Recognition-Primed Decision Model in Nursing Practice

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Introduction

Organizations go through changes all the time. Whether it is managerial, structural, or strategical, employees are often expected to adapt to the differences as fast as they can. Due to a lack of proper change management, some employees often disapprove of any type of switch. Resistance to advancement is one of the most common problems in companies today. It can be attributed to various things but most importantly is the employees’ involvement.

On the same note, the resistance can also lead to a stressful environment. One can argue that the improvement of the process can be problematic and cause tension or stress for the staff. This is especially so if they do not understand the different processes that are changing. Thus, when dealing with modifications, one also should deal with stress management. The essay focuses on the management of resistance to change and how potential sources of stress can be used to mitigate the resistance. The arguments proposed are based on the recognition-primed decision model. The essay will use secondary academic sources to support the premises proposed.

A brief overview of the history of the problem reveals that many organizations struggle to implement advancement even when the employees understand the importance of the same. There have been arguments that this happens when the employees are involved late in the process. Currently, more companies are considering the way of making employees initiate the change themselves to fully own the process.

The chosen problem is relevant in the nursing field because health facilities are now encouraging nurses to take up managerial roles. It is prudent to point out that initially, nurses were not given any managerial roles. In the last couple of years, nurses have taken a keen interest in management and have engaged with their facilities to get such roles. However, a key challenge to the process is the mindset of the nurses themselves who believe their jobs cannot be intertwined with managerial roles.

The selected decision model is deemed suitable for the discussion due to two main things. The first is the fact that it is also applicable to stress management. The second reason the model was chosen is its applicability to the nursing profession as well. Sadler-Smith and Hodgkinson (2017) explain that the recognition-primed decision model has three main components that address organizational change and stress management. The first is experiencing the situation (Sadler-Smith & Hodgkinson, 2017).

This first component encourages the creation of a simulation that mimics the proposed improvements. For example, a facility can promote some nurses in managerial roles for a short period. These nurses will not only learn how to be managers but will also prove to the rest that they should be part of the decision-making processes in the facility by participating in managerial roles. A facility can also choose to make all its nurses’ managers through a virtual application to help them make decisions and see the effects of those decisions.

The second component of the recognition-primed decision model is analyzing the situation. Here, the management and all the nurses involved in the first phase can discuss some of the experiences and find solutions to challenges. It is at this point that the nurses also get to ask questions based on their experiences. The last phase is the implementation of the decision. This is only applicable if there were consensus and willingness to proceed after the second phase.

Background

There is very little research that identifies influential nursing managers in the world. Florence Nightingale considered the mother of nursing, played an important role as a manager. Despite this, the nursing coursework does not fully advocate for nurses to take up managerial roles. Van Bogaert, Peremans, de Wit, Van Heusden, Franck, Timmermans, and Havens (2015) argue that one of the reasons for this is the misconception that managers cannot do normal nursing duties such ward rounds. Indeed, many nurses prefer the actual duties of their careers to administrative work. However, as Van Bogaert et al. (2015) explain, with proper management, nurses can do both tasks successfully.

It is prudent to point out that the lack of interest in managerial and administrative duties allowed other professionals within the hospital set up to become managers. The additional fact that the importance of administration work in nursing was not stressed enough in school ensured that nurses never perceived themselves as managers. Van Bogaert et al. (2015) note that other professionals working in the hospital also felt superior to nurses, thus, had more entitlement over the title “boss”.

One of the reasons managerial tasks are now stressed in nursing is the impact of decisions made on behalf of nurses. Indeed, service delivery is very key in nursing practice. It is highly affected by other activities such as the availability and use of resources within the hospital. If nurses are not included in the decision-making of these and other similar cases, then their service delivery might be jeopardized. Numminen, Leino-Kilpi, Isoaho, and Meretoja (2014) explain that nurse managers also oversee patient care.

Indeed, whereas the doctors treat the disease, nurses are tasked with treating the patient. It has, thus, become imperative for nurse managers to oversee patient care from a managerial point. On the same note, it can be argued that budgets for patient care can often be overlooked in health facilities. However, as Numminen et al. (2014) admit, more patients prefer hospitals where they are made as comfortable as possible. Since nurses work with patients all the time, they are best suited to advice on how to improve patient care and this would ideally also relate to the budget.

