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Creative Nursing, Volume 17, Issue 1, 2011

Creative Nursing , Volume 17, Issue 1, 2011 Rebecca Otten, EdD, RN, is an assistant professor

Rebecca Otten, EdD, RN, is an assistant professor of nursing and assistant coordi- nator of pre-licensure programs at Califor- nia State University, Fullerton.

programs at Califor- nia State University, Fullerton. Tiffany Chen, BSN, RN, MPH, is a staff nurse

Tiffany Chen, BSN, RN, MPH, is a staff nurse on a Telemetry/ Cardiac Observation unit at Anaheim Re- gional Medical Center in Anaheim, CA.

unit at Anaheim Re- gional Medical Center in Anaheim, CA. Change, Chaos, Adaptation: The Effects of

Change, Chaos, Adaptation:

The Effects of Leadership on a Work Group

Rebecca Otten, EdD, RN Tiffany Chen, BSN, RN, MPH

As nurses, we are very familiar with the environmental factors associated with change, the impact of chaos on working relationships, and the general milieu of a nursing unit. This story relates how a student in a leadership practicum was encouraged to look at change through an organizational lens when the leadership dynamics changed in a work group. The Roy Adaptation Model and chaos theory were applied as frameworks for this assessment as a way to organize and foster learning. Through this serendipitous opportunity, the student gained an insight into the dynamics of group process and an appreciation of the work it takes for leaders and managers to keep the work group in a healthy functional state.

T he primary goal of clinical practicums in nursing programs is to give students an opportunity to hone their psychomotor, organizational, and observational

skills as providers of patient care. Near the end of the curriculum at California State University, Fullerton, most often during the leadership rotation, students are given the opportunity to shadow a nursing manager to gain insight into the complexity of the leadership/management role at the unit level or point of care. Creating and maintaining a healthy environment in which staff members are en- gaged in the development of a culture of shared values requires an important skill set that the students are asked to observe during this particular practicum. Clinical instructors are always alert to situations that will give students oppor- tunities for learning and professional growth. During a recent practicum, on one particular patient care unit, the long-time nursing manager was changing posi- tions within the medical center and a new manager was to be chosen. The student assigned to this unit was encouraged to observe how this change in leadership affected the work group and how the group adapted. The observations were in- cluded in a journal and as part of a writing assignment to describe the impact of this change in leadership on the staff’s adaptation to change over time. This assessment of a work group in the context of change and daily routines provided the student with a powerful insight into the functioning of a work group, with future application to transition and socialization into a work group as a newly licensed registered nurse. The dynamics of servant leadership was another aspect that added to the richness of this experience. The Roy Adaptation Model and chaos theory frameworks help to organize and guide this story.

WORK GROUP CHARACTERISTICS

Nurse managers are responsible for engineering operational flow processes that guide and direct staff in the work environment. In the acute care setting, this in- cludes patient care delivery models, staffing patterns, and a supportive, efficient, and client-centered environment. One aspect of client-centered care pertains to meeting the needs of clients and families as they enter into a role that may be quite stressful and unwanted. This role may bring uncertainty about what to expect and how to get through a time that may be particularly difficult. Being the providers of care to our clients, we know that our caring presence is one of trust and support to help them deal with the changes they experience and to assist with adaptation to the experience. Nurse managers have the inherent responsibility to assure that the clients’ needs are met by the nurses working together on the unit. A manager working in one area for a long time develops a certain level of comfort with the nursing staff. Expectations are known and team cohesiveness is part of the culture. The impact of this relationship results in greater job satisfaction and a stability within the work group. Porter-O’Grady and Malloch (2007) discuss this phenomenon in reference to the quality of work life in which key characteris- tics include predictable work patterns; support to maintain competencies; defined roles and expectations; and a strong, open communication system. Roy’s (2009) adaptation framework suggests a connection between the quality of work life, role identity, and a sense of belonging. In this model, the stabilizer subsystem (strategies and processes for group stability) and the innovator subsys- tem (emotional and cognitive strategies toward change within the group) are the two major control mechanisms that guide the adaptive processes of a work group (Roy, 2009). Development of a group’s identity is a process in which group culture is es- tablished with shared goals, values, and expectations—groups work together over time and socialization becomes part of the innovator subsystem, an important pro- cess when a change to the group membership occurs. The innovator subsystem addresses the process of growth of the work group toward common goals and team building (Roy & Andrews, 1999; Roy, 2009; Hanna, 2006). The environmental boundaries, work routines, established roles, structure, and values are part of the stabilizer process. This process “helps to forestall turmoil when change is being introduced” (Hanna, 2006, p. 226) to the work group.

Environmental boundaries, work routines, established roles, structure, and values help to forestall turmoil when change is being introduced to the work group.

ORGANIZATIONS HAVE THE POTENTIAL TO BE CHAOTIC

Although it may be difficult for an outsider to understand how the absence of one person can cause so much tension on a hospital unit, chaos theorists acknowl- edge that small changes can have large effects on systems (Levy, 1994; Thietart & Forgues, 1995). Support systems from group cohesion offer a dynamic interplay with the environment that may initially focus on the loss to the work group and introduce a tension response into the work group norm.

