Grief, Fear and a Petition With 2,300 Signatures: Understanding Resistance to a Pediatric Unit Closure and the Nurse Leader's Role in the Transition
[Student Name]
University of Phoenix
NSG/557: Organizational Dynamics and Systems Thinking
Week 5 Assignment
[Instructor Name]
[Date]
The hospital, its people and all events are a composite written for a model paper.
In Week 4, the hospital chose Kotter's eight stages with Bridges's transition model to guide the closure of its 14-bed pediatric inpatient unit and its replacement with a short-stay unit, a regional partnership and pediatric readiness nurse roles. Six weeks after the decision was shared, resistance is visible from several directions. As the director of women's and children's services, I am responsible for leading nurses through the change. This paper analyzes the resistance and the responses.
Resistance as Information
Resistance is often treated as an obstacle to overcome. A more useful view treats it as information about what people are losing, fearing or seeing that leaders have missed. Bridges (2009) argues that people resist not the change itself but the losses it brings, and that transitions begin with endings that must be acknowledged. The question for a nurse leader is not how to stop resistance but what each form of it is telling her.
Pediatric Nurses: Grief and Identity
Nineteen nurses work on the pediatric unit. Some cried at the staff meeting where the decision was shared; others were silent. Three have resigned for the children's hospital. In conversations, nurses said they were losing "our unit, our team and the kind of nursing we chose." The source of this resistance is loss of identity and community, the cultural assumption identified in Week 2 that pediatric nursing is a distinct specialty.
Response: acknowledge the loss directly and repeatedly; offer every pediatric nurse a choice among the new pediatric readiness roles, the short-stay unit, a rotation at the children's hospital through the partnership or another unit, with a guaranteed position; involve the senior pediatric nurses in designing the new roles; and plan a closing event where staff and former patients' families can mark what the unit meant. Bridges (2009) describes such rituals as a way to help people let go.
Emergency Nurses: Fear of Workload and Safety
Emergency nurses fear that every pediatric admission will now wait in their department for hours during transfer, with children they feel less prepared to care for. The source is realistic concern about workload and competence, supported by the Week 3 analysis showing that closure could increase pediatric boarding.
Response: take the concern seriously as a safety issue; commit to specific safeguards before closure, including pediatric readiness nurses on every shift, pediatric competency training for all emergency nurses and a transfer agreement setting target transfer times; and measure pediatric boarding time from the first day, reporting it to emergency staff monthly.
The Community Pediatrician: Loss of Control and Access
The senior community pediatrician publicly opposed the closure, arguing that families without cars would be forced to travel 70 miles. The source combines a real access concern with loss of control over his patients' care.
Response: meet with him personally; invite him to chair the group writing the short-stay admission criteria, giving him influence over which children stay locally; and ask him to help design a family transportation and lodging assistance program with the children's hospital's family services. His concern about access is valid and improves the plan.
Families and the Community: Loss of a Symbol
A petition to save the unit gathered 2,300 signatures, and the local newspaper ran a front-page story. The source is the unit's symbolic meaning, the donor plaque and mural, and the value of care close to home.
Response: hold community forums with the hospital president, the community pediatrician and a children's hospital physician, explaining what will stay local and what will change; publish the transfer and family support arrangements; ask the donor family's permission to move the plaque and mural to the new short-stay unit; and report back to the community at three and six months.
The Nurse Leader's Role
Kotter (2012) emphasizes the guiding coalition and communication; for the nurse leader, the most demanding part of the role is personal. Four practices guided mine. Be present: I spent time on the pediatric unit on every shift, including nights, during the first month after the announcement. Be honest: I did not promise that nothing would be lost or that every nurse would be happy in the new roles. Listen before explaining: in each conversation I asked what people were worried about before describing the plan. And take care of myself and my managers: leading through a closure is emotionally heavy, and the chief nursing officer and I met weekly to debrief.
Why Culture Made Resistance Predictable
The resistance was predictable from the cultural analysis in Week 2. Schein (2010) describes basic underlying assumptions as beliefs so taken for granted that challenging them causes anxiety and defensiveness. The assumptions that the hospital should provide everything locally, that system decisions come from people who do not understand the community and that pediatric nursing is a distinct specialty were all challenged at once. Knowing this in advance allowed the leadership team to plan acknowledgment and involvement rather than be surprised by the intensity of the response.
Resistance Within Leadership
Resistance was not only on the front line. Two members of the hospital's leadership team privately opposed the closure and were slow to support it in their own departments. The chief nursing officer addressed this directly, asking each to state their concerns in the guiding coalition rather than outside it. One concern, that the maternity unit would lose pediatric support, was valid and led to readiness nurse coverage for the maternity unit.
Timing
The six months between decision and closure were planned to allow grief, questions and preparation. A shorter timeline would have saved money but deepened resistance; a longer one would have prolonged uncertainty and lost more nurses.
What Changed Because of Resistance
Resistance improved the plan. Emergency nurses' concern led to readiness nurses on every shift rather than only days. The pediatrician's concern led to a family transportation program. Pediatric nurses' input shaped the readiness role to include teaching emergency and maternity staff, preserving their identity as pediatric experts.
Measuring Whether Resistance Eased
The leadership team tracked signs of the transition: resignations, sick calls on the pediatric unit, questions raised at forums and the tone of the community's response. Resignations stopped after the job choices were announced, and the petition group agreed to meet with leaders.
A Lesson for Future Changes
The main lesson is that resistance was most intense where loss was least acknowledged at first. When leaders named the loss, resistance softened into questions that could be answered.
Conclusion
Resistance to the closure came from grief among pediatric nurses, fear of workload among emergency nurses, loss of control and access concerns from a pediatrician and loss of a symbol for the community. Each source called for a different response: acknowledgment and choice, safeguards and measurement, influence and partnership, transparency and respect for symbols. The nurse leader's role was to listen, respond to each source honestly and let resistance improve the change.
References
Bridges, W. (2009). Managing transitions: Making the most of change (3rd ed.). Da Capo Press.
Kotter, J. P. (2012). Leading change. Harvard Business Review Press.
Schein, E. H. (2010). Organizational culture and leadership (4th ed.). Jossey-Bass.
How this NSG 557 Week 5 example is structured
The NSG/557 description addresses the role of the nurse leader during organizational change. This paper treats resistance as information: it analyzes each group's resistance by its source, matches responses to sources rather than applying one approach to everyone and closes with the leader's own conduct, since a leader's behavior during a painful change shapes how it is received. Students search this week as NSG 557 Week 5, NSG557 Wk 5 or NSG/557 Wk 5; all three are the same assignment.
NSG/557 Week 5 questions, answered
What does NSG/557 Week 5 usually ask for?
The course description addresses the role of the nurse leader during organizational change. Many sections ask students to analyze resistance to a change and describe how a nurse leader would respond.
Is resistance to change always a problem?
No. Resistance often signals a real concern, such as a safety risk or a loss that has not been acknowledged. Treating it as information can improve a change.
How should a nurse leader respond to grief in a change?
By acknowledging the loss openly, giving people time and ways to mark the ending, being honest about what will happen and involving them in shaping what comes next.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official University of Phoenix document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.