Ch. 2: Change and innovation

15. The first stage of planned change involves: a. accepting the need for change. b. cognitive redefinition. c. integration and stabilization. d. problem solving.

ANS: A Change must begin with an awareness of the need for change and end with a general acceptance of the necessity of change.

17. A nursing manager recognizes that the changes that she is expected by administration to implement will be met with staff resistance. She is committed to determining the root of the resistance and communicating positively with her staff. The nurse manager's actions characterize her as a(n): a. change agent. b. implementation expert. c. restructuring motivator. d. supervisory threat.

ANS: A The change agent needs to anticipate resistance, determine why it is occurring, and try to determine what the person who is resisting is trying to protect.

4. A small critical care unit forms a team of nurses to implement bedside rounds at shift change. The nurses have researched the efficacy of bedside rounds and have determined that this evidence-based practice will lead to improved communication of patient status. Which type of change does this demonstrate? a. Transforming care at the bedside b. Second-order change c. Emergent change d. Organizational change

ANS: A Transforming care at the bedside was an initiative created to improve quality and safety on medical-surgical acute care units by engaging in changes to improve practice.

3. During periods of stress and change, which of the following strategies should managers use to provide emotional support to staff members? (Select all that apply.) a. Reframe difficult questions. b. Communicate facts through e-mail. c. Provide active listening. d. Promote action steps and solutions. e. Keep staff informed of decisions. f. Communicate with participation.

ANS: A, C, D, E, F Emotional responses are an expected part of change, and managers need to be able to provide emotional support to staff during periods of stress. Some of the effective strategies are active listening, promoting action steps and solutions, keeping staff informed of decisions, soliciting input, encouraging participation, and reframing difficult questions.

4. The probability of effectiveness of the change process can be increased through several techniques. Which of the following actions will likely increase effectiveness? (Select all that apply.) a. Explain the rationale for a change so that individuals understand it. b. Simply announce the change without laying a foundation. c. Give participants all the information they need. d. Rely only on formal authority in implementing change. e. Help individuals cope with change.

ANS: A, C, E Announcing the change without laying a foundation and relying only on formal authority in implementing change are actions to be avoided when implementing change within an organization.

13. Almost all changes encounter: a. attitudes. b. resistance. c. knowledge. d. communication.

ANS: B Almost all changes encounter some resistance as a natural phenomenon. Resistance may be rooted in anxiety or fear.

16. The identification of forces that drive and restrain change is called a(n): a. equilibrium evaluation. b. force field analysis. c. status quo analysis. d. refreezing system.

ANS: B Driving and restraining forces influence any situation. A force field analysis facilitates the identification and analysis of driving and restraining forces in any situation.

2. The use of a new idea or method is the definition of: a. change. b. innovation. c. resistance. d. stereotyping.

ANS: B Innovation is the use of a new idea or method.

1. A hospital system is implementing an electronic health record. The facility conducts education and training for nursing staff, medical staff, and ancillary staff over a period of 6 months. This is an example of: a. emergent change. b. planned change. c. transformation. d. innovation.

ANS: B Planned change is a decision to make a deliberate effort to improve a system.

10. _____ is an expected part of change and is often related to fear and anxiety. a. Depression b. Resistance c. Acceptance d. Denial

ANS: B Resistance to change should be expected as integral to the process of change. It may be rooted in anxiety or fear.

7. According to the ___________ people move through a series of states when modifying their behavior. a. Organizational Change-Readiness Scale (OCRS) b. Transtheoretical Stages of Change Model c. Rapid Cycle Change d. plan-do-study-act model

ANS: B The Transtheoretical Stages of Change Model used research to show that people move through a series of stages when modifying their behavior. Readiness to change is a key aspect.

20. An experienced nurse has recently taken a position on a telemetry unit in the local hospital. After 2 weeks on the job, he finds that the staffing is not what was discussed during his employment interview with the nurse manager. Which approach would be most appropriate for the nurse to take? a. Give 2 weeks' notice and begin seeking employment at another hospital. b. Discuss the situation with the nursing manager who interviewed him. c. Talk to other employees about the staffing situation. d. Notify the charge nurse that this was not what was explained to him prior to employment.

ANS: B The nurse should discuss the situation with the nursing manager who interviewed him before quitting. Perhaps there is a temporary problem affecting staffing that could explain the situation. If after this discussion it is believed that the staffing is not now or ever will be as it was relayed to him in the interview, then he should seek employment elsewhere.

14. The charge nurse of a small nursing unit would like to gain staff acceptance of a time-intensive, budget-imposed change required by the hospital administration. She plans to emphasize several evidence-based research projects that have shown improved patient health outcomes as a result of implementing this change. This is an example of which of the following organizational change concepts? a. Budget-oriented change b. Transformation c. Resistance d. Emergent change

ANS: B Transformation is the use of new ideas, innovation, and creativity to change fundamental properties of the state of a system.

2. Learning organizations adapt to change through their ability to be open, dynamic, and responsive to changes in the environment. Which of the following learning disciplines are true of these types of organizations? (Select all that apply.) a. Learning is conducted in individual parts rather than in groups. b. Viewing the organization as an interrelated system is known as systems thinking. c. Individuals utilize mental models to understand how their vision affects their decisions and actions. d. Shared vision is conducted within a group to determine plans to get to the preferred future. e. Personal mastery encourages individuals to create results as they see fit.

ANS: B, C, D Mental models allow individuals to develop, create, and project a personal vision and understand how these views affect their decisions and actions. Shared vision is encouraged within a group for development of plans. A sharing of learning skills is encouraged as a group so that learning can occur as a group. The organization is viewed as an interrelated system, rather than in unrelated parts, in systems thinking.

