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Demystifying ward nurse manager's approach to managing change

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Background The current literature and Department of Health (DH) policies suggest change should be implemented by frontline clinicians using a transformational leadership approach (Alimo-Metcalfe and Alban-Metcalfe, 2008; Darzi, 2008; DH, 2009, 2010; Govier and Nash, 2009). Despite this, change is still often led by senior managers utilising a 'top down', transactional approach (Edmonstone, 2009; Muha and Manion, 2010; NHS Institute of Innovation and Improvement, 2005). It could be argued that this is primarily due to an absence of clinical leadership due to a paucity of leadership development opportunities for clinicians. In order to encourage frontline clinicians to lead change we firstly need to understand how change is implemented on the frontline and to ascertain their development needs.

Aims This paper explores how frontline clinical leaders, specifically ward nurse managers (WNMs), implement change and why they choose a particular strategy. The aim is to explore the change process, through investigating change management from the perspective of those leading change.

Methods A case study methodology was adopted (Cohen et al, 2000; Yin, 2009). The case study comprised 18 WNMs from one acute NHS hospital within the UK. The data were collected via semi-structured questionnaires and interviews.

Results The case study demonstrates the WNM's soft approach to change management, based on transformational principles, is in contrast to senior managers who focus on managerial leadership (Edmonstone, 2009). This point is not explicit in the previous literature and two new models are offered to explain this conclusion.

Originality/value This study provides new insight into the WNM's approach to managing change and their development needs. This is an important perspective that so far has been neglected.

Conclusion WNMs appear to be intuitively adopting change models and using a pragmatic, experiential approach to implement change. However, their progression from change novice to expert is stifled by their poor theoretical evidence base and their lack of experience of leading change. A bespoke 'Leading Change' development programme for WNMs is recommended.


Document Type: Research Article

Publication date: February 1, 2013

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