nursing and change

1. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Initiating and Managing
Change

2. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Learning OutcomesLearning Outcomes
1. Explain why nurses have the
opportunity to be change agents.
2. Describe how different theorists
explain change.
3. Discuss how the change process is
similar to the nursing process.
4. Differentiate among change strategies.

3. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Learning OutcomesLearning Outcomes
5. Discuss how to handle resistance to
change.
6. Describe the nurse's role in change.

4. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
ChangeChange
• Change:
– Is essential for adaptation and growth
– Is the process of making something
different from what it was
– Is a continually unfolding process rather
than an either/or event

5. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
ChangeChange
• Change:
– Can be threatening
– May cause a grief reaction even when
planned
– Produces new opportunities

6. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Institute of Medicine ReportInstitute of Medicine Report
(2010)(2010)
• Future of nursing
• Proposed radical changes, including:
– "Nurses should be full partners with
physicians and other health care
professionals in redesigning health care
in the United States."

7. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Change AgentsChange Agents
• Change agents:
– Work to bring about change
– Are role models for others
– Stimulate the need for change and help
shape its success

8. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Nurse as Change AgentNurse as Change Agent
• Nurses facilitate change
• Must be proactive in shaping the future
• Opportunities exist now for nurses,
especially in management positions

9. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
LewinLewin
• Driving forces versus restraining forces
• Three-step process
– Freezing
– Moving
– Refreezing

10. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
LippittLippitt
• Expanded Lewin's theory to a seven-
step process
• Focuses on what change agent must do
• Emphasizes importance of participation
of key members for success

11. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Comparison of Change ModelsComparison of Change Models
LEWIN LiPPIT
Unfreezing Diagnose Problem
Moving Assess Motivation
Refreezing Assess Change Agent’s Motivation and Resources
Select Progressive Change Objects
Choose change Agent Role
Maintain Change
Terminate Helping Relationship

12. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
The Change ProcessThe Change Process
• Same path as nursing process
– Assessment
– Planning
– Implementation
– Evaluation

13. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Table 5-2 Steps in the Change Process

14. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
AssessmentAssessment
• Identify the problem or the opportunity
• Ask the right questions
– Where are we now?
– What can we do that is different?
– What is the driving stimulus in our
organization?
– What prevents us from moving?
– What kind of change is required?

15. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
AssessmentAssessment
• Collect data
– Identify all driving and restraining forces
– Assess political climate
 Who will gain? Who will lose?
– Assess costs and benefits
• Analyze data

16. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
PlanningPlanning
• Determine who, how, and when
• Include organization/system members
• Plan resources required to make the
change and establish feedback
mechanisms

17. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
ImplementationImplementation
• Plans are put into action.
– Akin to Lewin's moving stage
• Methods to change individuals
– Information giving
– Training
– Gaining support of key people
• Methods to change groups
– The power of the group

18. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
EvaluationEvaluation
• Evaluate effectiveness
• Stabilize the change
– Energizer role is still needed to reinforce

19. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Power-Coercive StrategiesPower-Coercive Strategies
• Based on the application of power by
legitimate authority, economic
sanctions, or political clout
• Through laws and policies.
• Useful when a consensus is unlikely
despite efforts to stimulate participation
• Accept it, or leave it

20. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
EmpiricalEmpirical–Rational ModelRational Model
• Revolves around knowledge
• Assumption is that people are rational
and will follow their rational self-
interest if it clear to them.
• Change agent uses expert power

21. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
NormativeNormative–Reeducative StrategiesReeducative Strategies
• Assumption that people act in
accordance with social norms and
values
• Power = Skill in interpersonal
relationships
• Effective in reducing resistance,
stimulating creativity

22. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Resistance to ChangeResistance to Change
• If no resistance, change may not be
significant enough
• Forces changes agent to:
– Clarify
– Keep interest high
– Establish reason for change

23. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Reasons for Resistance to ChangeReasons for Resistance to Change
• Lack of trust
• Vested interest in status quo
• Fear of failure
• Loss of stature or income
• Misunderstanding
• Belief that change is unnecessary or
that it will not improve the situation

24. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Look for these statementsLook for these statements
• “we tried that before”.
• “It won’t work”.
• “No one else does it like that”.
• “We can’t afford it”.
• We don’t have the time”.
• “It well make the angry”.
• “Every new boss wants to do something
different”.

25. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Managing Resistance to ChangeManaging Resistance to Change
• Talk to those who oppose the change.
• Clarify information.
• Be open to revisions.
• Present negative consequences of
resistance.
• Emphasize positive consequences.

26. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Managing Resistance to ChangeManaging Resistance to Change
• Keep resisters involved in face-to-face
contact with supporters.
• Maintain climate of trust, support,
confidence

27. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Nurse’s Role in ChangeNurse’s Role in Change
• Change not always initiated from top
management level
– Mid-level managers are more effective
• Staff nurses can initiate change
– Mandotory skill for nurses
• Cultivate and master characters of
successful change agents
• Engage strategies for accessing power

28. Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
Nurses Role in ChangeNurses Role in Change
• Assist in other ways
– Planning
– Information sharing
– Managing the transition
• Change has become the norm