One of the advantages of good teamwork is the familiarity that team members have with one another. They know whom to call upon when they need help, a good laugh, a shoulder to cry on, or to celebrate their successes. When change is introduced, routines and staff relationships are often disrupted or severed. This chapter outlines common staff responses and offers explanations and strategies for helping staff manage what happens when the once familiar is gone. In this chapter, you will learn: 1. What happens when the former way of being must give way to the new 2. What behaviors to look for when staff is face with the end of what once was familiar 3. Tips for helping staff let go of the past The old way of being is no more! It is over. Depending on the significance of the impending change, these words can create no response, a mere ripple, or send shock waves through an organization or workplace. Even though this may be anticipated when changes affect clinical practice or workplace relationships, staff will still react. Some will be excited about the possibilities that change can bring, while others may experience disbelief, betrayal, anger, grief, loss, fear, or a combination of these responses. With the announcement of impending organizational change, well-meaning leaders invest a great deal of energy carefully crafting the message in such a way as to get staff “buy-in.” They may attempt to rally the troops with the familiar battle cry, “People, the train is leaving the station.” When staff members hear this, they will probably feel railroaded into accepting the impending change, and feelings of suspicion, anger, resistance, and powerlessness will take hold. Resistance is guaranteed. As you consider communication about change, keep in mind that verbal communication comprises only 7% of an interpersonal interaction. Therefore, staff members’ verbal responses of support to messages about change may mask underlying and unexpressed feelings. During this time, nurse managers are well advised to listen carefully to what staff is not saying, observe nonverbal actions, and be open to many fascinating reactions. When staff is overheard making the remark, “it ain’t broke,” it is a clear signal of a communication gap between the intent of the message and what is perceived. It may also reflect blame that staff members are inclined to assign when they do not see the benefit of impending change. Some nurse managers will mistakenly try to convince staff that their perceptions are wrong when they hear these comments. Sadly, all this accomplishes is to drive the comments underground, shut down communication between the manager and staff, or fuel the fires of “our manager doesn’t understand.” Depending on the amount and frequency of change staff has experienced, they may react with a high degree of cynicism. Do not be surprised. They may refer to the pronouncement as a “flavor-of-the-month” initiative. This usually indicates that staff does not see the value of the proposed change and has little faith in a successful outcome. This remark also speaks to a lack of trust in leadership. What staff may really be saying is, “I do not see the need for this change” or “I don’t have enough information” or “I don’t understand” or “I don’t trust you”—or a combination of all of these responses! This response can reflect staff’s level of awareness about what is happening in the broader organization, the timing of the message, or how the message is delivered. While a comment like this seems resistant and dismissive, it actually serves as a cue that the information received may not be what was intended or that this most recent change is no change at all in the minds of some. Some staff members have been around long enough to believe that they have “seen and done it all.” The danger lies in their potential to influence others in a negative way. How much this remark influences the peer group depends on how much power the individual has. Many staff will state that their peer group at work is like their second family. When staff groups are forced to separate due to restructuring, the loss can be so profound that the grief and anger can last for years. Anger toward management’s decision to make these changes can be intense. Some staff members have more to lose than others when the group membership is altered or disbanded. Depending on the nature of their workplace relationships, some individuals will lose real or perceived power and status. This can be threatening not only to the individual who has the power but also to group members, who may believe they have lost their informal leader. Losing more than one staff member can create a powerful grief reaction among remaining staff. When the sense of loss at work is this severe the potential for individual and group depression is very real. Change cannot successfully be absorbed until the underlying issues related to grief and loss are dealt with in a compassionate manner. Grief among staff members is experienced during real or perceived loss, and the effects can be vast. Left unmanaged, its toll becomes apparent in staff relationships. Chronically negative workplace relationships emanating from unresolved grief can result in a mindset that a replacement manager will never fill the void. Successive nurse managers may face huge resistance and staff rejection than can persist for years. Dealing with this type of anger and loss will require patience, understanding, skilful handling, and refocusing of staff members’ attention on their patients and professional practice. Many staffs have a high need for order and predictability. Not knowing what lies ahead can induce mild to severe anxiety and behaviors that reflect any number of symptoms, including decreased productivity, complaining, irritability, and increasing use of sick time. Fear of making a career-limiting move may cause some staff to become non-participative, go through the motions, or mentally “shut down.” It is safe to assume that there may be numerous real and perceived losses experienced when traditional ways of performing a task or procedure change, familiar staff are relocated, or a department is closed and a new location is opened. Loss can be associated with the threat of or actual job loss, personal or professional status (because of role or job change), peer group power dynamics, giving up the familiar, and the introduction of new equipment, processes, or care delivery. This process is a huge adjustment for all concerned, cannot be fixed quickly, and the process for integration closely rivals that of the challenges of blending families after divorce. Patience, compassion, and humor are key.
It’s Over
Managing the End of Old Ways of Being
THE TRAIN HAS LEFT THE STATION: ONE JOURNEY ENDS, ANOTHER BEGINS
BIG MISTAKE
IT’S NOT WHAT YOU HEAR, IT’S WHAT YOU DON’T HEAR THAT COUNTS
FASCINATING COMMENTS YOU MAY HEAR
1. “But It Ain’t Broke, Why Fix It?”
2. “Another Flavor of the Month”
3. “I Can’t Believe This! Where Is This Coming From?”
4. “Been There, Done That, Bought the T-Shirt.”
THINGS YOU MAY SEE
Breaking Up Is Hard to Do
When the Nurse Manager Is Downsized or Redeployed
Fear of the Unknown
Real and Perceived Loss
When Staff “Families” Blend
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