DNP/730 Week 6: Change Management and Resistance, sample paper

"We Tried This Two Years Ago": Treating Resistance to a Morning Discharge Change as Information, Building Readiness and Measuring Who Is Predisposed to Resist

[Student Name]

University of Phoenix

DNP/730: Organizational and Systems Leadership

Week 6 Assignment

[Instructor Name]

[Date]

The units and scenario are composites written for a model paper.

After success on 5 East, I introduced morning discharge changes to 5 West. At the first staff meeting, a senior nurse said, "We tried this two years ago. It lasted a month." Others nodded. Last week, a charge nurse let the afternoon huddle lapse three days in a row. This paper examines resistance and readiness on 5 West and plans a response.

Readiness as a Shared State

Weiner (2009) proposed a theory of organizational readiness for change, treating readiness as something a group holds together, made of two parts: resolve to carry the change out, which he calls change commitment, and shared belief that the group can manage it, which he calls change efficacy. Commitment depends on change valence, how much members value the change, for whatever reasons. Efficacy depends on members' informational assessment of task demands, resource availability and situational factors. He suggests there is no single best way to increase readiness.

Assessing 5 West

Using Weiner's constructs, I asked staff in two small-group sessions how much they valued morning discharges and how confident they were that the unit could achieve them. Valence was mixed: some valued relief for the emergency department; others saw no benefit to themselves. Efficacy was low: staff cited short staffing on day shift, no protected time for the huddle and doubt that hospitalists would change rounding.

Resistance: The Rest of the Story

Ford et al. (2008) argue that resistance is often portrayed as an irrational reaction located in change recipients, but that change agents contribute to it through broken agreements and violations of trust, communication breakdowns and resistance to resistance, meaning failure to listen to objections. They propose that resistance can be a resource, since recipients' concerns can improve the change and engagement with objections can build commitment.

The nurse who said "we tried this" was not refusing; she was reporting that the last leader broke a promise.

What the Resistance Reveals

Interpreting 5 West's reactions through Ford et al. (2008), the resistance reflects a broken agreement: two years ago, a director promised protected time for discharge planning and then withdrew it when census rose. It also reflects communication breakdown: 5 West learned of the 5 East pilot through rumor. The lapsed huddle reflects a real resource problem, since the charge nurse had four patients herself.

Signs of Growing Readiness

Within three weeks of the trust-repair meeting, two nurses volunteered for the working group and the lapsed huddle ran five days in a row. These behaviors, more than survey scores, show commitment and efficacy rising on a unit that had every reason to doubt the change.

Individual Dispositions

Oreg (2003) developed a scale measuring dispositional resistance to change, with four factors: routine seeking, emotional reaction to imposed change, cognitive rigidity and short-term focus, and showed that it predicts reactions to specific changes. Individuals differ in how they respond to change regardless of its merits. On 5 West, a few staff scored high on emotional reaction to imposed change when I used a brief version anonymously, which suggests that how the change is introduced matters more than its content.

Readiness Differs by Role

Hospitalists on 5 West showed higher commitment than nurses, because they felt pressure from emergency department colleagues. Case managers showed low efficacy, citing insurer delays. Readiness is shared but uneven, and responses must be tailored to each group rather than applied uniformly.

Responding to Valence

To raise valence, I will connect the change to what 5 West staff value: less afternoon chaos when discharges and admissions collide, and a shift in workload that makes afternoons calmer. I will share data from 5 East showing that afternoon admissions spread more evenly after the change.

Responding to Efficacy

To raise efficacy, I will address resources directly: the charge nurse will carry no patients from 2:30 to 3:30 p.m. for the huddle, funded by adjusting the staffing grid; a hospitalist champion assigned to 5 West will agree to see identified discharges first; and a 5 East charge nurse will coach 5 West for two weeks.

Repairing Trust

Acknowledging the broken agreement openly matters. At the next staff meeting, I will say that a previous commitment was not kept, explain what is different now and put the protected huddle time in writing with a review date. Ford et al. (2008) identify broken agreements as a driver of resistance; repairing them addresses the cause.

Inviting Objections

Rather than resisting resistance, I will hold a session asking, "What would make this fail here?" and record every answer. Staff raised the Monday surge of weekend admissions, which 5 East had not faced; the team will test a different huddle time on Sundays.

Addressing Workload Fears

Several nurses feared that morning discharges would add work to already heavy mornings. Data from 5 East showed that total work did not increase; it shifted from afternoons, when admissions arrived, to mornings, when fewer admissions came. Sharing this concretely addresses a fear that general reassurance would not.

Reducing Imposition

For staff high in emotional reaction to imposed change, the change will be co-designed. The unit's own team will run PDSA cycles, adapting 5 East's changes rather than adopting them wholesale.

Communication Plan

Communication breakdown fueled resistance before. Every change on 5 West will be announced first at the unit's own staff meeting, not by email or rumor. A weekly one-page update will describe what was tested, what was learned and what comes next, posted in the break room and sent to all staff, including night and weekend nurses.

Early Wins

Readiness grows with success. The team will choose a first test likely to succeed and visible to staff, such as evening prescription filling, which removes a frustration nurses already feel. An early win raises efficacy before harder changes, like rounding order, are attempted.

Engaging Informal Leaders

The senior nurse who said "we tried this" is respected on 5 West. I will ask her to join the working group, precisely because she remembers what went wrong. Informal leaders who move from skepticism to ownership carry colleagues with them.

When Resistance Is Right

Some resistance may reveal real flaws. If staff demonstrate that the huddle cannot work on weekends, the design must change. Treating resistance as information means being willing to change the plan, not just the messaging.

Monitoring Readiness

I will repeat the brief readiness questions at one and three months and track huddle completion as a behavioral sign of commitment.

Conclusion

Resistance on 5 West reflects low change efficacy, mixed valence, a broken agreement and communication gaps, along with some staff predisposed to react against imposed change. Using a theory of readiness, a view of resistance as information and a measure of dispositional resistance, the plan raises valence and efficacy, repairs trust, invites objections and lets staff shape the change.

References

Ford, J. D., Ford, L. W., & D'Amelio, A. (2008). Resistance to change: The rest of the story. Academy of Management Review, 33(2), 362-377. https://doi.org/10.5465/amr.2008.31193235

Oreg, S. (2003). Resistance to change: Developing an individual differences measure. Journal of Applied Psychology, 88(4), 680-693. https://doi.org/10.1037/0021-9010.88.4.680

Weiner, B. J. (2009). A theory of organizational readiness for change. Implementation Science, 4, Article 67. https://doi.org/10.1186/1748-5908-4-67