There was a shroud of sadness as the tissue box made its way around the over- crowded conference room. The unit manager attempted to complete the monthly staff meeting as sporadic sniffles overlapped her wavering voice admonishing her staff to complete their documentation correctly and communicate more efficiently with their assistive staff. This was the last staff meeting the manager would lead

Although it may be difficult for an outsider to understand how the absence of one person can cause so much tension on a hospital unit, chaos theorists acknowledge that small changes can have large effects on systems.

before taking her new position. A mix of emotions flowed through the staff; some were angry at the manager for leaving; some were happy for her but mourning the loss of her as their manager; some were relieved that she would still be working at the hospital; but all were worried about the future of the unit. (Chen, 2008)

Without the emotional support of the nursing manager to influence the effective- ness of the work group’s performance, the emotional competence of the unit staff has the potential to be negatively impacted by the loss (Kovner, Brewer, Greene,

& Fairchild, 2009). With this change in leadership, an integral part of a smoothly

run unit was thrown into a state of disorder and chaos. Disruptions that chal- lenge the equilibrium of the system can have far-reaching effects, creating un- predictable changes and responses. This challenge to group stability triggers activation of the innovator and stabilizer processes (Roy, 2009). Work groups seek role clarity through these processes using role relationships and informal leaders as role models.

A few weeks after the leadership change occurred, it became quite evident that the unit had changed. The overall morale was depressed. The staff maintained their standard of focusing on the needs of their patients but seemed to be in an automated routine mode, lacking enthusiasm and pride in their work. Many staff members had left for other jobs or transferred to other units. Many who were still there were in the process of applying to other jobs and others questioned if they wanted to continue to work at the hospital any longer. The manager’s departure had left a void in the heart of the unit and things seemed to be falling apart. Her willingness to listen, support, nurture, and encourage each nurse to achieve and then to celebrate his or her achievements were traits frequently mentioned when the staff talked about their loss. Awaiting the appointment of a new manager also added to the stress felt on the unit. (Chen, 2008)

Levy (1994) notes that chaotic systems typically follow repetitive patterns, which can be identified and which provide useful information for strategic planning. In this case, there was an expectation that a change in leadership would cause disruption among staff but the extent of the disruption was not clearly known. Kane-Urrabazo (2006) links this disruption to the perceived loss of trust that is developed over time within an organization and as a predictor of decreased job satisfaction where commitment and intent to remain with an organization are ques- tioned. With this in mind, it became the task of the leaders who remained on the unit to maintain as much balance as circumstances would allow (Porter-O’Grady

& Malloch, 2007).

UNDERLYING ORDER IN CHAOS

Within a chaos theory framework, the process of transition may be viewed with a focus on the collaboration within a group, the environment, and adaptation. Adap- tation in this sense suggests that the system has been changed and that, although the outcomes are not predictable, they may be viewed as desirable (Bussolari & Goodell, 2009). Work group cohesiveness becomes a strength and stabilizer when the group “uses established structures, values, and daily activities to accomplish the purpose of the group” (Roy, 2009, p. 478).

As time passed, the roaring waves of emotions subsided, the influx and efflux of employees trickled to a minimum, and the staff continued in their daily roles and

duties. The unit continued to function to the best of its ability within the preexist- ing infrastructure as a new manager came on board. The four clinical coordinators distributed the manager’s workload among themselves and the new department manager. Chaos and dysfunction were left behind as the new manager integrated herself into the unit. (Chen, 2008)

Chaos theory notes that as a new stability emerges, utilization of the current organization’s configuration becomes a foundation (Thietart & Forgues, 1995). Carroll (2006) interpreted the organization chaos theories presented by Thietart and Forgues (1995) and highlighted the following:

• Organizations are nonlinear, dynamic systems and have the potential to be chaotic.

• Amidst chaos is underlying order.

• Organizations often undergo a series of rapid changes and stabilize until the next round of rapid changes occurs.

• Leadership in these organizations must be flexible and able to respond quickly and appropriately to the rapid changes.

These principles can also be seen within the priority standards for groups as de- scribed by Roy (2009): ability to perform necessary functions, to maintain its own existence, and to grow.

ONE YEAR LATER

Serendipity interceded again to give this student the opportunity to observe the effect of time on the conditions that triggered the initial response of the work group. The student was assigned to the same patient care area for an externship. Once again, the student was encouraged to assess and journal about how the work group had progressed to a different, yet effective work dynamic.

