Any trainer or facilitator that has ever presented to a group of nurses can likely relate to feeling some resistance from them. Folded arms, scowling faces, and an unwillingness to participate or even hostile participation is not uncommon when groups of nurses gather for inservices. It is easy to understand why nurses may have a bad reputation when it comes to change management efforts. Yet understanding the resistance and making room for validation is an extremely powerful opportunity for healing and engagement.
What makes nurses angry and resistant to change?
Nurses are the biggest workforce in healthcare. Over 3 million in the USA and over 12 million worldwide. Our roles in delivering service interface with every aspect of our healthcare system. Nurses must make it through rigorous training and education to practice a profession that is extremely demanding intellectually, emotionally and physically. We must pass a difficult examination to obtain become licensed to practice and then maintain credentials through continuing education.
Despite these extremely demanding accomplishments, most nurses I know can relate to a culture shock experience from the world of academia into the world of work. Sadly, initial enthusiasm and commitment are often met with work cultures that lack respect. This can manifest in horizontal and vertical violence, unreasonable workloads, mandated overtime, relentless stress, chronic under-staffing, high rates of work-related injuries, and/or schedules that can be incompatible with raising families or having a healthy work-life balance. Additionally, nurse input in the day to day provision of care is often dismissed, ignored, and/or invalidated. Nurses work in environments where constant change impacts their work and have little control or at least little perceived control over the work they are the experts in and expected to do. Is it any wonder that resentments, mistrust and bitterness become familiar feelings among nurses and huge disconnections between frontline caregivers and management become entrenched?
Even progressive leaders who are trying to engage nurses in respectful dialogues may shake their heads in confusion as they try to empower staff, but are met with a lack of trust that presents as disengagement. Some nurses are angry, some have shut down and some have accepted being disrespected as OK. Leaving an organization may not be an option. Assertiveness may have been eroded, tentative, or never established. The skills to practice with respectful professionalism have been damaged by a complicated array of individual and organizational experiences.
There is Hope
Assuming that genuine empowerment of frontline staff is a goal, change agents can turn this resistance into engagement with a fairly simple, cost-effective, and powerful process of honesty and ownership. It is called validation! Making room for the feelings of resentments and anger by acknowledging them and allowing some time to discuss along with a clear expectation that moving on is critical. Some leaders may worry that a discussion along these lines will lead to a ranting and raving session making things worse or that a loss of power may ensue with a riotous mob of angry nurses. Being genuine about building respect, setting a time limit, and staying in charge will minimize this kind of energy.
Here’s an example of how a leader might begin a meeting:
I want to announce our organizational initiative to create a Safe Culture here at ABC Hospital. This is going to require learning, growth, and hard work from every one of us. I understand that there may be some anger or resistance from some of you because of the way you have been treated or perceived to have been treated. I know that moving on means building trust. I want you to know that you deserve to be respected. I’d like to spend a half hour now talking about some of the obstacles that you have experienced over the years.
At this juncture allow for some brainstorming where answers can be recorded and visible. Remember, you don’t have to agree or disagree, just listen. You might consider using the recorded input in a letter to staff, newsletter or poster. Don’t underestimate the power of using staff input verbatim. It is validating!
And how a leader might ensure moving on:
Thank you for your honesty. I can see we have many obstacles to overcome. I’d like to know if you are willing to work with me towards a new culture where our work is collaborative, respectful and most of all, safe for our patients? Look around the room. Make eye contact. Offer any additional support such as an Employee Assistance Program, (EAP) or open door policy, and/or pause for Q & A. Make next steps clear, look for opportunities to invite and utilize input, and get ready for an exciting new energy coming from your nurses.
Some Examples of Empowered Nurses Engaged in CHANGE
Interruption Awareness: A Nursing Minute for Patient Safety [embedplusvideo height=”281″ width=”450″ standard=”http://www.youtube.com/v/PGK9_CkhRNw?fs=1″ vars=”ytid=PGK9_CkhRNw&width=450&height=281&start=&stop=&rs=w&hd=0&autoplay=0&react=1&chapters=¬es=” id=”ep7805″ /]