Grohar-Murray TIF
Chapter 13: Managing Change
Learning Objective 1
Explain the theoretical perspective of change.
1. The nurse managers are meeting with the nurse supervisor to discuss unit-specific and
organization issues. Which of the following statements by a nurse manager is the most
accurate description of a nonlinear change?
1. “My nurses were having a lot of trouble with the new system to clock in and out
until we talked to the nurse educator.”
2. “We knew the surgeons would have to stop ordering those specific types of
dressing changes when the supplies ran out.”
3. “I understand that the administrators had to make the decision for us to use this
new product to shampoo the clients’ hair after the recall of our old product.”
4. “I’m not even really sure when it first occurred, but the nurses started doing
bedside shift change reporting, and it’s working out really well.”
Nursing Process: Implementation
Category of Client Need: Safe, Effective Care Environment
Cognitive Level: Application
2. The health care organization has decided to begin using a new computerized
documentation system. The nurse manager’s unit has been selected to pilot the new
documentation system. Which of the following staff nurse’s responses might be expected
during the initial phase of the pilot? Select all that apply.
1. “If you use this screen for your neurological assessment, you won’t have to go
to that other screen to document the Glasgow Coma Scale assessment.”
2. “I’m excited about this. I think it’s going to be a much better way to
document.”
3. “This doesn’t work as well as our old system.”
4. “So, is it really faster for you? I feel like it’s taking me a longer time to get my
assessment documented.”
5. “Maybe we could keep the old system in place as a backup until we get the
new system going well.”
Learning Objective 2
List the strategies used in the planned change process.
3. The nurse manager stated that anyone who continues to use the old paper system for
documentation will be required to come in to help with the hospital-based fundraiser on
their weekend off of work. Which of the following planned change strategies is the nurse
manager most likely attempting to use?
1. Normative-reeducative strategy
2. Nonintervention
3. Empirical-rational strategy
4. Power-coercive strategy
4. The health care organization has instituted a major change regarding a hospital policy.
During a discussion with the nurse staff members, the nurse manager is fielding many
questions and comments regarding the change. Which of the following questions or
comments are examples of a psychological-emotional objection to the change? Select all
that apply.
1. “I think this approach is far too liberal for my political views. We can’t take
care of everyone free of charge.”
2. “It is going to take a long time to adjust to these new changes, and a lot of
extra effort to get this going.”
3. “I can’t cope with all of these changes. It seems like we’ve changed some
policy or procedure every 2 months.”
4. “How do you know this way is going to be better? We’ve been doing it the
other way for 22 years, and it has worked well, in my opinion.”
5. “The cost to the hospital to implement this program must be really high. How
can you ensure that this change will be beneficial?”
5. Computerized charting will be initiated on selected units of the hospital. Orientation to
the new system will be provided by a team of nurses educated about nursing informatics.
Which of the following strategies for change is the hospital most likely using to bring
about change?
1. Empirical-rational
2. Power-coercive
3. Normative-reeducative
4. Radical intervention
Learning Objective 3
Identify the internal and external basis of change in nursing.
6. During a meeting among the physicians at the hospital, the physicians discussed
altering medication administration time schedules to better meet the needs of the
pharmacy department. Which of the following responses best articulates the nurse
manager’s independent role as related to the PERM complex?
1. “I need to prepare the students under my supervision for the upcoming
changes.”
2. “I would be happy to talk to the physicians about some ways to perform
research regarding this change.”
3. “I will meet with the physicians regarding the way this might alter client
care.”
4. “I need to know more about why this is happening so I can share the
information with the staff.”
7. During a discussion among hospital supervisors, changes are being considered. Which
of the following responses is an example of an internal force for change?
1. “We’re finding that the client acuity level in the Progressive Care Unit has
increased dramatically over the last year.”
2. “The amount of money that is being reimbursed by Medicare for knee
replacement surgery has decreased $250 over the last 2 years.”
3. “The number of people residing in this area who are at or below poverty level has
increased to 32%.”
4. “The local community college lost its accreditation by the National League of
Nursing again, and is dismantling its nursing program.”
8. The nurse manager is meeting with staff members. Which of the following responses
by a staff member is an example of an external force for change?
1. “This new computerized documentation system that we’re using is so much more
efficient than the old way.”