Also, there have been cases of unsafe working environments for nurses. Adriaenssens, Hamelink, and Van Bogaert (2017) argue that they are some of the most misused professionals in the world. Indeed, the setup of the hospital allows all types of professionals to at times work extra hours to save lives. However, some facilities have been accused of overworking nurses for the benefit of doctors and other health care workers.

Adriaenssens, Hamelink, and Van Bogaert (2017) compare the working hours of senior nurses and doctors and conclude that indeed, nurses work more hours than doctors. The senior nurses still had rotations of 12-hour shifts while the senior doctors involved in the study only had 6-hour rotations and did not work over the weekends or in the evening. In such a case, a nursing manager would ensure that the nurses have more regular hours in so doing, ensure that they offer better services to their patients. The manager also ensures that the working environment is safe as there have been cases of nurses being attacked by patients.

One can argue that there are several levels of change that are taking place in the hospitals now that nurses are keen on taking up managerial roles. First, the change affects nurses as their mindset and perception towards managerial jobs are evolving. Secondly, the improvements affect the other hospital staff as they are also not used to having nurses as managers. Whereas hospitals are employing different strategies to manage resistance to this stated advancement, there is little improvement.

One can argue that it is the lack of identification of stress areas that has hindered the management of the resistance. In the nursing profession, and taking managerial roles into account, one can argue that there are several stress pointers. The first is the additional work that the nurses perceive they will have if they also take on managerial roles. As mentioned, the nurses are already overworked, therefore, any additional work will be stressful.

A second stress point for the nurses is the perception of a strained relationship between them and other professionals in the workspace. Nibbelink and Reed (2019) observe that the relationship between different professionals in a hospital is often strained. Nurses are especially disregarded as their work is perceived to be less important than that of doctors and other specialists. On the same note, nurses are often seen as aids to the other professionals.

This is also reflected in their salaries as they get lesser remuneration compared to their colleagues. Therefore, any other activities and changes that would further negate the relationship between nurses and other health care workers are unwanted. In turn, this has affected their decision-making about their ability to become managers and hold other administrative posts in the hospital.

Literature Review

Laschinger, Zhu, and Read (2016) argue that the relationship between resistance to improvements and stress management lies in the attitude of the affected. There are several things one should consider when discussing resistance to change. The first is whether the resistance is immediate or deferred. Laschinger, Zhu, and Read (2016) conducted a research study to figure out whether nurses’ resistance to managerial jobs is immediately or deferred.

Towards this end, immediately refers to an action that is undoubtedly against the advancements. For example, if a hospital creates a nursing manager position and no nurse applied for it, then they have an immediate resistance to the modifications. Their action indicates that they do not want any part of the change. On the other hand, deferred action would be manifested in complaints and even strikes. Laschinger, Zhu, and Read (2016) argue that immediate actions are easier to deal with than deferred ones when it comes to organizational change.

The second thing that should be considered is that the resolution attempt should go hand in hand with the type of resistance recorded. Thus, the way the facility would deal with immediate resistance is different from the way it would handle a deferred one. To prove this, Laschinger et al. (2016) quote a study on how different strategies have been used to solve both deferred and immediate resistance to change.

Whereas deferred resistance is referred to as a deviant action, immediate is not. The main reason as Laschinger et al. (2016) points out is the fact that immediate resistance is often based on personal experience and lack of understanding of the importance of the improvements. It is more natural compared to deferred resistance. This type of resistance (deferred resistance) is premeditated. It is these differences that should inform the type of strategy to be used to resolve the problem and manage the stress created by the resistance.

Thirdly, one should consider the impact of the change. This is especially regarding those impacts that are not tangible. Taylor, Roberts, Smyth, and Tulloch (2015) reveal in their study that there are several types of non-tangible reactions to advancements. One common reaction is the loss of respect or motivation. Indeed, Taylor et al. (2015) explain that there are employees who would agree to implement innovations yet believe it was not the best choice for the organization. For instance, a nurse manager who is given the position and accepts it yet is frustrated as she believes it was not the right choice. The issue of non-tangible reactions to the change is important as it also brings in stress management.

