School of Nursing
Spring 2009
Nurs 4500W Nursing Leadership and Health Care Systems
Welcome to N4500W
In this course, you will develop leadership and management skills so that you can
practice safely and effectively as a new graduate nurse. The intent of the course is NOT
to prepare you to assume a formal managerial position, like a nurse manager, but to help
you transition from being a student to a practicing nurse – and to equip you with the
necessary knowledge, skills and abilities to practice as a professional nurse taking care of
patients and their families. The course provides an opportunity to examine issues
affecting nursing practice and then help you develop skills in key areas, e.g., creating
effective teams, interacting confidently with others, resolving conflict, managing
resources, playing a leadership role in assuring patient safety and quality care.
We are excited about the course and look forward to working with you. We view
ourselves as resources to help you learn the material and develop the necessary skills so
that you’ll be successful new graduate nurses. We are committed to doing our part in
making this course a valuable learning opportunity for you – and consider this a partnership
with you.
Joanne Disch & Mary Chesney
Spring 2009
4 semester credits (3 didactic, 1 clinical)
Didactic: 3 hours/week; Wednesdays, 8:05-10:55 a.m.
Clinical: 45 hours/semester – to be arranged
Didactic: Moos 1-451 (Twin Cities)
U Sq 397 (Rochester)
Course Prerequisites:
Nursing student status or instructor consent
Minnesota Board of Nursing Abilities:
This course meets the Minnesota State Board of Nursing Requirements for Nursing
Abilities: 6301.1900 Subp. 8A, 8B, 8C, 8D.
Course Objectives: In classroom and clinical situations the student will:
1. Discuss the origin and characteristics of the US health system:
a. in relation to global health conditions.
b. in terms of social, political, technologic, and economic factors with regard to
financial mechanisms that affect access, safety and quality.
c. in light of current legal and regulatory requirements.
2. Assess a health care unit/agency/organization in terms of structure;
governance; distribution of power, authority and responsibility; decision-making
processes; and the roles and functions of nursing.
3. Analyze models of nursing and health care delivery in terms of:
a. effectiveness and acceptability with diverse populations.
b. future nursing roles and functions.
c. improvements in providing client and community-focused services.
d. preventing illness and injury, improving health outcomes, and maintaining
4. Explore the role of contemporary nursing leadership and management in
promoting innovation in health care systems, including applications of
technology, information management, and human development.
5. Develop a personal philosophy of leadership based on knowledge of situational
and contemporary leadership theory and practice.
6. Demonstrate leadership skills in planning, organizing, implementing and
evaluating nursing care in collaboration with nurse colleagues, other licensed and
unlicensed caregivers, and members of the interprofessional health team.
7. Apply evidence-based strategies to improving the quality of health services and
client outcomes.
8. Apply theories of planned change, mindful of organizational culture and
behavior, in nursing and health care.
Course Faculty
Joanne Disch, PhD, RN, FAAN Educated at the Universities of Wisconsin (BS), Alabama
at Birmingham (MSN) and Michigan (PhD), Dr. Disch has served in clinical positions as a
staff nurse, head nurse, clinical director, faculty member, and chief nursing officer. She
is a nationally and internationally recognized nursing leader who served as president of the
American Association of Critical-Care Nurses, chairperson of ANA's Committee on
Nursing Practice Standards and Guidelines, and on the Board of the American Academy of
Nursing. Dr. Disch has received several awards including Outstanding Alumna from the
University of Wisconsin School of Nursing; the Distinguished Alumna from the University
of Alabama in Birmingham's School of Nursing; and Outstanding Faculty Member at Rush
College of Nursing. In May 2008 she received the Distinguished Alumnus Award from the
University of Wisconsin. She is a member of the Board of Directors of the Allina Health
System and Aurora Health System; and recently completed a term as Chair of the National
Board of AARP.
Mary Chesney, PhD, RN, CNP: Educated at the College of St. Catherine (BA),
University of Minnesota School of Public Health (MS), and University of Minnesota School
of Nursing (PhD), Dr. Chesney has had a variety of nursing roles including NICU staff
nurse, nurse educator, pediatric primary care provider, provider/care coordinator for
internationally adopted children and children with special health care needs, and Clinical
Director of the Pediatric Specialty Clinic at the University of Minnesota Medical CenterFairview. Dr. Chesney has served in a variety of leadership roles including President of Chi
Chapter of Sigma Theta Tau International Nursing Honor Society, President of MNChapter of National Association of Pediatric Nurse Practitioners (NAPNAP), and National
Chair of NAPNAP’s Reimbursement and Managed Care Task Force. She chaired the
Minnesota APRN Coalition Work Group that led to successful recognition of APRNs in
Minnesota’s Nurse Practice Act in 1999. In 1998, she received Minnesota NAPNAP’s PNP
of the Year Award and in 1999, was awarded MN NAPNAP’s President’s Award. Dr.
Chesney has been involved with legislative health care reform initiatives and recently
served as MNA’s representative on MN Department of Health’s Healthcare Workforce
Shortage Study Group. She serves on Minnesota’s Health Care Reform Review Council.
If you want to leave a message for Joanne, send an Email ([email protected]). If you
have not gotten a response within 48 hours, or want to see Joanne personally, please let
Arlene Birnbaum know and she can forward a message to Joanne. Arlene can be reached in
the Densford Center (4-185 WDH), at 612-625-1187. The best way to get in touch with
Mary is through email ([email protected]).
