NURS 458-Nursing Management and Leadership (5 units)
Spring 2015
22323 (Lecture) & 22324, 22325, 22326, 22327, 22328, 22329, 22330, 22331 (clinical)
COURSE INFORMATION
Class Schedule:
Fridays 12:00-2:40 AM AH 2108
Course Units:
3 units – lecture
Faculty:
Michael Gates, Ph.D, RN
Office:
Adams Humanities 3152
Office Phone:
(619) 594-3572
E-mail:
mgates@mail.sdsu.edu
Office Hours:
Fridays 2:40-5:00 PM or by appointment
2 units - clinical
Course Overview
Catalog Description: Theories and functions of nursing management and leadership within health care
systems. Economics of health care.
Course Purpose: The content of this course prepares students for the changing role of the professional
nurse in complex and diverse health care settings. The theories and methods of leadership and
management are explored and applied in the clinical experience. There is an emphasis on critical thinking,
team building, communication, priority setting, collaborative decision-making and advocacy. Students
will use nursing leadership and management theory as well as the basic and applied sciences and
humanities from previous courses.
This course introduces the management functions and leadership roles of professional registered nurses
within the structure of an organization and is grounded in evidence-based leadership principles. Emphasis
is given to organization theory, management theory, behavioral theory and political theory.
Accountability for quality improvement in the provision of nursing care, interdisciplinary communication,
and collaborative relationships are emphasized. Legal authority for nursing practice, the impact of
political and legislative processes and ethical issues in management, are also discussed. Various modes of
inquiry, including nursing process, problem-solving models and decision-making tools are emphasized.
Information competence is increased through computerized database searching. An experiential learning
approach, using group process and case studies, is used to foster critical thinking skills.
Student Learning Outcomes:
Upon completion of this course, the student will be able to:
1.
2.
3.
4.
5.
Analyze the elements of organizational design
Analyze the integration of components into organizational systems
Analyze the concepts used in designing Patient Care Delivery Systems
Analyze the leadership role of the professional nurse
Analyze the role of the professional nurse as a manager of client care. 6.
7.
8.
9.
10.
11.
12.
Analyze the role of the professional nurse in organizational management.
Analyze selected principles of health care economics
Analyze the financing and management of health care finances.
Analyze the concepts of Quality Improvement.
Analyze the components of Human Resource Management.
Analyze the components of Organization Change. Examine the future role of professional nursing in health care.
Enrollment Information
Pre-requisites:
NURS 415, 415L, & 416.
Co-requisite:
NURS 458L
Course Materials
Texts
Required :
Yoder-Wise, P (2013) Leading and Managing in Nursing, (5th ed revised). Elsevier/Mosby ISBN: 9780323241830
Course Structure and Conduct
Lecture:
Students are expected to complete assigned readings before each lecture class and listen to any captivate
lectures assigned for that week which can be found on Blackboard. It is a basic responsibility of
professionals to identify and fulfill their learning needs. Thus, if you find you do not remember the
relevant pathophysiology, anatomy and physiology, chemistry, microbiology, or other basic material, it is
your professional responsibility to review the deficient areas.
Professional education is by its very nature demanding and time consuming. Students are urged to
manage time carefully.
Captivate Lectures will be provided on blackboard with accompanying power point slides. Students will
be required to listen to the Captivate lectures prior to coming to class. This will free up class time to
develop critical thinking skills and go over case studies, review practice questions, and participate in
group activities.
Clinical Laboratory:
All students will participate in the clinical portion of the course and must successfully complete 90 hours
in the clinical setting by the end of the semester. Application of theoretical concepts and principles will
be made under the direction and supervision of clinical instructors and preceptors. Performance and
practice in the clinical setting constitutes a large portion of the students assigned time in the program.
There will be group meetings during the clinical experience with all students and clinical faculty in each
section. Specific days/times for these meetings will be provided by the clinical faculty. The clinical
faculty will be available on scheduled clinical experience days. The contact method, either beeper or
cellular phone or other, will be discussed by each clinical faculty on orientation day. This contact is to be
used for urgent and emergency needs requiring immediate attention. For non-emergent needs, the clinical
faculty should be contacted during regularly scheduled office hours, via email, or at phone numbers given
at orientation to the course.
Course Assessment and Grading
Grading Scale: You will receive 2 grades for N458 (one final grade for the lecture component and one
final grade for the clinical component. A grade lower than a C in either portion of the course will resort
in a course failure requiring that both components will have to be repeated.
A
AB+
93-100
90-92
87-89
B
BC+
83-86
80-82
77-79
C
CD+
73-76
70-72
67-69
D
DF
63-66
60-62
<60
Lecture Grading:
Exam 1 = February 20th
25 %
Exam 2 = March 27th
25 %
Exam 3 = May 11th
25 %
Homework =
15 %
Participation/attendance =
10 %
Clinical Grading:
Group Evidence Based Practice/Change Project =
50 %
Journals =
22.5 %
Clinical Preparedness and Professionalism =
22.5 %
Preceptor(s) Thank You Letters =
5%
LECTURE GRADING
Exams:
Attendance for all exams is expected. No provision is made for exams missed because of unexcused
absences from class. Unless a prior arrangement for an excused absence is obtained, a grade of F (0%)
will be given for the exam that is missed. Make-up exams may differ from the original exam and may be
of a different nature (e.g., essay, short answer, matching, etc.)
Test security is strictly maintained during both tests and review sessions. During exams, students must
leave all parcels, phones, pagers, PDAs, etc. at the front of the room. Students are allowed to have
pencils, erasers, and one scantron at their desks. Further, if you arrive to the classroom on an exam day
after any students have turned in their exam and left the classroom, you will not be permitted to take the
exam. Any student who, in the judgment of the faculty, is cheating during a test will receive a zero for
that test and will be reported to the University Judiciary Committee for further action. It is the
responsibility of the student to avoid any behavior which could give rise to a suspicion of cheating.
During test reviews, neither writing nor recording are allowed.
Scantrons: You will need one large red and white scantron (F-288-ERI-L) and 2 small red and white
scantrons (F-289-ERI-L).
Homework: When homework is due, it is due at the beginning of class and in hard copy form.
Homework due dates and assignment point value and directions will be posted on Blackboard.
Participation/Attendance: Class participation is the essence of any adult learning experience. The
learning experience is enriched by those that actively engage and not solely influenced or born by faculty.
We each share in the responsibility for achieving the defined objectives. Therefore, student grades (10
points overall) will reflect the degree of participation and overall contribution each student makes in
achieving the goals of the course including attendance.
Criteria for Measuring Class Participation:
1. Be present and on time
2. Turn off cellular and/or mobile devices
3. Come prepared by completing all reading in the text and on blackboard
4. Complete all in-class assignments
5. Respect the people and the process
6. Ask relevant questions
7. Provide input/insight through personal reference and experience
8. Share additional information and materials (articles, etc.) that “add value” and enrich the learning
experience for all involved
9. Attendance will be assessed using class sign rosters and weekly discussion questions.
10. Absences authorized in advance by the course coordinator can be made up through the following
process. First absence – submit a 1 page essay on professionalism in nursing with 2 references within 1
week of missed class. Second absence – submit a 2 page reflective essay on your growth as a professional
nurse during your tenure in nursing school, include at least one example of when you demonstrated
professionalism in your practice.
Attendance: Starting with the second day of class, I may display a list of about 3-5 randomly selected
students’ names at the beginning, middle, or end of class. These students will need to let me know that
they are present. If you are not present you will lose the 5 attendance points. Since names are randomly
drawn, you can be chosen more than once. If you are called a second time and you are absent, you will
lose half of your attendance points. Do not come up at the end of class to ask if your name was on the
list. Attendance is worth half (5 points of your total grade) of your Class Participation Grade.
