This document discusses theories and concepts related to nursing management, including power, change, innovation, and conflict management. It defines key terms, identifies sources of power for nurses, and describes traditional change theories like Lewin's force field model. The document also discusses how to promote change, responses to change, types of innovation, and methods for managing conflicts that can arise during times of change. The overall goal is to help nursing managers understand and apply these important aspects of leadership.

1. POWER,
CHANGE,
INNOVATION AND
CONFLICT
MANAGEMENT
PREPARED BY:
MIGUEL VERGEL BUSA, RN

2. Objective
2
• To be able to identify the important aspects of Theories and
practice in nursing management such as POWER, CHANGE,
INNOVATION AND CONFLICT MANAGEMENT
• Sub-objective
1. Identify the challenges of having power in nursing leadership
2. Facilitate a scholarly conducted innovation in patient care
practices
3. Realize the importance of conflict management in a department
that you will supervise

3. Power and
Accountability
Power as we refer to it in
leadership sense is the ability
to do, act or produce the
ability to control others
Power may also be
conceptualized as “one’s
ability to get things done
through mobilizing resources
and to get and use whatever
it is that a person needs for
the goals he or she is
attempting to meet”
3

4. SOURCES OF POWER
Type Source Examples for
Nursing
Expert Power derived from the knowledge
and skills nurses possess. The
more proficiency the nurse has, the
more the nurse is received as an
expert.
Communicating information from
current evidence-based journals
and bringing expert knowledge to
patient
care.
Legitimate Power derived from an academic
degree, licensure, certification,
experience in the role, and job title
in the organization.
Wearing or displaying symbols of
professional standing, including
license and certification.
Referent Power based on the trust and
respect that people feel for an
individual, group, or organization
with which one is associated.
Gaining power by affiliating with
nurses and others who have power
in the organization.

5. SOURCES OF POWER
Type Source Examples for
Nursing
Reward Power that comes from the ability to
reward others to influence them to
change their behavior.
Using a hospital award to alter
other’s behavior.
Coercive Power that comes from the ability to
punish others to influence them to
change their behavior.
Using the hospital disciplinary
evaluation system to alter another’s
behavior.
Connection Power that comes from personal
and professional relationships that
enhance one’s resources and the
capacity for
learning and information sharing.
Developing good working
relationships and mentoring with
your boss and other powerful
people.

6. EMPOWERMENT
6
Nurses strengthen their power by taking ownership of
their problems in serving patients. Leddy, Pepper, and
Hood (2002) stated, “When nurses blame others such as
physicians, administrators, or politicians for the state of
the health care delivery system, or constantly look to
others for improvement of this system, they weaken
their position and power base

7. Niccolo Machiavelli
•a political philosopher who lived in Italy
during the Renaissance period
•"The Prince," which he wrote in 1513
7

8. Machiavelli on Power
8
Machiavelli believed that a ruler should do whatever it
takes to maintain power, including lying, deceiving, and
using force if necessary. He believed that a ruler should
be feared rather than loved, as fear is a more effective
means of maintaining control. Machiavelli also believed
that a ruler should be willing to use violence if
necessary to achieve their goals.

9. Machiavelli on Power
9
In Machiavelli's view, a ruler should be pragmatic
and flexible in their approach to power, willing to
adapt their tactics as circumstances change. He
also believed that a ruler should be willing to
break their promises and betray their allies if it
serves their interests.

10. Change
10

11. CHANGE
11
Meriam-Webster - to make radically different
(Merriam-Webster, 2023 )
Change can be defined as “making something
different from what it was” (Kelly, 2010)

12. Traditional Change Theories
12
1.Driving Forces: These are the factors that push an
organization or individual towards change. Examples of driving
forces may include new technology, changes in the market, or
the desire to improve efficiency or productivity.
2.Restraining Forces: These are the factors that resist or
oppose change. Examples of restraining forces may include
employee resistance, lack of resources or expertise, or cultural
norms and values.
3.Equilibrium: The current situation or status quo is represented
by the equilibrium between driving and restraining forces.
Force-Field Model Lewin (1951)

