Identifying Paradox: a Grounded Theory of Nurse Leadership in Overcoming Organisational Change Resistance

Abstract

The present study applied the full grounded theory methodology to develop a theory explaining the process by which nurse leaders in a New Zealand public hospital led nurses through organisational changes. Using the Glaserian grounded theory approach, the central concern facing nurse leaders was identified as achieving enough influence within the organisation in order to develop and implement changes which would improve nurses' work conditions and work quality. Components of the grounded theory data analytic method used in this study included open and theoretical coding, theoretical sampling, constant comparison and the determination of near-core categories and the basic social process. A notable feature of the present study included the qualitative analysis of a quantitatively derived leadership questionnaire. Although initial results suggested that the questionnaire results were incompatible with qualitative data, subsequent qualitative analysis of the questionnaire lent support to the near-core categories of repressing leadership and multiple realities. The emergent basic social process was identifying paradox. The resultant theory, identifying paradox, comprises the sub-processes reconciling paradox and legitimising paradox. Reconciling paradox explains the ways in which non-repressed nurse leaders are able to reconcile paradoxical understandings of situations in order for nurses to positively perceive changes. Legitimising paradox occurs when repressed nurse leaders are caught in paradoxical situations, which result in paradoxical understandings and consequential negative perceptions of change. Identifying paradox also accounts for the realities of two other professional groups within the hospital (management and medicine) and how these groups influence the leadership of nursing. A subsequent model of identifying paradox expresses the grounded theory as a dynamic, non-linear process in which cycles or upward spirals lead to improved reconciliation of paradoxes throughout organisational changes. Alternatively, the vicious cycles and downward spirals of legitimised paradoxes occur as organisational changes are resisted. The grounded theory, identifying paradox, brings some new angles to the extant leadership literature. One important application of methods was the use of triangulation, a multimethod approach, to provide a deeper understanding of the benefits of analysing quantitative and qualitative data concurrently. Another key finding was the complexity of nurse leadership through organisational change. The present theory accounts for the multiple perceptions of respondents throughout continuous concurrent changes. Additional consideration was given for the historical and societal changes leading to the current situation in the organisation under study. Recommendations for future research include extending the present substantive theory by applying the grounded theory approach to a range of other substantive settings in order to generate a formal theory. Such research should also analyse qualitative and quantitative data simultaneously, in order to gain an even richer insight into the phenomenon under investigation. The present study also highlights the need for leadership research to address and incorporate the complexities and diverse range of variables surrounding leadership, rather than limit them due to the methodological constraints of popular mainstream leadership research approaches.