Creative Nursing, Volume 17, Issue 1, 2011

Change, Chaos, Adaptation:

The Effects of Leadership
on a Work Group
Rebecca Otten, EdD, RN
Tiffany Chen, BSN, RN, MPH

As nurses, we are very familiar with the environmental factors associated with change, the
impact of chaos on working relationships, and the general milieu of a nursing unit. This story
relates how a student in a leadership practicum was encouraged to look at change through
an organizational lens when the leadership dynamics changed in a work group. The Roy
Adaptation Model and chaos theory were applied as frameworks for this assessment as
a way to organize and foster learning. Through this serendipitous opportunity, the student
gained an insight into the dynamics of group process and an appreciation of the work it
takes for leaders and managers to keep the work group in a healthy functional state.

Rebecca Otten, EdD,

RN, is an assistant
professor of nursing
and assistant coordinator of pre-licensure
programs at California State University,
Fullerton.

Tiffany Chen, BSN,

RN, MPH, is a staff
nurse on a Telemetry/
Cardiac Observation
unit at Anaheim Regional Medical Center
in Anaheim, CA.

30


he primary goal of clinical practicums in nursing programs is to give students

an opportunity to hone their psychomotor, organizational, and observational
skills as providers of patient care. Near the end of the curriculum at California
State University, Fullerton, most often during the leadership rotation, students
are given the opportunity to shadow a nursing manager to gain insight into the
complexity of the leadership/management role at the unit level or point of care.
Creating and maintaining a healthy environment in which staff members are engaged in the development of a culture of shared values requires an important skill
set that the students are asked to observe during this particular practicum.
Clinical instructors are always alert to situations that will give students opportunities for learning and professional growth. During a recent practicum, on one
particular patient care unit, the long-time nursing manager was changing positions within the medical center and a new manager was to be chosen. The student
assigned to this unit was encouraged to observe how this change in leadership
affected the work group and how the group adapted. The observations were included in a journal and as part of a writing assignment to describe the impact of
this change in leadership on the staffs adaptation to change over time.
This assessment of a work group in the context of change and daily routines
provided the student with a powerful insight into the functioning of a work group,
with future application to transition and socialization into a work group as a newly
licensed registered nurse. The dynamics of servant leadership was another aspect
that added to the richness of this experience. The Roy Adaptation Model and chaos
theory frameworks help to organize and guide this story.
2011 Springer Publishing Company
DOI: 10.1891/1078-4535.17.1.30

WORK GROUP CHARACTERISTICS

Nurse managers are responsible for engineering operational flow processes that
guide and direct staff in the work environment. In the acute care setting, this includes patient care delivery models, staffing patterns, and a supportive, efficient,
and client-centered environment. One aspect of client-centered care pertains to
meeting the needs of clients and families as they enter into a role that may be quite
stressful and unwanted. This role may bring uncertainty about what to expect and
how to get through a time that may be particularly difficult. Being the providers of
care to our clients, we know that our caring presence is one of trust and support to
help them deal with the changes they experience and to assist with adaptation to
the experience. Nurse managers have the inherent responsibility to assure that the
clients needs are met by the nurses working together on the unit.
A manager working in one area for a long time develops a certain level of
comfort with the nursing staff. Expectations are known and team cohesiveness is
part of the culture. The impact of this relationship results in greater job satisfaction
and a stability within the work group. Porter-OGrady and Malloch (2007) discuss
this phenomenon in reference to the quality of work life in which key characteristics include predictable work patterns; support to maintain competencies; defined
roles and expectations; and a strong, open communication system.
Roys (2009) adaptation framework suggests a connection between the quality
of work life, role identity, and a sense of belonging. In this model, the stabilizer
subsystem (strategies and processes for group stability) and the innovator subsystem (emotional and cognitive strategies toward change within the group) are the
two major control mechanisms that guide the adaptive processes of a work group
(Roy, 2009).
Development of a groups identity is a process in which group culture is established with shared goals, values, and expectationsgroups work together over
time and socialization becomes part of the innovator subsystem, an important process when a change to the group membership occurs. The innovator subsystem
addresses the process of growth of the work group toward common goals and
team building (Roy & Andrews, 1999; Roy, 2009; Hanna, 2006). The environmental
boundaries, work routines, established roles, structure, and values are part of the
stabilizer process. This process helps to forestall turmoil when change is being
introduced (Hanna, 2006, p. 226) to the work group.

Environmental
boundaries,
work routines,
established roles,
structure, and
values help to
forestall turmoil
when change is
being introduced
to the work group.

