Facilitating change among nursing assistants in long term care.

In this article, the authors consider the implementation of change in long term care organizations (LTCOs) and present their study describing the process by which new nursing assistants are informally integrated into LTCOs in Quebec, Canada. The study method included 23 in-depth interviews with nursing assistants in two long term care centres. The findings enabled the authors to describe the informal process by which new nursing assistants are integrated into LTCOs and the manner in which informal work strategies enhance the work of nursing care, thus enabling the nursing assistants to manage heavy workloads. The authors discuss whether this teamwork is a deterrent to change or a lever for change and address issues regarding the collective structure of nursing assistant teams. Implications for practice include a Five-Step Innovation Plan. In conclusion, the authors propose that organizational change among nursing assistants in a LTCO is best accomplished when the leaders consider the nursing assistants' strong sense of community to be a change engine rather than a change obstacle.