Deck 17: Leading Change

Question 1

As a new manager,you are shocked to learn that your unit is still using heparin in heparin locks.You are aware of evidence related to this practice and want to change this practice as quickly as possible on your unit.You are in which stage of Lewin's stages of change?

A) Unfreezing
B) Experiencing the change
C) Integrating the change
D) Refreezing

Answer 1

Unfreezing

Question 2

An example of one strategy used to improve participation in the change process by staff fitting the behavioral description of innovators and early adopters is to:

A) Repeat the benefits of the change.
B) Share change experiences early in the process.
C) Initiate frequent interactions among staff.
D) Provide select information to the staff.

Answer 2

Share change experiences early in the process.

Question 3

Which of the following would be the most effective response to Elizabeth (Question 14)?

A) "I understand how you feel, but you are going to have to change."
B) "It is unfortunate that you feel this way. Others seem quite excited about the new information."
C) "It is difficult sometimes to change what we know very well. Sometimes it can be frightening."
D) "Perhaps I can arrange some more information sessions for you, so you can see just how important this change is to patient safety."

Answer 3

"It is difficult sometimes to change what we know very well. Sometimes it can be frightening."

Question 4

Elizabeth is an example of a(n):

A) Early adopter.
B) Late adopter.
C) Laggard.
D) Resister.

Question 5

An example of one strategy to improve participation in the change process by staff fitting the behavioral descriptions of laggards,early majority,late majority,and rejectors is to:

A) Encourage teamwork.
B) Transfer to a different unit.
C) Require attendance at staff meetings.
D) Delegate the roles and tasks of change.

Question 6

The clinical coordinator expects the position description of the new wound care specialist to change nurses' responsibilities in caring for clients with skin integrity problems.The best approach to address this need for change,yet to have the best outcomes for clients,staff nurses,and the organization,is to:

A) Select one of the change models.
B) Use Lewin's model and principles of change.
C) Apply both planned and nonlinear approaches.
D) Form a task force of nursing staff and wound care specialists.

Question 7

The oncology clinic manager and the educational coordinator asked nursing staff to complete a brief written survey to assess their attitudes and knowledge related to having used the new infusion equipment for 6 weeks.The stage of change in this situation is:

A) Developing awareness.
B) Experiencing the change.
C) Integrating the change.
D) Perceiving awareness.

Question 8

After speaking with Elizabeth,a few days later,you discover that she is now fine with the change but is concerned that other areas of the organization might resist the change because of perceptions related to patient safety and cost.She suggests that it is important to bring pharmacy on board as they have had previous concerns about the use of heparin.This type of campaign is best described as:

A) Political.
B) Marketing.
C) Military.
D) Cooptation.

Question 9

When goals/outcomes are somewhat unclear in early preparation for a complex change,the manager and the change management team develop several acceptable goals/outcomes.This change in management approach is termed:

A) Unfreezing.
B) Nonlinear.
C) Cybernetic.
D) Linear.

Question 10

You follow up with Elizabeth (Question 14)and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." Your response to her indicates that:

A) Elizabeth will never adopt the change.
B) Elizabeth is insecure in her practice.
C) Elizabeth requires more information about the practice.
D) Change involves emotions rather than intellect.

Question 11

In Question 12,staff nurses who gain information on current IV therapy practices are engaging in which phase of Rogers' decision-making process?

A) Persuasion
B) Knowledge
C) Confirmation
D) Decision

Question 12

The nurse manager frequently interacts with staff and other hospice facility employees.Communication was purposeful because the manager assessed current issues,such as specific satisfactions and dissatisfactions with the newly implemented computerized documentation system.Informally,the manager gathered available staff members to address similar learning needs.Many times,staff members were found coaching other staff about improving use of the new system.According to Senge (1990),the activities demonstrated in this example are:

A) Dialogue, team learning.
B) Resilience, personal mastery.
C) Shared vision, systems thinking.
D) Mental models, teachable moments.

Question 13

The home health agency hired an expert in financial management to evaluate and propose a plan for reversing growing expenses and decreasing revenues.The expert is well respected,both personally and professionally,by members living in this small community.To be effective,staff will need to perceive this change agent as:

A) Trusted, quiet.
B) Flexible, informal.
C) Credible, legitimate.
D) Communicative, personable.

