Between changes in technology, new discoveries, and research findings, it is inevitable that nursing practices would change to adapt to these technologies, discoveries, and the implications related to research. But change can be difficult and presents certain challenges. The purpose of this paper is to present a change which occurred in the author’s organization, analyze that change and its effectiveness, and assess how it might have been done differently.

Recently in the author’s organization a change was implemented. This change involved reducing the nurses’ work hours while somehow increasing the nurses’ case load. Unfortunately the nurse leaders did not handle the change fairly, neither supporting the nurses nor arguing against the change. Furthermore, the owners of the organization – who should also be considered leaders, even if they aren’t nurses – profited financially from the change; however, the nursing staff struggled to keep up with the workload.

While the desire to run an effective, efficient, productive, and profitable organization are understandable, in the health field there are certain considerations which cannot be ignored. The decision on the part of the owners and the way in which the nurse leaders chose to implement the changes create two problematic situations: first, the change did not take into consideration patient care outcomes, which is a critical element of nursing care (Wong, Cummings, & Ducharme, 2013), and second, the change resulted in a decrease in quality of care, a circumstance which should be unacceptable to any nurse or nursing leader, given that standards of care are so critical to the profession (American Nurses Association [ANA], 2010b).

The fact that the staff struggled reveals some troubling circumstances. Though it is true that the nurse leaders have to consider the business side of issues, it is also true that they are responsible for bringing such practices into alignment with nursing values (Murphy, 2012). The nurse leaders failed to employ certain critical elements of transformational leadership (TL), namely visibility, accessibility, and communication (Clavelle, 2012), which might have helped the leaders reconsider the change, or even adjust the changes to preserve quality practice, or at the very least enabled the nurses to understand the coming change and offer feedback prior to implementation.

On the heels of the statement about communication, the change could have been made more effectively if the nurses had been more involved in the decision-making process. Nurses have certain ethical obligations to society – namely to offer care and to protect the interests of their patients (ANA, 2010a; Fowler & ANA, 2008) – which were clearly not considered or preserved in the change. It is paramount that such ethical obligations which form the foundation for nursing practice be considered and preserved.

Another way that the change could have been more effectively handled is if the nurse leaders had meaningfully employed the principles of TL. According to Heuston and Wolf (2011), TL “is an effective approach in which leaders set the tone for positive change by building trust within their teams” (p. 248). The leaders should have built trust first, but their failure to do so led to several negative outcomes.

When leaders fail to establish trust with their followers, do not employ effective leadership, or fail to remember foundational tenets of nursing practice, they run the risk of making change for the worse. Only in using effective leadership methods and remembering those core tenets can effective change be made which positively impacts nursing practice.