Journal of Nursing Education

BRIEFS 

Use of Learning Modules to Teach Nursing Leadership Concepts

Sylvene Spickerman, MSN, RN; Belinda Temple Lee, MSN, RN; Frances Rogers Eason, EdD, RN

Abstract

Introduction

Teaching clinical content in a nursing leadership course is often frustrating for the baccalaureate nurse educator. Frequently, situations do not occur during the students' clinical experience which demonstrate appropriate leadership and management concepts. The quality of clinical sites vary among students. Additionally, one clinical group of students may be exposed to ideal management learning situations that other students are not able to experience for one reason or another. How then can the concepts of nursing leadership and management be made meaningful to all students regardless of the clinical site?

A variety of techniques have been documented as successful learning strategies for nursing leadership students. These strategies provide opportunities for students to integrate learning and to apply nursing leadership and management theory to practice. Oechsle and Volden (1984) describe the success of allowing students to select traditional or nontraditional clinical sites according to their career goals or selfidentified strengths and weaknesses. Lawrence and Lawrence (1984) describe a strategy in which faculty help students to progressively develop leadership skills over a 2½ year period while working with a voluntary health agency. The focus each year is different and culminates with the student functioning as a leader and change agent, and sharing in the decision-making process.

Zanecchia (1985) describes the use of hands-on experiential management tasks with nursing leadership students which ultimately influence their leadership style. Brandt and Craig (1985) describe a guided learning experience for leadership/management students which allows students to "follow the leader." These authors suggest that this strategy provides opportunities for students to observe leaders in action and to analyze the leadership/management theories incorporated in their practice. Interestingly, the leaders whom the students follow are not limited to nursing leaders/managers. Contrary to any strategy discussed, Tolbert and Gardner (1985) support the idea of a team-leading experience by senior nursing students. This experience involves senior nursing students supervising and evaluating the nursing care provided by four or five junior students in an acute care setting.

Table

This module provides the students with some basic ideas about schedule development. Students apply concepts from Blake and Mouton's (1978) Managerial Grid theory as they struggle with the task of developing schedules while considering the relationships among personnel. If developing the schedule becomes part of the job of one of our students, he/she has experienced the value of guidelines and knows the schedule must be designed to "fit" the personnel and institution. Students realize computer schedules can replace those worked out by the manager. They also know computer-developed schedules will be as satisfactory as the program guidelines used to develop them. Exercises such as this in undergraduate programs should reduce the trial-and-error frustrations of preparing schedules, as well as make the uninitiated more appreciative of the complexity of this one managerial function.

Conclusion

The staffing and scheduling module provides an example of one of the 15 topics developed and implemented within our entire course. Obviously, large groups of students could never experience an actual situation of preparing a schedule and seeing the work force implement the schedule. Examples of other learning modules developed for our course include conflict management, change, motivating others, and analyzing cost. The use of learning modules to teach leadership content has eased the frustration of teaching concepts in a theory course and "hoping" to find actual clinical opportunities that reinforce these concepts. These structured learning modules ensure that all students will have opportunities to apply nursing leadership and management concepts taught in this course.

FIGURE 1

STAFFING AND SCHEDULING MODULE

FIGURE 2

GUIDELINES FOR ASSIGNMENT A

FIGURE 3

SCHEDULE DEVELOPED USING GUIDELINES FROM ASSIGNMENT A

FIGURE 4

GUIDELINES FOR ASSIGNMENT…

Introduction

Teaching clinical content in a nursing leadership course is often frustrating for the baccalaureate nurse educator. Frequently, situations do not occur during the students' clinical experience which demonstrate appropriate leadership and management concepts. The quality of clinical sites vary among students. Additionally, one clinical group of students may be exposed to ideal management learning situations that other students are not able to experience for one reason or another. How then can the concepts of nursing leadership and management be made meaningful to all students regardless of the clinical site?