ORGANIZATIONS HAVE THE POTENTIAL TO BE CHAOTIC

Although it may be difficult for an outsider to understand how the absence of one
person can cause so much tension on a hospital unit, chaos theorists acknowledge that small changes can have large effects on systems (Levy, 1994; Thietart &
Forgues, 1995). Support systems from group cohesion offer a dynamic interplay
with the environment that may initially focus on the loss to the work group and
introduce a tension response into the work group norm.
There was a shroud of sadness as the tissue box made its way around the overcrowded conference room. The unit manager attempted to complete the monthly
staff meeting as sporadic sniffles overlapped her wavering voice admonishing her
staff to complete their documentation correctly and communicate more efficiently
with their assistive staff. This was the last staff meeting the manager would lead

Change, Chaos, Adaptation: The Effects of Leadership on a Work Group

31

Although it may
be difficult for
an outsider to
understand how
the absence of
one person can
cause so much
tension on a
hospital unit,
chaos theorists
acknowledge
that small
changes can
have large effects
on systems.

before taking her new position. A mix of emotions flowed through the staff; some
were angry at the manager for leaving; some were happy for her but mourning the
loss of her as their manager; some were relieved that she would still be working at
the hospital; but all were worried about the future of the unit. (Chen, 2008)

Without the emotional support of the nursing manager to influence the effectiveness of the work groups performance, the emotional competence of the unit staff
has the potential to be negatively impacted by the loss (Kovner, Brewer, Greene,
& Fairchild, 2009). With this change in leadership, an integral part of a smoothly
run unit was thrown into a state of disorder and chaos. Disruptions that challenge the equilibrium of the system can have far-reaching effects, creating unpredictable changes and responses. This challenge to group stability triggers
activation of the innovator and stabilizer processes (Roy, 2009). Work groups
seek role clarity through these processes using role relationships and informal
leaders as role models.
A few weeks after the leadership change occurred, it became quite evident that
the unit had changed. The overall morale was depressed. The staff maintained
their standard of focusing on the needs of their patients but seemed to be in an
automated routine mode, lacking enthusiasm and pride in their work. Many staff
members had left for other jobs or transferred to other units. Many who were still
there were in the process of applying to other jobs and others questioned if they
wanted to continue to work at the hospital any longer. The managers departure
had left a void in the heart of the unit and things seemed to be falling apart. Her
willingness to listen, support, nurture, and encourage each nurse to achieve and
then to celebrate his or her achievements were traits frequently mentioned when
the staff talked about their loss. Awaiting the appointment of a new manager also
added to the stress felt on the unit. (Chen, 2008)

Levy (1994) notes that chaotic systems typically follow repetitive patterns, which
can be identified and which provide useful information for strategic planning.
In this case, there was an expectation that a change in leadership would cause
disruption among staff but the extent of the disruption was not clearly known.
Kane-Urrabazo (2006) links this disruption to the perceived loss of trust that is
developed over time within an organization and as a predictor of decreased job
satisfaction where commitment and intent to remain with an organization are questioned. With this in mind, it became the task of the leaders who remained on the
unit to maintain as much balance as circumstances would allow (Porter-OGrady
& Malloch, 2007).
UNDERLYING ORDER IN CHAOS
Within a chaos theory framework, the process of transition may be viewed with a
focus on the collaboration within a group, the environment, and adaptation. Adaptation in this sense suggests that the system has been changed and that, although
the outcomes are not predictable, they may be viewed as desirable (Bussolari &
Goodell, 2009). Work group cohesiveness becomes a strength and stabilizer when
the group uses established structures, values, and daily activities to accomplish
the purpose of the group (Roy, 2009, p. 478).
As time passed, the roaring waves of emotions subsided, the influx and efflux of
employees trickled to a minimum, and the staff continued in their daily roles and
32

Otten and Chen

duties. The unit continued to function to the best of its ability within the preexisting infrastructure as a new manager came on board. The four clinical coordinators
distributed the managers workload among themselves and the new department
manager. Chaos and dysfunction were left behind as the new manager integrated
herself into the unit. (Chen, 2008)

Chaos theory notes that as a new stability emerges, utilization of the current
organizations configuration becomes a foundation (Thietart & Forgues, 1995).
Carroll (2006) interpreted the organization chaos theories presented by Thietart
and Forgues (1995) and highlighted the following:
Organizations are nonlinear, dynamic systems and have the potential to be
chaotic.
Amidst chaos is underlying order.
Organizations often undergo a series of rapid changes and stabilize until the
next round of rapid changes occurs.
Leadership in these organizations must be flexible and able to respond
quickly and appropriately to the rapid changes.
These principles can also be seen within the priority standards for groups as described by Roy (2009): ability to perform necessary functions, to maintain its own
existence, and to grow.

