Managing Adopting and Responding to Change as Change Agent In Nursing

The Managing Adopting and Responding to Change as Change Agent In Nursing. Change agents are responsible for managing the change process from start to finish. This includes developing a change strategy, creating an action plan, and ensuring everyone involved is aligned on the goals. They are also responsible for problem-solving and decision-making.

How Managing Adopting and Responding to Change as Change Agent In Nursing

As a change agent in the healthcare sector, you must facilitate the introduction of new practices, processes, or technologies, address potential resistance, and ensure smooth transitions. This requires a strategic approach that includes understanding change models, effective communication, and strong leadership.

Managing Change And Innovation

Managing change and innovation requires nurse leaders and managers to know the who, why, what, when, and how of change (Porter-O’Grady & Malloch, 2013):

Who: The who of change are the key stakeholders (e.g., patients and families, employees, communities) related to the work to be changed. To be able to change or motivate stakeholders, nurse leaders and managers must understand their own comfort and competence related to change. Nurse leaders and managers must be self-aware regarding their knowledge or lack of knowledge of the change process, personal comfort with change and risk taking, relationships, conflict, and negotiation skills.
Why: The why of change is a reasonable rationale for the change. A lack of understanding for the reason for change can result in resistance and unsuccessful implementation of the change and innovation. Given the complexity of health care and the limited resources today, change and innovation should be evidence based and linked to patient safety, quality health care, and improving the work environment.
What: The what of change is the actual change or innovation being implemented. Identifying what to change is determined after the rationale for the change is clear. Change and innovation may involve revising or creating policies, processes, procedures, and/or standards. Keep in mind that implementing the specific change may require additional resources and technology as well as education and competency development for staff.
When: The when of change is determining at what point to start the change process and how long it will take to achieve the change. The timing for change can be directed by the impetus behind the change. However, when to change is best determined by those who will be most involved with or impacted by the outcome of the change.
How: The how of change involves the techniques or processes needed for successful and sustainable change.

Facilitating change and innovation is more than establishing and implementing a plan. It requires four specific competencies (Porter-O’Grady & Malloch, 2013, p. 51):

Personal knowledge of and accountability for one’s own strengths and limitations specific to change and innovation, including technical capability and computer literacy
Understanding the essence of change and innovation concepts as well as the tools of innovation
Using change theory to plan for the implementation of organizational changes
Serving as a change agent by assisting others in understanding the importance, necessity, impact, and process of change
Supporting staff during times of difficult transitions
Recognizing one’s own reaction to change and striving to remain open to new ideas and approaches
Adapting leadership style to situational needs
4Competence in embracing vulnerability and risk taking

Nurse leaders and managers are responsible for designing innovations to effect change in practice and outcomes (ANA, 2016). The American Organization of Nurse Executives (AONE) established competencies for nurse leaders and man agers, including communication and relationship building, knowledge of the health-care environment, leadership, professionalism, and business skills (AONE, 2015). Change management is considered part of the leadership competency and includes the following skills (AONE, 2015, p. 8):

Effective nurse leaders and managers should be concerned with both people and productivity during the change process. Nurse leaders and managers must value staff and create an environment that supports the change. Managing change means being a change agent, responding effectively to change, adopting change, and being prepared to deal with barriers to change.

Becoming a Change Agent

Nurses at all levels can facilitate change. A change agent is one who leads and man ages the change process, including management of group dynamics, resistance to change, continuous communication, and the momentum toward the desired outcome. The responsibilities of a change agent can include the following:

Gathering data necessary to identify a problem that needs to be changed
Informing members of the group that change is needed and facilitating them to recognize and acknowledge the need for change
Setting goals and objectives for the change and developing a plan
Identifying those who will be affected by the change and including them in the process
Identifying resisting and driving forces
Implementing the change
Communicating continuously during the process
Providing support during the process
Evaluating the change and make modifications to the plan as necessary

Change agents must be effective communicators and must excel at interpersonal skills. Change agents need to develop the knowledge, skills, and attitudes to align people, processes, and purposes to achieve the change and innovation. Nurse leaders and managers often find themselves functioning as change agents. As change agents, nurse leaders and managers are responsible to manage change and assist staff in the change process. When nurse leaders and managers model a positive and enthusiastic approach to change and innovation, they can inspire staff.