A variety of techniques have been documented as successful learning strategies for nursing leadership students. These strategies provide opportunities for students to integrate learning and to apply nursing leadership and management theory to practice. Oechsle and Volden (1984) describe the success of allowing students to select traditional or nontraditional clinical sites according to their career goals or selfidentified strengths and weaknesses. Lawrence and Lawrence (1984) describe a strategy in which faculty help students to progressively develop leadership skills over a 2½ year period while working with a voluntary health agency. The focus each year is different and culminates with the student functioning as a leader and change agent, and sharing in the decision-making process.

Zanecchia (1985) describes the use of hands-on experiential management tasks with nursing leadership students which ultimately influence their leadership style. Brandt and Craig (1985) describe a guided learning experience for leadership/management students which allows students to "follow the leader." These authors suggest that this strategy provides opportunities for students to observe leaders in action and to analyze the leadership/management theories incorporated in their practice. Interestingly, the leaders whom the students follow are not limited to nursing leaders/managers. Contrary to any strategy discussed, Tolbert and Gardner (1985) support the idea of a team-leading experience by senior nursing students. This experience involves senior nursing students supervising and evaluating the nursing care provided by four or five junior students in an acute care setting.

Table

FIGURE 1STAFFING AND SCHEDULING MODULE

FIGURE 1

STAFFING AND SCHEDULING MODULE

Table

FIGURE 2GUIDELINES FOR ASSIGNMENT A

FIGURE 2

GUIDELINES FOR ASSIGNMENT A

Table

FIGURE 3SCHEDULE DEVELOPED USING GUIDELINES FROM ASSIGNMENT A

FIGURE 3

SCHEDULE DEVELOPED USING GUIDELINES FROM ASSIGNMENT A

Classroom and clinical learning experiences of nursing students are critical to their adjustment and productivity as graduate nurses. Stevens (1979) pointed out that basic students are prepared to cope with, not manage the environment. The authors believe baccalaureate students should learn beginning management/leadership skills as well as coping skills. This article describes one approach, the use of learning modules, for reinforcing the theoretical concepts of leadership and management.

Module Development and Implementation

Problems with nursing Jeadership clinical experiences mandate the development of varied learning strategies. As part of our practicum in nursing leadership course, 15 two-hour learning modules have been developed so that students can apply leadership and management theoretical concepts to clinical situations. Module topics are derived from content in the corequjsite theory course, "Nursing Leadership." The modules are teacher designed and contain objectives, preassignments, learner activities, and evaluation strategies. These guideline materials are available to the students at the beginning of the semester for module preparation.

Sample Module

An example of a learning module is shown in Figure 1. The "Staffing and Scheduling Module" offers opportunities for students to apply staffing concepts taught in the theory class. As a preassignment, the students are expected to read the ANA's (1977 »"Nursing Staff Requirements for Inpatient Health Services." The faculty provide ideas from sources such as Eusanio, Gillies, Rasmussen, Holle, and Marriner to complement the assigned reading. The role of the faculty is to facilitate the student's progress toward completing the Learner Activities and meeting the Learner Objectives.

To meet Staffing and Scheduling Module Learner objective 1, various aspects of the staffing component of management are discussed. Following this discussion, the students work in groups of three or four to develop a four-week time schedule (see Figures 3, 5, 7). Each group is responsible for developing one of the three different schedules within a 45-minute period. Each assignment has its unique set of requirements and constraints, called guidelines.

These guidelines include statements that assist the scheduler to complete the task in a minimal amount of time. The guidelines include some statements that give positive directions; other statements clarify situations that cannot occur because of unit or institutional policies. Finally, there are statements about actions that are generally considered undesirable, but sometimes unavoidable, in situations such as vacations, leaves of absence, or efforts to accommodate personal requests for specific days off.

Developing the guidelines requires more knowledge, experience, and analytical ability than does completing the schedule. It is not uncommon for the inexperienced nurse to be asked to make a schedule. It is unlikely that the same nurse would be expected to develop the guidelines prior to making the schedule. When the neophyte scheduler has no guidelines, the schedule is developed by trial and error and persona] preference. Those who have worked such schedules never forget the disastrous experience of being the "guinea pig" as the schedule maker honed his/her scheduledevelopment skills.