Course Content:
Week 1:
Week 2:
Week 3:
Week 4:
Week 5
Course welcome & overview
 Leaders in practice
 What do I want to learn?
Influencing others
 What am I willing to do?
 Emotional intelligence, emotional literacy
 Issue briefs
Effective communication
 How can I get my point across?
 Assertive, aggressive, persuasive
 Conflict resolution
Models of professional nursing practice
 What is nursing?
 Concepts of client-focused and patient-centered care
 Traditional and innovative nursing care models
 Care coordination and case management
The political process
 How can nurses influence public policy?
 Sources of power
 Legislative and regulatory influences
 Collective action
 The consumer movement
Week 6:
Week 7:
Week 8:
Week 9:
Week 10:
Week 11:
Week 12:
Week 13:
Week 14:
Delegation and Negotiation
 How do I supervise and work with others?
 ANA scope of practice
 Practice and professional performance standards
 Evaluating nursing care – yours and those assigned to you
 Resolving conflicts in patient care practice
 LEAD Self-Assessment
Leadership and management theories
 What’s the difference between leaders and managers, and when should I be
 Distinctions in being a leader, manager, follower, team member
 Situational leadership
 Models of management
Creating change
 How do I get others to do what I think is right?
 Models of change theory
 Evidence-based theory
 Strategies for changing/improving care based on evidence
 Leading and managing change at the point of care
Quality Improvement and patient safety
 How can I make a difference at 3:00am?
 IOM series
 The big picture: IHI, JCAHO, Leapfrog, etc
 Models of Quality Improvement
Managing Resources
 When will we have enough resources in health care?
 Shortages in health care
 Measuring and optimizing resources
 A spirit of abundance
Health Care Organizations
 Where do I want to work when I graduate, and why?
 Governance and organizational structure
 Mission, vision, policies and procedures
 Organizational culture – Magnet/Baldrige designation
 Resource management/economics
Information & knowledge management
 How can I make sense out of all of the information I’ll be generating and
 Informatics—practice and standards
 Data management
 Technology in health care – advantages & unintended consequences
 HIPPA—security vs. convenience
Context of Health Care
 If health care is a ‘right,’ how come 47 million people don’t have it?
 Assumptions & facts about health care and our health care system
 Financing health care (social, political, technological influences)
 Policies affecting care
 Global comparisons
Week 15:
Week 16:
Nursing as a life-long career
 Why is this the best time to be a nurse?
 The nursing lens
 Evidence-based leadership
 Maximizing your salary
That first year . . .
 How do I transition to being a novice nurse?
 Mentors, preceptors and other resources
 Career possibilities
 Designing the Final Exam
 Graduation run-through
 Course wrap-up
This course is a "writing intensive" course. University of Minnesota Policy states
that “writing-intensive courses integrate writing into the work of the course. They provide
a variety of formal and informal occasions for students to write. In formal writing,
students might learn the formats characteristic of a particular academic field, such as a
research report, a critical essay, or a laboratory report. In informal writing, students use
writing that may include logs, journals, or short in-class responses to readings and lectures
in order to learn course material. Through both formal and informal writing, students come
to understand something of the goals, assumptions, and key concepts operating in their
One conventional credit is defined as the equivalent of three hours of learning
effort per week averaged over an appropriate time interval, necessary for an average
student taking the course to achieve an average grade. For example, a student taking a 4credit course that meets for four hours a week should expect to spend an additional 12
hours a week on course work outside the classroom. This "rule of thumb" suggests that a
student might need to expend additional time and effort to receive an above-average
1. You are subscribed (using your U of MN E-mail address) to the class listserv.
We will be using this listserv to provide information about the course. For example, such
messages may include updates to required readings for class sessions, changes in due dates
for assignments, etc. It is important that you check your E-mail several times a week.
2. We will also be using a WebCT site for this class. Most materials for the course
will be available on the WebCT Site for this course.
3. Announcements will also be made in class. You are responsible for any
information communicated by us via Email, WebCT or in class. If you want to respond to
anything that we post on E-mail, we suggest you send a message personally to us using our
UMN E-mail; it helps us if you begin the subject line with N4500.
4. Papers and assignments will be returned during class; if you are not in class on
the day they are returned, they will be placed in the student mailboxes on 5th floor for
Twin Cities students, and in the designated area on the Rochester campus.
1. Yoder-Wise, P. (2007). Leading and managing in nursing. 4th Edition. St. Louis: Mosby.
2. Blanchard, K., Zigarmi, D., & Zigarmi, P. (1985). Leadership and the one minute manager.
New York: William Morrow.
3. American Nurses Association (2004). Nursing: Scope and Standards of practice.
Washington, DC: ANA.
Course grades will be determined based on the assignments and the final exam. You
will be successful in this class by completing the assignments and readings, attending and
participating in class, reviewing websites and contacting the instructors if you have any
questions or need assistance with the course. All assignments must be completed in order
to achieve a passing grade. Overall grading for NURS4500W is A-F. However, the learning
tool (part of the Quality/Safety project) is evaluated as S/N. This means that this
portion of the assignment must meet the requirements laid out for the assignment at or
above the C level to receive an S and be awarded the full number of points associated with
the assignment. A score of C- or below for the assignment will be given an N and no points
will be awarded for that portion of the assignment.
