A nurse is caring for a client who is comatose. The client has a living will that declines the use of artificial enteral nutrition as a life-sustaining measure, but the client's family has requested that the staff begin tube feedings. Which of the following actions should the nurse take?

Choice A rationale:

Informing the staff of the penalties that can result from medication errors represents an authoritarian approach to managing the issue. This approach relies on authority and fear to enforce compliance. By emphasizing the potential consequences, the nurse manager is attempting to control behavior through fear of punishment. While this might create a short-term change in behavior, it does not address the root causes of the errors or promote a culture of safety.

Choice B rationale:

Encouraging the staff to have two nurses verify medication orders to prevent errors is not an authoritarian approach. It involves collaboration and peer support to enhance medication safety. This approach promotes shared responsibility and accountability, which are not associated with authoritarian leadership.

Choice C rationale:

Providing a suggestion box for the staff to submit ideas for error prevention is not an authoritarian approach. This strategy fosters a participative and democratic leadership style. It encourages staff engagement and input, which contrasts with the top-down nature of authoritarian leadership.

Choice D rationale:

Asking three experienced nurses to help investigate common causes of the errors is not an authoritarian approach. It involves a collaborative and problem-solving approach that seeks input from knowledgeable staff members. This approach aims to identify systemic issues contributing to errors rather than focusing solely on punitive measures.

The correct answers are Choices A and C.

Choice A rationale: Modeling positivity leverages social learning and transformational leadership, sets constructive norms, reduces uncertainty, and promotes psychological safety, facilitating Lewin’s change movement and sustained adoption of bariatric workflows and equipment safely.

Choice B rationale: Redirecting negativity suppresses concerns, undermines just culture, and blocks feedback necessary for Lewin’s unfreezing, reducing trust, psychological safety, and data to address barriers, thereby entrenching covert resistance to change process.

Choice C rationale: Engaging supportive peers utilizes diffusion of innovations and social proof; peer dialogue surfaces practical barriers, shares tacit knowledge, normalizes change behaviors, and increases motivation and adherence to bariatric care practices.

Choice D rationale: Suggesting transfers is coercive and punitive, contradicting transformational leadership and just culture, damages morale and retention, bypasses root-cause analysis, and fails to address legitimate change barriers or build sustainable engagement.

Choice E rationale: Reprimanding resistance pathologizes normal adaptation, undermines psychological safety and voice, increases turnover intentions, entrenches oppositional behavior, and conflicts with evidence-based change management; reserve discipline for misconduct, not expressed skepticism alone.