Healthcare Change Management and Workforce Retention


Organizations change can be devastating for the management and the employees as it is indicated by Welford (2007 p. 409). The environment is changing to accommodate technology and also the increasing number of patients in the new institutions being established. Many reasons form a basis for the movement of the employee. Irrespective of the reason, the nurse may rebuff moving. The management must employ different techniques to manage the resistance and ensure that the institution continues giving services to the patient (Leach, 2008). There are many factors both internal and external that cause nurses to resist change. They range from personal to career reasons.

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In the management of nursing, changes occur that make the institution redistribute the available human resource (Crist, 2006). At times it has to be done within the shortest time possible since there may be many patients who require to be given medical intervention and yet there are barriers in the language (Jones, 2006). With the intention that institutions must maintain their services no matter what reason, the leadership of the institution must manage the change by implementing a strategy (White, 2004, p 50).

To be able to manage the change, the management must understand the reasons why nurses refuse to go along with change as well as implement the ways that will help the nurses accept change with less resistance (Fahey and Burbridge, 2008). In cases where there is complete resistance, then the management must manage the resistance. This essay will point out the process of change about moving nurses between health care institutions. It will also discuss ways that the institutions can put into operation to minimize resistance when it is time to move and the way to manage the resistance.

Causes of change in the health institution that cause movement of nurses

The human resource department in every institution plays a role in developing the working environment that will determine the success of the organizational goals. They are responsible for recruiting and maintenance of employees (Welford, 2007 p. 410). Maintaining employees require innovativeness and patience together with understanding for employees to stay long. One of the factors that cause change is the transfer of experienced nurses to other institution. Experienced workers are competent besides the fact that the institution may have engaged in training programs for the employee to be effective at work. In a hospital, the nursing management or administration is responsible for the staffing of nurses.

Pindus & Greiner (2010, pg. 1) in their research, note that nurses may be transferred to other institutions. Another factor for transfer is less staffing of nurses in other institutes. The organization may choose to change in structure and expand making nurses’ movement of inevitable (Burke, 2001). The institution may choose to establish nursing homes or clinics that are away and cause the nurse to move. Other reasons may be political and power struggles within the institution. The nurse may move as a victim of political power where they have been moved because they have personality differences with other employees.

In his research Ducharme (2009, p. 79) note that several factors lead to the movement of staff from one institution to another. Factors from within the organization include low motivated nursing staff with impacts of their services manifested by dissatisfied health patients. Other reasons include inadequate nursing staff where the number might be low and the nurses are being overworked (Foy et al, 2002).

Why nurses refute moving from one health institution to another

One of the factors that nurses consider and turn down the requests to move to another institution is poor communication flow. Ducharme (2009, p. 79) identify that if the information is given early and timely, the employee may be willing to respond positively and accept moving. In the information is given abruptly, the nurse may become defiant. The nurse may feel that the time is inadequate. This is because they may have felt that they should have been involved in the decision and should have contributed by giving their opinion. They assume that their moving would be without plans and forceful.

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The absence of teamwork can make nurses resist movement. This is because teams work is guided by objectives. Teams assist each member in dealing with challenging issues by making every problem the team’s problem. Therefore, members contribute to solving the problem by contributing ideas and offering help whenever needed. Breaking an already established unity can be difficult because the nurse will go to another environment that will require starting all over again (Meyer, 1988). This process is considered stressing and can make it impossible for the nurse to regain such unity as well as working without adequate support.

The National Institute of Clinical Excellence (2007, p. 7) discusses the impediments of moving nurses from one institution to another. Lack of understanding where there is needed to move can cause resistance to the movement of the nurse. The activities that will be undertaken and what will be done in difficulties. In some cases, it is the implementation of new policies that the management implements and the nurse have to relocate. Some nurses may perceive that they have been undermined by such policies and thereby resisting movement.

For any employee to be effective and efficient they require inspiration (Halvorson, 2007). Nurses who do not have self-drive to work may not be willing to move. This is because the movement may have been as a result of misconduct or failure to follow the procedures and ethics of an institution. At times it may be as a regulatory mechanism of the management to move the nurses to other institutions after a specific predetermined period. The individual may also be unable to move because of personal grounds (Scott 2008).

Scott (2003, p. 114) also says that resistance may be realized is the nurse has an attachment to the institutions where he will lose. This is because employees establish themselves in the workplace and become frustrated when an unpredictable change has to be implemented. As he notes, it may become more difficult if the employees form a culture of declining transfers and job rotations.

The nurse may have perceptions about the institution they will join. They may be positive or negative. If negative, they may reject the offer to move. They may consider the economic benefits and the general welfare and make judgments about what may happen to them after moving. Other nurses may find out that the institution does not go along with their beliefs and may opt to reject moving. This is because they may be required to perform tasks that are not in line with their personal beliefs. Other considerations may be growth in a career (Meyer, 1997).

