” This definition underscores the psychological impact of organizational changeterm·key, with these psychological shifts often evolving gradually throughout the change process [ 28 ]. In the management discipline, Cox also emphasizes the feeling of exhaustionterm·key and the harm it brings to the change process, defining change fatigueterm·dom as “the exhaustionterm·key employees experience from organizational changesterm·key, which makes the possibility of successful future changes unlikely” [ 9 ].

In the healthcare industry, change fatigueterm·dom is prevalent among key participants in the change process, primarily doctors and nurses [ 29 ]. Research indicates that nurses are particularly negatively affected by change [ 20 ], as they are responsible for managing, implementing, and evaluating changes [ 12 ]. For nurses, change fatigueterm·dom results from the rapid and continuous changes within healthcare institutions, a trend expected to persist and increase [ 10 , 30 ]. Initially, change fatigueterm·dom among nurses was broadly understood as “the overwhelming feelings of stress, exhausted, and burnoutterm·key associated with rapid and continuous change in the workplace” [ 31 ]. McMillan later defined it as “feelings of apathy, ambivalence, disengaged, exhaustionterm·key, and burnoutterm·key during periods of ongoing organizational changeterm·key” [ 2 ]. Additionally, some scholars view change fatigueterm·dom not only as a personal psychological experience but also as a deterioration in both individual and organizational adaptability [ 32 ]. Nurses experiencing change fatigueterm·dom find themselves drained of energy and struggling to adapt to new changes [ 33 ]. Excessive and rapid changes can impair nurses' ability to cope, leading to increased fatigueterm·dom [ 11 , 12 , 34 , 35 ]. Change fatigueterm·dom represents a cumulative effect, where simultaneous and ongoing changes undermine organizational stability and increase the risk of errors among nurses [ 32 ].

3.2. Defining Attributes The core of concept analysisterm·key is to identify the defining attributes of a concept—those attributes that are most relevant and that provide insight into the concept [ 36 ]. These attributes differentiate the intended concept from similar or related concepts. Our analysis identified four defining attributes of change fatigueterm·dom: exhaustionterm·key, nurses' exposure to constant change, decreased agencyterm·dom, and passive acceptance of changeterm·dom ( Table 2 ).

Defining attributes.

Exhaustionterm·key is the most central attribute of change fatigueterm·dom among nurses and represents the most intuitive experience during periods of change. In an environment of frequent organizational changeterm·key, nurses face exhaustionterm·key, burnoutterm·key, and feelings of being overwhelmed due to prolonged exposure to the pressures of constant change [ 33 , 42 ]. This is supported by McMillan's qualitative study, which reported that nurses experienced strong feelings of exhaustionterm·key and burnoutterm·key [ 15 ]. Additionally, this exhaustionterm·key is recognized as overwhelming emotional exhaustionterm·key that surpasses the individual's ability to sustain [ 7 , 22 ]. Vestal also notes that the drain on resources caused by change stretches nurses to their limits, necessitating additional support or intervention to alleviate work-related stress and exhaustionterm·key [ 10 ].

Nurses' exposure to constant change is a key attribute of change fatigueterm·dom. Stress in the nursing profession arises from various sources, but a crucial prerequisite for change fatigueterm·dom is frequent organizational changeterm·key. Many studies have found that nurses who suffer from change fatigueterm·dom experience continuous and frequent change [ 1 , 11 , 16 , 21 , 38 , 39 ]. The overall impact of frequent organizational changesterm·key on nurses' job responsibilities, work environment, and organizational culture forces nurses to constantly adapt to new requirements and settings, affecting both their professional and personal lives [ 22 ]. Changes typically involve two main areas: alterations in organizational structure and changes in nursing practice [ 6 ]. Organizational changesterm·key include restructuring and shifts in staffing, while changes in nursing practice involve optimizing patient treatment outcomes and enhancing the quality and efficiency of care.

Decreased agencyterm·dom is another key attribute of change fatigueterm·dom, primarily manifesting as passive participation in change initiatives. Nurses may lose interest in change, becoming unwilling or less active in implementing new programs or processes, and simply do what is required without actively seeking improvements or innovations [ 42 ]. In addition to the weakening of intrinsic motivation, there is an increase in external control. McMillan et al. found that nurses felt that they lacked the ability to participate in decision-making during the implementation process [ 40 ]. Additionally, nurses frequently experience a sense of disempowerment during change, feeling unable to effect changes in the current situation [ 42 ]. When nurses perceive that their role in the change process is undervalued, their motivation and willingness to engage in change are diminished [ 20 ].

