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Which statements by a hospital executive reflect power-coercive strategies to implement change?

"We must follow the federal guidelines in the way we bill for our services." "If we don't reduce our nosocomial infection rate, Medicare won't reimburse us." "Administration has to make this change or our accreditation status will be at risk."

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?

"Well, we don't want to rock the boat too much." "Do you think we can get enough support from the nurses to make this change?" "We tried making a change like this before and it didn't work out well."

Which factor best represents a driving force in the process of change?

. A financial deficit of millions of dollars

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?

. Empirical-rational model

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?

. Nurses routinely interact with multiple disciplines.

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?

. Pay attention to the people above and below this person on the organizational chart.

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?

. Research the options that will work best for the nursing staff and the hospital.

The nursing committee is planning a change in the unit's organization. Which statement reflects the priority expected outcome of these change agents' work?

. The change will lead to improved client care on the unit.

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?

. The supervisor has gradually withdrawn from the role of change agent.

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?

A normative-reeducative strategy

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?

Who is in control of the way holiday shifts are being assigned? Who will lose when holiday shift assignments are changed? Who is benefiting the most from the way holiday shifts are currently assigned?

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?

Collect and analyze information about how the current system is working.

Which action will have the greatest impact on the successful implementation of a planned change?

Creating a supportive environment for those undergoing the change

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?

Disciplinarian Fact manager Liaison Support person Discussion leader

A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change?

Disperse information about the change as quickly as possible. Remind staff that change is part of the health care environment. Talk about the change in positive terms.

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?

Early majority

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?

I have information to share with you about the new IV pump we are considering for the unit."

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?

Include the staff in identifying problems related to teaching strategies.

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?

Meet with the supervisor and discuss modification of the proposed change. Slow down the change process. Work together to identify strategies to overcome resistance. Proceed with the 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?

Normative-reeducative

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?

Nurses are doing both the old work and the new work. A nurse says, "I guess everything we've done for years is wrong." Nurses are doing parts of the old procedure and parts of the new procedure

The nurse manager is facing resistance to change from many staff nurses. Why should the manager work hard to address this resistance?

Resistance can negatively impact future client care

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?

Solutions are identified to create change

Hospital administration is working with a university school of nursing to establish a nursing residency program. Why is this a desired action?

The Institute of Medicine has proposed residency programs for nurses

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?

The manager distributes a handout explaining the new system and how to use it.

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?

"Have we looked at all available data in order to make an informed decision?" "What are the obstacles to implementing this change within the organization?" "Are we including the opinions of all stakeholders in this decision?"

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?

"I don't care what they say; I'm not giving care that way." "I bet I can make it very difficult for this change to occur."

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?

"I know that suggesting this change may backfire on me." "I see an opportunity to make a difference in the way this facility provides nursing care." "This change is certainly going to be a challenge, but that's okay."

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?

"I think the implementation will go much better if I stay available the whole time."

Which statements by the nurse manager would demonstrate effective change management?

"We cannot lose sight of the mission and values of our institution as we begin to integrate these changes." "Although this task is going to be difficult, we have the full support of our hospital administration."