Change Resistance as Practicing Moral Authenticity: A Qualitative Study

Background and purpose: Organizational changes are increasingly rapid and continuous in health care as organizations strive to meet multiple external pressures. Much change in health care fails and nurse resistance is commonly blamed for such failure. Nurse resistance to organizational change is often described as overt behaviours and are deemed destructive to the change process. Much of the literature describing organizational change comes from the perspectives of administrators, there is little known about nurses' experiences of organizational change. The purpose of this inquiry was to explore the nature of frontline nurses' experiences of rapid and continuous change. Methods: A qualitative critical hermeneutic design was applied. 14 Registered Nurses participated in face-to-face interviews. Open-ended questions were used. The setting was an urban pediatric teaching hospital located in Canada. Research ethics board approval was obtained as required. Member reflections ensured accurate portrayals of participant's experiences. Results: The findings from this study suggest that acts of resistance to change are not overt, but rather covert behaviors in micro-ethical moments. Nurses engaged in resistance as means to provide morally authentic care at the bedside. These acts were utilized to take back power over their practice amidst feelings of powerlessness, however, paradoxically, when participants described the concept of power, they understood it solely in the context of feeling powerless within the planning, implementation and evaluation of organizational change initiatives. Nurses engagement with resistant behaviours in the context of organizational change demonstrated ethical action and political agency that enabled morally authentic nursing practice. Implications for practice: The findings from this study offer new understandings of a well-established concept in nursing and can be used when considering the ethical dimensions of nursing work amidst rapidly changing health care institutions.