1. Menix, Kristi D EdD, RN, MSN, CNAA


Without appropriate educational preparation, nurse managers may not have the competencies to effectively manage accelerated change that is so pervasive on the front lines of healthcare organizations in transformation. Part 1 of this article describes the findings from on extensive literature review of nursing, business, and higher education literature on the subject of change management. A comprehensive reference list is provided. Part 2 reports the results of a Delphi study from which baccalaureate-prepared nurse manager experts and nurse educator experts in baccalaureate nursing programs validated what linear and nonlinear change management concepts they believed were relevant in managing change in today's dynamic environment. With key roles as organizational change agents, staff development educators and administrators can use the validated concepts to develop educational offerings to promote effective change management.


Relative stability in the healthcare delivery environment as it relates to the practice of nursing management is now the exception. The transformation of health care is occurring at a rapid, accelerated rate creating contextual alterations in change management situations, such as the factors of time, information, decision making, and planning (Begun & White, 1995; McDaniel, 1998; Porter-O'Grady, 1997; Porter-O'Grady & Wilson, 1995).


Professional registered nurses manage change as an inherent and primary responsibility regardless of the levels of their positions-top, middle, or point of care delivery (Boynton & Rothman, 1996). Nurse managers share accountability with other managers and administrators as well as staff development educators to react, and preferably to prepare to respond to expected and unexpected changes brought about by internal and external influences (Menix, 1995, 1999).


Nurse managers need the competencies to effectively forecast, plan, and manage a variety of changes, both predictable and unpredictable (American Association of Colleges of Nursing [AACN], 1995; AACN, 1996; American Organization of Nurse Executives [AONE], 1992; Porter-O'Grady, 1997; Porter-O'Grady & Wilson, 1995). Strategic planning alone can no longer prepare organizations to meet environmental demands effectively, as the complexity and uncertainty in the environment preclude long-term planning (Murphy, Ruch, Pepicello, & Murphy, 1997; Wheatley, 1992).


Baccalaureate nursing programs typically teach planned, linear approaches to manage change (Douglass, 1996; Gender, 1996; Gillies, 1994; Huber, 1996; Marquis & Huston, 1996; Marriner-Tomey, 1996; Menix, 1995; Sullivan & Decker, 1997; Swansburg, 1996; Tappen, 1995). Is it feasible to continue to use only a planned change approach as the standard approach to managing accelerated change? The emphasis on linear approaches has "created the impression that linear and solvable systems were the only ones....that came very close to being a prejudice in favor of systems as regular and predictable as clockwork" (Kellert, 1993, pp. 134-135). "Leaders must now be fluid and flexible in style and approach and create the kind of situation that will allow those who do the work of health care to connect in new ways and to interact as necessary to build a truly healthy community" (Porter-O'Grady & Wilson, 1995, p. x).