Change and Power, Policy, and Politics
Name at least 6 professional nursing organizations.
1) Academy of neonatal nursing 2) American nurses association 3) Association of Women's health, obstetrics, and neonatal nurses 4) Sigma Theta Tau international- Society of Nursing 5) National League for Nursing 6) American Academy of Nursing Website lists other professional nursing organizations: http://www.nsna.org/CareerCenter/Associations.aspx
Describe five basic causes of resistance to change.
1) economic factors 2) inconvenience 3) uncertainty 4) fear of loss of job 5) loss of prestige/status 6) loss of job satisfaction
Discuss resistance to change.
Because change disrupts the homeostasis or balance of the group, resistance should always be expected. Resistance is a natural and expected response to change. Subordinates should speak openly so the options can be identified to overcome objections. Planned change must a collaborative process.
Discuss the role of change agents.
Change agents lead and manage the change Change agent may be from inside or outside the organization In large organizations the change agent may be a multidisciplinary team Change agent is responsible for the success of the project Change agent manages the dynamics of the change process
Name the characteristics of change agents.
Change agents: Must have knowledge of the organization Must have knowledge of the change process Must have knowledge of the participants in the change Must have an understanding of the feelings of the people in the group Change agents should possess the following characteristics: Trust & respect Ability to maintain and communicate the vision of the change Must have ability to communicate Have good interpersonal skills Ability to empower others
Define Change.
Change is something new or different; change can be considered a predictable linear process or a complex, highly interrelated process.
Summarize the characteristics of three strategies for effecting change.
Empirical-rational strategies- *power ingredient is knowledge *assumptions are that the change agent, being knowledgeable, has the power to persuade people to accept a rationally justified change that will benefit them (example-new technology) Normative re-educative strategies- *provides a more holistic approach to change *recognizes needs, feelings, values, and attitudes on efforts toward change *use group norms and peer pressure to socialize and influence people so that change will occur *assumes that people are social creatures *uses group process to effect change *education alone is not enough to implement change *people act according to their level of personal commitment to social norms *people are rational beings Power coercive strategies- *focuses on overwhelming resistance to change *needs, values, feelings, and attitudes are recognized *feature the application of power by legitimate authority, economic sanctions, or political clout of the change agent *assumes that consensus cannot be reached through persuasive methods *assumes the when change is needed in the presence of resistance, power must be seized *appropriate when time is short, when much resistance is anticipated, and change is crucial for organization survival
Identify four competencies needed for promoting effective change.
Essential competencies for effective change include: 1)Personal knowledge and accountability for strength ad limitations specific to change innovations 2)Understanding the essence of change and innovation concepts as well as the tools of innovation 3)Ability to collaborate and fully engage team members 4)Competence in embracing vulnerability and risk taking
Differentiate between the types of power.
Expert power- gained through knowledge, expertise, or experience limited to a specialized area Legitimate power- derived from the title or position within an organization Referent power- power a person has because others identify with the leader may be gained through association with an individual that has power coercive power- the opposite of reward power based on fear of punishment if the manager's expectations are not met Reward power- derived from the ability to grant favors or reward others with something they value positive leadership through rewards tends to develop a great deal of loyalty and devotion to the leader Charismatic power- a personal type of power Informational power- individual has information that others need to accomplish their goal
List the components of professional negligence.
Five elements must be present for a professional to be held liable for malpractice or professional negligence • 1) Duty to use due care (defined by the standard of care) or the care that should be given under the circumstances • 2) failure to meet standard of care (not giving the care that should be given under the circumstances) • 3) foreseeability of harm (the nurse must have had the knowledge or availability of information that not meeting the standard of care would result in harm) • 4) A direct relationship between failure to meet the standard of care and injury can be proved (patient is harmed because proper care is not given) • 5) injury (actual harm results to the patient)
Describe and diagram the Force-Field Analysis components.
Force Field Analysis is a useful decision-making technique created by Lewin. It helps you make a decision by analyzing the forces for and against a change, and it helps you communicate the reasoning behind your decision. You can use it for two purposes: to decide whether to go ahead with the change; and to increase your chances of success, by strengthening the forces supporting change and weakening those against it.
