The Nursing MS Degree in Management

By: Gary J. Salton, Ph.D.
Chief: Research & Development
Professional Communications, Inc.


INTRODUCTION
This research blog investigates whether students attending Second Career and traditional Master of Science programs are equal sources of nurse management talent. The research finds that program participants are different and will appear so to observers. But they are virtually identical in their ability to provide “management ready” talent.

The research then compares nursing with people pursuing a master’s degree in other professions. It finds that nursing MS programs provide less than half as much managerial perspective to the talent pool than do other professions.

Finally, a Migration Strategy of offsetting the shortage of nursing is offered. The strategy can be applied to any nurse (AA, BS or MS) and provides a non-threatening, measured option for both the nurse and the medical institution. This strategy is more fully specified in an Addendum to this research blog.


DIFFERENT KINDS OF MS GRADUATES
There are two major programs producing nurses with MS degrees. The traditional program admits nurses who have completed undergraduate nursing programs. The Second Career MS program admits students with who completed their undergraduate degree in other fields.

Data is available from 29 students completing Second Career Master of Science (MS) degrees and 81 students in a traditional MS program at a major research university. Graphic 1 shows that the students in the two programs are statistically different along two dimensions.

Graphic 1
SECOND CAREER AND TRADITIONAL
MASTER OF SCIENCE PROGRAMS

Traditional students put more reliance on the idea-oriented RI strategy. The Second Career students put greater emphasis on the disciplined action of the LP style. However, this is not the relevant test for the issue at hand. That issue is how well the two group profiles match the needs of nursing management.

Graphic 2 shows only one statistically significant difference between Second Career students and existing management. Second Career students tend to use the innovative RI strategic style less than does existing management.

Graphic 2
SECOND CAREER AND TRADITIONAL MASTER OF SCIENCE
STUDENTS vs. ESTABLISHED NURSING MANAGEMENT

The difference in innovation based RI is large enough for both educators and employers to notice it. However, no single strategic style determines overall managerial “fit.” That requires considering all of a person’s strategic styles simultaneously.

To test the overall “fit” a composite profile was constructed by averaging the “I Opt” scores from all hospital management levels (from CNO to Assistant Nurse Manager). Student profiles falling within 30% of this standard were deemed to share management’s information processing perspective. They are likely to approach issues in about the same manner as existing management. Effectively, they can be seen as “management ready.”

Graphic 3 shows the MS Program participants who lie within 30% of the management standard. The circles (i.e., centroids) are Cartesian averages. They locate a point of central tendency along all four of the “I Opt” styles simultaneously. Blue circles are the Second Career students, the yellow are the traditional. The red circle is the composite management centroid.

Graphic 3
SECOND CAREER AND TRADITIONAL
MASTER OF SCIENCE STUDENTS SCREENED
BY 30% MANAGERIAL CANDIDATE CONVENTION

The two types of MS programs appear to be functionally equivalent. Variation in some styles is compensated for by differences in others. The dispersion of both student groups is roughly equal.

Table 1
PROPORTION MS STUDENTS WHO
DEVIATE 30% OR LESS FROM THE
EXISTING MANAGEMENT PERSPECTIVE

Table 1 below reinforces equivalence. It shows that both programs are virtually identical in the depth of talent they provide. About 17% of the people in both programs have an “I Opt” profile that “fits” with the existing management. For managerial assessment purposes, the two programs can be treated as a single entity.



ADEQUACY OF THE “MANAGEMENT READY” NURSING POOL
Having two MS programs able to supply management talent is to be welcomed by the profession. However, the adequacy of the absolute size of the management pool merits investigation.

One method of testing adequacy is to compare nursing MS students with master degree candidates in other professions. A non-nursing average management standard was constructed using 4,945 executives from all industries and areas. The positions sampled were from General Manager through supervisor. The “I Opt” profiles of these executives were averaged to arrive at a non-nursing management standard.

A total of 611 masters’ candidates in disciplines such as engineering, business, computer science and manufacturing science from five universities provided a non-nursing sample. These students will typically fall under the supervision of the management identified as the standard. Students falling within a 30% range of the non-nursing “all management” standard are shown in Table 2.

Table 2
NON-NURSING AND NURSING MASTERS CANDIDATES
SCREENED BY 30% MANAGERIAL CANDIDATE RULE

The results are striking. Nursing has less than half of the depth of “management ready” masters’ candidates. One cause might be a difference in the standard being used. In other words, nursing might have a management standard (represented by the centroid of the average manager) more challenging than that of the other professions. Graphic 4 addresses this possibility.

Graphic 4
NURSE AND NON-NURSE ENTRY LEVEL SUPERVISORS INFORMATION PROCESSING PROFILES

Statistical tests confirm the obvious. There is no statistically significant difference between the two management groups. In information processing terms, nursing management could move to industry and nobody is likely to notice the difference—and vice versa

If the profiles of nurse/non-nurse management are the same and the methodology is the same, the character of people being attracted to nursing MS programs must be different. This is exactly the case. But the difference is not obvious. It requires the exact measurement capabilities of “I Opt” technology to lay the reason bear.

Graphic 5 shows that there are statistically significant differences between nursing and non-nursing masters’ candidates. The nurses are more idea-oriented (RI) and fall a bit short in their inclination toward analysis and assessment (HA). However the size of the differences do not appear to be enough to account for nursing having 50% fewer “management ready” candidates.

Graphic 5
NURSE AND NON-NURSE
MASTER OF SCIENCE STUDENTS

If averages cannot account for the divergence the answer must be in the distribution of students. This is exactly the case. Graphic 6 shows the centroid distribution of both nursing and non-nursing masters’ students. The non-nurse portion of the graphic uses a 110 person random sample drawn the 611-person non-nursing students. This makes the non-nursing group visually comparable to the 110 nurse MS population. There is no need to make mental adjustments for different size samples.

