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Finkelman, Leadership and Management for Nurses: Core Competencies for Quality
Care, 3rd edition.
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Chapter 3: Change and Decision Making
LEARNING OUTCOMES AND SUGGESTED CLASSROOM AND CLINICAL
ACTIVITIES
LEARNING OUTCOME 1
Examine the implications of The Future of Nursing; Leading Change, Advancing Health.
Suggestions and Strategies for Classroom Experience
• Ask students to review The Future of Nursing report available online through the
LEARNING OUTCOME 2
Discuss critical nursing issues related to reengineering, redesigning, re-regulating,
rightsizing, and restructuring.
Suggestions and Strategies for Classroom Experience
• Ask students to identify examples for each of the five R’s from literature and
clinical experience.
Suggestions and Strategies for Clinical Experience
• Students could develop a survey by using healthcare concerns identified by the
Institute of Medicine. This survey could then be given to practicing nurses in
LEARNING OUTCOME 3
Explain why the concept of change is important in the healthcare environment and to
nursing leadership and management.
Suggestions and Strategies for Classroom Experience
Finkelman, Leadership and Management for Nurses: Core Competencies for Quality
Care, 3rd edition.
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Suggestions and Strategies for Clinical Experience
• Students can be asked to identify a change that they observed in clinical and to
LEARNING OUTCOME 4
Assess the external trends and factors that impact nursing practice and healthcare
organizations.
Suggestions and Strategies for Classroom Experience
• Select one external factor and discuss the impact it has on delivery and change
within the system.
Suggestions and Strategies for Clinical Experience
• Ask students how external trends might impact their patients.
LEARNING OUTCOME 5
Compare and contrast two key change theories.
Suggestions and Strategies for Classroom Experience
• Divide students into teams to identify a change experience that some or all of the
students have experienced (might not be related to nursing courses), and then
Suggestions and Strategies for Clinical Experience
• In post-conference discuss the implication of change on the unit and patient care
based on the theories.
LEARNING OUTCOME 6
Apply eight key steps in the change process.
Suggestions and Strategies for Classroom Experience
• Assign an example of a change (e.g., new procedure or policy, use of new
equipment, introduction of a clinical nurse specialist on a unit, etc.) to a team.
Finkelman, Leadership and Management for Nurses: Core Competencies for Quality
Care, 3rd edition.
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3
Suggestions and Strategies for Clinical Experience
• Ask the nurse manager to discuss how the manager implements change on the
unit. How does this compare to the eight steps?
LEARNING OUTCOME 7
Analyze the issue of resistance to change and strategies for overcoming this resistance.
Suggestions and Strategies for Classroom Experience
Suggestions and Strategies for Clinical Experience
• Discuss in clinical conference how resistance to change might apply to a patient
LEARNING OUTCOME 8
Develop strategies to improve responses to change.
Suggestions and Strategies for Classroom Experience
• Ask students to select one of the coping guidelines identified in Box 3-3, and
explain why it is important.
Suggestions and Strategies for Clinical Experience
• Ask the nurse manager to discuss his experiences with change on the unit with
students in a clinical conference.
LEARNING OUTCOME 9
Apply the decision-making process.
Suggestions and Strategies for Classroom Experience
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• Ask students how they would describe themselves as decision makers. This can
be done as a written or verbal exercise.
Suggestions and Strategies for Clinical Experience
• Ask students to explain how they use critical thinking in their clinical practice.
• Students can identify decisions that are made by RNs (staff, team leader, nurse
manager), LPNs, and UAPs. What are the differences?
LEARNING OUTCOME 10
Critique the keys to successful strategic and operational planning.
Suggestions and Strategies for Classroom Experience
• Ask students to provide examples of the four types of thinking identified as
relevant to new thinking.
Suggestions and Strategies for Clinical Experience
LEARNING OUTCOME 11
Distinguish between strategic and project planning.
Suggestions and Strategies for Classroom Experience
• Ask students for examples of when they experienced or observed poor planning.
What happened?
