Journal of Nursing Education

Syllabus Selections: Innovative Learning Activities Free

Leaderless Organization: Active Learning Strategy in a Concept-Based Curriculum

Heather V. Nelson-Brantley, BSN, RN, CCRN; Delois M. Laverentz, MSN, RN, CCRN

The Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health (2010), calls for new approaches in nursing education, including developing curricula to teach fundamental concepts that can be applied in a variety of situations. Concept-based teaching as a pedagogy focuses student learning on a core set of concepts relevant to nursing, such as perfusion, pain, coping, or glucose regulation. By gaining a deep understanding of key concepts, students are able to recognize recurring characteristics and apply them to a wide variety of clinical situations (Giddens, 2013). This article reports an active learning activity designed by undergraduate faculty (H.V.N.-B., D.M.L.), who teach from a concept-based curriculum, as an innovative way to deliver educational content from a concept-based pedagogy.

Active Learning Strategy for the Concept of Leadership

Background and Learning Objectives. Leadership is one of the core concepts taught to baccalaureate nursing students during their second semester at a large university in the midwestern United States. The concept is taught in a 3 credit-hour professional development course that meets for 90 minutes two times per week. This course is the second in a series of three professional development courses that students complete in this concept-based curriculum. Students are introduced to the concept of leadership on day 4 of the 16-week course. Course faculty believe that students might come to class with preconceptions of the meaning of leadership. With this in mind, the faculty decided to flip the concept. The following is an excerpt from this learning activity.

Activity. Prior to class, students read chapter 37 of the Giddens (2013) Concepts for Nursing Practice textbook, which covers the concept of leadership in nursing. During class, rather than asking students what they define as leadership, students were asked to imagine a leaderless organization and, working in teams, to craft a visual representation of what that organization would look like. To complete the activity within the 90-minute class session, the class of 97 students was divided into 10 groups and were provided with the following instructions:

Imagine a hospital absent of all leadership. Working in groups of 10, discuss and design a visual representation of how that organization functions, addressing the following: “What, if any, roles are present? How are tasks completed? How are decisions made? What is communication like?”

Students were provided with markers, crayons, and large-format paper and were given 20 minutes to design their group’s poster. Each group then had 5 minutes, totaling 50-class minutes, to present their poster and ideas to the class.

Results and Student Responses. Visual representations included a dying heart rhythm electrocardiogram strip, a bicycle with a flat tire, The Wizard of Oz (LeRoy & Fleming, 1939), and Survivor (Parsons & King, 2000). Common themes emerged during the team presentations, including chaos, selfishness, competition, apathy, lack of efficiency, and poor patient outcomes. Some of the student comments during their presentations included “There would be chaos—anger, frustration, selfishness, apathy, negativity, competition, nonsustainable, lack of job satisfaction, and unclear roles. Leaders may arise but they are not effective leaders.” In the Survivor analogy, students reported that:

Roles are present, but everyone is doing their own thing with patients dying off to the side; instead of a team-work mentality; everyone is out for themselves. It’s survival of the fittest. Leaders may emerge simply because they have a strong personality, not because they are a good leader.

After the student presentations, faculty facilitated a 20-minute, full-class discussion, which promoted a synthesis of salient themes and challenged students to consider the difference between leadership and management, leaders and followers, and their own role as nurse leaders at the bedside. Students reported that this activity allowed them to consider the importance of leadership and its impact on patient outcomes in a way they had not thought of before. In addition, students stated that this activity also had an impact on their personal perception of themselves as leaders and that nurse leaders are not “just those who have formal titles behind their names.” Students unanimously concluded that a health care organization devoid of leadership was not an organization of which they wanted to be a part.


Students came to understand that leadership, at both the micro- and macrosystem level, is key to quality care and patient safety. Concept-based learning activities by their very nature are ideal for both nursing practice- and professional-focused courses, limited only by the imagination of the faculty themselves. The authors’ aim to provide an interactive, innovative, and meaningful learning activity on the concept of leadership was achieved and their hopes were affirmed to facilitate lasting professional excellence for the future of the profession.


  • Giddens, J.F. (2013). Concepts for nursing practice. St. Louis, MO: Mosby Elsevier.
  • Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.
  • LeRoy, M Producer. & Fleming, V. Director. (1939). The wizard of Oz [Motion picture]. Beverly Hills, CA: MGM Studios.
  • Parsons, C Writer. & King, D.R. Director. (2000). Survivor [Television series]. In Probst, J.Producer., , New York, NY: CBS Entertainment.

Heather V. Nelson-Brantley, BSN, RN, CCRN

Delois M. Laverentz, MSN, RN, CCRN
University of Kansas School of Nursing

The authors have disclosed no potential conflicts of interest, financial or otherwise.


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