CALIFORNIA STATE UNIVERSITY, DOMINGUEZ HILLS - SCHOOL OF NURSING
Learning Contract for BSN 451 (Leadership & Management)
Student Name: _____________________Phone_______________Email address_____________
1. Agency Name: _______________________Phone_________________Fax ___________________
Agency Address: ______________________________________________________________
2. Nursing Administrator / Contact Person: ___________________________________________
3. Preceptor’s Name: ____________________________Preceptor’s Title_____________________
Preceptor’s Phone: _____________________Preceptor’s Email Address: _____________________
4. CSUDH Course Instructor’s Name______________________________Phone______________________
Email Address_____________________________________
In case of emergency, contact CSUDH School of Nursing at 310-243-3596
The number of hours of clinical experience required for this course is:_________________________________
Beginning Date__________________________________Final Date__________________________________
Practice Setting (Check all that apply):
 Acute Care (Type:______________)
 Home Care

School Health
 Adult Day Care
 Hospice Care

Substance Abuse Care
 Ambulatory Care (circle one)
 Long-term Care

Occupational Health
 Other:
primary care
specialty clinics
 Mental Health
surgery
birthing center

Public Health
_____________________

Rehabilitation
_____________________
 Health Education
Preceptors must attach a curriculum vitae or resume.
Preceptor’s signature indicates approval of the Learning Contract and Objectives.
Preceptor’s Signature: _____________________________________Date:______________________
Student’s Signature: ______________________________________Date: ______________________
A copy of this form should be given to the preceptor and posted to Certified Background.
BSN 451 (Leadership & Management) Course Objectives
Student Name:______________________ Date: _________ Version (if resubmitted):_____
The student needs to discuss with the preceptor and fill out the “Learning Activities” and “Evaluation Measures”
in the columns below.
Course Objectives
1. Throughout the preceptored
experience, the student will
seek to engage in guided
experiences that illustrate
concepts, tools and techniques
that are covered BSN450:
Leadership and Management in
Nursing.
2. The student will apply
management/leadership skills
and techniques to formulate a
plan for change that is designed
to resolve an organizational,
leadership, or management
problem in a specific practice
setting illustrating management
and leadership concepts.
3. The student and preceptor will
enable educational
opportunities during a planned
clinical experience in several
content areas as listed below
such that the preceptor will
provide an evaluation of stated
learning outcomes.
(check those that apply)
Leadership, management and
followership
Mission, vision, philosophy, and
goals
Stages of change
Tools and strategies used in
leadership and management
processes
Legal and ethical principles related
Learning Activities
(Activities to Achieve the Objectives)
Evaluation Measures
to decision-making
External and internal forces that
drive health care organizations
Budgets and other financial
aspects of management
Organizational, group and
interpersonal communication
Staffing and logistics of clinical
care delivery
Quality management and process
improvement
Employee satisfaction and
performance evaluation
Strategies for empowerment of
self, staff, and nursing as a
profession
4. OPTIONAL: Students may add
additional objectives to meet their
personal professional goals: