chapter 8 | People and the Process of Change 105Whatever alternative they chose, the nurses were
being challenged to f ind a solution that enabled them
to move into a new comfort zone. To accomplish this,
they would have to f ind a consistent, dependable
source of child care suited to their new schedule and
to the needs of their children and then refreeze their
situation. If they did not f ind a satisfactory alterna-
tive, they could remain in an unsettled state, in a
discomfort zone, caught in a conflict between their
personal and professional responsibilities.As this example illustrates, even what seems to be a
small change can greatly disturb the people
involved in it. The next section considers the many
reasons why change provokes resistance and how
change can be unsettling.
Resistance to Change
People resist change for a variety of reasons that
vary from person to person and situation to situa-
tion. You might find that one patient-care techni-
cian is delighted with an increase in responsibility,
whereas another is upset about it. Some people are
eager to risk change; others prefer the status quo
(Hansten & Washburn, 1999). Managers may find
that one change in routine provokes a storm of
protest and that another is hardly noticed Why
does this happen?
Receptivity to Change
Recognizing Different Information Processing
Styles
An interesting research study suggests that nurse
managers are more receptive to change than their
staff members (Kalisch, 2007). Nurse managers
were found to be more innovative and decisive,
whereas staff nurses preferred proven approaches,
thus being resistant to change. Nursing assistants,
unit secretaries, and licensed practical nurses were
also unreceptive to change, adding layers of people
who formed a “solid wall of resistance” to change.
Kalisch suggests that helping teams recognize their
preference for certainty (as opposed to change) will
increase their receptivity to necessary changes in
the workplace.
Speaking to People’s Feelings
Although both thinking and feeling responses to
change are important, Kotter (1999) says that the
heart of change lies in the emotions surrounding it.
He suggests that a compelling storywill increase
receptivity to a change more than a carefully
crafted analysis of the need for change. How is this
done? The following are some examples of appeals
to feelings.
■Instead of presenting statistics about the number
of people who are re-admitted due to poor dis-
charge preparation, providing a story is more per-
suasive: an older man collapsed at home the
evening after discharge because he had not been
able to control his diabetes post surgery. Trying to
break his fall, he fractured both wrists and is now
unable to return home or take care of himself.
■Even better, videotape an interview with this
man, letting him tell his story and describe
the repercussions of poor preparation for
discharge.
■Drama may also be achieved through visual
display. A culture plate of pathogens grown
from swabs of ventilator equipment and patient
room furniture is more attention-getting than an
infection control report. A display of disposables
with price tags attached used for just one surgi-
cal patient is more memorable than an account-
ing sheet listing the costs.
The purpose of these activities is to present a
compelling image that will affect people emotion-
ally, increasing their receptivity to change and
moving them into a state of readiness to change
(Kotter, 1999).Sources of Resistance
Resistance to change comes from three major
sources: technical concerns, psychosocial needs,
and threats to a person’s position and power
(Araujo Group).Technical Concerns
Some resistance to change is based on concerns
about whether the proposed change is a good idea.
The change itself may have design flaws.The Professional Practice Committee of a small hos-
pital, in order to save money, suggested replacing a
commercial mouthwash with a mixture of hydrogen
peroxide and water. A staff nurse objected to this
proposed change, saying that she had read a research
study several years ago that found peroxide solutions
to be an irritant to the oral mucosa (Tombes &
Gallucci, 1993). Fortunately, the chairperson of the