A quadrant by quadrant comparison reveals that the nurses are more widely scattered than their non-nursing counterparts. Nursing is apparently more hospitable to and thus attracts a wider range of perspectives than do other professions. The compassion that drives many nurses is more widely spread that are the mathematical capabilities of engineers or the logic of the computer scientists. This is as it should be in a healing profession.

Graphic 6
NURSE AND NON-NURSE MASTERS CANDIDATE
"MANAGEMENT READY" DISTRIBUTION

The effect of the dispersion of MS nurses is seen in the magnification. The circle in the center shows the number of people falling within 30% of the respective management standard (i.e., the green and red circles). Even though the sample size is the same, there are twice as many yellow circles among the non-nursing professions. The position of the management centroids differs slightly. But the wider ranging “I Opt” profiles among the nurses’ accounts for most of the dispersion.

IMPLICATIONS
Table 3 compares nurses in the MS programs with general staff nurses (including both graduate and non-graduate nurses).

Table3
NURSING MS CANDIDATES Vs STAFF NURSES
SCREENED BY 30% MANAGERIAL CANDIDATE RULE

The MS offers a small increase in the pool of “management ready” talent. But the MS degree does not serve as a strong management filter. Since the nursing MS is targeted primarily at providing talent for the various nursing specialties, this is not an unexpected result.

However, nursing management is itself a specialty. Earlier studies (Staff Nursing Paradox and The Nurse Management Staircase) have shown that it demands a unique perspective. That perspective carries with it skills that are not widely shared. The exercise of these skills (or absence of them) effects such important areas as nurse retention, quality, efficiency and effectiveness. This is not a minor matter.

Simply attaching more standard “management” courses to the nursing curriculum is unlikely to have any effect in adding to the nurse management pool. Adding familiar course content focused on techniques, processes or organizational theory is unlikely to have an effect.

One reason is that the problem is not technical knowledge, it is in management perspective. Trying to address hospital level problems with the detailed orientation of a staff nurse is predestined to failure. Equally, trying to deal with the mechanics of a ward using the expansive hospital level thinking is likely to create a degree of very visible chaos. It does not matter how well the techniques used to apply these misaligned perspectives are executed.

Leadership training is also unlikely to remedy the condition identified here. The managerial perspective revealed by these nursing studies is not confined to leadership. It applies how problems are defined, the meaning of terms (e.g., “fast” means different things to different styles) and the “right” way to address an issue. All of these things and more are precedent to leadership. They define the direction that leadership will take. Adding skills on how to execute that direction will do nothing to address the fundamental issue of what that direction should be.

This research blog indicates that the dearth of management talent in nursing is going to persist. Nursing schools are unlikely to fill the gap. It is doubtful that students better aligned with a management perspective could be attracted in any appreciable numbers. A program to show nurses how to prepare themselves could help (see Migration Strategy below) but its effects in appreciably increasing the management talent pool will take many years to realize. Medical institutions will probably have to rely on themselves to grow the talent that they need.


THE MIGRATION STRATEGY
The interests of hospitals are probably best served by helping existing nurses who want to enter management to realize their aspirations. Standard management programs can teach them techniques and processes. What is needed is a method of aligning their information processing perspective with that of management. This does not happen automatically.

Unlike psychological states, “I Opt” information processing profiles can be changed. However, change cannot be imposed. This is because change is not confined to work. It affects an entire life and a personal commitment is needed to effect that kind of change. It is also not fast. Profile shifts typically take at least 18 months. A nursing management program aimed at aligning profiles will be neither inexpensive nor fast. But it can be done so that produces positive, cost reducing returns to the hospital along the way.

The basic idea is to provide the nurse candidate with specific tools to offset the vulnerabilities inherent in whatever profile that she holds. Then structure an environment so that she can use the tool repeatedly. As it is used, performance is improved. Another process then takes hold to yield lasting benefit to all involved. That process is that success breeds success.

The tool is merely a temporary aid. As it is used a nurse becomes increasingly familiar with the behavioral option it promotes. In practicing she is actually practicing the use of an alternative strategic style(s). With success the behavior becomes embedded in her repertoire of automatic responses—her strategic profile. Effectively, her profile is migrating from one state into another. This new state is preparing her to assume managerial responsibilities.

The migration strategy is a measured approach. There is no sudden shift in overall behavior. The nurse gets to work the new approach into her life pattern—at work, home and other venues in which she participates. Co-workers get the opportunity to adjust their expectations. The pressure on the nurse candidate to maintain past behavior patterns is reduced. The hospital gets steadily improving management performance.

Migration strategy process is simple. (1) Identify specific behavioral vulnerabilities using “I Opt” technology (2) design methods to offset them one at a time (3) practice (4) Once command is gained, return to item #1 for another vulnerability and restart the process. Since each nurse has a unique profile, the migration strategy is tailored to the specific needs of each nurse. The results can reasonably be expected to be more powerful than any “one size fits all” solution.

Space limitations prevent a fuller specification of the Migration Strategy here. An “I Opt” Engineering research blog Addendum is available for those interested in more detail


SUMMARY
This research has demonstrated that traditional and second career nursing MS programs are equivalent in their ability to produce managerial talent. Their common level exceeds that available from the general nursing staff but only by a small amount. Advanced nursing education does not appear to be geared to fill the nursing management gap.

The study also shows that the nursing Master’s program also falls far short of the results posted by other disciplines and areas. These other areas produce twice as many “management ready” graduates than does nursing. Evidence shows that this is not the result of the demands of nursing management. It is due to the nature of the nurses themselves.

This study traced the nurse management shortfall to the wide dispersion of “I Opt” profiles among nurses. This is likely that this is due to the nursing MS degree serving primarily as a tool for entering nursing specialty areas rather than as a vehicle for promotion to managerial ranks. This means that it is unlikely that traditional management development programs will address the issue identified. The issue lies at the very way the average nurse perceives the world, not how they go about executing a course though it.

Finally, an outline of a Migration Strategy for developing a managerial perspective was offered. It proposes a staged, systematic migration that will equip nurses to handle the kind of issues encountered at the various management levels. The process is outlined in this research blog and more fully specified in its Addendum.