2. “I learned that the health care insurance companies are paying $100 less than they
were a year ago for clients with a DRG of pneumonia.”
3. “This new product the hospital adopted makes ostomy appliance changes a lot
easier.”
4. “Ever since we opened that new surgical unit, our client acuity levels are
decreasing on this unit.”
9. A new chairperson of the Nursing Department has been appointed, and plans to
institute new programs for faculty development based on innovative teaching strategies.
Rank the following actions by the new chairperson in order of occurrence according to
the process of change.
____ Reinforce the efforts of faculty as they use new teaching strategies.
____ Monitor quality of process and outcome achievement following the change.
____ Request assistance from faculty to develop a plan for implementation of new
teaching strategies.
____ Provide an adequate period of time to educate faculty regarding new teaching
strategies prior to implementation.
____ Include active participation from the staff to identify problems related to current
teaching strategies.
Answer:
10. The health care organization is canceling its contract with the company that provided
all of the IV pumps due to staff members’ complaints about the quality of the product. A
new IV pump is needed. Which of the following is the best way to initiate the change to a
new IV pump?
1. Administrators should decide which IV pump is the most cost-effective for the
organization.
2. Vendors who provide IV pumps to hospitals should be contacted to provide
the nursing staff members with an opportunity to explore their options.
3. The old IV pumps should be maintained to keep them operating for as long as
possible until they do not work anymore and a new IV pump must be
implemented.
4. The nurse supervisor must gain support for the change to a new IV pump.
11. The nurse manager is planning to initiate new policies in the department. Which of
the following behaviors is associated with the moving stage? Select all that apply.
1. The staff members identify feasible solutions to the problem.
2. The nurse manager shares information with the staff about why a change is
needed.
3. The nursing manager identifies staff members who might be allies during the
change process.
4. The process change is piloted on the night shift.
5. The new behaviors have been internalized by staff members on all shifts.
12. The nurse supervisor determined that the nurse managers were not communicating
effectively with each other. Which of the following actions would be included in the final
refreezing stage of the change process?
1. The nurse supervisor continues to monitor the nurse managers’
communication techniques and how well they continue to implement the
changes that have been made.
2. The nurse managers and the nurse supervisor meet to discuss how their poor
communication techniques might be affecting the organization and other staff
members.
3. The nurse supervisor identifies several nurse managers who are acting
defensively towards the nurse supervisor.
4. The nurse managers brainstorm about many ways the problem could be
solved. Feasible solutions are identified.
Learning Objective 6
Describe the skills of the change agent.
13. The nurse manager believes that the nurses who work in the department are working
overtime more often than necessary. Which of the following steps by the nurse manager
has the highest priority when preparing for change?
1. Develop a list of interventions to implement to reduce overtime paid to staff
members.
2. Develop a list of allies to assist with the change process.
3. Attempt to minimize anxiety related to the change process.
4. Collect and analyze data surrounding overtime and client acuity levels.
Learning Objective 7
Identify strategies to improve responses to change.
14. The organization is in the process of change. A new product that is being used to help
bathe the clients has been implemented. Which of the following statements by the nurse
manager are reflective of the best ways to assist the staff members during the process of
change? Select all that apply.
1. “Let me talk to the vendor and see if they can come and talk to us about the
best way to use this lotion with the product.”
2. “Remember, we decided to use this product because our clients were reporting
that their skin was drying out with our old way of bathing them.”
3. “I’m sorry, but you cannot use the old product on the client.”
4. “Let’s all meet in the conference room after this shift to see how the change is
going.”
5. “After this change, I’m not making you guys change anything for a long
time.”
Learning Objective 8
Describe the role of evaluation in the change process.
15. Due to time constraints, the nurse manager has not adequately monitored for quality
improvement following the recent organization-wide change to a new patient-controlled
analgesic pump. Which of the following responses by the staff nurses can be expected?
1. “The change to the new PCA pumps is really going well.”
2. “I can’t get anyone to tell me how to clear the pump without going through
five different steps. It seems to take forever.”
3. “It sounds like the change is costing the organization a lot less money to rent
the pumps.”
4. “The nurse manager said that the new pumps are saving the nurses an average
of 7 minutes throughout their day.”