Passive acceptance of changeterm·dom represents a form of silent dissent, distinct from overt change resistanceterm·dom, and is more oriented toward silent conflict [ 18 ]. It is a direct response to change fatigueterm·dom. Nurses experiencing change fatigueterm·dom often feel dissatisfied but are reluctant to openly express their dissent [ 16 , 31 ]. They may question the value and goals of the change, exhibit impatience [ 30 , 42 ], or display apathy toward the change process [ 20 , 41 ].

3.3. A Model Case A model case exemplifies a concept by including all its defining attributes, thereby clarifying the meaning of the concept [ 26 ].

Mrs. X, aged 32, was a charge nurse with 11 years of experience at the hospital. During the COVID-19 pandemic, her department underwent multiple changes in work processes, such as the requirement to track the movements of all patients' relatives at noon and in the evening, which increased Mrs. X's workload. Concurrently, a new evidence-based practice project was implemented in the unit. However, the integration of this new practice was poorly executed. The new evidence-based practice not only demanded higher research skills but also added to the existing workload. For instance, the introduction of a new risk assessment scale required Mrs. X to evaluate patients twice upon admission. This additional task made her feel apprehensive and irritable before each procedure and led her to question the validity of the new change. Mrs. X increasingly felt that while her energies were diverted by the new changes, she still needed to meet the demands of patients and management simultaneously. As a result, Mrs. X became exhausted and dissatisfied with the changes.

In this case, change fatigueterm·dom among nurses manifested through rapid and constant change over a short period, leading to exhaustionterm·key, powerlessness, and impatience and questioning the value of the change, accompanied by resistance to it.

3.4. A Borderline Case A borderline case contains most of the defining attributes of a concept.

Mrs. Y, aged 31, was a nurse practitioner with 6 years of experience at the hospital. Due to hospital accreditation and the department's focus on specialty construction, her department frequently revised its routines, processes, and policies. This involved interpreting guidelines, updating specialty disease diagnoses and treatments, and conducting literature research for accreditation preparation. The increased workload and frequent overtime led to negative emotions. Despite this, Mrs. Y viewed the changes as a natural progression necessary for the hospital's successful accreditation and believed that the situation would improve once accreditation was complete. She managed her emotions and continued to support the change process through self-regulation.

This borderline case included nearly all the attributes of change fatigueterm·dom: Mrs. Y experienced constant changes, developed feelings of exhaustionterm·key and powerlessness, and exhibited mild change fatigueterm·dom. However, instead of remaining passive, she proactively participated in and gradually adapted to the changes, resulting in a gradual easing of her change fatigueterm·dom.

3.5. A Contrary Case A contrary case is one in which none of the conceptual attributes are included.

Mrs. Z, aged 34, is a charge nurse with 11 years of experience at the hospital. Despite the department undergoing numerous changes, including staffing restructuring, evidence-based practice projects, and the development of specialty areas, Mrs. Z did not experience change fatigueterm·dom. The unit was well-prepared for these changes, with experienced doctors and nurses providing strong support for their implementation, enabling Mrs. Z to adapt effectively. Throughout the change process, Mrs. Z recognized the importance of these changes and believed that participating in them would contribute to the hospital's development and improve the quality of care. This perspective made her feel fulfilled and increased her sense of self-worth.

In this case, although frequent changes occurred, Mrs. Z did not develop change fatigueterm·dom. Instead, she experienced a boost in self-worth as a result of the changes.

3.6. Antecedentsterm Antecedentsterm are events or situations that must already exist before a concept can occur [ 26 ]. We reviewed the literature and classified antecedentsterm into individual and organizational factors.

Individual factors include gender, age, and personal resilience. Brown et al. found that male nurses had higher change fatigueterm·dom scores than female nurses and that personal resilience was negatively correlated with change fatigueterm·dom among nurses [ 16 ]. Additionally, younger nurses were more likely to experience change fatigueterm·dom than older nurses [ 10 ]. Education level also serves as a predictor of personal resilience: Higher education levels are associated with greater resilience, which indirectly affects the level of change fatigueterm·dom among nurses [ 41 ].

Organizational factors include the pace of change, workload, and readiness for change.

