An analysis of selected variables influencing the acceptance of an innovation (autonomous nursing units) by nurses in an acute care setting

This descriptive study focuses on innovation diffusion, within a nursing department in a large inner-city teaching hospital. The implementation of a relatively untested nursing innovation, autonomous nursing unit (ANU) concepts, in relation to organizational structure, leadership, and nursing culture is analyzed. Little is known about the extent to which grassroot variables influence how nurses acquire greater degrees of power within an organization, as a means to functioning more effectively. Two nursing units were compared. One unit had chosen not to implement the innovation at the time, while the other had been implementing ANU concepts for eighteen months. A triangulation of methodologies was used, incorporating both quantitative and qualitative approaches to data gathering. Qualitatively, interviews and surveys were used to gather data pertaining to inter-unit communication, the evolution and nature of the innovation within the institution, and the realities of leadership and structure influences upon the diffusion process. Quantitatively, the Job Description Index was used to ascertain information about nurses\u27 attitudes about their work and work situation. The Work Environment Scale was used to ascertain information about the specifics of the work situation on each unit. The theoretical framework for this study was Schein\u27s work because of his holistic approach to the study of organizational culture and change. Lewin\u27s writings were also drawn upon. The results demonstrated no appreciable difference between the nursing cultures of the two units. Acceptance of the innovation was strongly influenced by leadership styles and the degree to which the department structure consistently provided support and motivation for ANU concept assimilation. It was concluded that ANU concept diffusion is easily staged and not too complex an undertaking. However, the diffusion process is necessarily slowed to accommodate the need for a paradigm shift away from traditional modes of nursing. These shifts concern altered head nurse/staff nurse relationships and leadership accountabilities, and group decision-making activities. Lastly, current nursing educational curriculums do not adequately prepare nurses, in any practical sense, for the evolving and broadening role of the nurse