Essentials of Nursing Leadership and Management, 5th Edition

chapter 8 | People and the Process of Change 107

be a very small change in routine had provoked sur-
prisingly strong resistance because it threatened the
clerk’s sense of importance and power.

Recognizing Resistance

Resistance may be activeor passive(Heller, 1998).
It is easy to recognize resistance to a change when
it is expressed directly. When a person says to you,
“That’s not a very good idea,” “I’ll quit if you
schedule me for the night shift,” or “There’s no way
I’m going to do that,” there is no doubt you are
encountering resistance. Active resistance can take
the form of outright refusal to comply, such as these
statements, writing memos that destroy the idea,
quoting existing rules that make the change diffi-
cult to implement, or encouraging others to resist.
When resistance is less direct, however, it can be
difficult to recognize unless you know what to look
for. Passive approaches usually involve avoidance:
canceling appointments to discuss implementation
of the change, being too busy to make the change,
refusing to commit to changing, agreeing to it but
doing nothing to change, and simply ignoring the
entire process as much as possible (Table 8-1).
Once resistance has been recognized, action can be
taken to lower or even eliminate it.

Lowering Resistance

A great deal can be done to lower people’s resis-
tance to change. Strategies fall into four categories:
sharing information, disconfirming currently held
beliefs, providing psychological safety, and dictat-
ing (forcing) change (Tappen, 2001).

Sharing Information

Much resistance is simply the result of misunder-
standing a proposed change. Sharing information
about the proposed change can be done on a
one-to-one basis, in group meetings, or through

written materials distributed to everyone involved

via print or electronic means.

Disconf irming Currently Held Beliefs

Disconfirming current beliefs is a primary force for

change (Schein, 2004). Providing evidence that

what people are currently doing is inadequate,

incorrect, or inefficient can increase people’s will-

ingness to change. The dramatic presentations

described in the section on receptivity disconfirm

current beliefs and practices. The following is a less

dramatic example but still persuasive:

Jolene was a little nervous when her turn came to

present information to the Safe Clinical Practice

Committee on a new enteral feeding procedure.

Committee members were very demanding: they

wanted clear, research-based information presented

in a concise manner. Opinions and generalities were

not acceptable. Jolene had prepared thoroughly and

had practiced her presentation at home until she

could speak without referring to her notes. The pre-

sentation went well. Committee members commented

on how thorough she was and on the quality of the

information presented. To her disappointment,

however, no action was taken on her proposal.

Returning to her unit, she shared her disap-

pointment with the nurse manager. Together, they

used the unfreezing-change-refreezing process as a

guide to review the presentation. The nurse manager

agreed that Jolene had thoroughly reviewed the

information on enteral feeding. The problem, she

explained, was that Jolene had not attended to the

need to unfreeze the situation. Jolene realized that

she had not put any emphasis on the high risk of

contamination and resulting gastrointestinal dis-

turbances of the procedure currently in use. She had

left members of the committee feeling comfortable

with current practice because she had not empha-

sized the risk involved in failing to change it.

At the next meeting, Jolene presented additional

information on the risks associated with the current

enteral feeding procedures. This disconf irming

evidence was persuasive. The committee accepted

her proposal to adopt the new, lower-risk procedure.

Without the addition of the disconfirming evidence,

it is likely that Jolene’s proposed change would never

have been implemented. The inertia(tendency to

remain in the same state rather than to move toward

change) exhibited by the Safe Clinical Practice

Committee is not unusual (Pearcey & Draper, 1996).

table 8-1

Resistance to Change

Active Passive

Attacking the idea Avoiding discussion

Refusing to change Ignoring the change

Arguing against the change Refusing to commit to the

change

Organizing resistance Agreeing but not acting

of other people