By Rose O. Sherman, EdD, RN, FAAN
“The most important capacity we possess is our ability to influence ourselves and others. Learn to see every important challenge you face as an influence challenge”. The Influencer: The Power to Change Anything
Several months ago, one of my nurse leader students talked with me about an ongoing frustration that she had not been able to make the practice of bedside end of shift report stick on her unit after the initial orientation of staff to this new organizational expectation. “My staff do well with this for a few months but have now drifted back to their old practices. I am now hearing that it takes too long and patients are asking too many questions. I think we did well with it when we started but changing the staff behavior over time has been more challenging.”
The authors of the Influencer: The Power to Change Anything make the point that complex problems are not solved by silver bullets. Through their research, they have found that change will be more successful if you find a few vital behaviors that will have the most impact in contributing to the desired change. In the situation above involving bedside end of the shift of report, you might identify the following three vital behaviors:
1. Nurses from both tours will be present for the end of shift report at the patient’s bedside.
2. Nurses will use the end of shift report communication tool as a guide for what should be communicated.
3. Nurses will include the patient and/or family in the conversation and incorporate discharge planning into the discussion.
Once the vital behaviors have been identified, you can then use 4 of the six sources of influence described below to promote these key behaviors.
1. Personal Motivation
It can be hard to change behavior especially when the personal motivation of the staff is low to do so. The nurses may perceive bedside report as taking too much of their time. To shift this dynamic, you may need to develop new motives to influence behavior. Most nurses are aware that there is a new focus today on highly coordinated discharge planning. How can this happen if it does not involve all staff and is not ongoing from the time of admission? The bedside rounding can be recast as the opportunity to both improve communication about patient care but also to identify discharge planning needs. The human consequences of missing these needs can be very high and should be highlighted as most nurses are passionate and caring professionals.
2. Personal Ability
Sometimes when we look to change behavior, we assume that it is simply a lack of motivation. This may not always be the case. Effective influencers actually over-invest in helping others to increase their ability so they are more likely to enact the change. In our scenario above, we might assume that nurses know how to give a report. While they may feel comfortable giving report to another nurse, adding the patient and family to the audience for the report can change this dynamic. Providing a structured way of giving the report in this new forum with opportunities to practice may substantially increase the nurse’s feelings of competency. These scenarios could include all types of responses and questions that could arise from the patient and family.
3. Harness Peer Pressure
Peer pressure can provide incredible power to enact behavioral change. On any given nursing unit, there are opinion leaders. Engaging the opinion leaders in the change process is critical. Opinion leaders can be the champions of change or can torpedo innovative efforts if they are disengaged.
4. Find Strength in Numbers
There is power in numbers. When enacting a change such as a bedside report, you don’t necessarily need 100% buy-in at the outset from all staff. You do need a critical mass of nurses who are committed but you do need enough on each tour that you have the social capital to influence change.
5. Design Rewards and Demand Accountability
It is often said that what gets measured gets rewarded. If the vital behaviors outlined above in the bedside report were included as part of an annual performance appraisal, it would quickly get the attention of the nursing staff. The problem with many performance appraisal tools today is that they are too general and don’t include specific behavioral expectations.
6. Change the Environment
When we look to influence behavior, we rarely think about the power of the environment as a source of influence. Sometimes simple changes in a unit environment can influence behavior. In the bedside report example, what if there was no place in the nursing station or on the unit for staff to sit down and give the report? What if there were no tape recorders available to tape report? What if we made sure that a nurse always had an assignment where patients were clustered in the same geographic area? What if we did allow and encourage our nurses to sit down if they needed to and give the report in the patient’s room? What if we asked our staff for their ideas about how we could change our room configuration to enhance their ability to give bedside report?
Promoting change is not an easy process. Effective influencers know that the more intentional you are in setting the stage for change, the more likely you are to be successful. There is no one size fits all with change. It takes multiple sources of influence and success needs to be re-evaluated across time.
Read Rose Sherman’s new book available now – The Nurse Leader Coach: Become the Boss No One Wants to Leave
Read to Lead
Patterson, K., Grenny, J., Maxfield, D., McMillan, R. & Switzler, A. ( 2008). Influencer: The power to change anything. New York: McGraw-Hill.
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