Ch 5 - Initiating & Managing Change
The nurse administrator has been asked to work with other administrators to make a change in a long-standing hospital policy. What should be the nurse's first action? 1. Research the options that will work best for the nursing staff and the hospital. 2. Speak positively of the change to ensure the most "buy-in" from the nurses. 3. Encourage the other administrators to choose the option that is easiest for the nurses. 4. Ensure that each nurse is aware of the change and why it is necessary.
Correct Answer: 1 Rationale 1: Assessment is always the first action for a nurse in any situation. Rationale 2: This constitutes an intervention and is not the first action. Rationale 3: This constitutes an intervention and is not the first action. Rationale 4: This constitutes an intervention and is not the first action.
The nurse manager is facilitating change to a new documentation system in the unit. If the manager wants to use the most common method to overcome resistance to the change, which strategy would be chosen? 1. The manager distributes a handout explaining the new system and how to use it. 2. The manager creates a "quick tip" sheet about how to use the system and schedules practice sessions for each nurse. 3. The manager identifies a key supporter of the change and has that nurse act as mentor to the remaining staff. 4. The manager threatens to transfer anyone who resists the change.
Correct Answer: 1 Rationale 1: Giving information is the most common method of changing individuals' perceptions, attitudes, and values. Rationale 2: Providing information and an opportunity to practice is called training. Training is not the most common method of changing perceptions, attitudes, and values. Rationale 3: While having a mentor may be a desirable method for the learner, it is not the most common method of changing perceptions, attitudes, and values. Rationale 4: Transferring or terminating those who resist change is a method of changing the perceptions, attitudes, and values of the remaining staff. It is not the most common method.
A nursing supervisor would like the nurse manager to serve as change agent for a needed revision to unit policy. Which statements would alert the supervisor that this manager is not the best choice for this assignment? Select all that apply. 1. "Well, we don't want to rock the boat too much." 2. "Do you think we can get enough support from the nurses to make this change?" 3. "We tried making a change like this before and it didn't work out well." 4. "To make this big change, we need to start making smaller changes now." 5. "There is going to be resistance, but I think it can be overcome."
Correct Answer: 1,2,3 Rationale 1: Fear of "rocking the boat" may prevent the manager from effectively leading the change. Rationale 2: Fear that no one will support the change may prevent the manager from effectively leading the change. Rationale 3: Recalling that previous efforts at change have failed may prevent the manager from effectively leading the change. Rationale 4: The ability to see the end result and what it will take to make the plan work is a sign that the manager could be an effective change agent. Rationale 5: The ability to handle resistance and a display of confidence are signs that the manager could be an effective change agent.
Which statements by a hospital executive reflect power-coercive strategies to implement change?Select all that apply. 1. "We must follow the federal guidelines in the way we bill for our services." 2. "If we don't reduce our nosocomial infection rate, Medicare won't reimburse us." 3. "Administration has to make this change or our accreditation status will be at risk." 4. "This change is the only logical action we can take." 5. "All our sister institutions in the association have already made this change."
Correct Answer: 1,2,3 Rationale 1: Power-coercive strategies are based on the application of power by a legitimate authority—in this case, the federal government. Rationale 2: Power-coercive strategies are based on the application of power by a legitimate authority—in this case, Medicare. Rationale 3: Power-coercive strategies are based on the application of power by a legitimate authority—in this case, the accrediting body. Rationale 4: The empirical-rational model of change focuses on logical actions. Rationale 5: Normative-reeducative strategies rest on the assumption that people act in accordance with social norms and values.
A nursing supervisor has introduced a needed change in policy to the nurse managers. The managers have met maximum resistance when attempting to gain support for the change. Which options reflect valid strategies for the nurse managers? Select all that apply. 1. Meet with the supervisor and discuss modification of the proposed change. 2. Slow down the change process. 3. Meet with the supervisor and suggest abandoning the change. 4. Work together to identify strategies to overcome resistance. 5. Proceed with the change.