The Nursing Staircase and Managerial Gap

By: Gary J. Salton, Ph.D.
Chief: Research & Development
Professional Communications, Inc.


INTRODUCTION
This evidence-based research blog outlines the discovery of a nursing staircase. Its steps are systematic and quantifiable. The staircase impacts patient care, nursing quality, organizational effectiveness and nurse retention among many other things.

The staircase automatically creates a communication “gap.” This can compromise coordination and can give rise to significant tensions that can affect an entire nursing organization. This research shows the dimensions of the issue and traces some of its implications as applied to nursing.


NURSING MANAGEMENT
This study draws on data from two hospitals. One is a government facility and the other a private hospital. A total of 52 nurses in management positions guide the activities of 344 staff nurses.

As with other goal directed organizations, nursing management is a hierarchy. In this study the Chief Nursing Executive and various Nurse Administrators (e.g., Cardiac, Woman's Health, etc.) occupy senior positions. The Nurse Manager sits in the middle and the Assistant Nursing Manager lies at ranks below. The hierarchical composition and names assigned vary by hospital but there are always positions at the different levels.

Graphic 1 shows that the information-processing strategies used by these various levels at the hospitals studied differ both systematically and significantly.

Graphic 1
INFORMATION PROCESSING STRATEGIES
OF LEVELS OF NURSING MANAGEMENT

A “stair step” arrangement of information processing strategies is instantly apparent. The higher the level, the less reliance is placed on structured approaches (LP and HA) and the greater the dependence on strategies that build on unpatterned input (RS and RI). This is same phenomena has been found in non-nursing teams, in functional areas such as engineering and in hierarchies in general. As yet unpublished ongoing research has revealed many similar instances. The relationship is ubiquitous.


THE STAFF NURSE
The “stair step” relationship within the management structure creates issues between management levels. However, the real impact on any organization will be felt where “the rubber hits the road.” In the case of nursing, that happens at the staff nurse level.

The staff nurse is the core of any hospital. They are the people who nursing management must successfully direct in order to realize their vision. A companion Staff Nursing Paradox research blog has shown that staff nurses tend to use a Logical Processor (LP) strategic style. This earlier study argues that the LP style is the one best suited to their core function. Graphic 2 reveals that the staff nurse’s choice fits neatly into the “stair step” found in management. Exactly the same managerial “gap” processes are at work throughout the hierarchy.

Graphic 2
INFORMATION PROCESSING STRATEGIES
INCLUDING STAFF NURSES (in red)

The fact that the differences are significant is apparent from Graphic 2. However, just to be sure the various management levels were consolidated (n=52) and compared to the staff nurse population (n=344). In every case the level of statistical significance far exceeds academic standards at the p < .001 level. This is no accidental relationship.


IMPLICATIONS
There is no mystery on why the staircase has evolved. As a person rises in a hierarchy the problems they address become less and less “standard.” Issues that can be resolved by traditional practices (LP-action based) and by known analytical processes (HA-thought based) have been already addressed at lower levels. The manager is left with issues that favor innovative approaches (RI-thought based) and/or which require decisive action even in the absence of full information (RS-action based).

The staircase is the result of a natural filter. It systematically sorts out people by their information processing approach. It matches these to the kinds of issues that exist at the various organizational levels. But there is also a cost. The “stair steps” are communication impediments. In order to address an issue at a particular level, you have to focus on it. In doing that, you lose focus on allied issues at other levels.

For example, a nurse facing a patient related crisis is likely to instantly deploy methods she knows work in a manner that has proven to be efficient and effective (an LP approach). In doing this she automatically loses focus on the possibility of less certain but potentially more viable options that might be applied (the RI approach). If these kinds of issues continually arise, the strategic style tends to be reused. With reuse the approach solidifies into a perspective. It becomes an efficient and effective way of navigating life.

People whose “I Opt” strategic profile (i.e., the combination of styles they normally employ) match the demands of a particular environment tend to prosper. They begin to generalize their strategies. If it works here, it must work there. Their strategy becomes the “right” way to do things. People addressing these issues using a different strategy are “wrong.” After all, if there is a “right” there must be a “wrong.” Thus is born a basis for organizational tension.

This kind of thinking can even leak into the meaning of words. For example, a person working in a Trauma Center is likely to favor the instant action RS style. That person will probably interpret the word “fast” to mean immediately. The RS interpretation works in the Trauma environment. This is evidence that it is the “right” meaning.

A person working in Radiology will probably favor the analytical HA style. They are likely to see “fast” as meaning as soon as things have been completely thought out. As with the RS above, this meaning of fast becomes generalized. Same word, different meanings.

The example used the word fast. In fact any term that is relative in nature is subject to this kind of interpretation divergence. For example terms like creative, thorough and precise are equally susceptible. This alone is enough to cause serious coordination problems. But it does not stop there.

The meaning of words sets expectations. Expectations are the standard against which judgments of “good” or “bad” are made. When applied to work performance these judgements of good and bad can influence assignments, raises and promotions. This is serious business.

People compare their judgment of what they have done with that of the person evaluating them. If these two people have different strategic profiles (i.e., different information processing strategies) the standards used can vary. One person can see an assessment as "just" while the other believes they have been “wronged.” At this point emotions can come into play. A different standard backed by emotional energy is a formula for continuing tension.

There is no right or wrong here. Both parties in the example are using a “right” strategic posture. Both parties have interpreted the terms being used in a “right” way. The standards based on their “right” interpretations are themselves “right.” What has happened is that the staircase has built divergence into the system. The divergence cannot be avoided. It can only be managed.


STAIRCASE MANAGEMENT
The existence of the staircase presents chronic but not fatal problems. The structure has functioned for centuries in various forms and can probably continue to function for centuries more. Prior to “I Opt” uncovering its basic dynamics, there was not much to be done. Now there is.