ONE YEAR LATER

Serendipity interceded again to give this student the opportunity to observe the
effect of time on the conditions that triggered the initial response of the work
group. The student was assigned to the same patient care area for an externship.
Once again, the student was encouraged to assess and journal about how the work
group had progressed to a different, yet effective work dynamic.
Initially, it was sad to discover that so many of the staff had left in the months I had
been away. There was, however, a core group of staff who were still there and who
seemed to have made it their goal to create a productive work group with high
standards of patient care. In fact, they were no longer just the Tele Unit but had
become the Tele-Stroke Unit of a recently designated stroke center. They were busy
orienting and socializing new nurses to the unit, which was a positive and worthwhile endeavor since all the nurses who were part of the work group remained
because they wanted to be there and work with dedication toward excellence in
client outcomes. Emotional bonds are difficult to break; a few of the staff continue
to go to their former manager for advice and to cling to the relationship for comfort. When I asked about the new manager, they said her style is not as open but
they know they are supported and respected. She allowed the staff time to catch
up with all the changes that had occurred and renewed a sense of responsibility
and accountability for the unit routines. The foundation of mutual respect helped
to foster trust in the new relationship and proved to be a solid starting point for
developing shared hopes and goals for the unit. (Chen, 2009)

Roy (2009) describes the cohesion of a group as a common bond with characteristics
of shared identity, camaraderie, and recognition of values in the practice environment. To claim successful achievement of the environmental change, respect and

Change, Chaos, Adaptation: The Effects of Leadership on a Work Group

The staff were

busy orienting
and socializing
new nurses
to the unit, a
positive and
worthwhile
endeavor since
all the nurses
who were part
of the work
group remained
because they
wanted to be
there and work
with dedication
toward
excellence in
client outcomes.

33

The emotional
understanding
that the new
manager brought
to the unit is
described as
worker care.
This aspect
of servant
leadership
provided flexibility
and a renewed
sense of caring
needed for this
particular work
group to move
forward.

recognition for each member of the work group needs to be realized. Improving
communication with problem solving as a shared objective is the focus of this
behavioral approach. Each challenge to stability forges change that allows the organization and leadership to evolve as well to adapt to organizational changes
(Porter-OGrady & Malloch, 2007).
The emotional understanding that the new manager brought to the unit is
described by Jenkins and Steward (2010, p. 48) as worker care. This ability to
provide a nurturing relationship addressed the emotional needs of the staff and
fostered a climate of trust and security. This aspect of servant leadership provided
flexibility and a renewed sense of caring needed for this particular work group to
move forward.
LESSON LEARNED
The student summarized her experience in relation to chaos theory and adaptation
theory as follows:
The value of chaos theory lies not in the ability to predict the outcomes of human behavior to change, but in the anticipation and preparation for chaos in planning for a
known change event, such as management succession, on an established work group.
Adaptation theory gives a perspective on group identity where cohesion and development of said identity become part of the affective response toward group
well-being.
With this new knowledge, I will be better prepared to understand the effects of
change on group dynamics. The experience has left me with a deep appreciation of
the work it takes for leaders and managers to keep a group in a healthy, functional
state. (Chen, 2009)

CONCLUSION
When a change in leadership is the stimulus for chaos, giving nurses on a unit permission to work through the change and discover the means to adapt and grow as
a team is a complex task. The new manager wisely allowed the staff time to catch
up with the change that brought her to the unit. The newly expanded mission
gave the unit new routines and a fresh identity that contributed to the settling-in
process. The former and the new leaders each had traits that the staff recognized
as directed toward their ability to perform the duties that nursing requires and to
keep a focus on creating a healthy, cohesive environment.
The clinical practice setting is full of rich opportunities for students professional growth. Through this serendipitous opportunity, the student gained insight
into the dynamics of group process and an appreciation of the presence of leaders
and managers who keep work groups in a healthy, functional state.
REFERENCES
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98107.
Carroll, P. (2006). Nursing leadership and management. Clifton Park, NY: Thomson Delmar
Learning.
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Otten and Chen

Chen, T. (2008). Leadership succession, organization chaos theory, and hospital management. Unpublished manuscript, Department of Nursing, California State University, Fullerton.
Chen, T. (2009). Externship reflection journal. Unpublished personal entries, Department of
Nursing, California State University, Fullerton.
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Correspondence regarding this article should be directed to Rebecca Otten, EdD, RN, at rotten@fullerton.edu

Change, Chaos, Adaptation: The Effects of Leadership on a Work Group

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