Correct Answer: 1,2,4,5 Rationale 1: Modifying the change and compromising with resisters is a valid strategy. Rationale 2: Trying to change too much too fast can escalate resistance. Rationale 3: Abandoning the change is not a viable offer, as the supervisor has indicated that change is needed. Rationale 4: Overcoming resistance is often necessary for change to occur. Rationale 5: In some cases, change must proceed despite resistance. Those who can live with the change stay, and those who cannot leave.
A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change? Select all that apply. 1. Disperse information about the change as quickly as possible. 2. Discourage any negative discussion about the change. 3. Remind staff that change is part of the health care environment. 4. Talk about the change in positive terms. 5. Withdraw slightly from those who oppose the change.
Correct Answer: 1,3,4 Rationale 1: Communicating openly and honestly with those who support the change and those who oppose the change is the best strategy. Rationale 2: The pros and cons of the change should be openly discussed. Rationale 3: Change is constant in health care. Rationale 4: Emphasizing the positive outcomes of the change is a strategy to reduce resistance. Rationale 5: The nurse manager should maintain support for and confidence in all staff. Global Rationale:
The health care facility has elected to make a significant change in organization strategy. The change has been thoroughly researched and all levels of leadership have been included in the decision. Which roles are commonly undertaken by the nurse manager when such a change is necessary? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Disciplinarian 2. Resister 3. Fact manager 4. Liaison 5. Support person 6. Discussion leader
Correct Answer: 1,3,4,5,6 Rationale 1: The nurse manager may be placed in the role of disciplining staff members who are impeding the work of the organization. Rationale 2: Once the decision to make a change has been made, the nurse manager should not act as a resister. Rationale 3: The nurse manager may be in the role of one who supplies information about the needed change. Rationale 4: The nurse manager may act as a liaison between the committee and the staff. Rationale 5: The nurse manager fulfills the role of support person for staff adapting to the change. Rationale 6: The nurse manager may act as discussion leader, both in formal and informal discussions.
The nurse manager has determined that changes are necessary in the way holiday shifts are assigned. When assessing the political climate surrounding this potential change, the nurse manager would ask which questions? Select all that apply. 1. Who is in control of the way holiday shifts are being assigned? 2. What communication technology is available to distribute information about the change in holiday shift assignments? 3. Who will lose when holiday shift assignments are changed? 4. Will changing holiday shift assignments affect the budget? 5. Who is benefiting the most from the way holiday shifts are currently assigned?
Correct Answer: 1,3,5 Rationale 1: It is important to identify who is in control of the way things are being done currently. Rationale 2: Communication technology may be helpful in completing the change but is not assessed as part of the political climate surrounding the change. Rationale 3: Early knowledge of who will lose in the change is essential to preparation. Rationale 4: Costs and benefits of the change should be assessed but are not a part of the political climate. Rationale 5: Political climate involves power, benefits, and losses.
A nursing administrator overhears nurses conversing during a break in a seminar on change. The administrator would interpret which statement as meaning that the nurse who made it is ready to become a change agent? Select all that apply. 1. "I know that suggesting this change may backfire on me." 2. "I don't expect too much conflict or resistance to this change." 3. "I see an opportunity to make a difference in the way this facility provides nursing care." 4. "I think the status quo is just fine for now." 5. "This change is certainly going to be a challenge, but that's okay."
Correct Answer: 1,3,5 Rationale 1: This statement exemplifies the willingness to take risks that is necessary to become a change agent. Rationale 2: The nurse should always expect that change will be met with resistance and possible conflict. Rationale 3: Nurses should always look for ways to improve client outcomes. Rationale 4: Change occurs when people become uncomfortable with the status quo. Rationale 5: Accepting that change is challenging is part of being a change agent.
Hospital administration is working with a university school of nursing to establish a nursing residency program. Why is this a desired action? 1. A residency program eliminates the hospital's liability if a novice nurse makes an error. 2. A residency program is established to make nursing education more like physician education. 3. The Institute of Medicine has proposed residency programs for nurses. 4. A residency program ensures that nurses participate in lifelong learning.