The politics of change management can also affect how innovations are implemented. Milton, Nel, Havenga, and Rabie (2015) quote a study that indicates that many employees believe that the drive for advancements normally comes from third parties. As mentioned previously, many employees who are not directly involved in the improvements from the start often do not own the process. Additionally, companies are still trying to find out how to best assure difference is initiated by the employees.

In the case of managerial and administration roles for nurses, one can argue that the improvements were initiated by the nurses themselves. Indeed, one of the reasons why nurses had to be keen on administrative duties is the impact their non-participation had on their duties. Since nurses did not have representatives in the management of many hospitals, they were least favored when it came to budgeting. In turn, this negatively affected their ability to offer quality services to their patients.

The chosen decision model, the recognition-primed decision model, can be very effective in the implementation of change in the nursing field. As mentioned earlier, the model allows for those involved to test the new implementations to understand the possible implications better. Nibblelink and Reed (2019) employ an approach in acute care nursing research. The scholars explain that the approach is effective in fast decision-making as it allows for the involved to fully appreciate the different elements that the improvements might bring.

Additionally, the simulation allows for the involved to capture the different components that the new change would encourage. In nursing, decisions should be made with several things into consideration. For instance, patient care is affected by both internal and external pressures and decisions have to be made with all these in mind. The approach allows for this making it an effective way of helping nursing managers lead properly.

Rockstuhl, Ng, Ang, and Presbitero (2019) conduct a study that also tests the relevance of the chosen model for purposes of change and stress management. The scholars apply the concept to global work giving an overview of how it can be applied in a highly pressured environment. One of the key things that this study indicates is that the recognition-primed decision model can be implemented without the initial knowledge of the employees.

In the case of nursing, the introduction of nurses into the management of a hospital can be done casually. The main reason for this is the fact that the approach reduces bias. An example can be given to explain further. If a nurse is asked to stand in for a manager that has taken some time off, he or she can start to appreciate the managerial role. Therefore, it becomes easier if the same nurse is asked to become a nursing manager as they will find the experience familiar.

Gregory et al. (2017) argue that the decision-making model has also been used effectively in the labor and delivery unit. The scholars argue that the stated unit is mainly run by nurses. Doctors and other specialists are only required if there is a Caesarian section or other pregnancy-related complications. The authors explain that there have been few studies done on the relationship between the decision-making style, stress management, and quality of approach in nursing. The authors confirm that all these are caused by the fact that there are few nurses in the administrative and managerial sectors of hospitals. The study also included other physicians to draw differences between the decision-making styles used.

Sadler-Smith and Hodgkinson (2016) suggest that intuition is equally important in decision-making. The scholars agree that whereas the recognition-primed decision model is a great tool for lowering resistance to change and proper stress management, those involved in the process have to also be in the right state of mind. Therefore, whereas modifications to the process are important, the implementers have to fully understand the process to attract other employees to the same. Caution should be taken when dealing with non-tangible reactions to advancements such as stress as they can have long-term impacts on the staff. Also, the inclusion of the staff at the very beginning of the change process is critical in the success of the model.

Results

Several results were realized from the quoted studies. Gregory et al. (2017) realized that negative attitude led to avoidant decision-making styles. Out of the 110 people that took part in the study, only 16 stated that negative attitude did not affect their decision-making style. This can be applied to the nursing management problem highlighted throughout the paper. As mentioned previously, other professionals in the health facility set-up perceive nurses as helps.

They are perceived as aids and rarely is a nurse in charge of a facility that has doctors and other professionals such as clinical officers. This perception has created a negative attitude towards nurses as managers. In turn, the attitude has led to the avoidance of giving nurses managerial jobs. Additionally, when nurses are given such duties it is normally within the same cadre. Such as nurses can only manage other nurses and not a whole hospital and so forth.

Gregory et al. (2017) also realized that the participants who recorded higher levels of stress also made poor decisions. This realization goes to prove that the identification of stress pointers during the change management can help ensure the successful implementation of the innovations. Since facilities are different, the management can identify the major elements that cause stress among nurses to the extent that they do not want to take up managerial roles. Once these stress pointers are determined, the management can come up with viable solutions that would then improve the decision-making process by encouraging nurses to take up administrative roles. The scholars conclude that a combination of stress relievers and the right decision-making model can lead to quality clinical decision-making.