Minimizing misinterpretation and its associated standards divergence is simple. Just make sure everyone knows where everyone else is “coming from.” This transparency only requires access to “I Opt” profiles. There is nothing secret about them. We all display them every day. The problem is that not everyone sees each other every day. That means that it is easy to make a wrong guess just because of selective, irregular exposure.

The benign character of “I Opt” profiles has been demonstrated. "I Opt" has multiple major clients (i.e., Fortune 500 firms) who regularly use small foam profiles mounted for display. They are passed out in training and consulting sessions. They end up on display in offices and workstations and can stay there for years. Some clients have been using this tool for a decade. If there were any exposure they would have discovered it by now. No problem has ever arisen.

Even smaller steps can help. Individual “I Opt” profiles evolve to fit the specific life that is being led. We did not “choose” them. People see these patterns in their own behavior. People will refer to themselves as creative, precise, analytically adept or responsive. But they seldom reflect on the implications of these patterns. The “I Opt” profile makes these implications visible. Visibility quickly converts to knowledge. Knowledge is a precondition for the adjustment mechanisms that limit misinterpretation. It is a good thing.

Transparency comes with a bonus. It limits emotional escalation. For humans, behaviors always have a “reason.” If one is not apparent, it is created. An easy attribution for offensive behavior is malicious intent. With this can come an enduring emotional response. This is a bad thing.

The availability of an alternative “reason” reduces the likelihood of assigning malicious intent as a cause. The “I Opt” profile provides that alternative. The behavior might still be offensive but at least does not carry the same intentional component. The chances emotional escalation are reduced.

STAIRCASE EFFICIENCY AND EFFECTIVENESS
The staircase works by Darwinian selection. People are selected and installed in management positions. Over time they either work out or don’t. If they don’t workout they either separate themselves or are otherwise separated. The people who remain generally fit the needs of the role.

The first option for improving staircase operation fits into the earlier transparency prescription. “I Opt” styles are not immutable. They can be changed. Telling nurses how they might fit into the staircase can be a first step. A report that identifies their strengths and exposures in a leadership context can give them a template. If the fit is not good for a position to which they aspire they can start making adjustments. Change is not easy but it can be done.

Another option is to use the “I Opt” profile as a scanning mechanism. For example, Graphic 3 shows the results of scanning the 344 staff nurses in this study against the average profile of an Assistant Nurse Manager. The circle designators (i.e., centroids) are Cartesian Averages that locate the point of central tendency along all four of the “I Opt” styles simultaneously. Yellow circles identify nurses falling within 30% of the Assistant Nurse Manager (in blue). The scan isolates those nurses whose strategic style perspective roughly matches that of presumably successful existing management.

Graphic 3
SCAN OF NURSES WITHIN 30% OF
ASSISTANT NURSE MANAGER PROFILE (in blue)

The scan cannot be used as a selection mechanism. It does not consider things like experience, education, aptitude or any number of other factors that are relevant to selection. But it can serve to alert management to potential candidates who might otherwise have been missed. For example, a nurse working the night shift may not get the exposure of an equivalent person working the day shift. A scan can help level the playing field.

The screening standard in the example was the Assistant Nurse Manager. There is some indication that various parts of the hospital favor somewhat different profiles. Graphic 4 contrasts nurse managers from the ICU and Trauma Center.

Graphic 4
ICU vs PSYCH MANAGERS AVERAGE
STRATEGIC STYLE DISTRIBUTION

The sample is admittedly thin. But it serves to alert the nurse leader to the fact that the standard used for scanning can be tailored to specific needs. All that needs happen is to adjust the average used as a standard. People at relevant level of management in the area of interest can serve as a standard just as well as did the Assistant Nurse Manger in the example used here.

Darwinian processes will eventually sort out the well suited and ill suited to create the staircase. However, the process is inefficient and unnecessarily brutal. Scanning the pool of possibilities can help insure that people who already have appropriate perspective are considered. People whose strategic profile is ill suited but who are otherwise qualified can be given support to increase their odds of success. It is a win-win for all involved—the hospital and the candidates.


SUMMARY
Information processing profiles form a staircase. The staircase was not planned. It is the outcome of a natural filtering process that aligns an individual’s information processing strategy with the nature of the work being performed. It will always be there.

It is the staircase that integrates the patient, ward/unit and hospital level interests into a single, unified whole. All of the different information flows, distinct objectives and unique responses are accommodated somewhere on the staircase. The staircase is what allows a hospital—along with all of the benefits it provides—to exist.

The staircase carries some inherent downside aspects. Miscommunication along with its potential for emotional escalation is one of the more ubiquitous exposures. This cannot be escaped but it can be minimized. The simplest, least expensive and most durable way of doing this is a program of transparency.

The staircase is constantly being rebuilt as new people come and go. The Darwinian process that produces the staircase can be refined. The populations of potential management candidates can be scanned to insure that everyone who merits consideration is in fact considered. People whose skills match the hospitals needs but whose information processing perspective is misaligned can be helped to adjust.

Nothing will dissolve the issues that the staircase creates. However, knowledge that the staircase exists and awareness of the processes that produce it give nurse management an edge. They can now actively manage the process. In doing so the entire nursing profession will be well served. Hospital management becomes more efficient and effective. Professional nurses will work in a more supportive environment and are given a “fair shot” at management positions regardless of where or when they work. The information processing perspective is a concept worth incorporating in the toolbox of the nursing profession.

The Staff Nursing Paradox

By: Gary J. Salton, Ph.D.
Chief: Research & Development
Professional Communications, Inc.


INTRODUCTION
This evidence-based research traces nursing from entry through nurse training and into maturity as a staff nurse in a hospital setting. The research finds that the average staff nurse holds a consistent worldview as defined by the “I Opt” Logical Processor strategic style. This homogeneity means that initiatives are likely to have a profound effect. Everyone will be affected the same way. The dampening effects of style variation will likely be low.