Correct Answer: 3 Rationale 1: There is no reduction of the hospital's liability for errors. Rationale 2: Residency programs for nurses are not being established to mimic physician education. Rationale 3: The IOM has made this proposal. Rationale 4: There is no assurance that nurses who participate in residency programs will engage in lifelong learning.
A nurse manager is faced with the task of introducing an unpopular change to a staff that includes several nurses who have acted as rejecters to previous changes. The manager expects resistance but hopes to identify these rejecters early in the process. The manager should be particularly alert to which statements? Select all that apply. 1. "I don't care what they say; I'm not giving care that way." 2. "I don't think this is going to work, but I'll probably come around to it sooner or later." 3. "I'm not crazy about this idea, but we do need to change how we are providing care." 4. "I bet I can make it very difficult for this change to occur." 5. "It won't be so bad. I like change."
Correct Answer: 1,4 Rationale 1: Rejecters often respond with active opposition. Rationale 2: This statement is characteristic of an early or late majority resister. Rationale 3: Acknowledging that change is necessary is characteristic of an early adopter. Rationale 4: Making the change more difficult is a form of sabotage, which is characteristic of a rejecter. Rationale 5: Innovators love change and thrive on it.
The new chairperson of the nursing department has determined that the faculty's teaching is stagnant and outmoded. The chairperson would like to encourage the faculty to adopt more innovative teaching strategies. According to Lewin, what is the first step in initiating this plan? 1. Bring an expert on innovative teaching strategies to campus for a meeting with faculty. 2. Include the staff in identifying problems related to teaching strategies. 3. Ask staff to assist in the development of a plan for implementing new teaching strategies. 4. Implement interventions to improve the teaching strategies currently used.
Correct Answer: 2 Rationale 1: Bringing in an expert to talk to the faculty would be ineffective until the faculty is beginning to "unfreeze" their current beliefs about teaching. Introducing an expert at this time might do more harm than good. Rationale 2: The first step is to unfreeze the existing equilibrium by asking staff to become part of the process of change, particularly in the first phase. Rationale 3: Asking the staff to assist in developing a plan is incorrect because the planning part of the process occurs after the problem areas have been identified. Rationale 4: The faculty will likely not be receptive to new strategies until they have identified a need to change.
A proposed change in a health care organization is controversial and will require cooperation from all parties involved. Which change strategy should the change agent use? 1. Empirical-rational 2. Normative-reeducative 3. Power-coercive 4. Empirical-reeducative
Correct Answer: 2 Rationale 1: Empirical-rational strategy is used when little resistance to the proposed change is expected. Rationale 2: Normative-reeducative strategy uses collaboration as its primary decision-making technique. It is most likely to result in the greatest number of people being happy with the decisions made. Rationale 3: Power-coercive strategy is the least likely to result in everyone agreeing with the change. Rationale 4: This is not one of the change strategies.
The nursing supervisor identifies ineffective communication as a problem among the managers. According to Lippitt's phases of change, which action by the supervisor reflects the final stage of improving this issue? 1. The supervisor uses outcome data to evaluate the amount of change that has occurred. 2. The supervisor has gradually withdrawn from the role of change agent. 3. The supervisor has developed strategies to maintain the change. 4. The supervisor has determined if anyone in the group is sabotaging change efforts.
Correct Answer: 2 Rationale 1: Evaluating the amount of change would occur before the final stage. Rationale 2: According to Lippitt's phases of change, the final stage is terminating the helping relationship. Rationale 3: Maintaining the change is the next to last of Lippitt's stages. Rationale 4: Looking for persons who may be sabotaging change efforts is not the last of Lippitt's stages. Global Rationale:
The nurse manager feels that changing the unit's method of assigning break times would benefit the flow of client care. What should be the manager's first action associated with this idea? 1. Tell the staff that a change is coming, but that it is positive and they should not be worried. 2. Collect and analyze information about how the current system is working. 3. Mention in a staff meeting that the current system is causing a lot of trouble. 4. Identify how the manager would know if the change is benefiting the unit.
