NURS 491 Week 3 Nehemiah: Managing through Change Example

Nehemiah: Managing Through Change and What a Nurse Manager Can Learn From the Wall

Introduction

Change in health care rarely arrives one piece at a time. A unit may be asked to move into a new building, adopt a new electronic record and absorb new staff in the same year, while patient care continues without pause. The book of Nehemiah describes a leader facing change on that scale. Nehemiah, cupbearer to the Persian king, learned that Jerusalem's wall lay broken and its people lived in "great trouble and shame" (English Standard Version Bible, 2001/2016, Nehemiah 1:3). Within months he had organized a discouraged population to rebuild the wall in 52 days, under ridicule and threat, and then led years of reform to keep the community from sliding back. This paper examines Nehemiah's managerial skills during that change, connects each to current research on nurse managers and change leadership and applies them to a medical-surgical unit preparing to move into a new hospital tower.

Assessment Before Action

Nehemiah's first response was neither a plan nor a speech. He wept, fasted and prayed "for days" (Nehemiah 1:4), and about four months passed between the report in Chislev and his request to the king in Nisan (Nehemiah 1:1; 2:1). When he arrived in Jerusalem, he waited three days and then inspected the walls at night with a few men, telling no one what God had put into his heart (Nehemiah 2:11-16). He gathered his own information before announcing anything.

Perez-Gonzalez et al. (2024), in a scoping review of 62 studies on nurse manager leadership, identified knowledge, vision and acting as a change agent among the most frequently cited characteristics of effective nurse managers. A vision built on secondhand reports is fragile. For a manager whose unit is moving, Nehemiah's night inspection suggests walking the new space before the plans are final: checking sight lines from the nurses' station, distances to supply rooms and where call lights will sound, and doing it quietly enough to form a judgment before the debate begins.

Planning and Securing Resources

When the king asked what Nehemiah wanted, he "prayed to the God of heaven" and then answered with a specific plan: a leave of absence, letters of safe passage to the governors beyond the river and a letter to Asaph, keeper of the king's forest, for timber for the gates, the wall and his own house (Nehemiah 2:4-8). He knew how long he would need and what materials the work required before he asked.

Velasco Arias et al. (2025) reviewed 17 studies of nurse manager competencies during the COVID-19 pandemic and grouped them into collaboration, maintaining control, adapting to change and preserving competitiveness, with communication, decision-making, training and adaptability among the most essential. Securing resources is part of maintaining control. A nurse manager facing a move should go to administration as Nehemiah went to the king, with a specific request: extra staffing hours for move day, training time on the new equipment and a timeline, rather than a general complaint that the change will be hard.

Organizing the Work

Nehemiah 3 reads like a work assignment sheet. The high priest and his brothers rebuilt the Sheep Gate, the men of Jericho built next to them, and section by section the wall was assigned to families, guilds and towns. Several people repaired the part "opposite his house" (Nehemiah 3:10, 23, 28-30), which gave each worker a stake in the section that protected his own family. The chapter also records honestly that the nobles of Tekoa "would not stoop to serve" (Nehemiah 3:5), while ordinary people of their town completed two sections.

This is delegation through clear, bounded accountability. On a nursing unit, the same principle means dividing a move into owned pieces: one charge nurse responsible for supply rooms, a group of nursing assistants for patient transport lists, the unit educator for equipment training and a staff nurse champion for each shift. People work hardest on the part they will live with.

Managing Opposition

Opposition came in stages. Sanballat and Tobiah first mocked the builders, Tobiah joking that a fox would break the wall down (Nehemiah 4:1-3). Nehemiah responded with prayer and kept building, "for the people had a mind to work" (Nehemiah 4:6). When enemies plotted an attack, he prayed and "set a guard as a protection against them day and night" (Nehemiah 4:9). When workers from Judah said the strength of the burden-bearers was failing and the rubble was too much (Nehemiah 4:10), he did not dismiss them. He stationed people by families, told them not to be afraid and to remember the Lord, and reorganized so that half worked while half stood guard, with a trumpet to rally everyone to any point under attack (Nehemiah 4:13-20).

McDonnell et al. (2026), reviewing 17 studies of change management in health care, found that high-quality communication and strong leadership were the most common enablers of change, while barriers included applying change models rigidly and lacking ways to monitor progress. Nehemiah adapted his plan as threats changed rather than holding to the original schedule. A manager will also meet opposition, some of it from outside, such as departments resisting new workflows, and some from tired staff saying the load is too heavy. The lesson of chapter 4 is to take the second kind seriously: listen, adjust the plan and give people both protection and hope.

Confronting Injustice Inside the Team

The most serious threat in Nehemiah came from within. Poor families cried out that they had mortgaged their fields and were selling their children into slavery to pay debts to their own wealthier countrymen (Nehemiah 5:1-5). Nehemiah was "very angry," but he "took counsel" with himself before acting, then confronted the nobles and officials publicly, called an assembly and secured a promise to return the land and stop charging interest (Nehemiah 5:6-13). He did not let the project's urgency excuse an injustice that was breaking his workforce.