STAFF NURSES
Staff nurses favor the Logical Processor (LP) strategic style as their short-term decision making strategy. Their level commitment is shown in Graphic 1. The LP strategic style is characterized by a disciplined, methodical approach to issues. It is often accompanied by high level of loyalty, commitment, integrity, consistency and dependability. People holding this style put high value on precision, certainty of outcome and stability.

There is also paradoxical side of the LP coin. Consistency is supported by an attitude of skepticism. A cautious posture toward change braces stability. A slow pace of adaptability insures that precision is maintained. A need for full specification buttresses certainty of outcome. These qualities are the corollaries that allow the more favorable qualities to exist.

Graphic 1
STAFF NURSE “I Opt” STRATEGIC STYLE COMMITMENT
(Sample Size = 344)

The question of whether the LP style is optimal for nursing can be answered by looking the system that generates the strategic style distribution. Different system elements all pointing in the LP direction would indicate that there is consensus that the LP approach is optimal for the task. This approach uses behavior rather than opinion as its validation tool and starts with the student nurse.


FIRST YEAR STUDENT NURSES
Why are students’ attracted to nursing? As part of the survey process, students were given an opportunity to assess nursing using their own words. Table 1 shows a content analysis of these responses.

Table 1
PRINCIPAL WORD CONTENT ANALYSIS
FREQUENCY OF CITATION

The “job” dominates the responses. This is confirmed by a contextual review. Responses like “job guarantee”, “job security” and “I’ll always have a job” reoccur. Students are seeing nursing as a low risk career choice. It would be expected that the Logical Processor (LP) style would be attracted to this situation. The style is inherently risk averse because of value it places on consistency and predictability. Graphic 2 shows that this is exactly what occurs.

Graphic 2
1st YEAR STUDENT NURSE vs. STAFF NURSES
INFORMATION PROCESSING STRATEGIC STYLE COMMITMENT

First year students appear to be cut from the same cloth as staff nurses. There are statistically significant differences. But not in the dominant LP approach. Both groups tend to interpret the world in the same manner.

There is an immediate implication to this finding. If you want to change the mix of strategic styles in nursing, lessen job security. A different kind of student will be attracted and existing staff nurses will exit at first opportunity. Initiatives that trade-off job security for incentive pay will likely have this kind of effect. This kind of diagnostic prediction shows one of the benefits of knowing how people use information processing to interpret the world. It can effect policy decisions.


FOURTH YEAR STUDENT NURSES
Fourth-year students continue to focus on the “job” (see Table 1). We would expect that the risk adverse LP style will persist as the student matures. Graphic 3 shows that this is exactly the case.

Graphic 3
4th YEAR vs. 1st YEAR STUDENT NURSES
INFORMATION PROCESSING STRATEGIC STYLE COMMITMENT

Statistical tests (both Mann-Whitney and t-Test) confirm the obvious. There is no difference in the style profiles of the 1st and 4th year students. This means that the nursing school experience had no affect on their basic mindset. They came in as strong LPs and left as strong LPs. The school taught them what to think about. It did not change how they go about thinking about it.


DIFFERENT SCHOOLS
It could be argued that the results are particular to the school surveyed. To answer this potential concern the results from two very different universities were contrasted. One group of students is from a major research university. The other is from a large, regionally anchored university. The results are shown on Graphic 4.

Graphic 4
RESEARCH vs. REGIONAL UNIVERSITY STUDENT NURSES
INFORMATION PROCESSING STRATEGIC STYLE COMMITMENT

There is one statistically significant difference between the schools. The regional students are more inclined to use the HA style (Hypothetical Analyzer) to think through issues and options (p< .01). However, their commitment is only 16% higher. Further, both groups of students fall in the middle of the moderate range. In other words, the difference is statistically significant but of little practical consequence. This finding means that it is reasonable to treat nursing students as a single population. Initiatives that work in one school will probably work in all of them.


DIFFERENT HOSPITALS
The staff nurse sample was drawn from two hospitals, one private and the other a government facility. It could be argued these different environments attract different kinds of staff nurses. Graphic 5 shows that this is not the case.

Graphic 5
PRIVATE vs. GOVERNMENTAL HOSPITAL NURSES
INFORMATION PROCESSING STRATEGIC STYLE COMMITMENT

The similarity of the two groups is obvious. There is a statistically significant difference in the Relations Innovator (RI) style (p<.05). But it is a difference without consequence. The nurses at government hospital are 15% higher in RI but groups still fall in the “low” category. As was the case with nursing schools, the staff nurses from different hospitals can be treated as a single population. Managerial strategies that work in one hospital are likely to work equally well in another.


STAFF vs. STUDENT NURSES
Graphic 6 combines the students from the two schools and the nurses from the two hospitals. The result can be seen as a reasonable sample of staff and student nurses as a whole.

Graphic 6
STAFF vs. STUDENT NURSES
INFORMATION PROCESSING STRATEGIC STYLE COMMITMENT

The Logical Processor strategic style dominates both groups. There is no statistically significant difference between the groups on the LP dimension. This LP approach will be both familiar and comfortable to the student as they transition from school to work.

The three remaining strategic styles do show significant differences. Staff nurses are about 13% more committed to the analytical HA style than are the students (p<.001). This is probably due to the supervised nature of schools. Students are expected to make errors and they are usually corrected without consequence. The need to consider carefully before acting is diminished. Staff nurses do not have a comparable safety net. They have more choice and their choice carries greater consequence. It is reasonable for them to develop a more thoughtful, analytical posture. Students will probably evolve into the same posture as they mature in line positions. Staff nurses also differ from students in both the spontaneous action RS style (p<.001) and the idea generating RI styles (p<.001). However, the level of commitment is “low” for both groups. The differences may be noticed but are not notable.


THE STORY PAINTED BY THE NUMBERS
First year students enter with an LP orientation. This suggests that people see the nursing profession as favoring their way of interpreting the world. They evidence this judgment by choosing nursing.

The education component of the nursing system also appears to see nursing as an LP profession. Universities have the time, reward structure and control necessary to alter the strategic style of students if they chose to. They do not do it. This behavior evidences the fact that schools recognize and support the value of the LP approach.

