The aim of this study was to explore the nature of frontline nurses’ experiences of living with rapid and continuous organizational change in a tertiary health care institution. The phenomenon under study was organizational change. A component of this research was also to explore the possibility of change fatigue in nurses’ discourse.
Change is inevitable, and increasingly rapid and continuous in health care as organizations strive to adapt, improve and innovate in response to external pressures. These pressures challenge hospitals to strive for patient safety, quality assurance and provision of exceptional family centred care. Attending to these pressures require time, energy and money. Rapid and continuous change creates a push/pull relationship between innovation and budget. New technologies require extra resources however, simultaneous restructuring and optimization efforts see hospitals decreasing available resources. This creates a challenging workplace for nurses who must engage in organizational change activities with limited resources.
Organizational change challenges health care providers in a variety of ways because it restructures how and when patient care delivery is provided, changing ways in which nurses must carry out their work. Little research has been done regarding the impact of rapid and continuous organizational change for frontline health care providers, most notably, nurses. In this study a critical hermeneutic design was applied. Guided by the theoretical framework of critical management studies, the researcher explored concepts of organizational change, experience of change, change fatigue, and power and voice. The setting was an urban pediatric teaching hospital located in eastern Ontario. The researcher sought breadth, depth, complexity and richness of data in understanding the experience of organizational change, which supported a decision to seek a sample size of ten to fifteen participants. Thick description commenced at fourteen participants. Face to face interviews were conducted using open-ended questions to understand nurses’ experiences of change. Brown and Gilligan’s Voice-centred relational method of data analysis was used – a multi-levelled analysis exploring the concept of voice in relation to self, other, culture, society and history.
Rapid and continuous organizational change in the workplace profoundly impacted nurses’ work, their relationships to the self, other, culture, society and history. Nurses recognized that many change initiatives reflected an ideological shift in health care that supported a culture of service, whilst sacrificing a culture of care. A culture of service prioritized cost-savings and efficiency, which saw nurses lose the time and resources required to provide quality, safe care. Nurses felt morally responsible to uphold a culture of care, which proved challenging, and at times unobtainable. The inability to provide quality, safe care resulted in a multitude of negative emotional repercussions, which fostered moral distress. Nurses exhibited elements of change fatigue, further contributing to feelings of voicelessness and powerlessness within their workplace.
Organizational change must be re-conceptualized in ways that ensure change initiatives uphold institutional integrity and better support the provision of morally authentic nursing practice. Health care organizations should place nurses at the forefront of planning, implementation and evaluation of change initiatives in order to alleviate the many negative experiences of organizational change noted in this study.
| Identifer | oai:union.ndltd.org:uottawa.ca/oai:ruor.uottawa.ca:10393/37980 |
| Date | 13 August 2018 |
| Creators | McMillan, Kimberly |
| Contributors | Perron, Amélie |
| Publisher | Université d'Ottawa / University of Ottawa |
| Source Sets | Université d’Ottawa |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
Page generated in 0.0023 seconds