Suggestions and Strategies for Clinical Experience
KEY CHAPTER CONCEPTS
1. The Future of Nursing; Leading Change, Advancing Health report has had a major
impact on the profession of nursing. Recommendations include education and practice
2. The five R’s of change in nursing are reengineering the healthcare organization,
3. The IOM discusses reengineering in health care; the goal is to make patient care
4. Redesigning the workforce has been a critical method for adjusting how work is done.
5. Re-regulating goes hand-in-hand with many of the changes to ensure that licensure
requirements support changes. Telenursing is one example that has required a new
6. Rightsizing has caused stress for the nursing profession. Rightsizing focuses on how
many staff members are required to do the job, suggesting that the healthcare
7. Restructuring education must be related to the changes that occur as a result of
9. Change disturbs equilibrium. Each staff member and nurse manager needs to
10. Each nurse is presented with opportunities to be a change agent, but these
11. There are many external factors that affect nursing practice, such as healthcare
legislation, accreditation, economics and reimbursement, and technology. External
12. There are many theories about change. Two key change theories are Lewin’s theory
and Quinn’s theory.
Finkelman, Leadership and Management for Nurses: Core Competencies for Quality
Care, 3rd edition.
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14. Quinn’s theory emphasizes that organizations that accept the status quo can
experience a “slow death,” and that organizations that take on change engage in “deep
15. Eight-step process for leading organizational change: creating a sense of urgency;
creating a guiding coalition and mobilizing commitment to the process; developing and
16. Progress requires readiness: staff that is willing to take on the challenge of change;
18. Resistance most commonly is due to lack of staff input and participation, and due to
the experience of loss. Change typically means someone will need to give up something
19. Resistance should be viewed as a motivator to make the message clearer and to use
20. Planning for resistance needs to be included whenever change will occur. Employees
21. When change is addressed and strategies are developed to respond to change, factors
22. Guidelines for coping with change focus on creativity, willingness to look at different
23. Change agents/coaches look for opportunities to improve, which means changing and
initiating adaptive work, or figuring out the best way to adapt how work is done and still
24. Nurses use decisions in a variety of situations and frequency. Changes in the
25. There are a variety of decision-making styles.
27. The key steps in decision making are to recognize and define the problem, gather
28. Critical thinking is important in effective decision-making (see Box 3-2).
30. Critical questions to ask during decision making consider the issue or problem, facts,
31. Decision-making conditions consider who is responsible for making a decision, her
comfort level with making a decision, and her competency in making decisions.
32. Data collection and analysis of data are important parts of making decisions, and
34. Examples of decision-making processes, tools, and methods are gap analysis, cost-
benefit analysis, PDSA Cycle, and Deep Dive Process.
36. A plan is a future vision that is best arrived at by staff participation and that requires
multiple decisions.
37. Strategic planning focuses on long-term needs and goals of the organization. It
38. Project planning focuses on operations or getting the work done. Typically, it focuses
on one aspect of the work—for example, a change in documentation, development of a
40. Planning should include SWOT, teams, and proactive leadership.
APPLYING LEADERSHIP AND MANAGEMENT
BSN and Master’s Essentials: Application to Content
Chapter identifies which Essentials apply to the chapter content. This information is
primarily for the instructor, but students should understand how these nursing education
to apply content and be creative in how they accomplish this. Students should maintain a
record of their work per chapter and build on previous responses from one chapter of My
Hospital Unit experience to the next.
Applying AONE Competencies
The AONE competencies for nurse leaders are found in Appendix A. Ask students to
Chapter Features: Case Study and Applying Evidence-Based Practice
The Chapter Features: Case Study and Applying Evidence-Based Practice features may
ADDITIONAL CASE
This case is not found in the textbook. It may be used for individual or team assignments:
written assignment and classroom or online team discussions. It may also be used as an
essay question for exams.
Case:
The Chief Nursing Officer is leading her weekly nurse manager meeting; the major
Questions:
1. What is the difference in a strategic plan and an operational plan?
2. Who is primarily responsible for developing each of these types of plans?
3. How does the operational plan relate to evaluation?
4. What should you include in an operational plan?
5. What is the role of staff in developing the operational plan?
