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112 unit 2 | Working Within the Organization CikguOnline
Study Questions
1. Why is change inevitable? What would happen if no change at all occurred in health care?
2. Why do people resist change? Why do nursing staff members seem particularly resistant to change?
3. How can leaders overcome resistance to change?

4. Describe the process of implementing a change from beginning to end. Use an example from your
clinical experience to illustrate this process.

Case Study to Promote Critical Reasoning
A large health-care corporation recently purchased a small, 50-bed rural nursing home. A new
director of nursing was brought in to replace the former one, who had retired after 30 years. The
new director addressed the staff members at the reception held to welcome him. “My philosophy is
that you cannot manage anything that you haven’t measured. Everyone tells me that you have all
been doing an excellent job here. With my measurement approach, we will be able to analyze
everything you do and become more efficient than ever.”The nursing staff members soon found
out what the new director meant by his measurement approach. Every bath, episode of inconti-
nence care, feeding of a resident, or trip off the unit had to be counted, and the amount of time
each activity required had to be recorded. Nurse managers were required to review these data with
staff members every week, questioning any time that was not accounted for. Time spent talking
with families or consulting with other staff members was considered time wasted unless the staff
member could justify the “interruption” in his or her work. No one complained openly about the
change, but absenteeism rates increased rapidly. Personal day and vacation time requests soared.
Staff members nearing retirement crowded the tiny personnel office, overwhelming the single staff
member with their requests to “tell me how soon I can retire with full benefits.”The director of
nursing found that shortage of staff was becoming a serious problem and that no new applications
were coming in, despite the fact that this rural area offered few good job opportunities.
1. What evidence of resistance to change can you find in this case study?

2. What kind of resistance to change did the staff members exhibit?
3. If you were a staff nurse at this facility, how do you think you would have reacted to this change in
administration?

4. Why did staff members resist this change?
5. What could the director of nursing do to increase acceptance of this change? What could the nurse
managers and staff nurses do?

References Dent, H.S. (1995). Job Shock: Four New Principles Transforming
Our Work and Business. N.Y.: St. Martin’s Press.
Araujo Group. A compilation of opinions of experts in the field Deutschman, A. (2005). Change or die. Fast Company, 94,
of the management of change. Unpublished report. 52–62.
Berman-Rubera, S. (2008, August 10). Leading and embracing Englebright, J.D., & Franklin, M. (2005). Managing a new medica-
change. Business/Change-Management. Retrieved August tion administrative process. Journal of Nursing
20, 2008, from http://ezinearticles.com/?Leading- Administration, 35(9), 410–413.
And-Embracing-Change&id=1180585 Farrell, K., & Broude, C. (1987). Winning the Change Game: How to
Bilchik, G.S. (May 2002). Are you the problem? Hospitals and Implement Information Systems With Fewer Headaches and
Health Networks Magazine, 38–42. Bigger Paybacks. Los Angeles: Breakthrough Enterprises.
Cameron, K.S. & Quinn, Q.E. (2006). Diagnosing and Changing Flower, J., & Guillaume, P. (March/April 2002). Surfing the edge
Organizational Culture. N.Y.: Jossey-Bass. of chaos. Health Forum Journal, 17–20.