Question 1

A nursing supervisor would like the nurse manager to serve as change agent for a needed revision to unit policy. Which statements would alert the supervisor that this manager is not the best choice for this assignment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
A) "Well, we don't want to rock the boat too much."
B) "Do you think we can get enough support from the nurses to make this change?"
C) "We tried making a change like this before and it didn't work out well."
D) "To make this big change, we need to start making smaller changes now."
E) "There is going to be resistance, but I think it can be overcome."

Accepted Answer

1. Fear of "rocking the boat" may prevent the manager from effectively leading the change.
2. Fear that no one will support the change may prevent the manager from effectively leading the change.
3. Recalling that previous efforts at change have failed may prevent the manager from effectively leading the change.
4. The ability to see the end result and what it will take to make the plan work is a sign that the manager could be an effective change agent.
5. The ability to handle resistance and a display of confidence are signs that the manager could be an effective change agent.

Question 2

The nurse manager is facilitating change to a new documentation system in the unit. If the manager wants to use the most common method to overcome resistance to the change, which strategy would be chosen?
A) The manager distributes a handout explaining the new system and how to use it.
B) The manager creates a "quick tip" sheet about how to use the system and schedules practice sessions for each nurse.
C) The manager identifies a key supporter of the change and has that nurse act as mentor to the remaining staff.
D) The manager threatens to transfer anyone who resists the change.

Accepted Answer

1. Giving information is the most common method of changing individuals' perceptions, attitudes, and values.
2. Providing information and an opportunity to practice is called training. Training is not the most common method of changing perceptions, attitudes, and values.
3. While having a mentor may be a desirable method for the learner, it is not the most common method of changing perceptions, attitudes, and values.
4. Transferring or terminating those who resist change is a method of changing the perceptions, attitudes, and values of the remaining staff. It is not the most common method.

Question 3

Hospital administration is working with a university school of nursing to establish a nursing residency program. Why is this a desired action?
A) A residency program eliminates the hospital's liability if a novice nurse makes an error.
B) A residency program is established to make nursing education more like physician education.
C) The Institute of Medicine (IOM) has proposed residency programs for nurses.
D) A residency program ensures that nurses participate in lifelong learning.

Accepted Answer

1. There is no reduction of the hospital's liability for errors.
2. Residency programs for nurses are not being established to mimic physician education.
3. The IOM has made this proposal.
4. There is no assurance that nurses who participate in residency programs will engage in lifelong learning.

Question 4

A nurse leader is contemplating change on the unit. Which is the first step in the change process?
A) Defining costs/benefits
B) The problem has been clearly defined
C) Identify driving and restraining forces
D) Select and analyze data
E) Develop a plan for change

Accepted Answer

1. Defining costs/benefits are part of the second step.
2. The first step in the change process is to clearly define the problem.
3. Identify driving and restraining forces is part of the second step.
4. Selecting and analyzing data are part of the third step.
5. Developing a plan for change is a part of step four.

Question 5

The nurse manager is facing resistance to change from many staff nurses. Why should the manager work hard to address this resistance?
A) Resistance will keep the change from occurring at all.
B) Resistance from the late majority can keep others from accepting the change.
C) Resistance can negatively impact future client care.
D) Resistance allows others to take power from managers.

Accepted Answer

1. Resistance generally does not completely prevent change, but it may stall or delay it.
2. The late majority eventually does accept the change.
3. Client care is always the most important reason that nurses do what they do. If the change does not improve client care in some respect, is it worth the effort? If resisters interrupt the work of the unit or refuse to provide care as directed by the change, the quality of care may suffer.
4. Resistance is a normal part of change and does not mean that power has been diverted to the resisters.

Question 6

A nurse manager is faced with the task of introducing an unpopular change to a staff that includes several nurses who have acted as rejecters to previous changes. The manager expects resistance but hopes to identify these rejecters early in the process. The manager should be particularly alert to which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
A) "I don't care what they say; I'm not giving care that way."
B) "I don't think this is going to work, but I'll probably come around to it sooner or later."
C) "I'm not crazy about this idea, but we do need to change how we are providing care."
D) "I bet I can make it very difficult for this change to occur."
E) "It won't be so bad. I like change."

Accepted Answer

1. Rejecters often respond with active opposition.
2. This statement is characteristic of an early or late majority resister.
3. Acknowledging that change is necessary is characteristic of an early adopter.
4. Making the change more difficult is a form of sabotage, which is characteristic of a rejecter.
5. Innovators love change and thrive on it.

Question 7

A nursing supervisor has introduced a needed change in policy to the nurse managers. The managers have met maximum resistance when attempting to gain support for the change. Which options reflect valid strategies for the nurse managers? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
A) Meet with the supervisor and discuss modifications of the proposed change.
B) Slow down the change process.
C) Meet with the supervisor and suggest abandoning the change.
D) Work together to identify strategies to overcome resistance.
E) Proceed with the change.