CLINICAL GRADING
Clinical Lab Hour Requirements
Each student will need to fulfill 90 clinical hours during the semester. Students will receive credit for
their post conference time (determined by your clinical faculty member) as well as 8 hours for group
work on your Evidence Based Practice Project. The remaining time will be met by working with your
preceptor at your assigned facilities. In addition, participation in community events/professional
meetings/conferences is expected and can be used to meet some of your clinical hours (these activities
must be approved by your clinical faculty and the student must show how the event they are
attending meets course objectives/outcomes). The number of clinical hours for these community
activities will be determined by your clinical faculty member.
Potential list of community activities (must be cleared with clinical faculty):
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Toastmasters
Local Nursing Organization/Chapter meeting (required)
Sigma Theta Tau International Meeting
Sigma Theta Tau Odyssey Conference (Fall Conference)
California Student Nurses Association Meeting
AACN Meetings (1st Wednesdays/month at 1730; location & topic TBD)
Oncology Nursing Society (ONS) meetings (3rd Thursday/ month; dinner meeting at 1800; topics
and locations TBD)
A visit to a local/state policy maker
Attending leadership conference
Evidence Based Practice workshops, presentations, meetings
State/Local open forums
Non-profit organizations- meetings, forums- especially anything related to health
Evidence-based/change practice (EBP) project:
Learning how to manage and facilitate change is one of the major components necessary to developing
future nurse leaders. The group EBP project will provide the student the experience to initiate and
coordinate planned change in a health care organization.
The purpose of this assignment is to engage the student in an analysis of evidence-based practice within
their clinical experiences. The assignment will account for 50% of the clinical grade and will be divided
into 3 phases plus a peer review. Your clinical instructor will assign deadlines for each phase of the
project.
Phase I: Problem Identification and Evidence-Base
1. Problem Identification: A clinical problem will be uncovered during clinical experiences in
collaboration with the unit leaders and your clinical instructor. Digging up clinical problems can
start with observation of practice on your assigned unit, asking staff about the problems they face
delivering care, looking through policies and procedures and guidelines of care, and talking with
patients about their perceptions of the care they are receiving. A clinical question should be
developed using the PICOT process.
2. Review of literature: The review of literature should begin with a description of the search
process used to identify articles. The majority of the literature reviewed should utilize systematic
reviews, meta-analysis, or clinical guidelines. Individual studies, review articles and clinical
articles can be used as supportive literature for clinical issues with limited research.
Approximately 15 citations should be adequate (or 3 per group member), see your clinical
instructor if you have a problem with a particular content area. Students are encouraged to use
evidence- based sources from the Internet, as appropriate. Use of a clinical/medical librarian is
strongly encouraged and may be required by your clinical instructor.
3. Critical Analysis: The critical analysis section should include a discussion of the rationale for the
existing clinical practice, as stated by the nursing staff in light of the review of literature. The
existing practice should be contrasted and compared to the evidence gained from the review of
literature. The individual sources should be critiqued and a summary evidence grid be completed.
Phase II Proposal: Implementation Strategies:
This section should describe the innovation or new practice based on the best evidence and explore
strategies to implement the practice. Change theory should underpin the implementation strategies
selected. Key stakeholders should be identified. Challenges to implementing evidence-based practice in
the clinical setting should be identified with potential solutions for each challenge explored. A proposed
implementation timeline should be included. Outcomes measures should be identified and an evaluation
plan be proposed.
1. Clinical practice: The description of clinical practice can be a client care scenario in which the
student was involved or be clinical practices observed while in a given clinical area. The rationale
nursing staff offers for engaging in the particular clinical practice should also be explored.
2. Innovation/New practice: The proposed change in practice should be outlined.
3. Implementation Strategies: An implementation strategy should be outlined with clear evidence of
integration of the change theory chosen to guide the project.
Phase III Dissemination:
This section will be the materials used to disseminate your project findings to the clinical agency.
