chapter 8

A change in the skills mix has been proposed at a care facility. What action by the nurse-manager would best support a rational-empirical change strategy? A) Presenting the research evidence that supports the change B) Publicizing the change to generate enthusiasm C) Appointing "champions" to ensure communication throughout the change process D) Ensuring that employees know the consequences of resisting

A Title: Classic Change Strategies Feedback: Rational-empirical change strategies assume that resistance to change comes from a lack of knowledge and that humans are rational beings who will change when given factual information documenting the need for change. Actions to create awareness and enthusiasm are more consistent with normative-reeducative strategies. A punitive approach would be more consistent with a power-coercive strategy.

In planning strategies to prevent stagnation and promote renewal, which action would most likely result in the desired outcome? A) Developing a program for recruitment of young talent B) Rewarding employees by promoting from within C) Having set pay increases mandated annually D) Using length-of-service to determine committee selection

A Title: Organizational Aging: Change as a Means of Renewal Feedback: The constant influx of young talent brings new ideas to the organization. Each of the other listed strategies may promote stagnation and inhibit the promotion of renewal.

Which characteristic of a planned change is most likely to threaten its success? A) The suggested change is introduced to staff after the plan has been formalized. B) Individuals affected by the change are involved in planning for the change. C) The change agent is aware of the organization's internal and external environment. D) An assessment of resources to carry out the plan is completed before unfreezing.

A Title: Planned Change as a Collaborative Process Feedback: Employees should be involved in the change process. When information and decision making are shared early in the process, subordinates will be more accepting of the change. Awareness of the environment and assessment of resources support successful change.

A nurse-manager has introduced a proposed change to the operations of an ambulatory clinic and has been met with resistance. How should the manager best interpret this resistance? A) Resistance is an expected component of a proposed change. B) Resistance confirms that the proposed change is necessary. C) The presence of resistance suggests that the change may be unsuccessful. D) The presence of resistance indicates a need to implement power-coercive strategies.

A Title: Resistance: The Expected Response to Change Feedback: Resistance is an expected component of a change process and it does not suggest that change will be unsuccessful. However, the presence of resistance does not necessarily validate that the change was necessary. A manager should interpret the presence of resistance as indicated a need to implement power-coercive change strategies.

Many nurses at an ambulatory clinic have expressed frustration about the low quality of care that clients have been receiving. How should a manager best interpret this situation? A) The nurses may be in the unfreezing phase of change. B) The clinic is likely an aged organization. C) The movement phase of change will be difficult to initiate. D) There is a need for the manager to demonstrate power-coercive strategies.

A Title: Unfreezing Feedback: During the unfreezing stage, people become discontented, and even angry, with the status quo. This is a necessary precursor to the movement phase of change. This is a positive development and does not indicate a need for power- coercive strategies. Similarly, this does not demonstrate that this is an aged organization.

The manager on a hospital unit has highlighted some of the large gaps between desired client outcomes and actual client outcomes. What component of Lewin's change theory is the manager demonstrating? A) Unfreezing B) Movement C) Refreezing D) Resistance

A Title: Unfreezing Feedback: Unfreezing occurs when the change agent coerces members of the group to change, or when guilt, anxiety, or concern can be elicited. This impetus for change must precede the other phases, such as movement and refreezing. There is no indication that the manager's information has caused resistance.

The leader-manager has successfully implemented a change and is now entering the refreezing stage of the change process. During this stage, the leader-manager should prioritize: A) restoring stability to the workplace. B) rewarding the employees who embraced the change early. C) communicating the specific benefits of the change. D) addressing the concerns of resistors.

A Title: Refreezing Feedback: During the refreezing phase, the change agent assists in stabilizing the system change so that it becomes integrated into the status quo. The distribution of rewards is not a high priority in this phase, although this may help reinforce the change. Communicating the benefits and addressing concerns should take place in the early stages of the change process.

The nurse-manager is describing the forces that are driving change in today's health-care environment. What phenomena should the nurse describe? Select all that apply. A) Increased cost of health-care services B) Shortages of health-care professionals and providers C) Decreased third-party reimbursement for health-care services D) Decreased use of technology due to high cost of implementation E) Increased need to update health-care-related technologies

A B C E Title: Introduction Feedback: Many forces are driving change in contemporary health care, including rising health-care costs, declining reimbursement, workforce shortages, increasing technology, the dynamic nature of knowledge, and a growing elderly population. Even though technology is expensive, its use is increasing.