Inability to turn in assignments on designated due dates must be negotiated with
Joanne Disch or Mary Chesney in advance. One point will be deducted from a student’s
grade for each day that an assignment is late. If there is not a mutual agreement as to
the need for adjusting the due date, the student may receive no credit for the
University Grading Standards
Achievement that is outstanding relative to the level necessary to meet course
Achievement that is significantly above the level necessary to meet course
= Achievement that meets the course requirements in every respect.
Represents failure (or no credit) and signifies that the work was either (1)
completed at an unsatisfactory level or (2) was not completed and there was no
agreement between the instructor and the student that the student would be
awarded an I (see also I).
Achievement that is worthy of credit even though it fails to meet fully the
course requirements.
Assigned at the discretion of the instructor when, due to extraordinary
circumstances (e.g., hospitalization) a student is prevented from completing the
I (Incomplete) =
work of the course on time. Requires a written agreement between instructor
and student.
The following grading scale will be used:
< 70.0
Assignments in this course have been designed to help you learn skills that will be essential
in practicing effectively as a novice nurse.
What are the assignments, when are they due, and who will be grading each one?
Issue Brief
Situational Leadership
Quality/Safety Project
 The Learning Tool w/ rationale
 Analysis of team functioning
Clinical Leadership Synthesis
Independent Learning Experience
ATI on Leadership
J Disch
M Chesney
J Disch
M Chesney
J Disch
Important Grading Note: Any disagreement with grades received on assignments must be
handled in the following way due to the large number of students in the class:
1. Submit a brief written proposal requesting a change in grade
2. Outline exactly where in the assignment you believe you should have earned
points, and how many should be adjusted.
3. Provide rationale for your recommendation
4. Email this to Dr. Disch.
Academic Integrity
Students are expected to adhere to the University of Minnesota standards for
student conduct. Please refer to the academic conduct policies published in the School of
Nursing Undergraduate Student Handbook. Academic dishonesty in any portion of the
academic work for a course shall be grounds for awarding a grade of F or N for the entire
course. One type of academic dishonesty is plagiarism. Plagiarism is the act of
representing someone else's intellectual property as your own. Plagiarism is unethical and
may also be a violation of copyright law. To learn more about plagiarism, and to find tips on
how to properly paraphrase someone’s work, visit the U of M web page at the following
URL address: Faculty at the University of
Minnesota use a variety of safeguards against plagiarism, including electronic software
designed to detect copying (e.g., Any student found to be plagiarizing will
receive an F in this course.
Student/Faculty Responsibilities and Expectations
In class on January 21, we will have a joint discussion about what we expect from
the class and from each other. A compact will be developed from this discussion that will
guide behavior for faculty and students throughout the course.
Statement of Inclusivity
The University of Minnesota is committed to the policy that all persons shall have
equal access to its programs, facilities, and employment without regard to race, color,
creed, religion, national origin, sex, sexual orientation, marital status, disability, public
assistance status or veteran status. It is University policy to provide, on a flexible and
individualized basis, reasonable accommodations to students who have documented
disability conditions (e.g. physical, learning, psychiatric, vision, hearing, or systemic) that
may affect their ability to participate in course activities or to meet course requirements.
Nursing students who suspect they may have a disability condition are encouraged to
contact Barbara Blacklock or Tim Kamenar at Disability Services for a confidential
discussion of their individual needs for accommodations. Disability Services is located in
Suite 180 McNamara Alumni Center, 200 Oak Street. Barbara or Tim can be reached by
calling 612/626-1333 voice or TTY. Student feedback about the inclusivity of the course
content and teaching methods will be appreciated and taken into consideration.
Policy on Use of Class Notes for Commercial Purposes
Students may not distribute class notes, handouts, or other instructor-provided
materials for commercial purposes, through the Internet, or for any reason other than
personal study among classmates enrolled in the course, without the express written
consent of the instructor. Alternatively, faculty will not showcase exceptional student
papers without their expressed consent.
Evaluation of course
At the end of the term, students will be asked to provide formal feedback. We will
provide specific information on this process toward the end of the course. In addition,
throughout the semester, we welcome verbal or written suggestions on how to improve any
aspect of the course. We also are willing to talk with you as you work on assignments to
help clarify the intent or expectations of the assignment. We view ourselves as resources
to you to help you learn the content, develop the skills and explore new experiences.
Accommodations for Students with Special Needs
The University of Minnesota is committed to providing all students equal access to learning
opportunities. Disability Services is the campus office that works with students who have
disabilities to provide and/or arrange reasonable accommodations. Students registered
with Disability Services, who have a letter requesting accommodations, are encouraged to
contact the instructor early in the semester. Students who have, or think they may have,
a disability (e.g. psychiatric, attentional, learning, vision, hearing, physical, or systemic),
are invited to contact Disability Services for a confidential discussion at 612-626-1333
(V/TTY) or at [email protected] Additional information is available at the DS website AHC students should contact Barbara Blacklock at [email protected]
or Sara Hegge at [email protected] at Disability Services if you have any questions.