Correct Answer: 2 Rationale 1: It is not a good idea to indicate that a change is coming until further planning is completed. Rationale 2: Assessment is the first step of the change process, just as it is the first step of the nursing process. Rationale 3: Planting the seed of discontent with the status quo occurs after the problem has been assessed. Rationale 4: Operational indicators of success are developed when the planning phase is near completion.
Hospital administrators are considering changing from the traditional method of creating work schedules to a system in which the nurses will choose their own workdays. Choices will be made according to seniority. Which change strategy would likely be best for this endeavor? 1. A power-coercive strategy 2. A normative-reeducative strategy 3. An empirical-rational model 4. A driving force
Correct Answer: 2 Rationale 1: Power-coercive strategies are used when much resistance is anticipated, time is short, and the change is critical for organizational survival. This strategy may meet with resistance from the nursing staff. Rationale 2: In most cases, the normative-reeducative approach to change is effective in reducing resistance and stimulating personal and organizational creativity. Rationale 3: The empirical-rational strategies are most often effective when little resistance to the proposed change is expected, and the change is perceived as reasonable. This is likely not the case with the change described. Rationale 4: A driving force is a behavior that facilitates change by pushing participants in the desired direction in spite of restraining forces.
The nurse manager is planning to initiate new policies in the department and is reviewing several change theories. Which step of Havelock's model will the nurse find most closely resembles Lewin's moving stage? 1. Self-renewal occurs among all participants. 2. Solutions are identified to create change. 3. Resources are acquired to facilitate change. 4. Relationships are formed among all participants.
Correct Answer: 2 Rationale 1: Self-renewal and stabilization occur during the final stage and are most like Lewin's refreezing stage of change. Rationale 2: Choosing a solution and gaining acceptance are most like Lewin's moving stage. Previous to this stage in both models, the work is to convince participants that change is necessary and to secure resources for the change. After solutions are identified and implemented, the final stage begins. Rationale 3: The first three steps of Havelock's theory are building a relationship, diagnosing the problem, and acquiring resources. These three steps are most like Lewin's unfreezing stage. Rationale 4: The first step of Havelock's model is building relationships among participants. This is one of the steps that are equivalent to Lewin's unfreezing stage.
The nurse is working on a committee tasked with making a major organizational change. Which comments by the nurse would help to advance the work of this committee? Select all that apply. 1. "I would like to focus on completing this process so we can move on." 2. "Have we looked at all available data in order to make an informed decision?" 3. "What are the obstacles to implementing this change within the organization?" 4. "Are we including the opinions of all stakeholders in this decision?" 5. "I think it does not really matter when we institute this change, as long as it is over quickly."
Correct Answer: 2,3,4 Rationale 1: Completing the process is not the major focus of the work. Rationale 2: Those involved in change should be certain that sufficient data is present to make an informed decision. Rationale 3: Persons working on this committee should be aware of obstacles they may face. Rationale 4: It is important to consider the opinions of the organization's stakeholders. Rationale 5: Getting the change instituted quickly is not the focus of committee work.
The staff is transitioning to a major change in the provision of nursing care in a large hospital. Which behaviors should the nurse manager watch for that would indicate possible problems? Select all that apply. 1. Nurses are discussing the change at breaks and meals. 2. Nurses are doing both the old work and the new work. 3. A nurse says, "I guess everything we've done for years is wrong." 4. The provision of care with the new system takes longer than expected. 5. Nurses are doing parts of the old procedure and parts of the new procedure.
Correct Answer: 2,3,5 Rationale 1: It is natural that the staff would discuss the change and its implications. Rationale 2: Adding the new work to the old work is a sign that the transition is not healthy. Rationale 3: This attitude is a sign that the transition is not healthy. Rationale 4: It is natural for the transition to a new process to take time. The nurse manager should be on the alert if this continues. Rationale 5: Making individual decisions about what parts of the old method to retain and what parts of the new method to adopt is a sign that the transition is not healthy.
The CEO of the hospital approaches the chief nurse with a request that the nurse act as the primary change agent in the implementation of a new hospital-wide policy. Why would the nurse be a good choice for this assignment? 1. Nurses thrive on transition and work best in such circumstances. 2. Nurses are role models for reacting positively to change. 3. Nurses routinely interact with multiple disciplines. 4. Nurses are always acting in the client's best interest.