Question 14

Elizabeth,an RN with approximately 15 years of service on your unit (Question 11),walks away from one of the learning sessions on IV care,and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effect." According to Havelock (1973),this comment may originate from failure in which phase of the six phases of planned change?

A) Generating self-renewal
B) Choosing the solution
C) Diagnosing the problem
D) Building a relationship

Question 15

To engage your staff in awareness of their current practice and how it is affirmed or not by evidence,you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency.You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice.This learning approach is an example of which change management approach?

A) Linear
B) Nonlinear
C) Facilitative
D) Integrative

Question 16

To effectively achieve a change goal/outcome in a change situation,the wound care specialist will:

A) Preserve the status quo.
B) Diminish facilitators and reinforce barriers.
C) Weigh the strength of forces.
D) Strengthen facilitating forces.

Question 17

Based on Elizabeth's insights and suggestions,you involve pharmacy,only to discover that the change in practice involves practice committees,a medical practice committee,and concerns from administration about potential costs and safety of the proposed change to the IV protocols.The change process at this point is:

A) Linear.
B) Nonlinear.
C) Sabotaged.
D) Neutralized.

Question 18

The wound care nurse decided to involve those to be affected by change early in the change management process.This can positively result in:

A) Coordination.
B) Resistance.
C) Anticipation.
D) Participation.

Question 19

Complex change situations require that the change leader promote ongoing visioning among staff members.One strategy is to:

A) Consciously evaluate invisible mental models.
B) Allow for individual outcomes.
C) Encourage cooperative activities.
D) Operate between order and disorder.

Question 20

Resistance is most likely when change:

A) Is not well understood.
B) Involves many layers in an organization.
C) Involves nonprofessional workers.
D) Threatens personal security.

Question 21

As the unit manager,you spend a day performing direct patient care and work with a new system that is designed to capture patient documentation at the bedside.During discussions with staff while giving care,you discover that the number of screens that need to be opened during documentation makes charting more complex and time-consuming than traditional manual charting approaches.On the basis of this feedback,you:

A) Assume that the system is doing what it needs to do.
B) Provide reassurance to staff that the unit has achieved its goals in implementation of the system.
C) Ask some of the staff if they have had similar experiences with the system.
D) Consult chart audit data and end user consultation reports to determine if errors and problems are occurring.

Question 22

Which of the following are examples of application of the Leadership Rounding Tool?

A) "What is working well for you during bedside reporting?"
B) "What has not worked for you today?"
C) "Is there someone on your team who deserves special recognition for her efforts in the implementation?"
D) "Did you have a good vacation?"

Question 23

Sarah,RN,is one of your most enthusiastic staff and has been to a workshop on preparing educational materials for patients.On the basis of this workshop,she would like to develop an information website for patients who are being admitted to the ward.An appropriate response to Sarah's suggestion would be:

A) "That is a great suggestion, but we have no resources for such an expensive undertaking right now."
B) "Perhaps you can keep that in mind as we redesign our charting system."
C) "We have too many seniors as patients, and you know that they don't use technology."
D) "There is a great group here that meets to look at technology pilots. Let's see if you can join them and discuss your idea further."

Question 24

Edith has been vocal about her negative concerns related to a new charting system and frequently expresses the view that keeping the "old system" would have been just fine.In facilitating change,your best approach to Edith would be to:

A) Put her in the pilot planning group for the change.
B) Determine if she has considered retirement.
C) Schedule her work assignment so that it coincides with those of two staff members who are confident with technology and the change.
D) Avoid discussion of the change, and trust that with sufficient training and information, she will change.

Question 25

The situation in Question 22 is best captured in which theory of change?

A) Chaos
B) Planned change
C) Cybernetics
D) Innovation-decision process

Question 26

As the unit manager on the unit that is leading changes to heparin locks,you find that Elizabeth is very valuable in terms of her observations about other units and her knowledge of organizational processes,and now in discussing the new procedure with others.Elizabeth might be considered an:

A) Engager.
B) Innovator.
C) Informal change agent.
D) Informant.