Accepted Answer

1. Modifying the change and compromising with resisters is a valid strategy.
2. Trying to change too much too fast can escalate resistance.
3. Abandoning the change is not a viable offer, as the supervisor has indicated that change is needed.
4. Overcoming resistance is often necessary for change to occur.
5. In some cases, change must proceed despite resistance. Those who can live with the change stay, and those who cannot leave.

Question 8

A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
A) Disperse information about the change as quickly as possible.
B) Discourage any negative discussion about the change.
C) Remind staff that change is part of the healthcare environment.
D) Talk about the change in positive terms.
E) Withdraw slightly from those who oppose the change.

Accepted Answer

1. Communicating openly and honestly with those who support the change and those who oppose the change is the best strategy.
2. The pros and cons of the change should be openly discussed.
3. Change is constant in healthcare.
4. Emphasizing the positive outcomes of the change is a strategy to reduce resistance.
5. The nurse manager should maintain support for and confidence in all staff.

Question 9

Which statements by a hospital executive reflect power-coercive strategies to implement change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
A) "We must follow the federal guidelines in the way we bill for our services."
B) "If we don't reduce our nosocomial infection rate, Medicare won't reimburse us."
C) "Administration has to make this change or our accreditation status will be at risk."
D) "This change is the only logical action we can take."
E) "All our sister institutions in the association have already made this change."

Accepted Answer

1. Power-coercive strategies are based on the application of power by a legitimate authority-in this case, the federal government.
2. Power-coercive strategies are based on the application of power by a legitimate authority-in this case, Medicare.
3. Power-coercive strategies are based on the application of power by a legitimate authority-in this case, the accrediting body.
4. The empirical-rational model of change focuses on logical actions.
5. Normative-reeducative strategies rest on the assumption that people act in accordance with social norms and values.

Question 10

The Institute of Medicine (IOM), has made recommendations for the nursing profession in its report "The future of nursing: Leading change, advancing health." Which recommendations will help nurses lead change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
A) Engage in lifelong learning
B) Remove scope of Practice barriers
C) Implement nurse residency programs
D) Change the structure of the organization
E) Lead change to advance health

Accepted Answer

1. Engaging in lifelong learning is an IOM recommendation that will help nursing lead change.
2. Removing scope of Practice barriers is an IOM recommendation that will help nursing lead change.
3. Implementing nurse residency programs is an IOM recommendation that will help nursing lead change.
4. Changing the structure of the organization is not an IOM recommendation that will help nursing lead change.
5. Leading change to advance health is an IOM recommendation that will help nursing lead change.

Question 11

The nurse manager has determined that changes are necessary in the way holiday shifts are assigned. When assessing the political climate surrounding this potential change, the nurse manager would ask which questions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
A) Who is in control of the way holiday shifts are being assigned?
B) What communication technology is available to distribute information about the change in holiday shift assignments?
C) Who will lose when holiday shift assignments are changed?
D) Will changing holiday shift assignments affect the budget?
E) Who is benefiting the most from the way holiday shifts are currently assigned?

Accepted Answer

1. It is important to identify who is in control of the way things are being done currently.
2. Communication technology may be helpful in completing the change but is not assessed as part of the political climate surrounding the change.
3. Early knowledge of who will lose in the change is essential to preparation.
4. Costs and benefits of the change should be assessed but are not a part of the political climate.
5. Political climate involves power, benefits, and losses.

Question 12

The staff is transitioning to a major change in the provision of nursing care in a large hospital. Which behaviors should the nurse manager watch for that would indicate possible problems? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
A) Nurses are discussing the change at breaks and meals.
B) Nurses are doing both the old work and the new work.
C) A nurse says, "I guess everything we've done for years is wrong."
D) The provision of care with the new system takes longer than expected.
E) Nurses are doing parts of the old procedure and parts of the new procedure.

Accepted Answer

1. It is natural that the staff would discuss the change and its implications.
2. Adding the new work to the old work is a sign that the transition is not healthy.
3. This attitude is a sign that the transition is not healthy.
4. It is natural for the transition to a new process to take time. The nurse manager should be on the alert if this continues.
5. Making individual decisions about what parts of the old method to retain and what parts of the new method to adopt is a sign that the transition is not healthy.

Quiz 5: Initiating and Managing Change

The nurse manager is facilitating change to a new documentation system in the unit. If the manager wants to use the most common method to overcome resistance to the change, which strategy would be chosen?

Hospital administration is working with a university school of nursing to establish a nursing residency program. Why is this a desired action?

A nurse leader is contemplating change on the unit. Which is the first step in the change process?

The nurse manager is facing resistance to change from many staff nurses. Why should the manager work hard to address this resistance?

A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Which statements by a hospital executive reflect power-coercive strategies to implement change? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.