|Home||Chapter 16||Nursing Leadership and Management in Action|
Change is a dynamic process in which an imbalance between driving and restraining forces moves behavior to a new level where the forces reach a new state of equilibrium. Common strategies used to evoke change are power-coercive, empirical-rational, and normative-reeducative. In power-coercive strategies, legitimate authority, economic sanctions, or political clout is used to enforce change and handle resistance. The premise behind the empirical-rational approach is that people are rational and will accept a change that is in their best interest. The normative-reeducative approach is based on the assumption that people respond to social norms and values. Hence, roles, relationships, perceptual orientations, attitudes, and feelings influence the acceptance of change. Agents using a normative-reeducative approach collaborate with the group to effect change.
You are the nurse manager on a unit that has had all RN staff until about six months ago. At that time, nursing assistants (NAs) were added and assigned a set of tasks mostly personal care, bathing, and errands for the unit that they do for all patients on the unit. NAs were not assigned to work with particular nurses, only to a group of patients who might have several different RNs caring for them. Therefore, NAs did not have coaching and supervision in patient care. You believe that better care could be provided to patients if nurses and NAs worked in teams to care for designated groups of patients. You discuss it with your director and find that she is enthusiastic and will support your efforts. You recognize that the RN staff will need some additional education in delegation and coaching to make this work well. They liked taking complete care of their own patients, and have accepted, but not enthusiastically, having nursing assistants on the unit. You are ready for the first step of considering how you will approach making sure this change is successful.