Student Mental Health Resources
As a student you may experience a range of issues that can cause barriers to learning,
such as strained relationships, increased anxiety, alcohol/drug problems, feeling down,
difficulty concentrating and/or lack of motivation. These mental health concerns or
stressful events may lead to diminished academic performance or reduce your ability to
participate in daily activities. University of Minnesota services are available to assist you
with addressing these and other concerns you may be experiencing. You can learn more
about the broad range of confidential mental health services available on campus via
8:05 – 10:55 AM
Week Lectures
1/21 Chesney
At last! The last semester
Course Overview
100th Anniversary Launch – January 27
Influencing others
Effective communication
PYW, Ch 17, 22
Models of professional nursing practice
PYW, Ch 12, 21
ANA Scope/Stds
PYW, Ch 9, 18
The political process
Nurses Day on the Hill – February 24
Delegation & negotiation
Leadership and management
Creating change
PYW, Ch 1-3
Blanchard et al
PYW, Ch 16
Spring Break
Quality improvement and patient safety
PYW, Ch 19
Resources, shortages and abundance
PYW, Ch 11, 13
Health care organizations
PYW, Ch 6-7
Information and knowledge management
Research Day – April 11
The context of health care
PYW, Ch 10
Nursing as a lifelong career
PYW, Ch 25, 28
Wikipedia entry on
Emotional Intelligence
PYW, Ch 23
Nursing Grand Rounds – May 7
Graduation – May 15, 2009
Additional reading assignments and learning experiences:
Throughout the semester - for some of the lectures, we will add some additional exercises
and web-based content to the required readings. Here are a few to start with -
Week 5: The Political Process:
AARP. (n.d.). The Divided We Fail platform. From
Minnesota House of Representatives. (n.d.). State law process. From
Minnesota House of Representatives. (n.d.). Minnesota district finder. From
U.S. Government. (n.d.). Healthy People 2010 Leading health indicators: Priorities for
action. From Action.pdf
Week 6: Delegation & Negotiation
Minnesota State Board of Nursing.
National Council of State Boards of Nursing.
American Nurses Association.
Kelly-heidenthal P, & Marthaler M. (2005) Delegation of nursing care. Thompson-Delmar
Learning, Canada, ISBN #1-4018-1405-0.
Week 10: Quality Improvement and Patient Safety
Quality and Safety Education in Nursing (QSEN)
The Joint Commission –
Institute for Healthcare Improvement –
Institute of Medicine –
Assignment #1
Why do I have to do this assignment? In your professional life, you will
encounter situations in which you want to persuade someone to take a certain course of
action. This assignment helps you articulately and succinctly present an issue of concern in
health care, provide evidence to support your point of view, and make a recommendation
for action to a specific person. You will select an issue of concern and make a specific
recommendation for improving the situation; summarize pertinent aspects of the issue,
highlighting advantages and disadvantages associated with your recommendation; and
attach copies of two articles supporting your position.
Examples: A recommendation to the
 Director of Student Services to expand student support services
 nurse manager of your area to explore 12-hour shifts.
 legislator in your district to support a particular bill
 president of your School Board to eliminate soda machines
Format: The Brief should be 1-2 single-spaced, typed pages, written as a letter, to a
specific person. Copies of (2) evidence-based articles supporting the recommendation
should be attached. Materials obtained from the Internet must meet the same standards
of scholarship as those from peer-reviewed journals.
Grading criteria for Issue Brief:
Description of the
A complete, succinct, objective and accurate description of the issue
is presented along with strong support from an evidence base.
The recipient identified is an individual who possesses the knowledge
and power (position and personal) to effectively address the issue in
its context. Correct name, title and credentials must be included
The argument for change is presented completely, succinctly, and
objectively. A compelling rationale for change is outlined. Attention is
given to significant negative aspect(s) but rationale is provided as to
why they pose a lesser problem
Appropriateness &
Feasibility of
Recommended Action
The recommended action is clearly described and effectively fits the
Organization, Style,
Spelling, Grammar
The brief is logical, complete, well synthesized, grammatically
correct. No spelling errors.
Suitability of
Persuasiveness of
Due Date: February 18, 2009
Assignment #2
Why do I have to do this assignment? Understanding your preferred and
secondary leadership styles helps in determining which style to use in given situations, and
what you may have to do to be a leader in a situation which is not inherently a good fit for
you. Using the theory of situational leadership as a framework, and gaining insight from
Leadership and the One Minute Manager, you will learn about your style(s) and strategies
for adjusting when you’re called upon to be a leader in a situation which is more challenging
for you.
Guidelines for the Paper
1. Describe Situational Leadership Theory as you understand it and briefly discuss
all the key concepts associated with the theory (5 points).
2. Complete the LEAD questionnaire (The questionnaire, scoring instructions and
interpretation directions follow in the syllabus). Interpret your leadership style based on
the results of the LEAD within the context of Situational Leadership Theory. Include
Figures 1, 2, and 3 as appendices (5 points).
3. Describe a situation (task) in your life that required you to take the lead in
something, e.g., organizing a group of students to do something, teaching nursing assistants
how to do a new task, directing a church or community group, serving as chairperson of a
student leadership group; organizing a group of neighborhood kids in an activity. (2 points)
4. Describe the group of followers (number and make-up of the group and their
development level, e.g., 15 sophomore nursing students, or 3 experienced nursing
assistants); and the nature of the physical setting. Also assess their competence,
commitment and readiness according to the following areas: (3 points)
A. Competence
1. Describe the knowledge level of the followers related to the task.
2. Describe followers' skill/competency levels based on their education, training, and
experience in relation to the task.
3. Identify knowledge and skills necessary to accomplish the task.
B. Commitment
1. Describe the confidence of the followers in their abilities to accomplish the task.
2. Describe group members' motivation in relation to the task.
C. Readiness.
1. Summarize the overall development level (readiness/maturity) of followers for the
task as defined.