1. Presentation at Clinical Agency: a 10-15 minute overview of the problem,
evidence, and proposed plan.
a. Actual PowerPoint slides or some other method of effective communication of project.
b. Handouts materials for unit leadership if indicated
c. 2-3 discussion questions prepared by students to pose to their audience to generate discuss
about the project and potential for implementation
d. Presentation delivery: professional demeanor, professional dress, discussion generated
e.
Peer Review:
Please be aware that all members of a team for the group-based assignments are expected to function
together and provide peer feedback to keep all students sharing the workload for the assignments equally.
Each group will receive one grade and each group member will receive that grade for the project.
**Note: Team member evaluations also will be conducted for this project and will be used to adjust
grades for those for whom consistent evidence is shown of exemplary or unsatisfactory contributions to
the team. Peer evaluations will comprise 15% of each student’s grade for this assignment.
**Note: If 75-80% of your team votes you off the team (like Survivor), then you will be given an
alternative individual assignment that will be a lot more work than your original team assignment.
Evidence-Based Practice/Change Project Grading Guidelines
Criteria for Evaluation
Points
Possible
Points
Earned
Phase I: Problem Identification and Evidence Based-Scholarly Paper
1. Practice Problem Identification
a. description of clinical practice to be addressed
b. significance of project, to be able to answer the question: So why
is this problem significant
c. Problem statement in PICOT format
d. Query staff about the rationale for the clinical practicesummarize range of responses
2. Review of literature
a. Document search process for identifying articles. (consult
librarian)
b. Identify key search terms.
c. Search for evidence using the hierarchy addressed in EBP
lecture.
d. Body of evidence presented was necessary and sufficient (15
source minimum)
e. Fill in the Evidence summary Grid provided in the EBP lecture
or by your clinical instructor (attach to paper).
3. Critical Analysis
a. Synthesize the evidence in a 3-5 page summary format.
b. Summarize the implications for Nursing practice
c. Summarize what the evidence supports as the best practice
related to the problem you selected and a conclusion about
whether or not the clinical practice is consistent with the best
practice identified in the evidence.
10
15
20
Phase II: Implementation Strategy-Scholarly Paper or PowerPoint
3. Implementation Plan
a. Protocol outlining the steps involved in the change in
practice
b. Clear identification of a change theory and its application in
25
designing the project.
c. Identification of the organizational stakeholders
d. SWOT analysis (strengths, weaknesses, opportunities, and
threats)
e. Cost benefit assessment
f. Proposed timeline
Phase Three: Dissemination
5. PowerPoint presentation to unit leadership at clinical site
a. PowerPoint presentation
b. Handout material for clinical facility (PowerPoint slides,
evidence summary grid, others as needed)
c. 2-3 discussion questions
d. Presentation delivery
Peer Evaluation
Group Member Evaluation Form
TOTAL POINTS
15
15
100
Name _________________________
Group Member Evaluation Form
Nursing Management and Leadership
Please use this form to indicate each group member’s contribution to your project. Begin by
listing the members of your group below (including yourself). Then give each member of your
group a score from 1 to 10 (with 10 being the highest possible score) to indicate their
contribution to the project. Lastly, please note anything else good or bad relevant to your group
members’ contribution and anything else that I should know about your group’s dynamics. This
form and the information shared on it will not be seen by anyone but me. Please take into
account the following:
-
The amount of work they did on the project
Their dedication to the project
The value of their contribution
Their leadership role
Their attendance at group meetings
Group Member Name
(include yourself)
Overall Contribution Score
(1=lowest, 10=highest)
Notes about His/Her
Contribution
_________________
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Journals:
Students are responsible to submit a comprehensive journal as determined by your clinical instructor.
These journals should include the student’s perception of how they functioned in the leadership and
management role achieving the clinical outcomes. Activities are compared with the course outcomes and
logged. Self- evaluation should be included with each week’s log. This could be how the student feels
about their performance, areas of growth, ideas for desired growth, goals for the following week, and
analysis of the preceptor experience. Journals will be submitted via the method designated by the clinical
faculty each week during the rotation until all hours are complete.
