Planned change or emergent change implementation approach and nurses' professional clinical autonomy

Area of Science:

• Nursing
• Healthcare Innovation
• Organizational Change

Background:

• Nurses' clinical autonomy is crucial for patient outcomes.
• Implementation approach of innovations influences clinical autonomy.
• Limited evidence exists on the impact of emergent vs. planned change on autonomy.

Purpose of the Study:

• To compare changes in clinical autonomy, personal norms, and values.
• To evaluate planned change versus emergent change implementation of intensive insulin therapy.

Main Methods:

• Prospective comparative study on an intensive care unit (ICU).
• Two nurse teams randomly assigned to planned or emergent change conditions.
• Clinical autonomy measured using the Nursing Activity Scale.

Main Results:

• Clinical autonomy increased in the emergent change team; decreased in the planned change team.
• Personal values shifted towards developmental and rational scores in the emergent group.
• No significant difference in team learning processes between groups.

Conclusions:

• Emergent change implementation fostered greater clinical autonomy compared to planned change.
• Implementation approach significantly impacts nurses' clinical autonomy and value orientation.
• Emergent change is recommended for innovations requiring independent nursing decisions.