Nurses may be required to obtain training for new skills which is an important factor for them to consider before the change. This requires them to enrol for training and be able to perform competently (Graban, 2009). Learning means the nurse will create time to learn and must have the education to handle the new environment. Training does not only involve learning in class, but it also means learning the new environment. The nurse learns the structure and how to relate to new people. They need support from other employees to be able to learn within the given time. As a result, the nurse may have difficulties or be unwilling to train and hence fail to move (The National Institute of Clinical Excellence, 2007, p. 8).

The nurse may consider practical issues that may be involved as a factor to hinder them from moving. At times, the institution may be required to expand especially in infrastructure as a matter of priority; the nurse may decline moving if such plans are not implemented. This is because it may be impractical to work effectively. Another reason is that the nurse may learn that the institutions they will join has few human resources and therefore choose to decline because of fear of being overworked. Besides inadequate staff, the environment may be new and no other staff with experience has worked in the same environment.

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The National Institute of Clinical Excellence (2007, p. 8) mention that the financial determinants may make the nurse not move. This may be related to the new institution management where there may be inadequate funding for the institutions. Therefore, they may be unwilling to move because they may be expected to work under constrains.

Kotter and Schlesinger (2008 Para 1) argue that change in organizations is inevitable since the world is constantly changing. The changes in organizations may be welcomed or rejected by the worker. Whether it gratifies or displeases the employers they are affected emotionally. There are various rationales for why employees decline. Employees may refuse to give in to change because they will lose something they value so much. At times the nurses do not identify with the decision because they cannot comprehend clearly how the decision was arrived at. Again the employee could be holding the wrong assumption about the institutions change. Also, the employee can be a conservative individual who is not ready to change.

Preparation for acceptance of change

According to the National Institute of Clinical Excellence (2007, p. 11), the nursing administration must identify areas that might make the transfer of nurses to other institutions complicated. This will involve identifying areas that are different from existing practice. The analysis will aid in identifying areas that may cause problems related to resistance. The movement may be complicated due to inadequate training to meet the requirements of the new institution (Bissell, 1997).

Before considering moving nurses, the management can also find out the specific requirements for the nurse that is required to move. The other consideration is the precise number of nurses needed. It is also important to note requirements in training and the direct appropriate training that will be required. Furthermore, the management must make necessary arrangements on time (O’Brien, 2002).

According to Haywards (2010, Para 1), the working environment is as an important factor as it reflects the organizational goals of the institutions. For the institution to be successful the institution must adhere to values such as rewards for work well done, creativity in handling matters, and flexibility in decision making and an environment that allow further training and learning. Other values such as general concerned with the working conditions of the workers as well as their welfare (Abraham, 2000). The working environment reflects working ethics from the leadership and among the workers.

A good working environment is beneficial to the management because the employees are involved in making decisions and work willingly especially when there are changes that pertain them. Besides working with willingness the employees will work satisfactorily. They are self-driven and usually a few complain about their performance are experienced (Nembhard, 2009).

It is vital to maintain competent employees in the institutions even when there are changes involved. The management can ensure that there is a good flow of information within the institution. The frequency of how communication is done matters a lot. Employees appreciate the information given in time. The communication flow from the management to employees and from employees to management and among employees should be consistent for the institutions to execute its functions adequately (Leach 2005, p. 228).

The institution’s objectives should be the guiding principles in the organization. This is because the employees will be aware of their expectations and knowing their potentials will be willing to welcome changes that the institutions may make including transfers within the same institution and to other institutions.

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Managing the process of change in health institutions

Health care management should be able to identify the kind of resistance the employee manifests (Stahl, 2003). Establishing a culture of sharing information can ease resistance. Since adjusting to change can be difficult the institution can make it easy for the employee by offering necessary help. At times compromise and coercion may be used which must be applied with caution while paying attention to merits and demerits of the strategies.

Leach (2005, p. 228) point out that nursing management can give leadership in health institutions that will aid the changes that may occur in the staffing of nurses. They emphasize that the institution that receives the transferred nurse will have to be involved minimally in dealing with change-related resistance if the institution prepares the nurse for change.

To make the process of change smooth, the management must have a dialogue with people who may reveal important information. The receiving institution’s nurse in charge may give significant information that may be used to reveal difficulties that might be faced. The information can be acquired by visiting the institution when they are holding an assembly. The aim of obtaining this information is to generate suggestions that may relive the difficulty involved in the movement. Also, facts are obtained within a short period and save on cost as opposed to doing own research. The demerits of getting information from a key informant are that the information may be biased and it may take time to identify the informant (Ducharme 2009, p. 80).

Key informants can give the information needed for the recipient institution. In cases where there is no key informant, then observation can be made. One could observe the patients and the nurse’s behaviour note how they interrelate and also observe nurse correlation. Though difficult to observe with consent, this method is more reliable because it eradicates subjectivity. A questionnaire can be used to accumulate knowledge. It can give feedback that is needed about the new institution.

Resistance to move a nurse from one institution to another can be managed successfully. The National Institute of Clinical Excellence (2007, p. 20) point out that there are unique ways for handling diverse challenges in the process of change. Health institutions can avail reading material for nurses.