5. Finally, discuss whether your dominant leadership style would be appropriate in
that situation (task) and provide a complete rationale. If your leadership style is not the
most appropriate, propose a leadership style that would be appropriate for the situation,
explain your reasons and suggest how you would have to learn or do differently do be
successful in the situation. (5 points)
6. Use APA style (7th edition, 2005) to organize your paper and format title page,
citations, headings and subheadings, references and appendices. Paper is not to exceed
6 pages (excluding title page, references, and appendices).
DUE DATE: Friday, March 25, 2009
Leader Effectiveness and Adaptability Description (LEAD)
Paul Hersey and Kenneth H. Blanchard (1976)
Directions: Assume you are involved in each of the following twelve situations. READ each item
carefully and THINK about that you would do in each circumstance. Then CIRCLE the letter of the
alternative that you think would most closely describe your behavior in the situation. Circle only one
choice. For each situation, interpret key concepts in terms of the environment or situation in which you
most often think of yourself as assuming a leadership role. Say, for example, an item mentions
subordinates. If you think that you engage in leadership behavior most often as an industrial manager,
then think about your staff as subordinates. If, however, you think of yourself as assuming a leadership
role primarily as a parent, think about your children as your subordinates. As a teacher, think about your
students as subordinates. (Do not change your situational frame of reference from one item to another.)
1. Your subordinates have not been responding to your friendly conversation and obvious concern for
their welfare. Their performance is in a tailspin.
A. Emphasize the use of uniform procedures and the necessity for task accomplishment.
B. Make yourself available for discussion but do not push.
C. Talk with subordinates and then set goals.
D. Be careful not to intervene.
2. The observable performance of your group is increasing. You have been making sure that all members
are aware of their roles and standards.
A. Engage in friendly interaction, but continue to make sure that all members are aware of their
roles and standards.
B. Take no definite action.
C. Do what you can to make the group feel important and involved.
D. Emphasize the importance of deadlines and tasks.
3. Members of your group are unable to solve a problem themselves. You have normally left them alone.
Group performance and interpersonal relations have been good.
A. Involve the group and together engage in problem solving.
B. Let the group work it out.
C. Act quickly and firmly to correct and redirect.
D. Encourage the group to work on the problem and be available for discussion.
4. You are considering a major change. Your subordinates have a fine record of accomplishment. They
respect the need for change.
A. Allow group involvement in developing the change, but do not push.
B. Announce changes and then implement them with close supervision.
C. Allow the group to formulate its own direction.
D. Incorporate group recommendations, but direct the change.
5. The performance of your group has been dropping during the last few months. Members have been
unconcerned with meeting objectives. They have continually needed reminding to do their tasks on time.
Redefining roles has helped in the past.
A. Allow the group to formulate its own direction.
B. Incorporate group recommendations, but see that objectives are met.
C. Redefine goals and supervise carefully.
D. Allow group involvement in setting goals, but do not push.
6. You stepped into an efficiently run situation. The previous administrator ran a tight ship. You want to
maintain a productive situation, but would like to begin humanizing the environment.
A. Do what you can to make the group feel important and involved.
B. Emphasize the importance of deadlines and tasks.
C. Be careful not to intervene.
D. Get the group involved in decision making, but see that objectives are met.
7. You are considering major changes in your organizational structure. Members of the group have made
suggestions about needed change. The group has demonstrated flexibility in day-to-day operations.
A. Define the change and supervise carefully.
B. Acquire the group's approval on the change and allow members to organize the
C. Be willing to make changes as recommended, but maintain control of implementation.
D. Avoid confrontation; leave things alone.
8. Group performance and interpersonal relations are good. You feel somewhat unsure about your lack of
direction of the group.
A. Leave the group alone.
B. Discuss the situation with the group and then initiate necessary changes.
C. Take steps to direct your subordinates toward working in a well-defined manner.
D. Be careful of hurting boss-subordinate relations by being too directive.
9. Your superior has appointed you to head a task force that is far overdue in making requested
recommendations for change. The group is not clear about its goals. Attendance at sessions has been poor.
The meetings have turned into social gatherings. Potentially the group has the talent necessary to help.
A. Let the group work it out.
B. Incorporate group recommendations, but see that objectives are met.
C. Redefine goals and supervise carefully.
D. Allow group involvement in setting goals, but do not push.
10. Your subordinates, usually able to take responsibility, are not responding to your recent redefining of
A. Allow group involvement in redefining standards, but do not push.
B. Redefine standards and supervise carefully.
C. Avoid confrontation by not applying pressure.
D. Incorporate group recommendations, but see that new standards are met.
11. You have been promoted to a new position. The previous supervisor was uninvolved in the affairs of
the group. The group has adequately handled its tasks and direction. Group inter-relations are good.
A. Take steps to direct subordinates toward working in a well-defined manner.
B. Involve subordinates in decision making and reinforce good contributions.
C. Discussed past performance with the group and then examine the need for new practices.
D. Continue to leave the group alone.
12. Recent information indicates some internal difficulties among subordinates. The group has a
remarkable record of accomplishment. Members have effectively maintained long-range goals and have
worked in harmony for the past year. All are well qualified for the task.
A. Try out your solution with subordinates and examine the need for new practices.
B. Allow group members to work it out themselves.
C. Act quickly and firmly to correct and redirect.
D. Make yourself available for discussion, but be careful of hurting boss-subordinate relations.
LEAD Scoring And Interpretation
Leadership Style
Your leadership style (Hersey & Blanchard, 1972, pp. 82-83; 110-112) is the consistent pattern of
behavior that you exhibit when you attempt to influence the activities of people. This behavior has been
developed over time and is what others learn to recognize as you, the leader, as your style, or as your
leadership personality. Others expect and can even predict certain kinds of behavior from you. The
pattern generally involves either task behavior or relationship behavior or a combination of both. These
two types of behavior are central to the concept of leadership style.
Task Behavior: The extent to which a leader organizes and defines the roles of individuals and
members of her group by explaining what activities each is to do as well as when, where and how tasks
are to be accomplished. It is further characterized by the extent to which a leader defines patterns of
organization, formalizes channels of communication, and specifies ways of getting jobs accomplished.
Relationship Behavior: The extent to which a leader engages in personal relationships with
individuals or members of his or her group; the amount of socio-emotional support and psychological
strokes provided by the leader as well as the extent to which the leader engages in interpersonal
communications and facilitating behavior (Hersey & Blanchard, 1972).
The recognition of task and relationship as two important dimensions of leadership behavior has
played an important role in the work of management theorists over the last several decades. These two
dimensions have been variously labeled, including such terminology as autocratic, democratic, employeeoriented/production-oriented, and theory X/theory Y.
Your perception of your leadership style on the LEAD instrument can be determined
using Figure 1. Circle the letter of the alternative action you chose for each situation and then
total the number of times an action was used in each of the four sub-columns. Score one point for
each answer that falls in the column. The alternative action choices for each situation are not
distributed alphabetically, but according to the style quadrant a particular action alternative
represents. Quadrant scores from Figure 1 then can be transferred to the basic leadership
behavior styles in Figure 2.
Figure 1. Scoring the LEAD
Alternative Actions
Figure 2. Leadership Behavior Styles
Quadrant S3
Quadrant S2
High Relationship
Low Task
High Task
High Relationship
Quadrant S4
Quadrant S1
Low Relationship
Low Task
High Task
Low Relationship
The quadrant numbers in Figure 2 correspond to the quadrant numbers of the model, and indicate the
following styles/quadrant:
Quadrant (1) - High Directive and Low Supportive Behavior (Directing).
Quadrant (2) - High Directive and High Supportive Behavior (Coaching).
Quadrant (3) - High Supportive and Low Directive Behavior (Supporting).
Quadrant (4) - Low Supportive and Low Directive Behavior (Delegating).
Your dominant leadership style is defined as the quadrant in which the most responses fall. Your
supporting style (or styles) is the leadership style that you tend to use on occasion. The frequency of
responses in quadrants other than that of your dominant style suggests the number and degree of
supporting styles as you perceive them. At least two responses in a quadrant are necessary for a style to be
considered a supporting style.
Your dominant style plus your supporting styles determine your style range (Hersey & Blanchard,
1972). In essence, this is the extent to which you perceive your ability to vary your leadership style.
Your style range can be analyzed by examining the quadrants in which your responses to the
LEAD occurred in Figure 1 as well as the frequency of these occurrences. If your responses fall only in
one quadrant, then you perceive the range of your behavior as limited; if your responses fall in a number
of quadrants, you perceive yourself as having a wide range of leadership behavior.
The degree to which leadership behavior is appropriate to the demands of a given situation is
called style adaptability (Hersey & Blanchard, 1972). Someone with a narrow style range can be effective
over a long period of time if the leader remains in situations in which his style has a high probability of
success. Conversely, a person with a wide range of styles may be ineffective if these behaviors are not
consistent with the demands of the situation. Thus style range is not as relevant to effectiveness as is style
adaptability; a wide style range will not guarantee effectiveness.
The degree of style adaptability or effectiveness that you indicate for yourself as a leader can be
determined theoretically using Figure 3. Circle the score given each alternative action choice and then
calculate the total score as indicated.
Figure 3. Determining Style Adaptability (+24 possible points total)
Weightings for Alternative Actions
A weighting of a +2 to -2 is based on behavioral science concepts, theories, and empirical
research. The leadership behavior with the highest probability of success in a given situation is weighted a
+2. The behavior with the lowest probability of success is weighted a -2. The second-best alternative is
weighted a +1 and the third a -1. The situations in which you chose the theoretically "best" response will
have +2 circled on Figure 3. Likewise, the situations in which you chose the theoretically "worst"
response will have -2 circled. The situations in which a +1 is circled do not necessarily indicate a
theoretically "bad" choice but suggest there was a "better" choice (+2). On the other hand a -1 indicates an
inappropriate choice but suggests there was a "worse" choice (-2).
In the LEAD instrument, each of the twelve situations theoretically called for one of the four
basic leadership styles depicted in Figure 2. In each case, the situation described something about the
readiness level of a work group you might be working with in your role as a leader. Using the Situational
Theory of Leadership as the analytical tool, three of the situations demanded a High Task/Low
Relationship action (Quadrant 1), three required a High Task/High Relationship style (Quadrant 2), three
required a High Relationship/Low Task style (Quadrant 3), and finally three asked for a Low
Relationship/Low Task style (Quadrant 4).
According to Situational Leadership Theory, as the level of readiness of followers continues to
increase in terms of accomplishing a specific task, leaders should begin to reduce their task behavior and
increase their relationship behavior until the group is sufficiently ready for the leaders to decrease their
relationship behavior (socio-emotional support) as well. Thus, this theory focuses on the appropriateness
or effectiveness of leadership styles according to the task-relevant readiness of the followers.
(1) Blake, R. R., & Mouton, J. S. (1964). The managerial grid. Houston, TX: Gulf.
(2) Blanchard, K., Zigarmi, P., & Zigarmi, D. (1985). Leadership and the one minute manager:
Increasing effectiveness through situational leadership. New York: William Morrow.
(3) Fiedler, F. (1967). A theory of leadership effectiveness. New York: McGraw-Hill.
(4) Hersey, P., & Blanchard, K. H. (1972). Management of organizational behavior: Utilizing human
resources (2nd ed.). Englewood Cliffs, NJ: Prentice Hall.
And why must I be subjected to another group project?
You have participated in a number of group projects because much of your work as a nurse
will rely on forming effective teams and partnerships, sometimes working with people you
don’t know or like. This particular project emphasizes the steps to take and tools to use in
forming effective work teams, even if you haven’t previously worked together or don’t like
each other.
As a team, you are asked to
(1) select a topic from the topics in N4504 Professionals Course
(2) identify a group that you want to educate about the issue or a proposed course of
action related to the issue. This can be nursing staff in your clinical immersion unit,
a family group, teachers from a school that one of the group members has children
enrolled, faculty at the UMSoN, neighbors (3) conduct a learning assessment of the group to determine their knowledge of the
(4) develop a learning tool to educate the group about the problem, scope, prevalence,
recommended treatment, and consumer or community resources available. Use of
evidence and creativity will be highly rewarded (5) share your learning tool in N4504 (per schedule to be determined)
(6) share your learning tool with the original group you surveyed, assessing their
knowledge and getting feedback
As an individual, you are asked to
(7) write your individual paper analyzing the effectiveness of your team in achieving its
goals, the role you played in its success or lack thereof, and areas for personal
growth for you in group situations.
In this course, N4500, you will do Steps 2, 3, 6, 7
As a team, you will do steps 2, 3, 6 with same grade given to each team member (10 pts)
As an individual, you will do step 7
(15 pts)
In N4504, you will do Steps 1, 4, 5
NOTE: Students who are participating in the Clarion Case Study project, can use
that experience to count toward the learning assessment and learning tool portion of
this project. Thus, they will not have to do Steps 1-6 above:
For N4500, they will do Step 7
For N4504, they will write brief paper on Clarion topic (TBD)
Assignment #4
Why do I have to do this assignment? This portion of the course is your clinical
for N4500 and is comprised of a number of activities that expose you to several different
views of clinical leadership, and help you gain experience in analyzing how nurses exert
clinical leadership in a variety of ways and in diverse settings. Rather than have you work
in one setting for the entire 45 hours set aside for clinical (3 hours/week), we have
identified several different ways in which nurses are leaders, and developed learning
experiences for each. In addition, we have provided an opportunity for you to structure
two independent learning experiences to meet personal leadership goals.
Objectives for this Assignment
1. Understand how clinical leaders interact with all members of the health care team to
achieve effective outcomes in patient care.
2. Analyze the role that clinical leaders play in making decisions that influence standards
of practice and patient care
3. Gain understanding of the infrastructure, systems and processes that lay the
foundation of a patient care delivery system
4. Compare and contrast effective approaches to problem solving
5. Begin to develop a philosophy of leadership
Part One
16 hour experience
 Purpose – explore clinical leader’s background and philosophy of leadership;
observe his/her handling of challenging leadership situations; begin to formulate
your own philosophy of leadership
 Students will be assigned to a leader in their clinical immersion site. The
student is responsible for contacting the assigned leader and negotiating with
him/her to spend the time. Student should develop 2-3 objectives for the
experience, and share those with the leader
8 hour experience
 Purpose – gain experience in working with influential nurse in what might be
considered a non-traditional setting
 Students will select an organization to visit in class; and receive the name and
contact info for clinical leader
Students should contact clinical leader, negotiate 8 hour period (unless at an
organization that has selected the date already), develop 2-3 objectives for the
experience, and share those with the clinical leader
 After learning the name of your two clinical leaders, contact them to review the
assignment; share with them the specific objectives you wish to achieve during your
experiences (16 hour in your clinical immersion site, and 8 hours in non-traditional
site); and negotiate times with your two leaders
BY 2/11/09
 Complete Observation Experiences
BY 4/24/09
[OPTIONAL but very nice] Send a Thank You note to the leaders
 Write the paper analyzing your experience
BY 4/29/09
Criteria for Paper:
 Compare and contrast the two settings you spent time in
(private or public, profit or non-profit, size, type of
services provided, population(s) served, mission
statement, evidence of nursing as a valued component)
 Review the 14 forces of “magnetism.” Select 1 and
comment as to how one of your organizations
demonstrated that it met – or didn’t meet – the criteria.
Describe the experience, educational background, current
role, and philosophy of clinical practice leadership of the two
leaders with whom you worked.
Analyze the culture of the work environment in each of the
settings in which you worked. Give an example of a way in
which one of your leaders promoted interprofessional
Handling of a
Select a problem/issue faced by one of your leaders, and
describe how she/he effectively reached a decision or solved
a problem
Your philosophy 4
Describe your philosophy of clinical nursing leadership, and
how this experience influenced your thinking.
DUE DATE for the paper: April 29, 2009
Part Two
Independent study (16 hours)
 Purpose – select an activity of interest, and examine some aspect of leadership
 Students should select two activities from the attached list of Options.
 When an activity is finished, write up the 1 or 2 page paper and hand in for
comments and a grade of Satisfactory
Option #1
Attending Nurses Day on the Hill –February 24, for the entire day; or one of the other
relevant days on the hill, e.g., AHC or higher education days. This means signing up to
meet with your legislator, or go with someone else to see his/her legislator. Sign-ups can
be done online through, as can registration which is required.
Afterward, write a one page paper addressing the following information (you can use bullet
format): (1) what was the purpose of the day; (2) who was the audience; (3) what content
was covered; (4) what are two things you learned; (5) how did something you heard or saw
relate to something that was covered in class; (6) which legislator did you visit, what was
the time period you spent with the person, and what was the nature of the discussion; (7)
what points did you make about nursing and/or the UM School of Nursing.
Option #2
Attending the Spring meeting of MOLN (Minnesota Organization of Leaders in Nursing) –
March 19-20; students would attend one 8-hour day. The topic is Nursing Leadership:
Building Relationships, Supporting Healthy Work Environments . We are attempting to
negotiate a student rate which has historically been around $55-60. After attending, you
will write a one page paper addressing the following information (you can use bullet
format): (1) what was the purpose of the conference; (2) who was the audience; (3) what
content was covered; (4) what are two things you learned; (5) how did something you heard
or saw relate to something that was covered in class.
Option #3
Attending the Clarion case competition – dates TBA (8 hour participation during some
portion of the competition) . This option is NOT for students who have been part of a
Clarion team, and will be participating in the competition. For more information, contact After attending, you will
write a one page paper addressing the following information (you can use bullet format):
(1) what was the purpose of the day; (2) who was the audience; (3) what content was
covered; (4) what are two things you learned; (5) how did something you heard or saw
relate to something that was covered in class.
Option #4
Self-study module on disparities in health care – read the IOM report, Unequal
Treatment: Confronting Racial and Ethnic Disparities in Health Care (can be read online at - main report is 268 pages without
appendices; some campus library probably has a copy). Write a three(3) page paper
addressing the following issues: (1) provide highlights of current research findings on the
nature of racial and ethnic disparities in health care; (2) suggest reasons for why they
exist; (3) offer suggestions for ways in which nurses might be particularly helpful in
addressing these inequities (i.e., what skills do we have? What perspective? What
strengths or abilities?)
Option #5
Attending UMSoN Nursing Research Day– April 24, 2009 – hear nursing faculty present
their research findings; review poster presentations of faculty and students; hear
nationally recognized leader Dr. Ada Sue Hinshaw discuss nursing’s national research
agenda - attend the meeting (roughly between 12 and 5 p.m.) and write a 1-2 page paper
(you can use bullet format): (1) what was the purpose of the day; (2) who was the audience;
(3) what content was covered; (4) what are two things you learned; (5) how did something
you heard or saw relate to something that was covered in class.
Option #6
Attending an 8-hour portion of MNRS (Midwest Nursing Research Society) – some portion
of Mar 27-30. Participate in a truly exciting prominent nursing research meeting hosted
by our School of Nursing as part of our 100th anniversary celebration; more than 300
posters and presentations; silent auction; networking with colleagues from around the
upper Midwest. After attending, write a 1-2-page paper (you can use bullet format): (1)
what was the purpose of the conference; (2) who was the audience; (3) what research
findings particularly intrigued you; (4) what are two things you learned; (5) how did
something you heard or saw relate to something that was covered in class.
Option #7
Studying Health Care Reform (HCR) at the Minnesota Capitol – limited to the first 10
students to sign-up; date is to be negotiated based on legislative, student, and faculty
schedules. Join Mary Chesney for a “capitol experience” related to health care reform
issues in Minnesota: take a tour of the capitol, receive a 30 minute pre-hearing primersession to discuss issues expected be heard at either a MN House or MN Senate Health
and Human Service Committee hearing; attend the committee hearing. Following this
experience, write a 2 page paper briefly addressing the following information: (1)
describe the hearing you attended and describe one HCR or health-related issue that was
discussed at the hearing; (2) provide the occupation (e.g. Commissioner of Health, RN, MD,
health care consumer, etc.) and a very brief summary of viewpoints presented by two
persons who testified regarding your selected health issue at the hearing; (3) describe
your stance on the HCR issue you selected (e.g. are you for or against the bill and why?);
and (4) briefly describe your overall impressions of the hearing (e.g. what was interesting,
what surprised you, etc.).
Option #8 – this counts as two activities
Reading A Whole New Mind (Daniel Pink), Blue Ocean Strategy (Kim and Maubergne), or
Ghost Map (Stephen Berlin Johnson). Write a 2 page paper addressing the following
content: (1) what is the basic premise of the book and 3-4 key points; (2) what
implications does the book hold for nursing; (3) what two actions will you take as a result
of reading this book; (4) would you recommend this book to someone else – why or why not?
Option #9
Designing your own independent study on some aspect related to leadership. The activity
should take approximately 8 hours (reading, writing, attending conference, whatever). If
you have a question about the appropriateness of an alternate project, see Joanne or
Mary. Depending on the project, we will work with you on what should be turned in; it will
generally follow what we’ve asked for with the above options.
The Final Exam
There will be an open-book final exam during the Exam period, which includes use
of your notes. The format will be a combination of multiple choice items, and a
short answer questions. The exam will be based on content covered in class and
readings. PDAs, computers and other forms of electronic communication will not
be allowed during the exam, nor will sharing of books or notes. The exam will count
for 20% of the final grade.