13. Unfreeze-Move-Refreeze
1.Unfreeze: In this stage, the organization prepares for change by
acknowledging the need for it and addressing any resistance to it. The
organization must create a sense of urgency for change and break
down any existing behaviors or norms that may be preventing change.
2.Move: In this stage, the organization implements the change. This may
involve making structural or cultural changes within the organization,
implementing new processes or systems, or introducing new products or
services.
3.Refreeze: In this stage, the organization establishes the new behaviors
or norms as the new status quo. The organization reinforces the new
changes and ensures that they become integrated into the
organization's culture and way of doing things. 13

14. Traditional Change Theories
14
1.Diagnosis: In this phase, the need for change is identified,
and the problem or opportunity is diagnosed.
2.Assessment: In this phase, the organization assesses its
current situation and determines the desired outcome of the
change.
3.Planning: In this phase, the organization develops a plan for
how to implement the change.
The seven phases of change Lippit (1958)

15. Traditional Change Theories
15
4. Implementation: In this phase, the plan is put into action. This may involve
communicating the change to stakeholders, training employees, and making the
necessary adjustments.
5. Monitoring: In this phase, the organization monitors the progress of the change
and adjusts the plan as needed.
6. Stabilization: In this phase, the change is integrated into the organization's
culture, and the new way of doing things becomes the norm.
7. Refreezing: In this final phase, the change becomes permanent, and the
organization reinforces the new behaviors and practices to ensure they are
sustained over time.
The seven phases of change Lippit (1958)

16. Traditional Change Theories
16
1.Building a relationship with the client: This step
involves establishing a working relationship with the
organization or individual seeking to make a change.
2.Diagnosing the problem: This step involves gathering
data and analyzing the current situation to identify the
problem that needs to be addressed.
3.Establishing goals and objectives: This step involves
setting clear goals and objectives for the change
initiative, based on the diagnosis of the problem.
Six-Step Change Model Havelock (1973)

17. Traditional Change Theories
17
1.Developing an action plan: This step involves
developing a detailed plan for implementing the change
initiative, including timelines, resources, and
responsibilities.
2.Implementing the plan: This step involves putting the
action plan into action, monitoring progress, and making
adjustments as needed.
3.Evaluating the results: This step involves assessing
the effectiveness of the change initiative and
Six-Step Change Model Havelock (1973)

18. Chaos Theory
18
• Chaos theory hypothesizes that chaos actually has an order.
• According to this theory, the experiences of health care system in
terms of being chaotic is still normal
• Most organizations go through periods of rapid change and
innovation and then stabilize before chaos erupts again
• Even if the chaotic occurrence recur, it is not similar at all thus each of
the occurrence is unique and different. Order emerges through
fluctuation and chaos. Thus, the potential for chaos means that
nurses and the organization must be able to organize and implement
change quickly and forcefully.

19. Learning Organization Theory
19
- Learning organizations are based on five learning disciplines
and demonstrate responsiveness and flexibility
- Senge believes that because organizations are open systems,
they could best respond to unpredictable changes in the
- environment by using a learning approach in their
interactions and interdisciplinary workings with one another.
- The whole cannot function well without a part, regardless of
how small that part may seem.

20. How to promote CHANGE?
20
Strategy Description Example
Power-coercive
approach
Used when resistance is expected but
change acceptance is not important to the
power group. Uses power, control, authority,
and threat of job loss to gain compliance with
change—“Do it or get out.”
Student must achieve a passing grade in a
class project to complete the course
requirements satisfactorily.
Normative-
reeducative approach
Uses the individual’s need to have satisfactory
relationships in the workplace as a method of
inducing support for change. Focuses on the
relationship needs of workers and stresses
“going along with the majority.”
A new RN who is working eight-hour
shifts is encouraged by the other unit staff to
embrace a new unit plan for twelve-hour
staffing.
Rational-empirical
approach
Uses knowledge to encourage change. Once
workers understand the merits of change for
the organization or understand the meaning of
the change to them as individuals and the
organization as a whole, they will change.
Stresses training and communication. Used
when little resistance is anticipated.
Staff are educated regarding the scientific
merits of a needed change.