These materials which include journals, books and magazines among others have educative materials (MARSHALL, 1990). New policies are likely to be featured in current publications hence the nurse before being told to move might be psychologically prepared. Some articles may inspire the nurses to welcome change (Key, 1999). The publications are objective and may be taken as not biased. Reading materials can be used for reference despite the affordable price used to get hold of them. Besides, the affordable price journals and other publications are convincing.

The National Institute of Clinical Excellence (2007, p. 21) insist that health institutions should make use of periodical meetings such as conferences. These meetings are very effective in giving information on the latest developments. Usually, workshops are held where the practitioners engage in meaningful discussions and ask the experts questions. Nurses who have taken time to participate in the conferences would have minimal resistance.

The health institutions can make use of opinion leaders to cause change. The knowledge that they convey is highly regarded as true and therefore cherished. They can also be used as referees where they give their signature. They can be used through giving a talk or writing editorials on the publications (The National Institute of Clinical Excellence2007, p. 22).

Publications of the recipient institutions can be useful. This is because they indicate departments and the services they offer as well as the contacts that one can use to get access to more information. This information may motivate or discourage the nurse from moving depending on where they feel they will have the maximum benefit (Reineck, 2007 p. 388).

Diamanti et al (2007, Para 1) indicate that institutions “should put emphasis on communication, team work, education and training and an adaptive culture.” This is because the working environment is constantly changing and in most cases, change must occur to deal with the new problems. When the institutions develop the culture for change they will experience less resistance whenever they need to move nurses to other health institutions.

Managing change in an institution can be challenging as MacPhee (2007, p. 407) note. When moving nurses the management can employ creativity to make the pressure bearable. The management can negotiate with the employee for benefits to encourage them. Balfour (2005, p. 3) argue that the leadership of clinical institutions have the responsibility of using their expert knowledge to ensure that the process of change does not affect the institution or the individuals.

When change is about to be introduced Pearce (2007 p. 1) suggest that the SWOT analysis can be used to analyze the process of change. SWOT analysis involves assessment of the strengths and the weaknesses as well as the opportunities and threats. This analysis can be used at different levels of the institution. The nurses can evaluate themselves as individuals. Depending on the analysis, they will be able to understand the factors that surround their shifting to another health institution. The analysis can also be done at the organizational level.

In determining the strengths, the nurse can establish where she works more effectively and efficiently to give a fulfilling outcome (Key, 1999). One can consider positive comments from colleagues and achievements that he has gained. One can settle on what they are comfortable doing and also if you work well in a group.

It is important one considers the weaknesses they have in specific areas. If the movement offers an opportunity to improve on areas where there are weaknesses then they can consider a change. If it is impossible to improve on areas where one has weaknesses then choose what they are best in to avoid getting frustrated.

Opportunities offer development of the individual as Morris (2007) highlights. Whenever there is change there are usually opportunities that arise. One can benefit from training that comes along with being sent to another institution. This training increases one’s knowledge and contributes to the development of one’s career. Threats may come in and employees stand to lose the valuable social network they have established (Shanley, 2007 p. 540).

Pearce (2007, p. 1) articulates that the nurses can capitalize on their strengths so that they become successful. After doing the SWOT analysis then one can strategize how to make it the most out of the situation. Measures should be employed so that treats as well as opportunities kept on the mind. This is because the success of a career is dependent on them. It is important to consider the weaknesses and threats because they can be changed from negative to positive.

Barbara (2004, p. 2) sees the leadership of the organization as a very important aspect of change. This is because the process of change involves leadership in every stage. The leadership or management makes changes that will see the nurse be moved to another institution. The management is also involved in the process of preparing the nurse for change by offering assistance in training and facilitating the movement. The leadership is also significant in helping nurses who choose to move to adapt quickly to the new environment. Of equal importance is managing resistance in the movement of nurses to another institution.

The nursing staff considers what they will gain when they move as Kassean and Jagoo (2005 Para 21) point out. They can have resistant behaviour where they use their peer group as advisers. The peers may not be willing to let go of the peer and may influence them to deny moving.


In conclusion, it is important to manage change with caution. This is because dissatisfaction may lead to loss of competent employees especially if the movement was on coercion (Greenhalgh, 2004). Factors that make nurses resist change include poor communication, loss of valuables, beliefs and lack of adequate training. Lack of incentives and teamwork may also create resistance.

Improving communication and maintaining a culture of change can assist in dealing with changes like the movement of the nurses to other institutions. Educating the staff by availing reading materials as well as making arrangements for them to attend and participate in conferences can help reduce resistance (Glanz et al, 2008). Creativity in the strategy can be beneficial in implementing the change (Wood, 2005). However, the employee may still reject moving and the management may be forced to have a dialogue and negotiate with the employee. Other times they may use opinion leaders. And also motivation in the institution is valuable as Kuokkanen (2009, p. 116) indicates.

Information is useful to analyze the situation and make the right choice (Yetton and Southon, 1999). The information can be obtained from a key informant within the organization such as the sister. Information can also be acquired by observing and conducting interviews. One can use the SWOT analysis. After analyzing the management, as well as the individual, will be able to make informed decisions (Pearce 2007, p. 1).

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