The nurse manager is meeting with staff members. Which of the following responses by a staff member is an example of an external force for change?
1. "This new computerized documentation system that we're using is so much more efficient than the old way."
2. "I learned that the health care insurance companies are paying $100 less than they were a year ago for clients with a DRG of pneumonia."
3. "This new product the hospital adopted makes ostomy appliance changes a lot easier."
4. "Ever since we opened that new surgical unit, our client acuity levels are decreasing on this unit."
Answer: 2
Rationale: Internal and external forces influence changes to nursing practice. Internal forces for changes are those that come from inside the organization. The internal and external forces for change interact dynamically and influence all segments of health care. An internal force of change is when a new process, system, or product is adopted by an organization for use by the employees. Changes in reimbursement rates by a health insurance company, local socioeconomic factors, and area nursing programs are examples of external forces for change.
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