Table

FIGURE 4GUIDELINES FOR ASSIGNMENT B

FIGURE 4

GUIDELINES FOR ASSIGNMENT B

Table

FIGURE 6GUIDELINES FOR ASSIGNMENT C

FIGURE 6

GUIDELINES FOR ASSIGNMENT C

Today many institutions use computer technology to develop employees' schedules. Computer programs may be written by someone in the institution or software may be purchased to develop the schedules. If an in-house program is developed and used, statements such as those in the guidelines (see Figures 2, 4, 6) can be built into the program. Lant (1986) calls a group of statements such as our guidelines, "rule sets." Lant's "rule sets" specify such things as the agency's scheduling practices and employee agreements. Using guidelines or "rule sets" allows for greater flexibility in special situations. Guidelines, such as those in Figures 2. 4, and 6 can be developed into "rule sets" whenever an agency has available computer technology for schedule development. Without guidelines or "rule sets," the computer scans the list of employees, selects the first available name or number, and prints the schedules. Initially, such schedules may be quite economical; however, without guidelines or "rule sets," the schedules may lack rhyme or reason necessary to provide nursing care seven days a week, 24 hours a day. Depending on how unacceptable the schedule is, the nurse manager may have to "redo" the computer-made schedule. Certainly, this is not an efficient use of the manager's time. Schedules prepared without guidelines and not revised by the manager may result in the most expensive schedule - one that causes intense dissatisfaction and loss personnel by resignation.

Sample Assignments and Solutions

In Assignment A (see Figure 21, the guidelines specify that all nurses work 12hour shifts and work a maximum of three days without a day off. Note that this schedule repeats itself every three weeks. After completing Assignment A, (see Figure 3) the student can identify two major advantages of cyclical time schedules - ability to know one's schedule long in advance and the ease and cost effectiveness of preparing the schedule.

The guidelines for Assignment B (see Figure 4) describe a situation in which all staff nurses work eight-hour shifts and rotate to each shift within every four weeks. Assignment B (see Figure 5 ) is a more complex example of a cyclical schedule. Students identify problems of working seven days without a day off, two of every three weekends, and all three shifts every four weeks.

Students are able to describe a variety of positive and negative aspects of cyclical schedules in which staff rotate to all shifts at frequent intervals. Personnel adjustments and interruption of regular biorhythms are factors frequently discussed when students analyze a nurse's schedule using Assignment B guidelines.

Nurse managers are familiar with designing schedules, such as those in Figure 7, where no written guidelines exist. In Assignment C, there is no defined pattern, equality is extremely difficult to maintain, and personal requests are frequent because of one's inability to predict the schedule. Students who tried to develop Assignment C are convinced that there is no solution. They estimate making out such a schedule would require 20 hours or more per week; therefore, it would be very expensive and not cost effective use of the nurse manager's time. In the allotted time, 45 minutes, even with faculty assistance, most student groups rarely get beyond the first week of Assignment C. However, there are many solutions to Assignment C, one of which is found in Figure 7.

After the students study the solutions to Assignment A, B, and C, they discuss absenteeism and inequalities as far as rotations, weekends, and doubling back are concerned. They adamantly favor cyclical scheduling. Many have said if their jobs were to develop schedules such as the one in Assignment C, they would leave nursing. Completion and discussion of the assignment solutions enable the student to complete Learner Objective 2, Figure 1.

Developing a schedule may look like a mathematical exercise to the uninitiated. However, without humanistic concern for people, their desires, and wishes, most schedules are unsatisfactory. A highly prized schedule for one group of nurses may be unacceptable to another group.

Table

FIGURE 5SCHEDULE DEVELOPED USING GUIDELINES FROM ASSIGNMENT B

FIGURE 5

SCHEDULE DEVELOPED USING GUIDELINES FROM ASSIGNMENT B

Table

FIGURE 7SCHEDULE DEVELOPED USING GUIDELINES FROM ASSIGNMENT C

FIGURE 7

SCHEDULE DEVELOPED USING GUIDELINES FROM ASSIGNMENT C

This module provides the students with some basic ideas about schedule development. Students apply concepts from Blake and Mouton's (1978) Managerial Grid theory as they struggle with the task of developing schedules while considering the relationships among personnel. If developing the schedule becomes part of the job of one of our students, he/she has experienced the value of guidelines and knows the schedule must be designed to "fit" the personnel and institution. Students realize computer schedules can replace those worked out by the manager. They also know computer-developed schedules will be as satisfactory as the program guidelines used to develop them. Exercises such as this in undergraduate programs should reduce the trial-and-error frustrations of preparing schedules, as well as make the uninitiated more appreciative of the complexity of this one managerial function.

Conclusion

The staffing and scheduling module provides an example of one of the 15 topics developed and implemented within our entire course. Obviously, large groups of students could never experience an actual situation of preparing a schedule and seeing the work force implement the schedule. Examples of other learning modules developed for our course include conflict management, change, motivating others, and analyzing cost. The use of learning modules to teach leadership content has eased the frustration of teaching concepts in a theory course and "hoping" to find actual clinical opportunities that reinforce these concepts. These structured learning modules ensure that all students will have opportunities to apply nursing leadership and management concepts taught in this course.

References

  • American Nurses' Association. (1977). Nursing staff requirements for inpatient health care services. Kansas City, MO: Author.
  • Blake, R.R. & Mouton, J.S. (1978). The new managerial grid. Houston: Gulf Publishing Company.
  • Brandt, M.A. & Craig, R.M. (1985). Follow the leader: A learning experience. Journal of Nursing Education, 24(4), 139-142.
  • Eusanio, PL. (1978). Effective scheduling- the foundation for quality care. Journal of Nursing Administration, S(I), 12-17.
  • Gillies, D.A. (1982). Nursing management ... a systems approach. Philadelphia: WB Saunders Company.
  • Holle, M.L. (1982). Staffing: What the books don't tell you. Nursing Management, 13(3), 14-16.
  • Lant, T.W. (1986). Computerized nurse staffing systems: You'd better shop around- Nursing Management, 17(4), 37-38.
  • Lawrence, S.A. & Lawrence, R.M. (1984). Leadership - What it is and how to teach it. Journal of Nursing Education, 23(4), 173-176.
  • Marriner, A. (1984). Guide to nursing management (pp. 103-136). St. Louis: C.V. Mosby Company.
  • Oechsle, L.H. & Volden, C.M. (1984). Teaching leadership in nontraditional settings. Nursing Outlook, 32(6), 313-315.
  • Rasmussen, S.R. (1982). Staffing and scheduling options. Critical Care Quarterly, 5(1), 35-41.
  • Stevens, B.J. (1979). Improving nurses' managerial skills. Nursing Outlook, 27(12), 774-777.
  • Tolbert, R. & Gardner, K. (1985). Can you learn to be a leader? Nursing Success Tbday, 2(7), 10-15.
  • Zanecchia, M. D. (1985). Experiential learning and changing leadership style. Journal of Nursing Education, 24(9), 360-362.

FIGURE 1

STAFFING AND SCHEDULING MODULE

FIGURE 2

GUIDELINES FOR ASSIGNMENT A

FIGURE 3

SCHEDULE DEVELOPED USING GUIDELINES FROM ASSIGNMENT A

FIGURE 4

GUIDELINES FOR ASSIGNMENT B

FIGURE 6

GUIDELINES FOR ASSIGNMENT C

FIGURE 5

SCHEDULE DEVELOPED USING GUIDELINES FROM ASSIGNMENT B

FIGURE 7

SCHEDULE DEVELOPED USING GUIDELINES FROM ASSIGNMENT C

10.3928/0148-4834-19880201-08

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