Frequent and continuous change is a significant antecedentterm to the onset of change fatigueterm·dom among nurses and a necessary condition for its development. Nurses work on a very tight schedule, and implementing changes within this limited time frame can disrupt their workflow, leading to burnoutterm·key and fatigueterm·dom. Recent empirical studies have shown that excessive organizational changeterm·key makes nurses more susceptible to change fatigueterm·dom [ 17 , 19 – 21 , 43 ]. Change fatigueterm·dom increases with the speed, frequency, and volume of change [ 7 ]. This urgency often demands rapid adaptation of work processes, creating challenges at work and contributing significantly to psychological and emotional stress.

Both quality improvement and performance enhancement require the implementation of change. The increased workload associated with a growing number of changes can lead to heightened emotional fatigueterm·dom, which is a common cause of change fatigueterm·dom. During periods of change, work intensity often increases, resulting in longer shifts, more nursing duties on the wards, and additional workloads [ 15 , 22 , 38 , 44 ]. This can lead to frequent overtime, including weekends, and necessitate adjustments in resources such as manpower, materials, and time. A study revealed that during the COVID-19 pandemic, organizational changesterm·key surged, resulting in increased overtime for nurses, with over one-third working more than 10 additional hours per week [ 21 ]. Hospital size also affects workload; larger hospitals with more beds have larger patient intakes, and some studies have indicated a relationship between hospital size and nurse change fatigueterm·dom [ 16 ].

Insufficient readiness for change can also contribute to change fatigueterm·dom among nurses. A lack of adequate communication and unclear change criteria during the change process can lead to concerns about the unknown or misunderstandings regarding the change plan, resulting in additional distress and stress [ 12 , 17 ]. Additionally, a practice's ability to keep up with rapid change largely depends on its adaptive reserve [ 45 ]. A team with a weak adaptive reserve exhibits less resilience in implementing change and lower acceptance of it. Research has shown that insufficient adaptive reserve can lead to burnoutterm·key and change fatigueterm·dom [ 18 ].

3.7. Consequences The consequences of a concept arise from its existence [ 26 ]. According to the literature, the consequences of change fatigueterm·dom among nurses encompass both individual and organizational dimensions.

3.7.1. Individual Dimension Consequences One consequence is the change in nurses' personal behavioral intentions. Nurses often appear self-sacrificing, dedicating personal time and energy to working overtime to ensure patients receive necessary care [ 15 ]. This behavior can lead to health issues for the nurses themselves [ 15 , 41 ]. Additionally, as change continues, nurses may shift their energy and resources to other activities [ 42 ] and become reluctant to engage in clinical change efforts [ 12 ]. Persistent organizational instability and disregard for nurses' concerns can increase their likelihood of leaving their jobs [ 2 , 7 , 18 , 20 , 35 , 41 ].

Another consequence involves personal emotional responses. Constant adaptation to new demands and changes, without adequate time for preparation or adjustment, can exacerbate existing stress [ 34 ], leading to burnoutterm·key and decreased long-term job satisfaction [ 16 , 19 , 20 , 38 ]. It can also contribute to increased anxiety and depression [ 21 ]. When nurses' resources (e.g., time and energy) are insufficient to meet the excessive demands and expectations from superiors and patients, they are at high risk of experiencing moral distress [ 17 ]. Simultaneously, nurses may lose trust in the organization [ 30 ], resulting in decreased organizational commitment [ 7 , 19 , 20 , 38 ] and a crisis of confidence in management [ 41 ].

3.7.2. Organizational Dimension Consequences The emergence of change fatigueterm·dom among nurses can impede the implementation of practice changes. Nurses experiencing burnoutterm·key may become unwilling to participate in change initiatives and may exhibit oppositional or avoidant behaviors, which can hinder change implementation and increase the risk of failure [ 11 ]. As nurses continuously encounter new changes and demands, they must adapt to new processes, technologies, and task assignments. This ongoing process can disrupt established work patterns, interfere with work habits, and lead to decreased productivity and an increased likelihood of errors [ 32 , 34 ], which in turn affects the quality of care and heightens the risk of substandard care. Stability and consistency within nursing teams are crucial for providing efficient care. However, excessive change can lead to frustration and disillusionment among nurses, potentially prompting them to leave their jobs. This turnover can adversely impact organizational productivity and the team's ability to work cohesively [ 30 ].

