Do your staff members cling to old patterns of working just because “we’ve always done it this way”? This chapter will assist you in facilitating their understanding of the need for all of us to acquire the competencies that help in adapting to a new workplace environment. As new rules, roles, and competencies emerge, each of us must make a choice—to move toward a new way of being, remain the same, or stick our heads in the sand. Will this situation precipitate a personal crisis or professional opportunity? The choice is ours to make! In this chapter, you will learn: 1. The impact of transitioning from the “good ol’ days” to a new way of being 2. The key competencies that will positively influence nursing practice in a changing workplace 3. Strategies to manage the new competencies Reinforcing reality is a principle we all learned in psychiatric and mental health nursing. It remains a useful tool for today’s nurse managers in helping staff understand the requirement for personal and professional change in in order to thrive in today’s practice settings. It is fair to say that many organizational changes are driven by the forces of global economics and technological advancements. Thus, they are beyond staff control. However, some staff members undoubtedly believe that all this change is the direct result of some the hare-brained scheme developed by unknown people sitting in a dark room deliberately planning ways to mess up their lives. In the past, changes in nursing practice often resulted from internal requirements to improve patient care efficiencies, quality of care, and service delivery. Today, care provision is complex, being subjected to the influence of budgets, technology, acuity levels, changing demographics, intergenerational and culturally diverse workforces, dwindling human resources, and restructuring. In a world where change is the only constant, nurses must embrace new competencies, new rules, new roles, new structures, and new opportunities whether they like it or not! Your job is to help them understand and manage these requirements. Many organizations and professional disciplines are finding themselves caught in the middle of a clash of the Ages (as in historical eras) and often, ages (as in younger versus older staff) as workplaces evolve from the hierarchical mindset and practices of the Industrial Age to the Age of Information and Technology and then to the Age of Creativity. Quite a leap in a matter of a few decades! Transitioning and adapting to a changing workplace can be particularly challenging for staff who are seniors (born before 1945) and their baby boomer colleagues (born before 1965) who spent the majority of their work lives in highly structured, top-down, command-and-control environments. The role of the nurse manager, formerly known as the head nurse, has undergone unprecedented changes over the past three decades that include changes in title, scope of leadership practice, and place within the organization. Some nurses argue that these changes and expectations have made things worse. Others can barely contain their excitement about the opportunities that come with a position that has the authority to directly influence and bring improvements in the quality of care outcomes, service delivery, nursing practice, and the direction of the organization. The following discussion provides a brief, tongue-in-cheek glimpse at the role of the head nurse in the near past (the sixties, seventies, eighties, and nineties) and concludes with an overview of the ever-evolving role of nurse/clinical/health services manager. Many nurses gaze fondly on the past, longing for the stability and perceived desirability of seemingly less complex times when the “head nurse” was always there, answered all questions related to patient care, ruled her (for the nurse was almost always female) roost with an authoritarian style of leadership, and assumed all accountability for patient care outcomes, leaving many staff nurses feeling largely unaccountable for the outcomes of their practice. Head nurses were the source, the “go-to” person, and the solution for all things nursing. They had little influence or presence in organizational decision making, their operations and budgets were decentralized to those who had little or no knowledge of the practice setting, and hiring of their staff was a function of human resources. In the not-so-distant past, the head nurse’s influence extended only as far as the job descriptions of staff allowed. These descriptions were prescriptive and numbered, with a final category of “other related duties” tacked on the end. They frequently became a bone of contention between union and management. If staff members were asked to do something not listed in their job descriptions, the response was likely to be, “That’s not in my job description, if you make me do it, I’ll grieve!” In the good ol’ days, the union would be all over the head nurse like fleas on a dog. The head nurse was silenced. More than almost anything else in those years, policy and procedure manuals influenced practice. Originally designed to guide safe practice, the manuals soon morphed into a bureaucratic monster that covered every imaginable action staff might ever have to take. Best practice guidelines did not exist. Once dutifully written—their completion heralded, read, and initialled by staff—“P & P’s,” as they were fondly termed, were quickly banished to ever-expanding bookshelves until called forth to duty as the final pronouncement of what must happen next! Taking on mythic proportions they quickly became the showcased and dust-covered tomes that many considered to be the “law” in nursing practice. If staff members were asked to perform a task or procedure that could not be found in the policy and procedure manual, they might be overheard saying, “If it isn’t written in the P & P manual, it doesn’t exist, and I won’t or can’t do that!” In the past, relationships between union and management were more adversarial and inclined to focus less on professional practice and more on wages and job preservation. The workforce was primarily homogenous with respect to gender, ethnicity, and age. Today’s nurse managers work in what Vaill (1996), aptly refers to as “white water” workplace environments, where they frequently have operational responsibility for complex and multiple practice settings and 24-hour, 365-day accountability for the delivery of safe, ethical, and competent nursing and clinical care. In addition, many are involved at the organizational and community levels, participate in special interest groups, and are researchers and presenters at national and international conferences. Written job descriptions cannot possibly cover every aspect of nursing’s full scope of practice. Rapid technological changes, delegated medical acts, and changing patient demographics make it difficult to keep job descriptions current. Because of the complexities of the practice environment and patient acuity, staff must be flexible and do whatever it takes within the bounds of their scopes of practice to safely, ethically, and competently care for patients and clients. Nursing staff’s overreliance on policy and procedure manuals must slowly go the way of dinosaurs and be replaced by technological resources, critical thinking skills of practitioners, and evidence-based practice. Because Generation Xers and Ys prefer to use technology-based resources rather than reading manuals, and want to help the environment by “saving the trees,” they may add momentum to the urgent need for ready access to information and on-line technology. The introduction of technology into the workplace, especially handheld devices, has become a large problem in almost all practice environments. It can enhance practice with rapid access to information on best practice or it can be a source of great angst among managers and patients within the context of social media. For some staff the handheld device has become a lifeline attached to a body part; one that they must regularly check to avoid withdrawal setting in! The health care workplace today is all about relationships. Adversarial relationships between unions and management are no longer productive in moving the profession forward. While many staff from the senior and boomer generations were influenced by, and benefited from the demands of unions (for better workplace conditions and pay), younger generations are less inclined to feel the need for outside organizational support in these areas. Responding to this demographic shift, progressive union and nursing management relationships today are focused less on demands for job security and pay incentives and more on professional development and learning opportunities aimed at improving quality of work life, healthy workplace relationships, professionalism, and improved care practices. FAST FACTS in a NUTSHELL 
Competencies for a Changing Workplace
Managing New Rules, New Roles
OH, THE TIMES THEY ARE A CHANGIN’
REMEMBERING THE GOOD OL’ DAYS
EXTRA! EXTRA! READ ALL ABOUT IT! PROFESSIONAL NURSING PRACTICE IN A STATE OF TRANSITION
YOU’VE COME A LONG WAY, BABY!
A BIRD’S-EYE VIEW OF THE GOOD OL’ DAYS OF NURSING MANAGEMENT
That’s Not My Job!
The Workplace How-To Policy and Procedure Manual: Instrument of the Devil?
The Union–Management Hard Line
TODAY’S NURSE MANAGERS
Bye-Bye Job Descriptions?
Policy and Procedure Manuals: Relics of the Past?
Nurse Managers and Unions: Adversaries or Collaborators?
Nurse Key
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