Managers face smaller versions of this: a long-tenured nurse who always takes the easier assignment, or a scheduling pattern in which the same people absorb every short-staffed shift. Perez-Gonzalez et al. (2024) found that caring for the team and communicating effectively were among the most cited characteristics of nurse manager leadership. Caring for the team sometimes means confronting a powerful member of it, after reflection, and fairly.

Integrity and Example

For twelve years as governor, Nehemiah and his brothers did not eat the governor's food allowance, because "the service was too heavy on this people," and he fed 150 officials at his own table (Nehemiah 5:14-18). He also refused every attempt to draw him away from the work. Invited four times to meet his enemies at Ono, he answered, "I am doing a great work and I cannot come down" (Nehemiah 6:3). When a hired prophet urged him to hide in the temple, he refused to act in fear (Nehemiah 6:10-13).

Mastro et al. (2025), reviewing studies of authentic leadership among nurses in U.S. hospitals, linked it to less burnout and more compassion satisfaction among nurses. Authentic leadership emphasizes consistency between values and conduct, which describes Nehemiah's refusal of privileges his people could not share. A nurse manager who works a night shift during the move, eats what the staff eat and declines to schedule herself out of the hardest week shows the same integrity.

Delegating to Faithful People and Sustaining Change

The wall was finished in 52 days (Nehemiah 6:15), but Nehemiah's management did not end there. He placed Hanani and Hananiah over Jerusalem, noting that Hananiah was "a more faithful and God-fearing man than many" (Nehemiah 7:2). He supported Ezra's public reading of the Law, with the Levites helping the people understand it (Nehemiah 8:8), and led the community into a written covenant (Nehemiah 9:38). When he returned from the king years later, he found that the high priest had given Tobiah a room in the temple storehouse, the Levites had not been paid and had gone back to their fields and the Sabbath was being used for trade (Nehemiah 13:4-22). He removed Tobiah's belongings, restored the Levites' portions, appointed treasurers who "were considered reliable" (Nehemiah 13:13) and shut the gates on the Sabbath.

Chapter 13 is a sobering lesson about change. Gains fade when the leader is absent and when the structures that support them are not maintained. McDonnell et al. (2026) identified the lack of mechanisms to monitor change progress as a common barrier. For the unit moving into the new tower, sustaining change means choosing reliable people to own each new process after the manager's attention moves elsewhere, auditing the new workflows at three and six months and being willing, as Nehemiah was, to correct drift firmly.

Lessons for the Nurse Manager

Read as a whole, Nehemiah models a sequence any nurse manager can follow: grieve the problem honestly and pray, assess it personally, plan specifically and secure resources, divide the work so people own their part, protect and encourage workers when resistance comes, confront injustice inside the team, lead by visible example, entrust the work to faithful people and return to check that the change has held. Underneath every skill is dependence on God. Nehemiah prayed before he spoke to the king, prayed under threat and ended his book asking God to remember him "for good" (Nehemiah 13:31). Nehemiah's wall took 52 days; keeping the people faithful took the rest of his life.

Conclusion

Nehemiah led a discouraged people through a change that seemed impossible and then spent years protecting what they had built. His management skills, from careful assessment and planning to integrity and follow-through, match what current research identifies in effective nurse managers: vision, communication, care for the team, adaptability and authentic leadership. For a nurse manager leading a unit into a new building, his example suggests that the move itself is the easier part. The harder and more important work is building trust before it, protecting staff during it and returning after it to make sure the new way has truly taken hold.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Mastro, K. A., Courtwright, S. E., & Weaver, S. H. (2025). Systematic review of authentic leadership effects on patient, nurse, and system outcomes. Nursing Research, 74(6), 476-483. https://doi.org/10.1097/NNR.0000000000000855

McDonnell, R., Chauhan, A., Adams, C., Cardenas, A., Moscova, M., Walsan, R., Sina, M., Munro, A., Manias, E., Mitchell, R., Gust, A., Sabesan, S., & Harrison, R. (2026). Applying change models and methods during a period of vast digital transformation: A systematic review of practice in healthcare. International Journal of Health Planning and Management, 41(5), 1032-1053. https://doi.org/10.1002/hpm.70092

Perez-Gonzalez, S., Marques-Sanchez, P., Pinto-Carral, A., Gonzalez-Garcia, A., Liebana-Presa, C., & Benavides, C. (2024). Characteristics of leadership competency in nurse managers: A scoping review. Journal of Nursing Management, 2024, 5594154. https://doi.org/10.1155/2024/5594154

Velasco Arias, J. M., Peres, A. M., Nunes, M. G. J., Escandell Rico, F. M., & Noreña-Peña, A. (2025). Essential competencies required of nurse managers in times of COVID-19: A scoping review. International Nursing Review, 72(3), e13070. https://doi.org/10.1111/inr.13070