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When asked the theme of a nursing management are the macro-level (large-scale) changes that affect
conference, a top nursing executive replied, virtually every health-care facility.
“Change, change, and more change.” Whether it is Change anywhere in a system creates “ripples
called innovation, turbulence, or change, this theme throughout the system” (Parker & Gadbois, 2000,
seems to be a constant in the workplace today. p. 472). Every change that occurs at this macro
Mismanaging change is common. In fact, as many level filters down to the micro level (small-scale
as three out of four major change efforts fail change), to teams and to individuals. Nurses, col-
(Cameron & Quinn, 2006; Hempel, 2005). This leagues in other disciplines, and patients are parti-
chapter discusses how people respond to change, cipants in these changes.This micro level of change
how you can influence change, and how you can is the primary focus of this chapter.
help people cope with it when it becomes difficult.
Change and the Comfort Zone
Change The basic stages of the change process described by
Kurt Lewin in 1951 are unfreezing, change, and
A Natural Phenomenon refreezing (Lewin, 1951; Schein, 2004). Imagine a
Change is a part of everyone’s lives. Every day, peo- work situation that is basically stable. People are
ple have new experiences, meet new people, and generally accustomed to each other, have a routine
learn something new. People grow up, leave home, for doing their work, and believe they know what
graduate from college, begin a career, and perhaps to expect and how to deal with whatever problems
start a family. Some of these changes are mile- come up. They are operating within their “comfort
stones, ones for which people have prepared and zone” (Farrell & Broude, 1987; Lapp, 2002).
have anticipated for some time. Many are exciting, A change of any magnitude is likely to move peo-
leading to new opportunities and challenges. Some ple out of this comfort zone into discomfort. This
are entirely unexpected, sometimes welcome and move out of the comfort zone is called unfreezing
sometimes not. When change occurs too rapidly or (Fig. 8.1). For example:
demands too much, it can make people uncomfort- Many health-care institutions offer nurses the
able (Bilchik, 2002), even anxious or stressed. choice of weekday or weekend work. Given these
choices, nurses with school-age children are likely to
Macro and Micro Change
find their comfort zone on weekday shifts. Imagine
The “ever-whirling wheel of change” (Dent, 1995, the discomfort they would experience if they were
p. 287) in health care seems to spin faster every transferred to weekends. Such a change would rap-
year. By itself, managed care profoundly changed idly unfreeze their usual routine and move them
the way health care is provided in the United States into the discomfort zone. They might have to find
(Trinh & O’Connor, 2002). Medicare and a new babysitter or begin a search for a new child-
Medicaid cuts, increasing numbers of people who care center that is open on weekends. Another alter-
are uninsured or underinsured, restructuring, native would be to establish a child-care center
downsizing, and staff shortages are major concerns. where they work. Yet another alternative would be
Such changes sweep through the health-care sys- to find a position that offers better working hours.
tem, affecting patients and caregivers alike. They

Unfreezing Change Refreezing

Comfort Discomfort New Comfort
Zone Zone Zone

Figure 8.1 The change process. (Based on Farrell, K., & Broude, C. [1987]. Winning the Change Game: How to Implement
Information Systems With Fewer Headaches and Bigger Paybacks. Los Angeles: Breakthrough Enterprises; and Lewin, K.
[1951]. Field Theory in Social Science: Selected Theoretical Papers. N.Y.: Harper & Row.)