21. Response to Change
21
• 1. Innovators: Change embracers. Enjoy the challenge of change and
often lead change.
• 2. Early adopters: Open and receptive to change, but not obsessed with
it.
• 3. Early majority: Enjoy and prefer the status quo, but do not want to
be left behind. They adopt change before the average person.

22. Response to Change
22
• 4. Late majority: Often known as the followers. They adopt change
after expressing negative feelings and are often skeptics.
• 5. Laggards: Last group to adopt a change. They prefer tradition and
stability to innovation. They are somewhat suspicious of change.
• 6. Rejectors: Openly oppose and reject change. May be surreptitious or
covert in their opposition. They may hinder the change process to the
point of sabotage.

23. Innovations
23
•Innovation can be defined as the process of creating new
services or products.
•Tom Kelly, author of The Ten Faces of Innovation (2005),
stresses that the innovative process is now recognized as a
pivotal management tool in all industries including health care.
•Kelly emphasizes that innovation is a team event that is made
up of individuals who possess different strengths and points of
view. This team approach results in new innovative ways to
effectively solve problems.

24. Conflict Management
24
• - An important part of the change process is the ability to resolve conflict.
• - Conflict is a disagreement about something of importance to the people
involved.
• - Conflict can be stimulated by such things as
• 1. scarce resources
• 2. invasion of personal
space,
• 3. safety or security issues,
• 4. cultural differences,
• 5. scarce nursing resources,
• 6. increased workload,
• 7. group competition,
• 8. various nursing demands
and responsibilities.

25. The Conflict Process
25
• 1. antecedent conditions- there is a specific preexisting conditions
• 2. perceived and/or felt conflict- As the situation develops, conflict is
perceived or felt by the involved parties
• 3. manifest behavior,
• 4. conflict resolution or suppression, and
• 5. resolution aftermath

26. Conflict Management
26
Conflict Management Method Advantages Disadvantages
Accommodating—smoothing or
cooperating; one side gives in to
the other side
One side is more concerned with
an issue than the other side;
stakes not high enough for one
side and that side is willing to
give in
One side holds more power and
can force the other side to give
in; the importance of the stakes
are not as apparent to one side
as the other; can lead to parties
feeling “used” if they are always
pressured to give in
Avoiding—ignoring the conflict Does not make a big deal out of
nothing; conflict may be minor
in comparison to other priorities;
allows tempers to cool
Conflict can become bigger
than anticipated; source
of conflict might be more
important to one person or
group than others
Collaborating—both sides work
together to develop optimal
outcomes
Best solution for the conflict and
encompasses all important goals
to each side
Takes a lot of time; requires
commitment to success

27. Conflict Management
27
Competing—the two or three
sides are forced to compete for
the goal
Produces a winner; good when
time is short and stakes are high
Produces a loser; may leave
anger and resentment on
losing side
Compromising—each side
gives up something and gains
something
No one should win or lose, but
both should gain something;
good for disagreements between
individuals
May cause a return to the
confl ict if what is given up
becomes more important than
the original goal
Confronting—immediate and
obvious movement to stop
conflict at the very start
Does not allow conflict to take
root; very powerful
May leave impression that
conflict is not tolerated; may make
something big out of nothing
Negotiating—high-level
discussion that seeks
agreement,
but not necessarily consensus
Stakes are very high and
solution is rather permanent;
often involves powerful groups
Agreements are permanent,
even though each side has gains
and losses

28. Summary
Conflict management is an important part of the change and
innovation process. Change and innovation can often threaten
individuals and groups, making conflict an inevitable part of the
process. It is important to keep in mind that some conflicts
resolve themselves, so the change agent should not be too
quick to jump into an intervention mode. If the level of conflict is
too high, the nurse manager must apply conflict management
strategies. Change, innovation, and conflict are all positive
processes that promote growth. Leaders, managers, and staff
should be encouraged to embrace all three processes and
explore them as opportunities for personal and professional
growth. 28