5 Strategies to Help Nursing Staff Manage Change

Health care reform By Rose O. Sherman, EdD, RN, FAAN

Leaders in health care agencies today are trying to strategically plan for a different model of reimbursement. The new model will be based on value of the services versus the old model which was based on the volume of services. It is almost a certainty that the change will bring a reduction in some health care services and fewer hospital admissions. There will be a shift in care to lower acuity environments and the community. Wise nurse leaders are already preparing their staff for this different world.

Throughout the health care system, there have already been mergers of organizations as they plan for a shift to an environment that may favor accountable care organizations. Nurse leaders tell me that many nursing staff are having a difficult time accepting the changes that are being discussed. It is such a different environment from the one in which they initially began their careers. Helping staff to accept and manage change has become an important leadership skill.

Five Strategies to Help Staff Manage Change

1. Meet them where they are in the acceptance/transition process.

Not all of us accept change in the same way or on the same timeline. Kerry Bunker suggests that to avoid frustration, it is important to meet people where they are in the change process. Accept that some people will not be as far along as you might want them to be. Where they are in the process will depend on their comfort with change (ability to take on new learning) and capacity for change (ability to learn that which is required). Change can be quite emotional. It often means letting go of something that you have valued in the past. Where people are in the acceptance process can be very variable, and leaders need to assess this with their staff.

2. Frame the issues for them in easily understood language.

With proposed changes that will accompany health care reform and the declining reimbursements that agencies are already experiencing, there is reason for concern. Nursing staff wonder if their organizations are in crisis, and whether they should be worried about job security. Staff are depending on their leaders to help them understand the meaning of the changes that are being discussed. How leaders use language to frame people, situations, and events has important consequences for the way individuals make sense of the world and their actions. Most nursing staff understand that the costs, fragmentation in care and variable outcomes in today’s system are not sustainable moving into the future.

3. Recognize that there are different responses to change.

Kerry Bunker suggests that there are four distinct patterns of response to change (entrenched, overwhelmed, poser or learner). Entrenched staff will hope to wait the change out – ex. maybe it won’t happen until I retire. Overwhelmed staff have high anxiety levels and may have feelings of depression or powerlessness. Posers exhibit a high level of confidence in their ability to deal with changes but may not have the self-awareness and actual competence that they need. Bunker suggests that these individuals can be the most dangerous in the sense that they are likely to make quick decisions and lead the organization in the wrong direction. Learners feel challenged and stretched but are determined to move forward. They seek learning opportunities to expand their skills in response to the change. Learners can be a leader’s best ally in helping other staff transition during changes.

4. Help them identify where and how they can fit into the change.

In most situations where we are asked to change, we are substituting the old for the new and unfamiliar. This can make us feel insecure about our work and is often personally exhausting. The response of leaders to change or turbulence has a powerful effect on their staff. There are always possibilities in change that can lead to a new, brighter future and this needs to be conveyed. Leaders who remain calm, truthful and optimistic in their communications help to prevent the spread of misinformation and reduce staff anxiety. ar behaviors or practices for old comfortable ones.

5. Give them hope.

There are silver linings in any situation and the leader needs to be the first to help everyone see what they are. An optimistic attitude and outlook can be very energizing and contagious. It will motivate your staff to do their best. You need to expect success if you are to achieve it.

Read to Lead

Bunker, K.A. (2012). In Rush. S. (Editor) On Leading in Times of Change. Greensboro, N.C.: Center for Creative Leadership.

Kotter, J. (1996). Leading Change. Boston, MA: Harvard Press.

Kotter International. The Eight Step Process for Leading Change