Discuss the internal and external forces that influence change.
Forces that influence change include internal forces such as: change in priorities need for increased productivity need for cost containment staffing pattern changes shifts in philosophy work process changes need for better quality of work life Forces that also influence change include external forces such as: health care economics technology restructuring diversity changing demographics
Enumerate the steps in the change process.
Lewin identified three stages through which change agents must proceed before change becomes part of a system: 1) Unfreezing (when change is needed) 2) Moving (when change is initiated) 3) Refreezing (when equilibrium is established) Rogers described five phases of planned change: 1) Awareness 2) Interest 3) Evaluation 4) Trial 5) Adoption Lippitt's seven phases: 1) Diagnose the problem 2) Assess motivation/capacity for change 3) Assess change agent's motivation and resources 4) Select progressive change objective 5) Choose appropriate role of the change agent 6) Maintain change 7) Terminate the helping relationship Havelock's Six Step Change Model: 1) Build relationship 2) Diagnose problem 3) Acquire resources 4) Choose solution 5) Gain acceptance 6) Stabilize and self-renew
Discuss the stages in 4 traditional change theories.
Lewin identified three stages through which change agents must proceed before change becomes part of a system: 1) Unfreezing (when change is needed) 2) Moving (when change is initiated) 3) Refreezing (when equilibrium is established) *general model for most situations and organizations Rogers described five phases of planned change: 1) Awareness 2) Interest 3) Evaluation 4) Trial 5) Adoption Lippitt's seven phases: 1) Diagnose the problem 2) Assess motivation/capacity for change 3) Assess change agent's motivation and resources 4) Select progressive change objective 5) Choose appropriate role of the change agent 6) Maintain change 7) Terminate the helping relationship *good for chaning a process and general change Havelock's Six Step Change Model: 1) Build relationship 2) Diagnose problem 3) Acquire resources 4) Choose solution 5) Gain acceptance 6) Stabilize and self-renew *often used for educational change or cultural change
Identify strategies for developing political savvy.
Maintain personal energy Present a powerful picture to others Pay the entry fee Determine the powerful in the organization Learn the language and symbols of the organization Learn how to use the organizations priorities increase professional skills and knowledge Maintain a broad vision use experts and seek counsel be flexible develop visibility and a voice in the organization learn to toot your own horn maintain a sense of humor empower others
Discuss common myths about change.
Myth #1 : Change can be controlled --> This is false because change can only be facilitated. It cannot be stopped or harnessed. Myth # 2: Change is painful --> this is false because not everyone is reluctantly resistant to change. Some people readily embrace change as normative. Myth # 3: Change is always chaotic --> This is false because change can be planned or unplanned; the process can be managed Myth # 4: The environment does not impact a well-thought -out change process --> This is false because the environment is dynamic and continually changing
Define planned change.
Planned change is the deliberate application of knowledge and skills by a leader to bring about change.
Differentiate driving forces and restraining forces as they relate to change.
Restraining forces impede change because they push the participants away from the change, in the opposite direction. Restraining forces may come from the system itself or from individuals within the system. Driving forces are those forces that push the system toward the change
Discuss the Patient Self-Determination Act.
The PSDA was enacted in 1991 and it requires health organizations that receive federal funding to provide education for staff and patients on issues concerning treatment and end-of-life issues. This education includes advance directive and durable power of attorney.
Describe the sources of law as it pertains to nursing practice.
The sources of law include constitutions, statutes, administrative agencies, and court decision A constitution is a system of fundamental laws or principles that govern a nation, society, corporation, or other aggregate of individuals --> the purpose of a constitution is to establish the basis of a governing system for the future and the present --> little direct involvement in the area of malpractice Statutes are laws that are passed by the state or federal legislators and that must be signed by the president or governor --> the 51 Nurse Practice Acts are examples of statutes --> The nurse practice acts define and limit the practice of nursing, thereby stating what constitutes authorized practice as well as what exceed the scope of authority --> before the 1970s, very few state or federal laws dealt with malpractice crisis; since the malpractice crisis, many statutes affect malpractice Administrative agencies, are given authority to act by the legislative bodies and create rules and regulations that enforce statutory laws --> EX: State Boards of Nursing are administrative agencies set up to implement and enforce the state nurse practice act by writing rules and regulations Court decisions are also called tort law; this is court mode law and the courts interpret the statutes and set precedents; in the United States, there are two levels of court: trial court and apellate court
Discuss responses to change.