Initially, it was sad to discover that so many of the staff had left in the months I had been away. There was, however, a core group of staff who were still there and who seemed to have made it their goal to create a productive work group with high standards of patient care. In fact, they were no longer just the Tele Unit but had become the Tele-Stroke Unit of a recently designated stroke center. They were busy orienting and socializing new nurses to the unit, which was a positive and worth- while endeavor since all the nurses who were part of the work group remained because they wanted to be there and work with dedication toward excellence in client outcomes. Emotional bonds are difficult to break; a few of the staff continue to go to their former manager for advice and to cling to the relationship for com- fort. When I asked about the new manager, they said her style is not as open but they know they are supported and respected. She allowed the staff time to catch up with all the changes that had occurred and renewed a sense of responsibility and accountability for the unit routines. The foundation of mutual respect helped to foster trust in the new relationship and proved to be a solid starting point for developing shared hopes and goals for the unit. (Chen, 2009)

Roy (2009) describes the cohesion of a group as a common bond with characteristics of shared identity, camaraderie, and recognition of values in the practice environ- ment. To claim successful achievement of the environmental change, respect and

The staff were busy orienting and socializing new nurses to the unit, a positive and worthwhile endeavor since all the nurses who were part of the work group remained because they wanted to be there and work with dedication toward excellence in client outcomes.

The emotional understanding that the new manager brought to the unit is described as “worker care.” This aspect of servant leadership provided flexibility and a renewed sense of caring needed for this particular work group to move forward.

recognition for each member of the work group needs to be realized. Improving communication with problem solving as a shared objective is the focus of this behavioral approach. Each challenge to stability forges change that allows the or- ganization and leadership to evolve as well to adapt to organizational changes (Porter-O’Grady & Malloch, 2007). The emotional understanding that the new manager brought to the unit is described by Jenkins and Steward (2010, p. 48) as “worker care.” This ability to provide a nurturing relationship addressed the emotional needs of the staff and fostered a climate of trust and security. This aspect of servant leadership provided flexibility and a renewed sense of caring needed for this particular work group to move forward.

LESSON LEARNED

The student summarized her experience in relation to chaos theory and adaptation theory as follows:

The value of chaos theory lies not in the ability to predict the outcomes of human be- havior to change, but in the anticipation and preparation for chaos in planning for a known change event, such as management succession, on an established work group. Adaptation theory gives a perspective on group identity where cohesion and de- velopment of said identity become part of the affective response toward group well-being. With this new knowledge, I will be better prepared to understand the effects of change on group dynamics. The experience has left me with a deep appreciation of the work it takes for leaders and managers to keep a group in a healthy, functional state. (Chen, 2009)

CONCLUSION

When a change in leadership is the stimulus for chaos, giving nurses on a unit per- mission to work through the change and discover the means to adapt and grow as a team is a complex task. The new manager wisely allowed the staff time to “catch up” with the change that brought her to the unit. The newly expanded mission gave the unit new routines and a fresh identity that contributed to the settling-in process. The former and the new leaders each had traits that the staff recognized as directed toward their ability to perform the duties that nursing requires and to keep a focus on creating a healthy, cohesive environment. The clinical practice setting is full of rich opportunities for students’ profes- sional growth. Through this serendipitous opportunity, the student gained insight into the dynamics of group process and an appreciation of the presence of leaders and managers who keep work groups in a healthy, functional state.

REFERENCES

Bussolari, C. J., & Goodell, J. A. (2009). Chaos theory as a model for life transitions counsel- ing: Nonlinear dynamics and life’s changes. Journal of Counseling and Development, 87,

98–107.

Carroll, P. (2006). Nursing leadership and management. Clifton Park, NY: Thomson Delmar Learning.

Chen, T. (2008). Leadership succession, organization chaos theory, and hospital management. Unpub- lished manuscript, Department of Nursing, California State University, Fullerton. Chen, T. (2009). Externship reflection journal. Unpublished personal entries, Department of Nursing, California State University, Fullerton. Hanna, D. R. (2006). Using the Roy adaptation model in management of work groups. Nursing Science Quarterly, 19(3), 226–227. Jenkins, M., & Steward, C. (2010). The importance of a servant leader orientation. Health Care Management Review, 35(1), 46–54. Kane-Urrabazo, C. (2006). Management’s role in shaping organizational culture. Journal of Nursing Management, 14(3), 188–194. Kovner, C. T., Brewer, C. S., Greene, W., & Fairchild, S. (2009). Understanding new regis- tered nurses’ intent to stay at their jobs. Nursing Economics, 27(2), 81–98. Levy, D. (1994). Chaos theory and strategy: Theory, application, and managerial implica- tions. Strategic Management Journal, 15, 167–178. Porter-O’Grady, T., & Malloch, K. (2007). Quantum leadership: A resource for health care in- novation (2nd ed.). Sudbury, MA: Jones and Bartlett. Roy, C. (2009). The Roy adaption model (3rd ed.). Upper Saddle River, NJ: Pearson Education, Inc. Roy, C., & Andrews, H. A. (1999). The Roy adaptation model (2nd ed.). Stamford, CT: Appleton & Lange. Thietart, R. A., & Forgues, B. (1995). Chaos theory and organization. Organization Science, 6(1), 19–31.

Correspondence regarding this article should be directed to Rebecca Otten, EdD, RN, at rotten@fullerton.edu

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