Hospital behavior appears to agree that the LP approach as the right one for their staff nurses. They populate their staff nurse positions with people who favor the LP style. They have a choice. Graphic 7 shows that nurses come with a range of LP commitments. Hospitals could elect to hire and retain those at the lower end of the range. They don’t.

Graphic 7
STAFF and STUDENT NURSE LOGICAL PROCESSOR (LP)
STRATEGIC STYLE COMMITMENT

The actual behaviors of all involved suggest consensus judgment. The Logical Processor style is the one best suited to the staff nurse position as it is currently defined.

What this means is that it is useless to lament any undesirable qualities commonly cited as characteristic of staff nurses (e.g., resistance to change, rigidity, poor stress management, participation reluctance, etc.). Many of these are behavioral corollaries of those qualities that are ideal for the main mission. These corollary behaviors are to be managed, not corrected.


NURSING SCHOOL IMPLICATIONS
Nursing schools appear to be doing their job. They are attracting students whose “I Opt” profile matches the profiles of people in the positions that the students are likely to fill. They are graduating students without having altered that original match. This is not a bad outcome.

But there is a missing element in nurse education. That element is teaching students to manage both themselves and the mix of other strategic styles that populate the institution they will soon join. This does not refer to a psychological “understanding.” It pertains to actual behavior that will improve the student’s career outcomes and the personal satisfaction that they experience in navigating that career.

On a personal level, every “I Opt” strategic style necessarily carries with it strengths and vulnerabilities. A course that assesses each student’s personal approach to managing life’s information flows can alert them to their exposures and competencies. The program could then proceed to show the student how their strengths can be magnified and vulnerabilities offset. The individual students addressed by this kind of program will be different but “I Opt” is well-tested paradigm that will fit all of them.

The career component shifts focus on managing others. For example, nurse managers and executives markedly differ in their strategic style from the typical staff nurse (Kalisch and Begeny, 2007). What is logical to one group can appear irrational to the other. If this happens, it is a natural formula for conflict, dissatisfaction and poor organizational performance.

Teaching the student why this divergence exists and why it is functional is a first step. Teaching behaviors that facilitate the integration and optimization of the divergent strategic styles is the second step. Complete both steps and the success of the student as well as the reputation of the teaching institution will be positively magnified.

The investment needed to implement this initiative is small. A teacher can learn the basics of “I Opt” technology in 5 hours through an e-learning program. The student can acquire the knowledge applicable to their particular information processing approach in an afternoon. The cost is minimal. Non-profit charities currently buy the needed materials on an ongoing basis to support their own efforts. If they can afford it, the institutions training our future nurses can probably finance the effort out of petty cash. This is a doable and worthwhile initiative.


HOSPITAL MANAGEMENT IMPLICATIONS
The core issue for hospitals is managing the staff nurse component of their delivery system. This means maintaining the favorable elements of the LP style and mitigating its negative corollaries. The homogeneity of styles means that any management actions are likely to be magnified, for good or ill. Nurses talk to each other. When they do they are likely to reinforce each others view as the correct one. Positions can solidify quickly and can easily harden to the point of rigidity.

An obvious corollary to the above observation is that hospitals should make every effort to do things right the first time. The consequences of mistakes are magnified since all of the staff nurses are likely to be affected the same way at the same time. Of course the reverse is also true. Do things right and the benefits can be magnified just as quickly. It will pay hospitals to invest before acting.

One strategy that can give the hospital fast returns at a low cost is to invest in staff nurse knowledge. The first step might be to show how the process works. The way people process information affects how they behave. For example, if you don’t pay attention to detail you will not be precise. It does not matter how you “feel.” You simply will not have the information needed. This kind of reasoning moves the discussion to objective, non-personal dimension. It is easily accepted.

The next step is converting the new knowledge into practical behavioral options. As with the students, this could apply to both personal management and the management of relationships. The same methods as outlined for the students can be applied to the staff nurse

Hospitals need to take a third step. Staff nurses work in groups. It is important that they understand how the interplay of “I Opt” profiles affect the outcomes the group will enjoy or suffer. “I Opt” has the proven technology of TeamAnalysis™ and LeaderAnalysis™. These tools can calculate the effects of everyone on the team interacting simultaneously. The concept is easily grasped. The actual calculations require a computer and access to proprietary formulas. There are no substitutes.

These three steps—self-management, the management of interactions and team behavior—equip staff nurses with the tools needed to accommodate any management initiative. They will be better able to manage their own responses, gauge the suitability of the initiative and influence the outcome using a “win-win” perspective. “I Opt” can be seen as a universal facilitator for management actions.

The cost in terms of learning the new technology is small. The same e-learning program suggested for universities would apply to hospitals. Existing staff in the Training or HR functions can probably be enlisted to conduct the program.

The material needed to conduct the program will be a bit different than that used in universities. Universities need only focus on individuals. Hospitals need to encompass groups. The materials needed for groups are a bit more costly but easily within the reach. For example, small firms and even churches regularly use “I Opt” group reports to smooth organizational transitions as they grow or change. This suggests that even the smallest charity hospital will find the cost easily manageable.

The materials provided by “I Opt” technology will contribute immediate benefit. But the larger and more durable return will be enjoyed as “I Opt” is used as a lens to understand and support all of the complex processes and interactions that make a hospital work. Hospitals differ in their needs and their initiatives will be unique. However, regardless of content any initiative will involve information transfer. The information-processing framework of “I Opt” will always apply and will always affect the outcome. If managed properly, that effect will always be positive.


SUMMARY
This research has shown that staff nurses are a homogeneous group. The research traces the system that produces staff nurses. There appears to be a consensus among those entering the profession, the universities that train them and the hospitals that hire them. This consensus is that the Logical Processor strategy is best able to meet the responsibilities of the staff nurse position.

The favorable behaviors of the LP style have corollaries. These corollaries are what permit the strengths of the LP style to exist. They are also the source of challenge for management. Strategies for both universities and hospitals to help manage these challenges center on providing the staff nurse with the tools they need to manage themselves, their interactions and the environment in which they participate.