Responding to Change

Resistance to change is common. Various factors can affect a person’s ability to handle change and innovation, such as adaptability, comfort with the status quo, perceptions of the benefits of the change, and how threatened a person feels by the change. Effective change agents anticipate human responses to change and include strategies to manage the responses in the plan. Staff members need time to adjust to the thought of change and time to adjust to the actual change.

Nurse leaders and managers can help staff cope with change by making sure the rationale for the change is clear and allowing staff members to verbalize concerns and express their emotions. During the change process, nurse leaders and managers can also help staff members cope by ensuring open communication, providing feedback on a regular basis, and empowering them throughout the change process. As change agents, nurse leaders and managers can use several strategies when dealing with resistance.

Different strategies work in different situations, so change agents must consider which strategy is most appropriate for the change or innovation to be successful. Chinn and Benne (1969) described three common change strategies that can be useful for nurse leaders and managers during the change process. The normative-reductive strategy focuses on the relationship needs of staff members, uses peer pressure, and relies on staff members’ desires to have satisfactory work relationships (Chinn & Benne, 1969).

The normative-reductive strategy is used when some resistance is expected but nurse leaders and managers believe that staff will succumb to peer pressure rather than resist the change. The empirical-rational strategy assumes that staff members are essentially self-interested and providing information and education will assist staff in changing behavior and adopting the change or innovation (Chinn & Benne, 1969). Typically, when a change is being implemented the first step is to explain the need for the change. Once staff members understand the need for change and perceive personal benefit, they will embrace it.

The empirical-rational strategy is useful when minimal resistance is expected. The power-coercive strategy is based on power and authority and assumes that staff will respond to authority and threats of job loss (Chinn & Benne, 1969). This strategy is used when resistance is expected but nurse leaders and managers plan to implement the change regardless of how the majority feels. The power-coercive strategy results in rapid change and is often perceived by staff members as they must accept the change or find a new place to work.

Adopting Change

In general, people adopt change at different times during the process. Rogers (1995) suggested that people adopt change in various stages and can be categorized into five groups, as he illustrated the categories on a bell curve. The first 2.5% of people to adopt change are the “innovators,” also known as venturesome. Innovators are willing to take risks. The next 13.5% to embrace the innovation are called “early adopters”; they are more discerning when choosing to adopt an innovation.

The “early majority” makes up the next 34% to adopt the change. Known to be deliberate, the early majority usually interacts with the early adopters before making decisions. The “late majority” comprises the next 34%, who are skeptical and reluctant to adopt an innovation until most others have done so. Finally, the last to accept change are the “laggards” at 16%, who are stuck in the past traditions. Each category has specific characteristics. Nurse leaders must understand each group and how to focus time and energy appropriately to maximize the change effort.

Dealing With Barriers to Change

Change will happen. Change and innovation are necessary for survival and growth of health care and the nursing profession (Roussel, 2013). Continually facilitating staff to focus on the change or innovation must be a priority for nurse leaders and managers. However, 75% of all change initiatives fail (Manion, 2011, p. 230).

Change initiatives typically fail because of poor coordination, ineffective communication, and lack of staff cooperation. Thoughtful planning and ongoing communication can help overcome barriers to change. Nurse leaders and managers must position themselves to be in the forefront of change and innovation (Shirey, 2006).

Further, they must be the coaches, encouragers, and positive role models for change (Anderson, 2014). Nurse leaders and managers must be committed to and exhibit an attitude that supports the change or innovation. When change or innovation is imposed on the staff in an authoritarian manner, resistance is inevitable. Nurse leaders and managers can establish an environment for change by the following means (Roussel, 2013, p. 146):

Emphasizing relationships among staff members
Building mutual trust and confidence
Emphasizing interdependence and shared responsibility
Ensuring that responsibilities are shared equitably among all groups
Managing conflict effectively
Supporting careers by permitting job movement
Anticipating and rewarding change
Modifying the nursing organizational structure to accommodate changes that provide staff growth and development
Promoting a “can-do” attitude
Providing predictability and stability
Sharing bad news early, when necessary
Fostering a shift toward teamwork and process improvement

Savvy nurse leaders and managers recognize that there are different strategies for managing change and strive to match approaches to their particular circumstances to optimize the change process. Ineffective leaders try to make change happen, whereas system leaders focus on creating conditions that can create sustainable change (Senge et al., 2015).

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