Understanding Staff Nurse Responses to Change: Utilization of a Grief-Change Framework to Facilitate Innovation

I’ve always been a bit sad that this article was lost in past issues of the journal. The authors developed a model of staff responses to change that is based on two well-known descriptions. They used Lewin’s outline of the change process, melding it to Perlman and Takacs’ expanded version of Kubler-Ross’ stages of grief. By doing so, the authors blended a minimalist outline of change with grieving stages that occur in response to loss. The stages of loss, originally developed to explain the emotional responses to death, expand upon the change outline, providing the emotional context and tasks for each step. The change outline anchors the stages of grief, binding them to the larger purpose. Both normalize what can be a messy process. Perhaps because change is currently endemic in American business, including healthcare business, writings on change are plentiful. The Schoolfield-Orduna model has the advantage of familiarity. Most of us could describe Lewin’s and Kubler-Ross’ stages from memory. Too, because they come from the older literature, these descriptions have been reliably used in multiple and various clinical situations. Blending the stages and applying the result to any change process allows managers and consultants to identify when to simply validate, when to emphasize active support, when to focus on problem-solving, when to be more firm, what might be the balance of interventions to use. The authors note a wish to have worked with this model from the beginning of the change occurring in their institution at the time. Had they done so, the intervention section of Table 1 might well be more developed. I wish they had continued to work with this, and had published again as that element was revised and refined. Nevertheless, the model remains eminently practical, and continuously useful. Carrol A. Alvarez, MSN, RN, CS This article reviews the literature on the psychological effects of change and discusses the impact of an overarching organizational change on the staff nurses of a large oncology unit in the Midwest. Their reactions are compared with a grief-change framework synthesized from the literature. This framework was useful in explaining staff nurse behaviors and attitudes and offered interventions specific to each stage of the change process useful to the CNS. Dissemination of this information is discussed, as well as implications for advanced nursing practice.