3.8. Empirical Referents The final step of concept analysisterm·key involves identifying empirical references that support the interpretation of the concept. The universal Change Fatigue Scaleterm, developed by Bernerth et al. in 2011, was selected as the primary valid instrument for examining change fatigueterm·dom [ 7 ]. Originally, the scale was part of a set of measures designed to explore the impact of multiple organizational changesterm·key on employee well-being, organizational commitment, and turnover intentions. The scale consists of six items, using a 7-point Likert scale ranging from 1 (Strongly Disagree) to 7 (Strongly Agree) to assess overall change fatigueterm·dom. Higher scores indicate a greater degree of change fatigueterm·dom. The scale has demonstrated good reliability and internal consistency in larger sample populations, with a Cronbach α of 0.85 in non-nurse populations. In 2018, Brown et al. reported a Cronbach α of 0.94 for the scale in a sample of 521 nurses [ 16 ]. Cox adapted this scale to five items, while still using a 7-point Likert scale [ 9 ]. However, research tools specifically designed to effectively identify change fatigueterm·dom among nurses are still lacking. Existing tools often lack relevance and specificity for nurse populations, fail to encompass all attributes of nurse change fatigueterm·dom, and do not fully capture the phenomenon among nurses.

3.9. Definition of Change Fatigueterm·dom Among Nurses Change fatigueterm·dom among nurses is defined as a state of exhaustionterm·key, decreased agencyterm·dom, and passive acceptance of changeterm·dom resulting from exposure to constant change. This condition negatively impacts both the physical and mental health of nurses, as well as affects the organization as a whole.

4. Discussion The purpose of organizational changeterm·key is to enable the organization to adapt to a changing environment. However, change fatigueterm·dom resulting from frequent change poses a major challenge to organizational changeterm·key [ 15 ]. The impact of epidemics, in particular, introduces additional burdens of organizational changeterm·key and psychological stress [ 21 , 46 ]. This increased awareness among care managers about change fatigueterm·dom highlights the need for a standardized definition of the concept. This concept analysisterm·key aims to provide a comprehensive understanding of change fatigueterm·dom among nurses, benefiting both research and practice, and to draw attention to its potential impacts. Furthermore, this analysis may assist in subsequent incident reporting, risk monitoring, and intervention evaluation, ultimately exploring effective strategies for managing fatigueterm·dom. Thus, this concept analysisterm·key has significant implications for research on change fatigueterm·dom among nurses.

According to Walker and Avant's method [ 26 ], understanding change fatigueterm·dom among nurses involves identifying its attributes, antecedentsterm, and consequences. Change fatigueterm·dom is a complex experience that arises when nurses are subjected to frequent and continuous changes, negatively affecting both their physical and mental health, as well as the organization. The concept encompasses four defining attributes: exhaustionterm·key, nurses' exposure to constant change, decreased agencyterm·dom, and passive acceptance of changeterm·dom. The literature indicates that exposure to constant change is the most critical attribute of change fatigueterm·dom in clinical care environments. The attributes of exhaustionterm·key, decreased agencyterm·dom, and passive acceptance are the most significant manifestations of change fatigueterm·dom in contexts of frequent change ( Figure 2 ).

Change fatigueterm·dom concept analysisterm·key diagram.

The antecedentterm analysis of this study reveals that change fatigueterm·dom among nurses is influenced by both individual and organizational factors. It has been suggested that nurses and their managers might not recognize change fatigueterm·dom and may consider it a normal part of the job [ 39 ]. Identifying these antecedentsterm underscores the importance of proactively coordinating change to successfully implement new practices [ 47 ]. Our literature review identified gender, age, and personal resilience as individual factors affecting change fatigueterm·dom among nurses. Recognizing these factors can help increase nursing managers' awareness of risk factors for change fatigueterm·dom and identify potential causal elements. Analyzing organizational factors can aid nursing managers in better assessing and responding to environmental changes, thereby enhancing the organization's capacity for development. There is a need for decision-makers to educate and train nurses about change fatigueterm·dom [ 43 ]. By thoroughly understanding the causes of nurse change fatigueterm·dom and utilizing these insights to develop personalized and comprehensive strategies, better evaluation and prevention of change fatigueterm·dom among nurses can be achieved.

After analyzing the consequences of change fatigueterm·dom, it is evident that it is critical to the successful implementation of organizational changeterm·key. Nurses, being a crucial part of the healthcare team, directly interact with patients and provide care during the implementation of changes within the healthcare team. However, change fatigueterm·dom negatively impacts nurses, leading to burnoutterm·key and stress, as reported in various studies [ 18 , 20 , 21 ]. Additionally, individual emotional experiences affect job satisfaction, which is a key factor in recruiting and retaining nursing talent [ 48 ]. Increased nurse turnover undermines organizational stability and development [ 30 ]. Therefore, timely and effective intervention and management of change fatigueterm·dom among nurses are essential to address the challenges posed by subsequent changes. Establishing positive responses to these challenges can help nurses become more resilient and reassess their competence and value. Enhancing job satisfaction and increasing willingness for change can mitigate the difficulties associated with transformation. To some extent, the alignment and implementation of change are also influenced by the feedback from the consequences of change fatigueterm·dom.

Despite the significant implications of change fatigueterm·dom for nurses in the context of organizational changeterm·key, this concept is rarely applied in clinical nursing settings. This may be due to the reliance on universal scales from management disciplines to measure change fatigueterm·dom [ 7 ]. Further research is needed to develop assessment tools specifically tailored for nurses to recognize signs of change fatigueterm·dom and identify strategies to proactively reduce its occurrence. The development of such tools should consider all defining attributes of change fatigueterm·dom and not be limited to a single aspect. Additionally, factors related to various nursing environments, such as community nursing, nursing homes, and home care, should be incorporated. Specific measurement scales for different types of changes in nursing practice are also necessary due to the complexity of change in clinical settings.

Although specific interventions to prevent and mitigate change fatigueterm·dom among nurses are still limited, many studies emphasize the importance of active support from nursing managers. Decision-makers are urged to organize and manage change programs effectively to reduce the incidence of change fatigueterm·dom [ 22 ]. Research also suggests strategies such as providing information and training support to help nurses understand and actively engage with changes [ 43 ]. Supporting open communication can reveal change fatigueterm·dom and promote the sustainable development of change initiatives [ 49 ].

Change fatigueterm·dom among nurses remains a complex issue, and current research is insufficient for a comprehensive and systematic assessment of the influence and interrelationships among its antecedentsterm. Future research needs to explore the impacts of factors such as the work environment, frequency of changes, and individual psychological resilience. The interaction of these factors may reveal the underlying causes of change fatigueterm·dom. As highlighted by this conceptual analysisterm·mth, no single manifestation fully captures nurse change fatigueterm·dom, emphasizing the need to consider the overall picture and develop comprehensive assessment scales. Additionally, reducing nurse change fatigueterm·dom is crucial for facilitating effective change [ 9 ]. Therefore, designing preventive strategies, exploring proactive interventions, and evaluating their effectiveness are important areas for further research. The study of change fatigueterm·dom should involve multidisciplinary collaboration, advocating for interdisciplinary and cross-institutional research integrating knowledge from psychology, management, sociology, and other fields for a thorough investigation.

While this study provides valuable insights into change fatigueterm·dom among nurses, it has limitations. Firstly, the article's focus on English and Chinese sources may limit the scope of the research, potentially overlooking important perspectives. Secondly, the analysis of attributes and definitions may be subjective, as different individuals might have varying interpretations of change fatigueterm·dom, introducing potential bias. Additionally, the variability of concept definitions and the evolving nature of healthcare policies and practices may not be fully reflected, potentially limiting the study's temporal relevance. This suggests a need for new research to analyze the evolution of change fatigueterm·dom over time and in response to societal changes.

5. Implications for Nursing Management By analyzing the concept of change fatigueterm·dom among nurses, this study clarifies its significance and has broad implications for nursing management. First, the concept analysisterm·key aids nursing managers in developing a unified understanding of change fatigueterm·dom, which is crucial for guiding subsequent research and avoiding confusion in findings. This clarity helps reduce uncertainty and challenges in nursing management, ultimately enhancing efficiency and quality. Second, analyzing the antecedentsterm and consequences, along with specific cases, offers insights into the risk factors for change fatigueterm·dom. This information provides valuable guidance for managers in developing more effective and practical change programs, thus improving the success rate of organizational changesterm·key. Finally, understanding change fatigueterm·dom among nurses introduces new ideas and methods for innovating nursing management. It opens the door to developing new management models, technologies, and tools designed to reduce change fatigueterm·dom and support sustainable change.

Acknowledgments The authors would like to thank all the participants who contributed their time to the study.

Data Availability Statement The data used to support the findings of this study are available from the corresponding author upon reasonable request.

Ethics Statement Ethical approval was not required for this paper.

Conflicts of Interest The authors declare no conflicts of interest.

Funding No funding was used in this study.

References Associated Data Data Availability Statement The data used to support the findings of this study are available from the corresponding author upon reasonable request.