Resistance to Change literature review

A.sk AONE\s ABOUT MANAGEMENT TECHNIQUES BY MARJORIE BEYERS, PHD, RN, FAAN EXECUTIVE DIRECTOR THE AMERICAN ORGANIZATION OF NURSE EXECUTIVES management posi- tion, especially when everyone works to- what is expected.

But • I have been troubk lately about how to handle the behavior of one of the staff members. When the staff discusses improvements, this person finds reasons why we cannot change. She always has some reason for not quite completing care respon- sibilities and often upsets other staff members with comments and innuendos.

How can I turn this situation around?

Pat Peverly, MSN, RN, Ad- ministrative Director, Patient Care Sen/ices, Anderson i-ios- pitai Mar/vilie, iiiinois responds:

Managing in an environment of change requires a culture that accepts "change" as both constant and positive.

Em- ployee feedback is necessary for accurately assessing all as- pects of care delivery, but the managerial challenge is to channel the feedback to pro- ductive work groups where pro- cess improvement will result.

I will make two assumptions.

The first is that you have pro- vided an environment where employee communication and participation is encouraged.

Second, I will assume that the problem employee is just a "barrier to change" and that her negative focus can be redi- rected.

Often employees react neg- atively due to lack of under- standing.

I would start with fre- quent staff meetings where you provide a good orientation regarding the current status of health care, how your hospital has aligned its mission and ob- jectives to be successful with the changes, and specifically on how your unit/department must contribute. Provide time for discussion with the staff to solicit their feedback and to evaluate their commitment.

Next, I would focus on "team building" exercises to promote the skills and cohesiveness of group interaction. Train team leaders and facilitators, then as- sign work groups to study some of the unit activities or problems. When you deter- mine adequate "readiness" ex- ists for some formal activities, target those "barriers" for spe- cial assignments and roles. Your goal is to make that "vocal" em- ployee work toward problem resolution and take some own- ership for unit outcomes.

If these activities are not suc- cessful, realize that in any work- force you will have that small percentage of employees who are never going to be "shining stars" regardless of our man- agerial abilities. Concentrate on the majority of employees and celebrate the successes.

Sharon Denning, BSN, RN, Nurse Manager, iCU/ACMS, Nortii i\/lemoriai i\/ledicai Cen- ter, Minneapoiis, Minnesota, re- sponds: This employee demon- strates several challenges: resis- tance to change, less than optimal performance in patient care and poor interpersonal skills.

In this time of unprece- dented change, it is not unusual to experience resistance to new ideas.

To reduce resistance to change, involve employees in the change process, and com- municate regularly about ex- pected changes.

In this in- stance, however, all of these is- sues should be addressed by coaching the problem em- ployee.

Coaching should be con- ducted in privacy so that her dignity is preserved. Begin by describing the undesirable be- haviors and the impact of those behaviors, such as, "When you do not complete your work, pa- tients do not receive the best possible care and your cowork- ers have to do extra work to compensate." Be as specific as possible. Discuss your expecta- tions in regard to each of the performance issues. Follow the coaching session by giving feedback on a regular basis.

When you see improvement, provide immediate positive feedback.

If performance is- sues continue, additional coaching may be required.

If necessary, formal disciplinary processes may need to be im- plemented so that there are consequences for not demon- strating improvement.

Denise Ringer, MS, RN, Vice-President, Patient Care Services, Aibany Memoriai Hospitai, Aibany, New Yoric, re- sponds: Sounds as if it is time to have a serious talk with this employee.

I would point out the patterns of incomplete care responsibilities and the upset- ting comments using specific, objective examples. The impact of the actions, such as patient complaints or other staff mem- bers completing the tasks, should be explained. Give her an opportunity to identify what barriers may exist and develop an action plan for improve- ment.

It is essential that she perceive your desire to be sup- portive but also understand the consequences of not complet- ing care responsibilities or re- sisting change in a destructive manner.

If the other stafi' members have complained to you, help them set appropriate bound- aries in dealing with her.

In my experience, these behaviors usually have come from em- ployees who were unhappy in their present situation and eventually switched to another nursing career. Although nega- tive at first, several later thanked me for helping them face a dif- ficult decision. Good luck!

• Abstract:

An employee's negative focus can be redirected.

Three nurse executives discuss management techniques to use in an environment of change.

[Nurs Manage 1998:29(5):56] 56 Nursing Management/May 1998 www.nursingtnanagementconi