Readers who want to explore the Staff Nursing Paradox on a practical, "how to" level can link to the Staff Nursing Paradox Addendum on the "I Opt" Engineering research blog. That site offers specific recommendations in a "10 things you can do" format. While the format restricts depth, it does provide an opportunity for fast results. It also demonstrates the character (but not range) of the kind of initiatives that might be undertaken using "I Opt" technology. It is worth a look.

Structural Barriers to Change and Innovation in Nursing

by:
Beatrice J. Kalisch, Ph.D., RN, FAAN, Titus Professor of Nursing, University of Michigan
Suzanne Begeny, MS, RN, Ph.D. Applicant, University of Michigan

FOREWORD
This blog is based on an article published in the peer-reviewed academic journal Nursing Administration Quarterly in October/December 2006 (Vol. 30, No. 4, pp. 330-339). It is available for purchase at the journal’s website under the title Nurses Information Processing Patterns: Impact on Change and Innovation. This blog summarizes and extends the findings reported in that article. Information on the “I Opt” tools used can be found on www.iopt.com. Information on the intellectual underpinnings of “I Opt” technology can be found on www.oeinstitute.org.


INTRODUCTION
The focus of this research was the ability of nurses to accept, adopt and sponsor change in an era of high volatility in health care. The research was conducted at two geographically separated hospitals and involved a total of 578 nurses.

The research drew on the fully validated “I Opt” instrument that measures information processing preferences. It is based on the simple idea that the kind of information sought and accepted from the environment limits or facilitates certain types of behavior. For example, if you do not pay attention to detail, your responses cannot be precise. It does not matter how you "feel" about it. Similarly, if you choose to rigorously apply well-understood methods, you foreclose your ability to discover new, groundbreaking things. Closely following established methods blinds you to unexpected options. By governing the knowledge available a person’s "I Opt" (Input-Output-Processing-Template) profile systematically governs the behavior that can and will appear.


FINDINGS
The study was designed to address specific hypothesis with a high degree of academic rigor. Statistical significance testing used the academically accepted standard of p<.05 (95% probability that the result was not due to chance) or better. In the journal these findings are presented in a standardized academic format. Here they are presented in an operationally accessible manner more useful to executives and managers who are positioned to make use of them.


Finding 1: Nurses Differ Markedly from Non-Nurses
Nurses were compared to other functional areas. These areas included:

Customer Service Personnel (n=599)
Hourly Industrial Workers (n=71)
Plant Operations Management (n=593)
School Teachers (n=608)
Engineers (n=945)
Scientists (n=48)
Corporate Managers (n=721)

The findings indicated that nurses most closely resemble Customer Service Personnel. Customer Service is typically involved in authoritatively answering client questions by referring to approved information sources. There was no significant difference across all four “I Opt” Strategic styles between nurses and customer service personnel.

At the other extreme, nurses had significant differences along all four “I Opt” Strategic styles with Engineers, Scientists and Corporate Managers. These disciplines consistently scored higher in the unpatterned input strategies of Relational Innovator (ideas) and Reactive Stimulator (decisive action) than their nursing counterparts. These are the adaptive styles that are able to initiate and accommodate change with relative ease.

In the middle zone, nurses were significantly less idea oriented (RI) than schoolteachers and Plant Operations management. The nurses significantly exceeded these functions in disciplined action (LP). This suggests that these areas will find change and innovation more palatable than will nurses. Hourly Industrial workers significantly exceeded nurses in both disciplined action (LP) and analysis (HA) but equaled nurses in ideas (RI) and decisive action (RS).

The picture painted by this analysis is that nurses are among the least able to initiate and accept change among the functions reviewed. Their favored information processing strategy relies on certainty, precision and step-by-step operational knowledge. This posture forecloses information needed to initiate change (unproven possibilities, unexpected associations, etc.) and accept it readily (e.g., a willingness to use tools that may not be fully specified).

Nurses can, of course, adapt to change. However, if the same methods as used for engineers, scientists and corporate managers are applied to nurses the road will be difficult. And, it will be difficult for everyone. Nurses are likely to feel emotional pain as they are forced out of their preferred approach to life. The sponsors of change will feel pain as they meet reluctance and resistance. Standard business school management strategies must be modified if they are to be fully effective in nursing situations.

Finding 2: Nursing Specializations are more Similar than Different
The nursing data identified the specialization within which the nurse respondents worked. These areas included:

Emergency Room
Surgical
OB/GYN
Telemetry
Ambulance
Psychiatric
Medical
Intensive Care

The results of the research showed that there was no statistically significant difference between specialties in the disciplined action (LP) or analytical (HA) strategic styles. This means that all specialties are about equally committed to structured approaches.

There was some variation in unpatterned strategies (RS/RI). Nurses in Intensive Care and psychiatric were more idea oriented (RI) than the others. This seems to make some sense in that these areas are most likely to encounter cases that do not yield to standardized approaches.

The other nursing specialties scored significantly lower in either decisive action (RS) or novel ideas and approaches (RI). For example, surgical was significantly lower in spontaneous decisive action (RS). Again this makes sense. The operating room is a hierarchical system functioning under the direction of the surgeon. There is little room for independent nursing action.

This area of research has an implication. The commonality of disciplined action (LP) and analysis (HA) means that all of the nurses can be successfully approached using the same methods. This means that a uniform change management can be applied. The efficiencies available in a common approach can be captured.


Finding 3: Staff Roles are Different
The data collected identified the organizational role of the individuals sampled. This allowed direct comparisons of staff roles.

The first comparison was between Registered Nurses (n=344) and Nurse Aides (n=101). The Nurse Aides registered statistically higher levels disciplined action (LP). In all other dimensions the RNs exceeded levels of the Nurse Aides. This suggests that the difficulties with change and innovation extend down the organization. The RN’s reluctance to change will be magnified by the Nurse Aides who support them.

