When Change is Too Abrupt - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN. FAAN

We need innovation in our healthcare environments but change can easily fail if it is too much and too soon. The reality is that change is hard even when it is highly desirable. Our brains crave routine and too much disruption all at once can lead to an environment where staff feel psychologically unsafe. Skill with the change process is an important leadership competency. Any change should be considered strategically before new processes, practices and people are deployed. There are some leaders who thrive on the chaos that disruption brings when too much change is enacted all at one time. My experience has led me to believe that in certain situations, it can be a way of avoiding accountability for one’s impact.

What We Know About Change

In most situations where we are asked to change, we are substituting new and unfamiliar behaviors or practices for old comfortable ones. This can make us feel insecure about our work and is often personally exhausting. That is why the reaction to change can be quite emotional especially among more seasoned staff with well established clinical patterns of working. It is important to keep in mind that resistance to change is often a manifestation of insecurity.

The Role of the Nurse Leader in the Change Process

As a leader, reflecting on your own reaction to the change and what you are projecting to others is an important first step. You may be demonstrating resistance yourself in subtle ways that are both verbal and nonverbal. Leaders play a key role in framing the context of change for their staff. This is especially true in uncertain environments. You must help to manage change in a way that employees can cope with it. To be successful, change cannot be imposed but rather the leader should look for ways to enable and involve staff. Finding ways to successfully embed change into the culture matters. John P. Kotter, a Harvard Business Professor, is a highly regarded expert in the field of change management. He proposes the following 8 step model that leaders can use to understand and manage change:

Create a sense of urgency about the need for change – inspire staff to see the need for the change and make the change objectives real and relevant.
Build a team to help guide the change – get the right people in place (skills, abilities and attitude) to make the change happen.
Develop and communicate the change vision – a simple, clear strategy of what the change is and how the change will occur.
Communicate for buy-In -involve as many people as possible, keep them informed and respond to their needs.
Empower action – remove obstacles, provide feedback and reward progress.
Create short-term wins – establish some easy to reach goals – manage the change in bite-size chunks.
Don’t let up – build and encourage determination and persistence – report on the progress.
Make the change stick – this is the most challenging part of change -weave the change into the culture and practice in tangible ways.

Don’t Forget the People

Peter Drucker, the father of modern American management, once wisely observed that culture eats strategy for breakfast every time. Few of us would disagree with this. Part of a leader’s responsibility during times of change is to check in frequently with staff, answer questions and provide emotional support. Pacing the pace of change with consideration to the ability of your staff to absorb it can mean the difference between success and failure.

Read to Lead

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

Kotter International. The Eight Step Process for Leading Change