Essentials of Nursing Leadership and Management, 5th Edition

106 unit 2 | Working Within the Organization

committee recognized that this objection was based

on technical concerns and requested a study of

the evidence before instituting the change. “It’s

important to investigate the evidence supporting a

proposed change thoroughly before recommending

it,” she said.

A change may provide resistance for practical rea-
sons. For example, if the bar codes on patients’ arm-
bands are difficult to scan, nurses may develop a
way to work around this safety feature by taping a
duplicate armband to the bed or to a clipboard
(Englebright & Franklin, 2005), defeating the
purpose of instituting electronically monitored
medication administration.

Psychosocial Needs

Change often creates anxiety, much of it related to
what people fear they might lose (Berman-Rubera,
2008; Johnston, 2008). According to Maslow
(1970), human beings have a hierarchy of needs,
from the basic physiological needs for oxygen, flu-
ids, and nutrients to the higher-order needs
for belonging, self-esteem, and self-actualization
(Fig. 8.2). Maslow observed that the more basic

needs (those lower on the hierarchy) must be at

least partially met before a person is motivated to

seek fulfillment of the higher-order needs.

Change may make it more difficult for a person

to meet any or all of his or her needs. It may

threaten the powerful safety and security needs that

Maslow discussed (Hunter, 2004). For example, if a

massive downsizing occurs and a person’s job is

eliminated, fulfillment of all of these levels of needs

may be threatened, from having enough money to

pay for food and shelter to opportunities to fulfill

one’s career potential.

In other cases, the threat is subtler and may be

harder to anticipate. For example, an institution-wide

reevaluation of the effectiveness of the advanced

practice role would be a great concern to a staff nurse

who is working toward accomplishing a lifelong

dream of becoming an advanced practice nurse in

oncology. In contrast, it would have little effect on

unlicensed assistive personnel (UAPs), but a staff

reorganization that moves UAP to different units

could threaten the belonging needs of those who

have close friends on the unit but few friends outside.

Position and Power

Once gained within an organization, status, power,

and influence are hard to give up. This applies to

people anywhere in the organization, not just those

at the top. For example:

A clerk in the surgical suite had been preparing the

operating room schedule for many years. Although

his supervisor was expected to review the schedule

before it was posted, she rarely did so because the clerk

was skillful in balancing the needs of various parties,

including some very demanding surgeons. When the

supervisor was transferred to another facility, her

replacement decided that she had to review the

schedules before they were posted because they were

ultimately her responsibility. The clerk became

defensive. He tried to avoid the new supervisor and

posted the schedules without her approval. This sur-

prised her. She knew the clerk was skilled and did not

think that her review of them would be threatening.

Why did this happen? The supervisor had not real-

ized the importance of this task to the clerk. The

opportunity to tell others when and where they

could perform surgery gave the clerk a feeling of

power and importance. The supervisor’s insistence

on reviewing his work reduced the importance of

his position. What seemed to the new supervisor to

Highest Level

Lowest Level

Self-actualization

Growth, development,

fulfill potential

Esteem

Self-esteem, respect,

recognition

Love and belonging

Acceptance, approval,

inclusion, friendship

Safety and security

Physical safety, trust,

stability, assistance

Physiological needs

Air, water, food, sleep,

shelter, sex, stimulation

Figure 8.2Maslow’s hierarchy of needs. (Based on
Maslow, A.H. [1970].Motivation and Personality.
N.Y.: Harper & Row.)