Which statements are true regarding planned change? Select all that apply. A) Resistance to change should be expected as a natural part of the change process. B) Change should be viewed as a chance to do something innovative. C) Technical changes are more resisted by staff than social changes are. D) Change affects the homeostasis of a group. E) Careful planning can guarantee the success of a change initiative.

A B D Title: Key Concepts Feedback: Change should not be viewed as a threat but as a challenge and a chance to do something new and innovative. Change should be implemented only for good reason. Because change disrupts the homeostasis or balance of the group, resistance should be expected as a natural part of the change process. The level of resistance to change generally depends on the type of change proposed not the age of the staff affected by the change. Technological changes encounter less resistance than changes that are perceived as social or that are contrary to established customs or norms. Planning increases the chance of success, but it can never be guaranteed.

Which statement is true concerning the refreezing phase of the change process? Select all that apply. A) The focus of this phase is to integrate the change into the status quo. B) Stabilization of change requires a 6- to 9-month period of time. C) If refreezing is incomplete, prechange behavior will be resumed. D) The change agent must remain involved until the refreeze stage is complete. E) The priority in this phase is to identify resistance.

A C D Title: Refreezing Feedback: During the refreezing phase, the change agent assists in stabilizing the system change so that it becomes integrated into the status quo. If refreezing is incomplete, the change will be ineffective and the prechange behaviors will be resumed. For refreezing to occur, the change agent must be supportive and reinforce the individual adaptive efforts of those affected by the change. Because change needs at least 3 to 6 months before it will be accepted as part of the system, the change agent must be sure that he or she will remain involved until the change is completed. The successfulness of the refreezing stage is dependent on the acceptance of change by all staff. Identifying resistance and addressing it is performed during the unfreezing and movement stages.

The nurse-manager would be justified in making a change for which reasons? Select all that apply. A) To solve an existing problem B) To test workers' abilities to adapt C) To increase staff efficiency D) To reduce unnecessary workload E) To improve staff productivity

A C D E Title: Introduction Feedback: Change should be implemented only for good reasons such as the solution of an existing problem, increasing staff efficiency, eliminating unnecessary workload, and improving productivity. Introducing change for the sole purpose of testing workers' abilities to adapt would be unnecessary, disruptive, and likely unethical.

A nurse intends to enroll in graduate school and has informed a colleague of this intention. What response suggests that the colleague is in the precontemplation stage of change? A) "I haven't decided, but I might start looking into doing that as well." B) "That's a good idea for you, but I'm just thankful that I'm done with school." C) "I suppose that will open up some new opportunities for you." D) "That's my plan as well. When will you start?"

B Title: A Contemporary Adaptation of Lewin's Model Feedback: In the precontemplation stage, the individual has no intention of changing in the foreseeable future. Exploring the possibility of making a change would suggest the contemplation stage, and transitioning to movement characterizes the preparation stage.

A workplace health initiative has been launched in which subsidies are being offered for gym memberships and exercise equipment. This initiative is most likely to affect individuals who are in which phase of the stages of change model? A) Precontemplation B) Contemplation C) Action D) Maintenance

B Title: A Contemporary Adaptation of Lewin's Model Feedback: Motivations and incentives are particularly effective among individuals who are in the contemplation stage of change. In this case, this may be staff who would like to begin exercising but who have not yet done so. Staff who are in the precontemplation stage would not likely be affected because they have no desire to change their lifestyle. People in the action and maintenance stages are already engaging in change and likely need no further motivation.

A nurse is ostracizing a staff member who dresses "unprofessionally" and is encouraging other nurses to treat the staff member in the same way. This most closely represents which change strategy? A) Power-coercive B) Normative-reeducative C) Rational-empirical D) Resistance-withdrawal

B Title: Classic Change Strategies Feedback: Normative-reeducative strategies use group norms and peer pressure to socialize and influence people so that change will occur and do not require the change agent to have a legitimate power base. This exercise of power is not the principle guiding any of the other options.

A leader-manager plans to implement normative-reeducative strategies to facilitate change in a community health clinic. What action will the leader-manager most likely choose? A) Addressing likely points of resistance before they can be stated by nurses who are reluctant to change B) Communicating the fact that the majority of nurses are enthusiastic supporters of the change C) Publicizing the benefits of the proposed change and the research that supports it D) Providing incentives to nurses who are willing to adopt the change early

B Title: Classic Change Strategies Feedback: Normative-reeducative strategies use group norms and peer pressure to socialize and influence people so that change will occur. The change agent assumes that humans are social creatures, more easily influenced by others than by facts. Communicating the fact that most nurses support the change is an example of this form of pressure or persuasion. This does not necessarily involve a proactive approach to resistance. A focus on evidence is more consistent with the rational-empirical strategy. Incentives may be beneficial, but these do not necessarily create peer pressure.

A multidisciplinary team has been assigned responsibility for managing the change process in a large health-care organization. What goal should this team set for their activities? A) Resistors will face workplace discipline. B) Employees will not sabotage the change process. C) Change will happen as quickly as possible. D) Change will become a constant state in the organization.

B Title: Introduction Feedback: In some organizations, a team manages the communication between the people leading the change effort and those who are expected to implement the new strategies. Ultimately, this increases the chances of successful change and decreases the chance of sabotage. This is not achieved in a coercive way, such as punishing resistors. Rapid or constant changes are not typical goals; efficiency does not necessarily depend on speed.

Which factor is the greatest contributor to the resistance encountered with organizational change? A) Poor organizational leadership B) Presence of employee mistrust C) Ineffective organizational management D) Insufficient staff involvement in the process

B Title: Key Concepts Feedback: Perhaps the greatest factor contributing to the resistance encountered with change is a lack of trust between the employee and the manager or the employee and the organization. Although the other options may increase resistance, employee distrust is the primary barrier to change.

A team has been formed to consider a change in medication delivery. How can the team leaders best promote a successful change? A) Implement the change as rapidly as possible in order to diffuse resistance. B) When planning, involve as many people who will be affected by the change as possible. C) Bring in outside experts to implement the change. D) Enforce compliance with the change fairly and consistently.

B Title: Planned Change as a Collaborative Process Feedback: Whenever possible, all those who may be affected by a change should be involved in planning for that change. Making a change too quickly can result in poor outcomes because rigor is compromised. Outsiders are often resisted more than internal change agents. A collaborative approach is preferred to "enforcement," even though fairness and consistency are appropriate goals during a change process.

A planned change has been imposed by upper management at a large hospital and will greatly affect the delivery of care on inpatient units. What is an appropriate role for the leader-manager in this time of change? A) Mobilizing resistance in a respectful but assertive way B) Demonstrating a positive attitude toward the prospect of change C) Implementing the change as rapidly as possible D) Dialoguing with staff about the benefits of maintaining the status quo

B Title: The Leader-Manager as a Role Model During Planned Change Feedback: Even when a change process has not been collaborative, the leader-manager still has a responsibility to demonstrate a positive outlook on change. Mobilizing resistance would be a subversive act that would be reserved for only the most harmful of proposed changes. Rapid change can sometimes cause chaos rather than efficiency. Dialoguing with staff about keeping the status quo would have the effect of increasing resistance.

Frequent turnover in leadership at a health-care organization has meant that change has often occurred by drift. What are characteristics of this mode of change? Select all that apply. A) Changes are planned by teams. B) Changes occur accidentally. C) Changes take place even though they are unplanned. D) Changes take place only as the result of threats. E) Change takes place democratically.

B C Title: Key Concepts Feedback: Change by drift is unplanned or accidental. Change by drift is not necessarily the result of a threat. Even though change by drift happens "organically," this does not mean that it is necessarily a democratic process.

What characteristic of a health-care organization most clearly suggests that is an aged organization? A) The organization was established more than 75 years ago. B) The organization used to be the largest in the region but is now smaller than several similar organizations. C) The organization has a history of stifling innovation. D) The organization is having difficulty attracting new graduates.

C Title: Organizational Aging: Change as a Means of Renewal Feedback: A history of suppressing innovation is a hallmark of aged organizations. Age alone does not constitute an aged organization; well-established organizations can stay "fresh" and avoid becoming aged by promoting positive change and innovation. Many factors can contribute to being overtaken in size or in attractiveness to new graduates. These phenomena do not necessarily mean that it has become an aged organization.

A nurse-manager is applying chaos theory to a proposed change in the structure of care at a clinic. What skills will best facilitate the manager's application of this theory? A) Creating "buy-in" from the stakeholders B) Finding solutions to resistance to change C) Changing attitudes more than increasing knowledge D) Finding underlying order in seemingly random data

D Title: Chaos Theory Feedback: Chaos theory requires finding underlying order in apparently random data. This particular theory of change does not explicitly focus on creating buy-in, addressing resistance, or changing attitudes, although none of these activities is contrary to the theory.