Journal Guidelines
Writing in a journal can assist you in the process of getting the most out of your N458 clinical experience
by helping you fully explore your clinical experiences. The process will be challenging and difficult at
times, but also rewarding and fulfilling if you take some risks and use it for personal and professional
growth.
The experience journal is a written account of each clinical laboratory experience. Each clinical log is due
within the week of the clinical experience. Guidelines include:
1. Provide an attainment of course outcomes, overview of activities and tracking for clinical hours.
(Tracking form will be available on blackboard).
2. Provide a vehicle to communicate learning experiences, feelings, problems, and/or needs to the
clinical faculty.
3. Facilitate formulation of learning outcomes for each experience.
4. Provide a summary retrospective analysis of individual growth.
5. Turn your journal in weekly until you finish your clinical hours
6. Generally you will write from 1-2 8.5 x 11 pages. Longer isn’t better if you aren’t engaged in
self-reflection, self-evaluation, and exploring your perceptions.
7. Stay focused on the course learning outcomes – remember this is how you will be evaluated by
the clinical faculty.
8. The journal is about reflection and evaluation of your performance and experiences, identifying
areas for growth, ideas for desired growth, goals for the following week. You will need to provide
an analysis of your clinical experience based on your explanation of the concepts or theory
contained in the outcome to which you are writing.
9. Remember your clinical faculty is not with you and your preceptor, and is only seeing you
separate from your clinical experience activities via your journal, so the journal entries must
document what you are learning as related to the course outcomes.
Suggestions for how to structure it – the “content”
1.
You should be paying close attention to the course learning outcomes each week and
identifying goals for each clinical experience that are related to how you will meet the
learning outcomes.
2.
Be smart about how you use the journal – “This is an example of how I worked on
outcomes 1”, or “I had 3 new challenging experiences this week, they were”.
3.
Look at your leadership evolution over the rotation, talk about how you have
tried/observed different leadership styles, how they worked, what leadership styles do
you see other nurses using, what seems to work best?
4.
What you are doing on-line each week should help guide how you approach your journal,
review previous chapters in your text and link the content to what you are doing and
seeing in the clinical setting, analyze, synthesize, reflect. This is not a list of task and
activities that you did.
5.
By the end of the semester there must be evidence in the journal how you met the
learning outcomes.
Clinical Preparedness & Professionalism
Clinical preparedness and professionalism accounts for 22.5% of your overall clinical grade. Your
clinical instructors will assign this grade based on the following over the semester:
1. Observed interactions with facility preceptor (nurse manager, nurse educator, clinical nurse
specialist) – examples of interactions include did you clearly communicate what your goals for
the day would be, were you an active participant in the activities that you were asked to attend.
2. Preparedness in the leadership setting (were you prepared to participate in the activities your
leadership preceptor assigned you and were you able to answer your leadership preceptor’s
questions)
3. Handing in assignments on time (i.e., journals and EBP/Change Project)
4. Attendance/tardiness (if you were absent did you notify your instructor in a timely mannerprovide a doctor’s note if warranted, were you on time for your leadership rotations and post
conferences, etc).
5. Were you dressed professionally for your leadership rotation.
6. Did you handle criticism/constructive feedback from your instructor, preceptor, or peers
professionally.
7. Did you honor the confidentiality of the leadership environment you participated in.
8. Observed interactions with your fellow clinical group members (i.e., during work on EBP/Change
Project and in Post Conferences)
Note: Everyone will start the semester with a 100%. Your first offense in each category will result in a
2% point deduction. Example of point deductions: If you are late for clinical preceptorship or post
conference one day you will lose 2% points.
Repeated offenses in each category will result in a minimum of a 4% point deduction per offense and may
result in being placed on a learning contract. Also major professionalism offenses that are viewed as
major/severe by your instructor or preceptor may result in the loss of more than the 2% points for a first
offense or the 4% points for a repeated offense. The total point loss for these major offenses will be left
to the discretion of your clinical instructor and MAY result in a SIGNIFICANT loss of points or even
course failure.