Correct Answer: 3 Rationale 1: It is hard to prove that nurses thrive on transition. Rationale 2: Nurses have not always reacted positively to change. Rationale 3: Nurses are client advocates who routinely interact with multiple disciplines in the provision of quality care. Rationale 4: Nurses do act in the client's best interest, but this option is not as strong as another.
When faced with the prospect of change, the nurse states, "We have always done it this way and never had any problems." A few weeks later, the same nurse remarks, "This new way seems to work better than the old way did." This statement is characteristic of which type of change response? 1. Laggards 2. Early adopters 3. Early majority 4. Innovators
Correct Answer: 3 Rationale 1: Laggards dislike change and are openly antagonistic. Rationale 2: Early adopters are not as eager to change as are innovators but are still receptive to change. Rationale 3: The early majority prefers the status quo but eventually accepts change. Rationale 4: Innovators love change and thrive on it.
Computerized charting will be initiated on select units of the hospital. Orientation to this new system will be provided to each nurse by a team of nurses educated in nursing informatics. This is an example of which type of change strategy? 1. Normative-reeducative strategies 2. Lippitt's phases 3. Empirical-rational model 4. Power-coercive strategies
Correct Answer: 3 Rationale 1: Normative-reeducative strategies focus on people's roles and relationships, perceptual orientations, and attitudes that influence their acceptance of change. Rationale 2: Lippitt's phases of change are a seven-step process of change that involves participants in every step of the process. Rationale 3: The assumption of the empirical-rational model is that people are rational and will follow their rational self-interest if that self-interest is made clear to them. In this instance, when the nurses have the knowledge to use the charting system and have a chance to try it, it will become clear that it is in their best interest to adopt the new system. Rationale 4: Power-coercive strategies are based on the application of power by legitimate authority, economic sanctions, or political influence.
The nurse manager is facing resistance to change from many staff nurses. Why should the manager work hard to address this resistance? 1. Resistance will keep the change from occurring at all. 2. Resistance from the late majority can keep others from accepting the change. 3. Resistance can negatively impact future client care. 4. Resistance allows others to take power from managers.
Correct Answer: 3 Rationale 1: Resistance generally does not completely prevent change, but it may stall or delay it. Rationale 2: The late majority eventually does accept the change. Rationale 3: Client care is always the most important reason that nurses do what they do. If the change does not improve client care in some respect, is it worth the effort? If resisters interrupt the work of the unit or refuse to provide care as directed by the change, the quality of care may suffer. Rationale 4: Resistance is a normal part of change and does not mean that power has been diverted to the resisters.
The nurse manager knows that maximum power will be needed to achieve a desired change and has identified a key person on the organizational chart who will be affected by the change. What is important for the nurse manager to do? 1. Try to minimize the impact of the change when talking to this person. 2. Bypass this person and talk to the administrator who supervises him or her. 3. Pay attention to the people above and below this person on the organizational chart. 4. Try to find some information against this person to use as leverage.
Correct Answer: 3 Rationale 1: The nurse manager should always be honest when discussing the change. Rationale 2: The nurse manager should not "jump" the chain of command to speak to this person's supervisor. Rationale 3: The people just above and just below this person will be important to the way this key player reacts to the change. Rationale 4: This tactic would not be ethical.
Which factor best represents a driving force in the process of change? 1. An ineffective nurse manager 2. An administration composed of long-term employees 3. A staff composed of long-term employees 4. A financial deficit of millions of dollars
Correct Answer: 4 Rationale 1: An ineffective nurse manager is a restraining force that impedes change by discouraging participants from making specified changes. Rationale 2: An administration of long-term employees can be a restraining force that impedes change by discouraging participants from making specified changes. Rationale 3: A staff of long-term employees can be a restraining force that impedes change by discouraging participants from making specified changes. Rationale 4: A budget in the red necessitates change and pushes participants in the desired direction.