The RNs were then compared to Unit Secretaries (n=40). Like the Nurse Aides, the Unit Secretaries are significantly more committed to disciplined action (LP) than are the RNs. This means that there is still another layer of potential resistance to change that regularly interacts with and influences the RNs.

Finally, RNs were compare to Licensed Practical Nurses. The LPNs were significantly more committed to disciplined action (LP) than are the RNs. Still another layer of change resistance is added below the level of the RN.

The general sense arising from this portion of the analysis is that the difficulty in accepting, adopting and sponsoring change is even more difficult than it first appears. The nurses rest on an organizational support system that is even more reluctant to change than they are. Since these support functions interact constantly with the RNs, they are positioned to magnify the RNs basic disinclination toward change. A difficult job has become more difficult.

The implication of this finding is that change initiatives must be organizationally sensitive. They must understand that addressing the RNs is not the end game. They must also address the levels organizationally below the RN. They must also understand that the RN will face a challenge when they ultimately accept change. They must then turn around and “sell” it to their support staff. This is likely to be as difficult as “selling” the change to the RNs in the first place.


Finding 4: Nursing Managers are Different than RNs
Staff nurses in all specialties (n=344) were compared to Nurse Managers (n=52). The Nurse Managers had much higher levels of RI (ideas) and RS (decisive action). Overall, they resemble the average manager in other functional areas of society.

The implication of this is that Nurse Managers faces a challenge in sponsoring and guiding change initiatives. They do not think like the people that report to them. If they follow the “golden rule” they will do unto the staff as they would have done unto themselves. If they do this, the result will fall far short of optimal. The average RN does not want to be treated like a manager. They are sensitive to different variables, have different standards and are comfortable in different environments.

An analysis done outside of this study suggests that Nurse Managers strongly resemble managers in other industries. But there is a difference. In other industries the staffs being supervised are more diverse. Diversity means that there is likely to be someone relatively near the manager’s posture who can interpret matters in a way others can understand and accept. This creates “emissaries” to help managers “sell” their ideas and postures to the larger staff.

Nurse Managers do not have this luxury. Their job is more difficult. As shown in the next section, they face a solid wall of likely resistance. This means that Nurse Managers will need to be taught to lead people who are very different from themselves. Standard business school management education applies but must be supplemented if Nurse Managers are to be fully effective.


DISCUSSION AND IMPLICATIONS
In addition to the distinctions cited above, another aspect of the nursing staff became visible in the course of the study. The nurses are tightly clustered. This condition is shown in Graphic 1. It shows the distribution of actual nurses in one section of a major hospital. It is representative of the general distribution encountered in both hospitals and across all areas.

GRAPHIC 1 DISTRIBUTION OF NURSING STAFF “I OPT” PROFILES BY SHIFT

Each dot on the graphic represents the centroid (point of central tendency) of the information processing profile a particular nurse. There is a clear clustering in the lower right hand quadrant. This is the “Conservator” pattern. It seeks to conserve or preserve things that are proven and known to work. People using it strive for excellence and precise execution. It is the information processing posture that has the most structural resistance to change.

The implication of this condition is that it magnifies the difficulty of change even further. The nurses are personally disinclined toward change and have a staff that is even more reluctant to change. In addition, there is now a coalition factor. Nurses are likely to magnify their reluctance to change in there interactions with each other. The tight clustering means that they tend to think alike and will see much merit in each other’s judgments. A very difficult job has just been made more difficult.

The overall picture painted by this research and outlined in this blog is that Change Management in nursing will present a unique challenge to all involved. The internal capacities of a hospital are likely to require external support if success is to be enjoyed. A possible general framework for approaching change in a hospital environment might be:

A PLAN FOR INITIATING CHANGE IN HOSPITALS

1. Clearly define the goals of the change initiative and the areas of the hospital affected.

2. Collect “I Opt” Survey data for all levels of the areas affected—from executives to Nurse Aides. There is no substitute for exact measurement of the current condition.

3. Plot and analyze the “I Opt” findings. Assess the difficulty likely to be encountered by areas affected. Develop an overall plan to initiate the change that will be common to all areas. Develop sub-plans that will address unique aspects discovered in the analysis.

4. Initiate context specific Leadership training for all managers affected. This is not generalized “Leadership” instruction. Rather each leader will be trained to guide the specific group for which they are responsible. This is performance based training rather than developmental. Tools like “I Opt” LeaderAnalysis™ can be used to support this process.

5. Apply the generalized program created in Item 3 above to the RNs and their staffs. Create and apply supplemental training appropriate to the education and role of each staff category (e.g., RN, LPN, NA, US). Use the data collected in Item 2 above to design the supplemental material to exactly target the people involved.

6. Initiate a team based program to support the effort. This will help mitigate the coalition effects by focusing the people involved on their immediate interests and responsibilities. Tools like “I Opt” TeamAnalysis™ can be applied to initiate the effort.

7. Expect this process to take time. The Logical Processor style can and will change. But their information processing style demands a linear, step-by-step, exacting approach. The global Change Management programs currently popular in other industries are unlikely to yield any enduring gains.

8. If money is an issue, consider a viral strategy. Implement the above program in a relatively narrow area. People in other areas will see the success. At minimum, this will cause them to be more amenable to accepting the program. At best it will cause them to demand that they also get the benefits of the program. In this implementation the program is designed to act as a virus “infecting” other parts of the hospital in a positive manner.


SUMMARY
This research has proven to be eye-opening. Specific measurement has replaced opinions. Fully grounded, validated tools have replaced “on the fly” surveys. A well-defined “what causes what and why” theory has displaced speculative guesses. Most importantly, “I Opt” technology actually works when it is used in field settings. It is an excellent mix of academic rigor and operational utility.

One mark of productive research is that it gives rise to more questions. This was the case here. As a result of this study we are now involved in another study. This study will trace the causes and implications of the high level of commonality found among the nurses. Even at this point we are able to see the outlines of the system that has created the current condition. But for now, the above is a step in the right direction.