Thank You Letters:
We are guests at the clinical facilities we are using throughout the semester. Further the leadership
preceptors that have agreed to work with us are doing so without any formalized compensation. Since
each preceptor’s time is valuable, it is important to formally thank each of your primary preceptors by
providing them with a thank you letter.
Other Course Policies
San Diego Nursing Service-Education Consortium: Student Dress Code:
Pre-clinical/Leadership Rotation:
1.
Picture identification badge with name that meets the guidelines of AB 1439, which amended
Chapter 1 of Division 2 of the Business and Professional Code of the State of California. Some
facilities require both student and facility badges, or may allow either student or facility.
2.
Clean uniform or lab coat over street clothes of knee length or longer. No jeans or visible
midriffs. A lab coat must be worn over scrubs.
3.
Clean, low-heeled shoes with closed toes. Clogs must have a strap around the heels. No sandals
or flip-flops.
4.
Jewelry: Only wedding or simple rings and limited to one per hand. No piercings or
jewelry/hardware may be evident other than one small stud earring per ear.
5.
6.
7.
8.
9.
10.
11.
Hair color must fall within natural occurring shades, be neat, and if long, secured back. Facial
hair must be neatly trimmed.
Tattoos must be covered at all times.
Fingernails must be trimmed short. Light or clear polish without chips is acceptable. No artificial
or acrylic nails or components thereof are permitted.
Make up is to be worn in moderation.
No perfumes or scented lotions.
No low necklines.
Undergarments cannot be visible through the uniform
Academic Dishonesty: Students are reminded to read the University policy on academic
dishonesty/student discipline in the Undergraduate catalog. Academic dishonesty may include, but is not
limited to, cheating, plagiarism, fabrication, and knowingly assisting others in an act of academic
dishonesty. Any student that engages in cheating in any form will receive an automatic “F” as a grade
and will be referred immediately to SDSU’s Judicial Procedures Office.
Classroom Protocol: Behaviors that disrupt the classroom environment impede students’ ability to learn.
Examples of these behaviors are: talking during lectures and video presentations, interrupting others while
they are speaking, and arriving late and/or leaving early without previously notifying the instructor of
compelling reasons for entering or exiting the classroom while class is in session (see the 2007-08 SDSU
General Catalog, Student Discipline and Grievances, pgs. 447-448). Students will be notified the first
time that his/her behavior is inappropriate. The next time this inappropriate behavior occurs, SDSU’s
Judicial Procedures Office will be informed for disciplinary action.
Disability Accommodation:
If you are a student with a disability and believe you will need accommodations for this class, it is your
responsibility to contact Student Disability Services at (619) 594-6473. To avoid any delay in the receipt
of your accommodations, you should contact Student Disability Services as soon as possible. Please note
that accommodations are not retroactive, and that accommodations based upon disability cannot be
provided until you have presented your instructor with an accommodation letter from Student Disability
Services. Your cooperation is appreciated.
After accommodations have been authorized by SDS, students are responsible for notifying faculty in
advance of the need for accommodation. This can best be accomplished by making an appointment to
meet privately with the faculty member early in the semester, or as soon as possible in the event that a
disability is diagnosed during the course of the semester.
Syllabus Changes: While changes to the syllabus will be avoided as much as possible, I reserve the right
to make changes to the syllabus at any time during the semester. If changes are made, they will be posted
to Blackboard. Be sure to check Blackboard on a daily basis in the event that changes or announcements
are posted.
Other Policies:
This course requires students to participate in field trips, research or studies that include course work that
will be performed off-campus. Participation in such activities may result in accidents or personal injury.
Students participating in the event are aware of these risks, and agree to hold harmless San Diego State
University, the State of California, the Trustees of the California State University and Colleges and its
officers, employees and agents against all claims, demands, suits, judgments, expenses and costs of any
kind on account of their participation in the activities.
Students using their own vehicles to transport other students to such activities should have current
automobile insurance.