6. Which of the following factors is used to describe the degree to which successful planned change is thought to be better than the status quo? a. Complexity b. Compatibility c. Trialability d. Relative advantage

ANS: D Relative advantage is one of the factors that helps determine successful planned change. It is the degree to which the change is thought to be better than the status quo.

1. Which of the following statements are accurate descriptors regarding change? (Select all that apply.) a. Organization-wide change is more sustainable when leadership imposes the change. b. Change within an organization is often externally imposed. c. Change within an organization may originate internally. d. Nurses do not need to participate actively in the organizational changes. e. Change is often complex and irrational.

ANS: B, C, E Changes within an organization may be necessary due to external or internal demands. Change is seldom easy and may be complex and irrational.

5. A group of nurses is showing resistance to changes the manager is making with regard to staffing. Which of the following ways can the manager deal with the emotionality of the situation? (Select all that apply.) a. Use persuasion. b. Give the nurses adequate notice of change. c. Avoid discussion. d. Explain the rationale and patient impact. e. Inform staff that senior leadership made the decision.

ANS: B, D A factor in determining how change is accepted depends upon how it is managed. The way to deal with emotionality is to avoid persuasion and to allow people to express their feelings. Staff should be given as much notice as possible when making changes in staffing or scheduling, and discussion is encouraged. Staff should be informed about the rationale for the decision as well as patient impact. Effective managers possess self-confidence to explain the change without blaming.

21. The nurse manager on a medical-surgical unit wants to change to "walking rounds" in the patients' rooms for change of shift report. In the past, it has been "face to face" at the nurses' station. The nurse manager is meeting resistance from the staff, because they think that it will take longer, and the nurses will not finish their shift on time. What could the manager do to increase the nurses' acceptance of this change? a. Inform all shifts that there have been some lapses in communication regarding patient needs and that involving the patient in the report will help alleviate this. b. Inform all nurses that to reach Magnet status, this type of change of shift report is required. c. Ask the nurses to participate in the planning and implementation of the change. d. Ask the nurses to try this type of change of shift report for 1 week and then have them evaluate it.

ANS: C Change is always difficult, especially when it has been forced on people, threatens their security, or seems unnecessary. Change is more palatable when nurses participate in the planning and implementation and see that it is worthwhile.

3. The chief nursing officer (CNO) of a hospital system works with senior leadership for approval to initiate an electronic health system. He recruits a nursing informaticist and a chief medical informatics officer to begin the process of planning the education and rollout of the new electronic system. The CNO could be viewed as the: a. resister. b. innovator. c. change agent. d. strategist.

ANS: C The change agent is a person or thing that produces a particular effect or change. The change agent can be a person who functions as a change facilitator.

12. The development of new practices in response to new evidence is called: a. altered direction. b. organizational flux. c. planned change. d. status revision.

ANS: C The development of new practices in response to new evidence or best practices occurs regularly and falls under planned change. One example is the broad adoption of evidence-based protocols and practices as a way of making sure that desirable outcomes are achieved

11. Individual members of a group will adapt to change at different rates. Which of the following groups would take the longest to accept change? a. Early adopters b. Late majority c. Innovators d. Laggards

ANS: D Nurse leaders need to recognize that change will be accepted at varying rates and target interventions accordingly. The five categories in order are innovators, early adopters, early majority, late majority, and laggards.

19. A memo sent to the unit nurse manager reads that beginning next week; all nursing staff will be expected to conform to a new dress code selected by the hospital board of directors. The nurse manager understands that change will be more effective through which manner of communication? a. Storytelling b. E-mail c. Discussion d. Open communication

ANS: D Open communication within the change process, early involvement of staff, listening to their input and concerns, and engaging them in the change may be the most effective means to assess readiness for change.

8. A medical-surgical unit utilizes a group of nurses and patient care assistants to determine ways to reduce the number of falls in the unit. They conduct Internet research to locate best practice interventions. They create fall risk alerts in the unit, and they implement hourly rounding to assess the need for toileting. After putting these small changes into place, they will evaluate the data to determine effectiveness. This project is an example of: a. rapid response teams. b. Failure Modes and Effects Analysis. c. root cause analysis. d. Rapid Cycle Change.

ANS: D Rapid Cycle Change is used in health care to improve patient safety and quality. It is based on the idea

9. An organization has encountered a serious patient safety event that was reported to the state, The Joint Commission, and the Centers for Medicare & Medicaid Services (CMS). An extensive plan of correction was received, and the organization had to make some immediate changes in practice. Additionally the organization anticipates a costly lawsuit. What is the best method of educating staff about the practice changes that were issued? a. "These changes need to be made because the state and CMS require it." b. "We understand this is a knee-jerk reaction, but please change the practice while the surveyors are in the building." c. "We need to make this change because it will help our lawsuit." d. "This change is being made so that there is no further harm to another patient."

ANS: D Rapid Cycle Changes or those that are emergent are put into place to improve patient care, with the emphasis on patient safety and quality goals. Staff should not be educated that the changes are made based upon regulatory requirements or the avoidance of litigation. Misconceptions or inaccurate information can create resistance to change.

5. How is the refreezing stage of change similar to the nursing process? a. Refreezing is similar to the assessment phase of the nursing process. b. Refreezing is similar to the problem identification phase of the nursing process. c. Refreezing is like the planning and implementation phase of the nursing process. d. Refreezing is like evaluation in the nursing process.

ANS: D Refreezing is like evaluation in the nursing process.

18. A nurse manager recognizes that her staff's emotional responses to organizational change are similar to: a. adaptation techniques. b. integrative tactics. c. symptoms of mental illness. d. the grief model.

ANS: D The grief model is the most accurate, because change produces a longing for what is familiar, even if it is not what is best or realistic.