Through their study, Nibbelink and Reed (2019) realize that a viable decision-making model in nursing is necessary for the quality provision of services. What the scholars refer to as the practice-primed decision model is very similar to the recognition-primed decision model. Both models use simulations to help all the people involved in an advancement fully understand it. This makes it easier for those involved to also anticipate challenges and come up with solutions for those challenges before the actual implementation of the innovations. The researchers explain that their model is better as it has identified the key issues that would lead to stress and ineffective change management. It is these specific variables that are then used to draft suitable solutions to problems that would arise after the simulation.

Rockstuhl, Ng, Ang, and Presbitero (2019) note that intellectual familiarity is critical in any decision-making process. The scholars add that this element of decision-making has been neglected in almost all models. The result support principles encouraged by the recognition-primed decision model. For instance, people that use the recognition-primed decision model often have a feeling of familiarity when the change is implemented. Indeed, the model can also be implemented without the knowledge of the staff, as mentioned previously, to lower the chances of bias.

Recognition-Primed Decision Model, Resistance to Change and Stress Management in the Nursing Field

The literature review and the results section provide ample evidence that the chosen model can be effectively used in change and stress management in the nursing field. Steghofer (2017) notes that the model can be used to incorporate six values that are important in dealing with resistance to change and stress management. The first is education and communication. The first phase of the model involves the use of simulation to experience the change.

This will be a moment of learning and proper communication will be effective in ensuring that the people are involved in understanding the process. The second element is active participation. This is also incorporated in the first phase of the model. Indeed, critics have argued that participation in the change-making process is critical in handling resistance. The last component of the model, which is the implementation of the change, also encourages participation.

Thirdly, the model allows for support and commitment. As mentioned previously, the model can be mimicked to prove that the change is not only necessary but also effective. During this process, one can receive a lot of support and commitment. Using the previous example of the nurse who is asked to step in for a colleague on leave, he or she will receive a lot of support from management and fellow nurses. Fellow nurses will, at the time, not offer the support due to the temporary promotion, but will do in solidarity. This can then be used as a learning point for the eventual promotion into the managerial position.

Indeed, the model also encourages the development of positive relationships. Indeed, the change in making nurses take up more managerial jobs can strain relationships further. Two main relationships can be affected. The first, and the most obvious, is the relationship between the nurse and the other health care workers in the facility. This, as explained previously, is due to the misconception that nurses cannot be managers as they are aids to the other specialists in the hospitals.

However, it is also important to anticipate a strained relationship between the nurse selected for the managerial position and his or her other nurse colleagues. Whereas the advance is ideal also meant to help and support nurses, decision-making has to be clear and without bias. This can enhance tension between the nurses as they expect one of their own to always be on their side.

Taylor et al. (2015) add that the model helps with change and stress management by lowering resistance levels as it offers a fair approach to implementation. One can decipher the three phases of the model to be a form of pre-testing. The pre-test will highlight some of the challenges that both the current administration, the staff, and the person promoted to the managerial job will face if the innovations are implemented permanently.

It gives room for improvements and allows the person involved to fully understand the role such that they can give justifications for either accepting or rejecting the improvements. It is prudent to mention that the model does not in any way assure the successful implementation of innovations. However, it reduces the chances of resistance and manages any form of stress that might arise during the process.

Lastly, the model allows for coercion for the resisters. Since it requires some time to simulate and then implement, the management and all those involved also have time to explain the necessity of the advancement, how it affects everyday work, and how it affects the different employees and their duties. This will, in turn, ensure that the employees are supportive of the change, especially if they appreciate its value.

Conclusion

In conclusion, one of the major problems in the nursing industry today is the uptake of managerial positions by nurses. There are various reasons why nurses have shied off managerial responsibilities. First, they are deemed unfit for administrative work as they are seen as a lower cadre of health care workers. Secondly, nurses are not keen on taking up these jobs as they believe they are already overworked, and taking on more responsibilities can lead to ineffectiveness.

It is, however, prudent to point out that the nurses are mainly overworked due to a lack of representation in the management teams of their hospitals. Whereas many strategies can be used to encourage nurses to apply for managerial positions, many have been ineffective. One of the reasons for this is the fact that these strategies do not consider stress pointers than make such positions unattractive to nurses.

