Don’t forget this last step. After the change has been made, it is important to make sure
that everyone has moved into a new “comfort zone.’’
Ask yourself:
•
Is the change well integrated into everyday operations?•
Are people comfortable with it now?•
Is it well accepted? If not, why not? What can be done to increase acceptance? Is there any residual resistance that could still under- mine full integration of the change? If there is, how can this resistance be overcome?As Kotter noted, change “sticks” when, instead of being the new way to do something, it becomes “the way we always do things around here” (1999, p. 18).
CONCLUSION
Change is an inevitable part of living and working. How people respond to change, the amount of stress it causes, and the amount of resistance it provokes can be influenced by your leadership. Handled well, most changes can become opportunities for professional growth and development rather than just additional stressors for nurses and their clients to cope with.
118 ❖ Essentials of Nursing Leadership and Management
C R I T I C A L T H I N K I N G E X E R C I S E
A large healthcare 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 at this facility.
The new director addressed the staff members at the reception held to wel- come 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.
S T U D Y Q U E S T I O N S
1. Why is change inevitable? What would happen if no change at all occurred in health care?
2. Why do people resist 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.
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R E F E R E N C E S
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Araujo Group (no date). A compilation of opinions of experts in the field of the management of change.
Unpublished report.
Conger, J., Spreitzer, G., & Lawler, E.E. (1999). The Leader’s Change Handbook. San Francisco: Jossey- Bass.
Dent, H.S. (1995). Job Shock: Four New Principles Transforming Our Work and Business.New York: St.
Martin’s Press.
Farrell, K., & Broude, C. (1987). Winning the Change Game: How to Implement Information Systems with Fewer Headaches and Bigger Paybacks.Los Angeles:
Breakthrough Enterprises.
Hansten, R.I., & Washburn, M.J. (1999). Individual and organizational accountability for development of criti- cal thinking. J Nurs Adm, 29(11), 39–45.
Hastings, C., & Waltz, C. (1995). Assessing the outcomes of professional practice redesign: Impact on staff nurse perceptions. J Nurs Adm, 25(3), 34–42.
Heller, R. (1998). Managing Change. New York: DK Publishing.
Kotter, J.P. (1999). Leading change: The eight steps to transformation. In Conger, J.A., Spreitzer, G.M., &
Lawler, E.E. (Eds.). The Leader’s Change Handbook.
San Francisco: Jossey-Bass.
Lewin, K. (1951). Field Theory in Social Science: Selected Theoretical Papers.New York: Harper & Row.
Lichiello, P., & Madden, C.W. (1996). Context and cata- lysts for change in health care markets. Health Aff, 15(2), 121–129.
Maslow, A.H. (1970). Motivation and Personality.New York: Harper & Row.
Parker, M., & Gadbois, S. (2000). Building community in healthcare workplace. Part 3: Belonging and satisfac- tion at work. J Nurs Adm, 30(10), 466–473.
Pearcey, P., & Draper, P. (1996). Using the diffusion of innovation model to influence practice: A case study.
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Porter O’Grady, T. (1996). The seven basic rules for suc- cessful redesign. J Nurs Adm, 26(1), 46–53.
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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 incontinence 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 on full bene- fits.’’ The director of nursing found that shortage of staff was becoming a serious problem and that few 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 of this nursing home 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?
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121
Work-Related Stress and Burnout
O U T L I N E Consider the Statistics Stress
Effects of Stress Responses to Stress Reality Shock
Differences in Expectations
Additional Pressures on the New Graduate Burnout
Definition Aspects
Stressors Leading to Burnout Consequences
A Buffer Against Burnout Stress Management ABCs of Stress Management Physical Health Management Mental Health Management Conclusion
O B J E C T I V E S
After reading this chapter, the student should be able to:
• Identify signs and symptoms of stress, reality shock, and burnout.
• Describe the impact of stress, reality shock, and burnout on the individual and the healthcare team.
• Evaluate his or her own and colleagues’ stress levels.
• Develop strategies to manage personal and professional stresses.