Deck 18: Leading Change

Question 1

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 (1951)stages of change?

A) Unfreezing
B) Experiencing the change
C) Integrating the change
D) Refreezing

Answer 1

Unfreezing

Question 2

You follow up with Elizabeth and discover that she is quite angry about the information sessions because she believes that you are implying that what she has been doing all these years means that she is incompetent and does not care about her patients.Your response to her should indicate that

A) Elizabeth will never adopt the change.
B) Elizabeth is insecure in her practice.
C) Elizabeth requires more information about the practice.
D) change involves emotions rather than intellect.

Answer 2

change involves emotions rather than intellect.

Question 3

Which of the following would be the most effective response to Elizabeth?

A) "I understand how you feel, but you are going to have to change."
B) "It is unfortunate that you feel this way. Others seem quite excited about the new information."
C) "It is difficult sometimes to change what we know very well. Sometimes it can be frightening."
D) "Perhaps I can arrange some more information sessions for you, so you can see just how important this change is to patient safety."

Answer 3

"It is difficult sometimes to change what we know very well. Sometimes it can be frightening."

Question 4

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

A) unfreezing.
B) nonlinear.
C) cybernetic.
D) linear.

Question 5

The home health agency hired an expert in financial management to evaluate and propose a plan for reversing a growth in expenses and a decrease in 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

A) trusted and quiet.
B) flexible and informal.
C) credible and legitimate.
D) communicative and personable.

Question 6

An example of one strategy to improve participation in the change process by staff members for whom the behavioural descriptions of laggards,early majority,late majority,and rejectors fit is to

A) encourage teamwork.
B) transfer them to a different unit.
C) require their attendance at staff meetings.
D) delegate the roles and tasks of change.

Question 7

The wound care nurse decided to inform members of the health care team to be affected by change early in the change management process.This can positively result in

A) coordination.
B) resistance.
C) anticipation.
D) participation.

Question 8

A few days after you speak with Elizabeth,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 involve pharmacy staff because they have had previous concerns about the use of heparin.This type of campaign is best described as

A) political.
B) marketing.
C) military.
D) cooptation.

Question 9

Resistance is most likely to occur when change

A) is not well understood.
B) involves many layers in an organization.
C) involves nonprofessional workers.
D) threatens personal security.

Question 10

The nurse manager frequently interacts with staff and other hospice facility employees.Communication was purposeful because the manager assessed current issues,such as specific satisfactions and dissatisfactions with the newly implemented computerized documentation system.Informally,the manager gathered available staff members to address similar learning needs.Many times,staff members were found coaching other staff about improving use of the new system.According to Senge (1990),the activities demonstrated in this example are

A) dialogue and team learning.
B) resilience and personal mastery.
C) shared vision and systems thinking.
D) mental models and teachable moments.

Question 11

On the basis of Elizabeth's insights and suggestions,you involve pharmacy staff,only to discover that the change in practice involves practice committees,a medical practice committee,and concerns from administration about potential costs and safety of the proposed change to the intravenous protocols.The change process at this point is

A) linear.
B) nonlinear.
C) sabotaged.
D) neutralized.

Question 12

The oncology clinic 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

A) developing awareness.
B) experiencing the change.
C) integrating the change.
D) perceiving awareness.

Question 13

Elizabeth is an example of

A) an early adopter.
B) the late majority.
C) a laggard.
D) a rejector.

Question 14

In Question 12,staff nurses who obtain information on current intravenous therapy practices are engaging in which phase of Rogers's (1995)decision-making process?

A) Persuasion
B) Knowledge
C) Confirmation
D) Decision

Question 15

Elizabeth,a registered nurse (RN)with approximately 15 years of service on your unit,walks away from one of the learning sessions on intravenous 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 effect." According to Havelock (1973),this comment may originate from failure in which phase of the six phases of planned change?

A) Generating self-renewal
B) Choosing the solution
C) Diagnosing the problem
D) Building a relationship

Question 16

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

A) consciously evaluate invisible mental models.
B) allow for individual outcomes.
C) encourage cooperative activities.
D) operate between order and disorder.

Question 17

An example of one strategy used to improve participation in the change process by staff members for whom the behavioural descriptions of innovators and early adopters fit is to

A) repeat the benefits of the change.
B) share change experiences early in the process.
C) initiate frequent interactions among staff.
D) provide select information to the staff.

Question 18

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 intravenous patency.You meet with the educator to plan the goals for each session with the overall purpose of increasing knowledge and assess which staff members are ready to begin to question current intravenous practice.This learning approach is an example of which change management approach?

A) Linear
B) Nonlinear
C) Facilitative
D) Integrative

Question 19

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

A) Select one of the change models.
B) Use Lewin's (1951) model and principles of change.
C) Apply both planned and nonlinear approaches.
D) Form a task force of nursing staff and wound care specialists.

Question 20

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

A) preserve the status quo.
B) diminish facilitators of change and reinforce barriers to change.
C) weigh the strength of forces.
D) strengthen facilitating forces.

Question 21

As the unit manager on the unit that is leading changes to heparin locks,you find one staff nurse whose observations about other units and knowledge of organizational processes are very valuable in discussion of the new procedure with other staff members.This nurse might be considered an

A) engager.
B) innovator.
C) informal change agent.
D) informant.

Question 22

Ute has been vocal about her negative concerns related to a new charting system and frequently expresses the view that keeping the "old system" would have been just fine.In facilitating change,your best approach to Ute would be to

A) put her in the pilot planning group for the change.
B) determine whether she has considered retirement.
C) schedule her work assignment so that it coincides with those of two staff members who are confident with technology and the change.
D) avoid discussion of the change, and trust that with sufficient training and information, her attitude will change.

Question 23

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 patient's 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

A) assume that the system is doing what it needs to do.
B) provide reassurance to staff that the unit has achieved its goals in implementation of the system.
C) ask some of the staff if they have had similar experiences with the system.
D) consult chart audit data and end user consultation reports to determine whether errors and problems are occurring.

Question 24

Selina,RN,one of your most enthusiastic staff members,has attended a workshop on preparing educational materials for patients.On the basis of this workshop,she would like to develop an information website for patients who are being admitted to the ward.An appropriate response to Selina's suggestion would be

A) "That is a great suggestion, but we have no resources for such an expensive undertaking right now."
B) "Perhaps you can keep that in mind as we redesign our charting system."
C) "We have too many older people as patients, and you know that they don't use technology."
D) "There is a great group here that meets to look at technology pilots. Let's see if you can join them and discuss your idea further."

Question 25

The situation in Question 22 is best captured in which theory of change?

A) Chaos
B) Planned change
C) Cybernetics
D) Innovation-decision process

Question 26

Which of the following are examples of application of the Leadership Rounding Tool (Studer,2009)?

A) "What is working well for you during bedside reporting?"
B) "What has not worked for you today?"
C) "Is there someone on your team who deserves special recognition for her efforts in the implementation?"
D) "Did you have a good vacation?"