NURS433:

Lesson 3: Change

In this section we will discuss the implementation, effects, and evaluation of change and the role of the nurse executive/manager.  Health care systems and approaches to patient care are changing rapidly in the current environment which can be confusing and overwhelming to those individuals who must adapt.  The nurse executive/manager who understands the effects of change and implements the process in an organized, non-threatening manner facilitates change and minimizes confusion and stress.  

Objectives:

• Define the elements of organizational change.
• Analyze theories for effecting change.
• Analyze the role of the manager as a change agent
• Develop plans for implementing change

Assignment Overview:

• Read Chapter 5: "Initiating and Managing Change"
• Assignment #1: Types of Change - Part 1: Planned Organizational Change and Part 2: Unplanned Organizational Change
• Assignment #2: The Change Process

 

Initiating and Managing Change

Change can be viewed as a positive event whereby new ideas, approaches, ways of conducting business, or general everyday activities undergo a restructuring or re-evaluation to produce a revitalized perspective. Change also can be viewed as a not so positive event whereby individuals feel threatened or lose their sense of security. Generally, individuals tend to resist any type of change; they are secure with the status quo, like the comfort of a routine, fear the unknown, and fear the change itself. Change can be equated with some degree of risk and can be frightening to some. Myths and assumptions about the outcome of a change are always evident and in many cases are fueled by personal attitudes to change.

The perceptions of change vary, but the occurrence of change is consistent; it is inevitable. A major influence on the result of change is the manner in which it occurs and the individuals who facilitate it.

Types of Change:

An unplanned change occurs in a haphazard manner and results in unpredictable outcomes. This type of change does not offer individuals affected by its results a voice in its development or implementation. The manner in which it evolves produces great potential for negative outcomes. In organizations an unplanned change has far reaching effects, especially if the organization is large. Communication in large organizations can be problematic depending on the number of channels through which the communication flows. Rumors, misinterpreted statements, and written memos can result in confusion which can lead to disgruntled employees and, if the confusion reaches the population served by the organization, poor public relations. On a unit level an unplanned change can affect the smooth operation of the activities of the unit and have the same results as an organizational unplanned change, except on a smaller scale.

A planned change is purposeful; it is designed to include mutual goal setting and equal input from all individuals who will be affected by it. It occurs through the change process which is similar to the nursing process involving assessment, planning, implementation, and evaluation. A planned change has potential for positive outcomes. In organizations planned change involves representation in the change process from all groups who will be affected by the change. This may include representation from the population served by the organization. Communication in a planned change moves from the top downward, from the bottom upward, and from side to side; everyone affected by the change should receive all relevant information in a manner that can be interpreted equally by all groups. On a unit level a planned change should involve everyone on the unit so that everyone has an opportunity to define, shape, and facilitate the change.

Strategies for Change: In addition to power-coercive, empirical-rational, and normative-reeducative strategies for change that are reviewed in the text are facilitative strategies which make individuals aware of the availability of assistance to adapt to the change and persuasive strategies which attempt to bring change partly through bias in the way the message is delivered. The nurse executive/manager who participates in and facilitates change has to use not only change agent skills, but also has to be an educator/trainer, a role model, a researcher, a technical expert, and a resource person.

Facilitative strategies can be used when resistance to the change is expected. For example, an organization that is moving into computer based documentation can offer inservices, seminars, or one-on-one teaching to educate employees about computers and allow time for practice.

Persuasive strategies can be used to change attitudes and behaviors. Nurses use persuasive strategies all the time. For example, teaching a person to self administer insulin in many cases requires encouragement, support, teaching, and positive reinforcement, all of which can facilitate the person to accept and become comfortable with insulin administration.

Resistance to Change: While some individuals outwardly demonstrate a resistance to change through verbal interactions, there are also those individuals who use a more passive approach. The nurse executive/manager should be alert to non-verbal and/or passive indicators that the change process may be impeded. For example, indicators of resistance to change by individuals may be:

• constantly forgetting to follow through on the change
• consistently non-compliant
• not meeting deadlines or participating in the change process
• demonstrating an inability to participate in the changed behavior
• becoming angry
• blaming others for non-change
• claiming to be too busy to learn about or follow through on the change

If these behaviors are evident, perhaps the nurse executive/manager should assess the situations in which these occur and determine whether they should be taken at face value or assessed as resistors to change.

 

Read Chapter 5

Now please refer to your textbook Effective Leadership and Management in Nursing and read Chapter 5: "Initiating and Managing Change."

 

Assignment #1: Types of Change

Part 1: Discuss a planned organizational change in your current or previous place of employment. In your paper, answer the following questions related to that change. Use concepts and theories from the lesson to support your responses.

• How was the change process utilized?
• What change strategies were implemented?
• How were you involved in the process?
• Was the change easily accepted by you and others?
• What feelings among the individuals affected by the change were generated before and after the process of change?
• Was the change maintained or did the organization return to the previous state of being?  Why?
• Apply a change theory to this change, i.e., compare steps of the theory to the process you observed.

Using Word, write a one-to-two page paper on Planned Organizational Change. Be sure to address each of the questions above. Once you have written your paper, submit it to the Types of Change - Planned Organizational Change Assignment Drop Box.

Assessment: This assignment is worth 25 points. This assignment will be manually graded by the instructor. Once you submit your answers, allow approximately 1 week from the due date for your feedback and grade to be available.

Part 2: Discuss an unplanned organizational change in your current or previous place of employment. In your paper, answer the following questions related to that change.

• How was the change process utilized?
• What change strategies were implemented?
• How were you involved in the process?
• Was the change easily accepted by you and others?
• What feelings among the individuals affected by the change were generated before and after the process of change?
• Was the change maintained or did the organization return to the previous state of being?  Why?
• Apply a change theory to this change.

Using Word, write a one-to-two page paper on Unplanned Organizational Change. Be sure to address each of the questions above. Once you have written your paper, submit to the Types of Change - Unplanned Organizational Change Assignment Drop Box.

Assessment: This assignment is worth 25 points. This assignment will be manually graded by the instructor. Once you submit your answers, allow approximately 1 week from the due date for your feedback and grade to be available.

 

Assignment #2: The Change Process

Identify a needed change in the organization where you are currently employed or your previous place of employment.

• Using the change process as outlined in your textbook (Table 5-2 on page 59), outline each step you would take to initiate the change.
• Identify potential resistors to the change.
• Discuss change agent strategies as discussed in your textbook that would be applicable to the desired change.  Reference at least two books or articles that discuss change strategies to support the reason for the selection of the strategies discussed.
  • References need to be from professional sources and cited in APA format.
  • References must be included in the paper, but are not included in the required length of the paper.

Using Word, write a three-to-five page paper on The Change Process. Be sure to address each of the questions above. Once you have written your paper, submit it to the The Change Process Assignment Drop Box.

Assessment: This assignment is worth 50 points. This assignment will be manually graded by the instructor. Once you submit your answers, allow approximately 1 week from the due date for your feedback and grade to be available.

 

Summary

Change is constant, inevitable, positive, or not so positive. An understanding of change theories, the types of change, strategies to facilitate change, and resistors to change will assist the nurse executive/manager to identify the need for and approaches to change. Through the use of a systematic change process and change agent skills, the nurse executive/manager can help to transform the health care environment.