When applying the principles of complex adaptive systems (CAS) theory, the nurse-manager should consider what principle? A) Change must occur by organized, linear steps. B) Change should be guided by intuition instead of being constrained by planning. C) Change is easier in small organizations than large organizations. D) Small variations in the change process can have major effects.

D Title: Complexity and Complex Adaptive Systems Change Theory Feedback: CAS theory emphasizes the fact that even small variations can dramatically alter choice of action. It recognizes that change is often nonlinear and that it requires careful planning. Change is not necessarily easier in smaller organizations.

Which action represents a management function in planned change? A) Inspiring group members to be involved in planned change B) Visionary forecasting C) Role modeling high-level interpersonal communication skills in providing support for individuals undergoing rapid or difficult change D) Identifying the options and resources available to implement change

D Title: Display 8.1 Leadership Roles and Management Functions in Planned Change Feedback: Recognizing the need for planned change and identifying the options and resources available to implement change are management functions. Inspiration, role modeling, and exercising vision are more closely aligned with leadership functions.

Which activity associated with the unfreezing state of change will have the greatest impact on the success of the movement stage of the change process? A) Accurate identification of the problem requiring change B) Effective information gathering concerning the problem C) Key personnel voicing their opinions regarding the need for change D) The need for change is perceived by those affected by the problem

D Title: Display 8.3 Stages of Change and Responsibilities of the Change Agent Feedback: The change agent should not proceed to the movement stage until the status quo has been disrupted and the need for change is perceived by the others. Although the other options will affect the process, perception of the need to change by all affected by the change is the most impactful of the options provided.

The nurse who provides oversight to a large health-care organization can best demonstrate leadership during a time of change by: A) clearly and assertively reminding nurses of their responsibilities to accept change. B) asking permission of nurses before proposing a change process. C) acknowledging that there is going to be resistance during the change process. D) communicating a vision that change is an opportunity to be embraced.

D Title: Integrating Leadership Roles and Management Functions in Planned Change Feedback: The leader should be open and receptive to change and views change as a challenge and an opportunity for growth. A focus on responsibilities may create a backlash and increase resistance. Collaboration is necessary, but this is not synonymous with asking permission for change. Resistance should be expected, but stating this fact does not demonstrate leadership.

Which statement best describes the philosophy of nonlinear change theories? A) Change occurs in sequential steps of varying speed. B) Change is predictable with proper analysis. C) Change success relies on clear policies and hierarchies. D) Change is necessary because organizational stability is brief.

D Title: Organizational Change Associated With Nonlinear Dynamics Feedback: Most 21st-century organizations experience fairly brief periods of stability followed by intense transformation. Change is rarely sequential or linear, and it is usually difficult to predict, even with careful analysis. Policies and hierarchies are often not adaptable enough to accommodate nonlinear change.

The nurse-manager has begun the movement stage of a proposed change. What is the manager's most appropriate activity? A) Gather data about the need for change. B) Accurately diagnose the problem. C) Decide whether change is needed. D) Collaborate with stakeholders to develop a plan.

D Title: Resistance: The Expected Response to Change Feedback: A responsibility during the movement stage is to develop a plan. Responsibilities of the change agent in the unfreezing stage include gathering data, accurately diagnosing the problem, and deciding if change is needed.

Which activity should a change agent perform in order to best assure a successful implementation of a change? A) Helping followers arrive at total consensus regarding the change B) Encouraging subgroup opposition to change so many viewpoints can be heard C) Using change by drift if the resistance to change is too strong D) Being available to support those affected by a change until the change is complete

D Title: Resistance: The Expected Response to Change Feedback: The change agent needs to offer support to others so that the change occurs. Total consensus is not normally a realistic goal. The change agent should encourage a diversity of views, but not by fostering opposition by subgroups. Resistance should be expected and does not indicate that planned change should not occur.

Nurses on a hospital unit have been informed that a change to the documentation system is being proposed. What factor surrounding this change is most likely to cause unfreezing? A) The proposed documentation system has been introduced in many hospitals in the region. B) The leader-manager supports a change in the documentation system. C) An influential nurse has extensive experience with different documentation systems. D) The nurses find the current documentation system unwieldy and inefficient.

D Title: Unfreezing Feedback: Unfreezing occurs when the change agent convinces members of the group to change or when guilt, anxiety, or concern can be elicited. Thus, people become discontent and aware of a need to change. In this case, dissatisfaction with the current documentation system creates a powerful impetus for change. This factor is likely more significant than the support of the leader-manager and influential nurse or the fact that similar institutions have made a change.