There are different responses to change: Innovators --> these are the change embracers who enjoy the challenge Early adopters --> these are the respected peers and are sought out for advise and information Early majority --> these are the ones who enjoy and prefer the status quo but will accept new ideas Late majority --> these are the ones who are openly negative and agree to change after accepted by others Laggards --> this is the last group to adopt change; this group prefers tradition and stability instead of innovation; they are suspicious of change Rejecters --> these are the ones who openly oppose and reject change; they can interfere with the success of the change process
Describe the different types of power exhibited by nurses in patient care.
Transformational power- the ability to assist clients to transform their self-image Integrative power- the ability to help clients return to their normal lives Advocacy power- the ability to resolve obstacles Healing power- the ability to create a healing climate and nurse-client relationship Participative/affirmative power- the ability to draw strength from a caring interaction with a client Problem-solving power- the ability, through caring, to be sensitive to cues and search for solutions to problems
Discuss nursing advocacy as related to power and political influence.
• Advocacy is defined as acting on behalf of another • ANA code of ethics support advocacy process: "The nurse promotes, advocates for, and strives to protect the health, safety and rights of the patient" • Nurses are patient advocates • Advocacy can be seen as representing the patient to others in the health care organization; this representation for the nurse can be risky as some of the advocacy may be contrary to what the organization wants • There is strong argument that patient advocacy actually stem from patient power rather than a lack of power or vulnerability • Power used for advocacy process includes: o Expert power allows nurse advocates to be effective team members in meetings with other powerful players o Legitimate power nurse license from the state board grants legitimate power to nurses to be used as advocates for the public o Nurse policy advocates have access to referent power can be used to gain support from groups in the community o Reward power is available for nurse advocates reward power can be used to effectively reward policy makers as they seek votes to maintain their positions
Identify common causes of professional nursing license suspension.
• Common causes include: o Professional negligence o Practicing medicine or nursing without a license o Obtaining a nursing license by fraud or allowing other to use your license o Felony conviction for any offense substantially related to the function or duties of an RN o Participating professionally in criminal abortions o Not reporting substandard medical or nursing care o Providing patient care while under the influence of drugs or alcohol o Giving narcotics without an order o Falsely saying one is an APRN when they are truly not
What is the importance of power to the nursing profession?
• In order to achieve organization goals or personal goals, one must have an adequate power base • To help subordinates, patients or clients achieve their goals, one must have power since having access to and control over resources is often related to the degree of power one holds • Having power gives one the potential to change the attitudes and behaviors of individual people and groups
Identify guidelines for informed consent.
• Informed consent can be given only after the patient has received a complete explanation of the surgery, procedure, or treatment and indicates that he or she understands the risks and benefits related to it • The person giving consent must fully comprehend: o 1) the procedure to be performed o 2) the risks involved o 3) expected or desired outcomes o 4) expected complication or side effects that may occur as a result of treatment o 5) alternative treatments that are available • Consent may be given by: o 1) a competent adult o 2) A legal guardian or individual holding durable power of attorney o 3) An emancipated or married minor o 4) Mature minor o 5) parent of a minor child o 6) court order
Discuss strategies for building a personal power base.De
• There are six driving forces to increase a nurse's power base: o 1) Right timing o 2) size of the nursing profession o 3) Nursing's referent power o 4) Increasing knowledge base and education for nurses o 5) Nursing's unique perspective o 6) Desire of consumers and providers for change Strategies that can increase the power of the nursing profession include: 1) placing more nurses in positions that influence public policy 2) stop nurses from acting like victims 3) increase level of nurses' understanding regarding all health-care policy efforts 4) build coalitions within and outside of nursing 5) promote greater research to strengthen evidence-based practice 6) support nursing leaders 7) pay attention to mentoring future nurse-leaders and leadership succession