Research shows that stressed people make poor decisions. Nursing duties alone can be stressful as they require fast action yet are dealing with life or death issues. The additional stress of strained relationships and an increased workload can make nurses demotivated to apply for such positions and to resist innovations that encourage the same. It is suggested that the recognition-primed decision model be used to implement innovations of a leadership nature in nursing.

The model allows for those involved to test the change and come up with appropriate solutions to any challenges that might arise during the testing period. One of the main advantages of the model is its ability to bring together the staff and the promoted person while reducing the stress levels of all parties involved.

One of the implications of the use of the model in solving leadership issues within the nursing practice is an easier and more effective uptake of managerial jobs by nurses. This is important as nurses are the center of patient care. In turn, they contribute largely to the profitability of a hospital as patients will mainly come again after they are treated well both regarding their illness and the attitude and comfort they receive in the facility as well. Another implication is the appreciation of nurses as equals within any health facility, with the ability to lead just like any other health care worker professional.

Currently, there is a possibility to apply the model to my nursing practice. One of the applicable elements of this study is the importance of leadership studies for nurses. This can be included in the syllabus. Indeed, change is better if it is initiated from the inside. Many nurses believe that they cannot become managers. The same nurses will also not support a nurse manager due to misconceptions that have been developed over time.

Some studies indicate that this school of thought is advanced by older nurses as they have been in a system that does not see the value of nurse managers for a long time. However, now is a viable time to improvements this concept and encourage nurses to also take up managerial work. Overall, change and stress management can only be done when the involved participate in the process from the beginning. All involved also have to share the same vision that the advancement will initiate.

References

Adriaenssens, J., Hamelink, A., & Van Bogaert, P., (2017). Predictors of occupational stress and well-being in first-line nurse managers: A cross-sectional survey study. International Journal of Nursing Studies, 73(2017), 85-92.

Gregory, E. M., Sonesh, C. S., Feitosa, J., Benishek, E. L., Hughes, M. A., & Salas, E. (2017). Decision making on the labor and delivery unit: An investigation of influencing factors. The Journal of the Human Factors and Ergonomics Society, 59(6), 937-955.

Laschinger, S. K. H., Zhu, J., & Read, E. (2016). New nurses’ perceptions of professional practice behaviours, quality of care, job satisfaction and career retention. Journal of Nursing Management, 24(5), 656-665.

Milton, R. D., Nel, A. J., Havenga, W., & Rabie, T. (2015). Conflict management and job characteristics of nurses in South African public hospitals. Journal of Psychology in Africa, 25(4), 288-296.

Nibbelink, W. C. & Reed, G. P. (2019). Deriving the practice-primed decision model from a naturalistic decision-making perspective for acute care nursing research. Applied Nursing Research, 46(2019), 20-23.

Numminen, O., Leino-Kilpi, H., Isoaho, H., & Meretoja, R. (2014). Ethical climate and nurse competence – newly graduated nurses’ perceptions. Nursing Ethics, 22(8), 845–859.

Rockstuhl, T., Ng, Y. K., Ang, S., & Presbitero, A. (2019). That’s familiar! Testing a theory of recognition primed decision-making in global work performance. Academy of Management, 2007(1), 4-21.

Sadler-Smith, E., & Hodgkinson, P. G. (2017). An analytic-intervention model of managerial intuition. Academy of Management Proceedings, 2016(1), 12-17.

Steghofer, J. (2017). Change is afoot: Applying change management theories to self-organizing socio-technical systems. IEEE Technology and Society Magazine, 33(6), 56-62.

Taylor, B. Roberts, S., Smyth, T., & Tulloch, M. (2015). Nurse managers’ strategies for feeling less drained by their work: an action research and reflection project for developing emotional intelligence. Journal of Nursing Management, 23(7), 879-887.

Van Bogaert, P., Peremans, L., de Wit, M., Van Heusden, D., Franck, E., Timmermans, O., & Havens, S. D., (2015). Nurse managers’ perceptions and experiences regarding staff nurse empowerment: a qualitative study. Frontiers in Psychology, 6(2015), 1585.

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