The nursing committee is planning a change in the unit's organization. Which statement reflects the priority expected outcome of these change agents' work? 1. The nurses involved will demonstrate management skills. 2. The nurses will agree with the change and present a united front for its adoption. 3. The change will guide nursing practice on the unit. 4. The change will lead to improved client care on the unit.
Correct Answer: 4 Rationale 1: Demonstration of management skills is not the priority expected outcome. Rationale 2: Agreement and presentation of a united front is not the priority expected outcome. Rationale 3: It is hoped that the changes will guide nursing practice, but this is not the priority expected outcome. Rationale 4: All nursing responsibilities and changes have the expected outcome of improving client care.
Which action will have the greatest impact on the successful implementation of a planned change? 1. Disciplining individuals who continue to be resisters to the change 2. Ensuring there are no remaining pockets of disagreement when the change occurs 3. Continually rewarding those working toward the change and ignoring those who are not 4. Creating a supportive environment for those undergoing the change
Correct Answer: 4 Rationale 1: It is true that in some cases resisters are so disruptive that they must be disciplined. This is not the best method of assuring successful implementation of a change. Rationale 2: It is unlikely that everyone affected by the change will see it as positive. Attempts to ensure that everyone is happy with the change are generally a waste of energy and resources. Rationale 3: Rewards can be positive, but ignoring resisters is dangerous. Rationale 4: A supportive work environment for those experiencing the change is the strategy most likely to result in an easier transition.
A new IV pump has just been purchased by the facility. Which statement by the nurse manager reflects Rogers' first step in making the change to this new equipment? 1. "The nursing staff will have the final decision on whether to change to this IV pump." 2. "Before we make the final decision, we will do a 3-month 'test run' of the equipment to make sure we like it." 3. "I have looked at the pump and I like it." 4. "I have information to share with you about the new IV pump we are considering for the unit."
Correct Answer: 4 Rationale 1: Telling the staff that they have the final decision is a way of persuading. Rationale 2: The decision to adopt or reject a change occurs after the knowledge and persuasion steps. Rationale 3: Giving a personal endorsement of the change would be persuasion. Rationale 4: The first step of the diffusion of innovation occurs when the decision-making unit is introduced to the innovation and knowledge is gained
The novice nurse manager is acting in the role of change agent for the unit. Which statement indicates that this manager needs further training in regard to change? 1. "I must not get so bogged down in details that I lose focus on the ultimate goal." 2. "As we go through this process, I think I need to be flexible but persistent." 3. "Those who are resistant will probably accept it sooner or later with my support." 4. "I think the implementation will go much better if I stay available the whole time."
Correct Answer: 4 Rationale 1: The ability to retain a big-picture focus while dealing with each part of the change is a desirable trait for a change agent. Rationale 2: The change agent must have sufficient flexibility to modify ideas when this will improve the change, but enough persistence to resist nonproductive tampering with the planned change. Rationale 3: It is likely that those who are resistant will adapt to the change if given enough time and support. Rationale 4: Staying available the whole time is not realistic and will make it difficult for the change agent to maintain the energy it will take to make the change more successful.
Which statements by the nurse manager would demonstrate effective change management? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "If this approach doesn't work, at least we can say we've tried." 2. "Let's wait until the administration has completed their reorganization before we implement change." 3. "In order for this plan to work, everyone must agree to participate." 4. "We cannot lose sight of the mission and values of our institution as we begin to integrate these changes." 5. "Although this task is going to be difficult, we have the full support of our hospital administration."
Correct Answer: 4,5 Rationale 1: This statement suggests that the manager is not completely behind the projected change. This lack of decisiveness may confuse supporters of the change and encourage resisters to keep resisting. Rationale 2: This statement suggests that the manager may not be completely in favor of the change. In some cases the staunchest resister is the manager. Rationale 3: If the nurse manager waits until everyone agrees to be a participant in change, change will never occur. Rationale 4: All changes and actions that occur within an organization should flow from the mission and values. Rationale 5: It is important to acknowledge that change is difficult. Full support of the administration makes change easier.