Exam 18: Leading Change

Elizabeth,an RN with approximately 15 years of service on your unit,walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." Your response to her indicates that:

When goals/outcomes are somewhat unclear in early preparation for a complex change,the manager and the change management team develop several acceptable goals/outcomes.This change in management approach is termed:

Elizabeth,an RN with approximately 15 years of service on your unit,walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." After speaking with Elizabeth,a few days later you discover that she is now fine with the change but is concerned that other areas of the organization might resist the change because of perceptions related to patient safety and cost.She suggests that it is important to bring pharmacy on board as they have had previous concerns about the use of heparin.In relation to change theory,this is indicative of:

To effectively achieve a change goal/outcome in a change situation,the wound care specialist will:

The home health agency hired an expert in financial management to evaluate and propose a plan for reversing growing expenses and decreasing revenues.The expert is well respected,both personally and professionally,by members living in this small community.To be effective,staff will need to perceive this change agent as:

The clinical coordinator expects the position description of the new wound care specialist to change nurses' responsibilities in caring for clients with skin integrity problems.The best approach to address this need for change,yet to have the best outcomes for clients,staff nurses,and the organization,is to:

To engage your staff in awareness of their current practice and how it is affirmed or not by evidence,you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency.You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice.This learning approach is an example of which change management approach?

Elizabeth,an RN with approximately 15 years of service on your unit,walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." According to Havelock (1973),this comment may originate from failure in which phase of the six phases of planned change?

As the unit manager on the unit that is leading changes to heparin locks,you find that Elizabeth is very valuable in terms of her observations about other units and her knowledge of organizational processes,and now in discussing the new procedure with others.Elizabeth might be considered an:

Elizabeth,an RN with approximately 15 years of service on your unit,walks away from one of the learning sessions on IV care and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effects." You follow up with Elizabeth and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." Which of the following would be the most effective response to Elizabeth?

As the unit manager,you spend a day performing direct patient care and work with a new system that is designed to capture patient documentation at the bedside.During discussions with staff while giving care,you discover that the number of screens that need to be opened during documentation makes charting more complex and time consuming than traditional manual charting approaches.On the basis of this feedback,you:

An example of one strategy used to improve participation in the change process by staff fitting the behavioral description of innovators and early adopters is to:

An example of one strategy to improve participation in the change process by staff fitting the behavioral descriptions of laggards,early majority,late majority,and rejecters is to:

The oncology clinical manager and the educational coordinator asked nursing staff to complete a brief written survey to assess their attitudes and knowledge related to having used the new infusion equipment for 6 weeks.The stage of change in this situation is:

To engage your staff in awareness of their current practice and how it is affirmed or not by evidence,you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency.You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice.Staff nurses who gain information on current IV therapy practices are engaging in which phase of Rogers' decision-making process?

Elizabeth is an example of a(n):

As a new manager,you are shocked to learn that your unit is still using heparin in heparin locks.You are aware of evidence related to this practice and want to change this practice as quickly as possible on your unit.You are in which stage of Lewin's stages of change?

The wound care nurse decided to involve those to be affected by change early in the change management process.This can positively result in:

You anticipate that your region will soon move toward an e-health record system.You begin to discuss this with your staff and are disappointed that you receive little positive response from the staff about this possibility.One staff member,in particular,seems to sum it up by saying "e-health? Won't happen in my working life! There are too many problems with it,like privacy issues." This response is most likely motivated by:

Complex change situations require that the change leader promote ongoing visioning among staff members.One strategy is to: