NUR 410: Systems Leadership / Continuum of Care

Course Description

This course explores the principles of organizations and systems leadership and management strategies for the baccalaureate prepared registered nurse in a variety of healthcare settings. Emphasis will be on the skills necessary to facilitate group dynamics, personnel management and the coordination of care of clients and health care personnel. Current quality improvement and safety standards that differentiate health care organizations and the use of advanced technology to analyze and synthesize information to make critical decisions will also be examined.

(4 credits)


  • ENG 101: English Composition 1
  • ENG 102: English Composition 2
  • NUR 301: Baccalaureate Nursing Role
  • NUR 310: Healthcare Policy, Economics, Regulation and Ethics
  • NUR 315: Nursing Research and Expanded Evidence-Based Practice
  • NUR 400: Continuous Quality Improvement, Safety and Interprofessional Collaboration
  • OR permission of the instructor

Student Learning Outcomes (SLOs)

Upon completion of this course, the student will have gained knowledge about:

  1. Analyze the essential elements of leadership and management in nursing.

  2. Demonstrate an awareness of and responsiveness to the larger context of the healthcare system.
  3. Apply systems thinking and change theory strategies to the ethical, moral and legal dimensions of professional nursing and leadership.

  4. Discuss collaboration within healthcare organizations and systems utilizing advocacy and change theory to manage conflict.
  5. Delineate approaches to integrate leadership skills and systems thinking to facilitate change to meet quality patient outcomes.

  6. Apply quality improvement and safety standards as a basis for evaluating the effectiveness of organizations.

  7. Recognize the complexity of the healthcare delivery system including how patient care services are organized, financed, and reimbursed.

  8. Explain the centrality of the inter-professional team to quality patient care.
  9. Identify the impact of sociocultural, economic, legal and political factors influencing healthcare delivery and practice.
  10. Discuss the essential role of nurse leaders in budgeting and resource allocation.

  11. Analyze the relationship of informatics and technology to quality improvement and safety.

Course Activities and Grading


Discussions/ Forum Participation (8 @ 10 points)


Review and Reflection ( 6 @ 10 points)


Synthesis  Paper (1 @ 25 points)


Course/Self Evaluation (1@ 10 points)




This four credit hour course includes lecture or online discussion concentrating on how the nursing profession and specifically, nursing leadership, can improve healthcare by examining the serious issues facing the United States Health Care system today.  This course will look at complex issues related to the quality and safety of patient care as identified through evidence based practice supported by the Massachusetts Nurse of the Future Nursing Core Competencies (NOF) (2016) and the Quality and Safety Education for Nurses (QSEN) Core Competencies.  Discussions will concentrate on healthcare finance, healthcare reform, issues in the workplace, and diversity of individuals, families and the community.  Essential skills for the professional nurse such as effective means of communication, leadership and followership, ethical and legal issue in nursing, staffing, delegation, supervision and nursing care delivery systems will be emphasized.   Emphasis of discussions will include implementation strategies and skills for successful transition into the Capstone experience. All formal written assignments and discussions that require references are expected to conform to APA formatting (including in-text citations and reference lists) use a Sans Serif font 12 point type such as Arial, Tahoma, or Calibri.

Late Work Policy

Due to the accelerated nature of the NUR 300 & 400 courses, late work severely limits meaningful engagement with students, peers, and faculty, and jeopardizes collaboration and exchange of ideas.

The following standards relate to late submission of any assignment in this and all other NUR 300 & 400 courses:

  • All Discussion Posts must be posted by the due date/time deadline. Those posted late will be given a grade of zero.
  • All Other Papers/Projects: Failure to turn in, post, or in any way fail to meet the due date/time deadline, will result in a deduction of 10% per day of the total assignment value from the actual grade earned, for up to seven days.
  • Students who submit an assignment eight days late will receive a grade of zero for the assignment
  • If a student anticipates they will be unable to meet a deadline for any assignment regardless of the reason, they should contact the course faculty immediately.

Emergencies/Extenuating Circumstances: The Faculty and Program Director appreciate that emergencies come up in life. Emergencies/ Extenuating Circumstances are not planned activities and/or are not normally work-related.

  • Students will be required to submit reasonable documentation of emergencies/extenuating circumstances to the course faculty.
  • Any request(s) relating to emergencies/ extenuating circumstances requires documentation and approval of the course faculty, the Program Director, and other college personnel as necessary.

The following conditions acknowledge unexpected circumstances that impact students’ ability to submit an assignment by the due date:

  • If a student anticipates they will be unable to meet a deadline due to an emergency/extenuating circumstance, they should contact the course faculty immediately.
  • Students may turn in one assignment up to 7 days after the due date except for a discussion board assignment, a final course project, or other final course assignments, no questions asked.
  • Subsequent late submissions will be managed in accordance with the standards outlined above.

*Note: Students with accommodations in place may not receive an extension that is related to their disability

Required Textbooks

Available through Charter Oak State College's online bookstore

  • Cherry, Barbara. (2023). Contemporary Nursing - with Access. 9th ed. Elsevier Science. ISBN-13: 978-0-323-77687-5

Additional Resources

Course Schedule



Readings and Exercises




Topics: Concepts in Leadership: Nursing Leadership and Management


  1. Chapter 17 – “Nursing Leadership and Management”
  2. The Triple Aim: Care, health, and cost. Health Affairs. Berwick DM, Nolan TW, Whittington J. 2008 May/June; 27(3):759-769.
  3. The Future of Nursing: Leading Change, Advancing Health. Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. Washington (DC): National Academies Press (US); 2011. 5, Transforming Leadership. 
  4. Shingler-Nace, A. (2020, April 28). Covid-19: When leadership calls. Nurse Leader.

  • Read assigned chapters
  • Review Lecture
  • Participate in the Discussions
  • Complete Introductory post



Topics: Effective Communication and Conflict Resolution


  1. Chapter 19: “Effective Communication and Conflict Resolution”
  2. American Organization of Nurse Executive (AONE)
  3. The Joint Commission (TJC)
  4. "Multigenerational Challenges: Team-Building for Positive Clinical Workforce Outcomes" Moore, J., Everly, M., Bauer, R., (May 31, 2016) OJIN: The Online Journal of Issues in Nursing Vol. 21, No. 2, Manuscript 3.
  5. Psychological Distress and Workplace Bullying Among Registered Nurses. Berry, P., Gillespie, G., Fisher, B., Gormley, D., Haynes, J., and (August 10, 2016) OJIN: The Online Journal of Issues in Nursing Vol. 21, No. 3.
  6. Principles for social networking and the nurse, American Nurses Association. 2013.
  7. Reddy, B. V., & Gupta, A. (2020, August 25). Importance of effective communication during COVID-19 infodemic. Journal of family medicine and primary care.
  • Read assigned chapters
  • Review Lecture
  • Participate in the Discussions
  • Reflection assignment



Topics: Legal Issues in Nursing and Health Care


  1. Chapter 8 - “Legal Issues in Nursing and Health Care”
  2. The Joint Commission (TJC)
  3. "I'm going home": discharges against medical advice. Mayo Clinic proceedings, 84(3), 255-60. Alfandre D. J. (2009).
  4. Disparities/ Healthy People 2020.
  5. "Advancing Nursing Practice Through Social Media: A Global Perspective" Barry, J., Hardiker, N., (September 30, 2012) OJIN: The Online Journal of Issues in Nursing Vol. 17, No. 3, Manuscript 5.
  6. Siriwardhana, Y., Gür, G., Ylianttila, M., & Liyanage, M. (2020, November 4). The role of 5G for digital healthcare against COVID-19 pandemic: Opportunities and challenges. ICT Express.
  • Read assigned chapters
  • Review Lecture
  • Participate in the Discussions
  • Reflection assignment



Topics: Quality Improvement and Patient Safety


  1. Chapter 22– “Quality Improvement and Patient Safety”
  2. Montalvo, I., (September 30, 2007) "The National Database of Nursing Quality Indicators TM (NDNQI®)" OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 3, Manuscript 2.
  3. Institute of Medicine: To err is human; building a safer health system, Washington, DC, 2000, National Academies Press.
  4. The Joint Commission (TJC)
  5. "Quality and Safety Education for Nurses (QSEN): The Key is Systems Thinking" Dolansky, M.A., Moore, S.M., (September 30, 2013) OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 3, Manuscript 1.
  6. "Hospital-Based Fall Program Measurement and Improvement in High Reliability Organizations" Quigley, P., White, S., (May 31, 2013) OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2,Manuscript
  7. Kasda E, Robson C, Saunders J, et al. Using event reports in real-time to identify and mitigate patient safety concerns during the COVID-19 pandemic. Journal of Patient Safety and Risk Management. 2020;25(4):156-158.

  • Read assigned chapters
  • Review Lecture
  • Participate in the Discussions
  • Reflection assignment



Topics: Managing Patient Care; Effective Delegation, Supervision, Staffing and nursing Care Delivery Models


  1. Chapter 20: “Effective Delegation and Supervision”
  2. Chapter 21: “Staffing and Nursing Care Delivery Models”
  3. Chapter 4: “Nursing Licensure and Certification”
  4. National League for Nursing (NLN)  Focus on advocacy and public policy
  5. American Nurses Credentialing Center (ANCC) Focus on work environment
  6. Institute of Medicine (US) Committee on the Work Environment for Nurses and Patient Safety; Page A, editor. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington (DC): National Academies Press (US); 2004. 1, Nursing: Inseparably Linked to Patient Safety. Available from:
  7. "Developing Delegation Skills" Weydt, A., (May 31, 2010) OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 2, Manuscript 1.
  8. Colo., I. (2021). SOS in a pandemic: Staffing strategies for covid-19 : Nursing management. LWW. Nursing Management (Springhouse): April 2021 - Volume 52 - Issue 4 - p 22-30doi:  10.1097/01.NUMA.0000733628.46685.bc

  • Read assigned chapters
  • Review Lecture
  • Participate in the Discussions
  • Reflection assignment



Topics: Ethical Issues: Ethical and Bioethical Issues in Nursing and Health Care


  1. Chapter 9: “Ethical and Bioethical Issues in Nursing and Health Care”
  2. Chapter 10: "Cultural Competency and Social Issues in Nursing and Health Care"
  3. Chapter 17: "Nursing Leadership and Management"
  4. Code of Ethics for Nurses
  5. "Ethical Awareness: What It Is and Why It Matters" Milliken, A., (January 31, 2018) OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 1.
  6. "The Nursing Code of Ethics: Its Value, Its History" Epstein, B., Turner, M., (May 31, 2015) OJIN: The Online Journal of Issues in Nursing Vol. 20, No. 2, Manuscript 4.
  7. Gebreheat, G., & Teame, H. (2021, May 6). Ethical challenges of nurses in covid-19 pandemic: Integrative Review. Journal of multidisciplinary healthcare.

  • Read assigned chapters
  • Review Lecture
  • Participate in the Discussions
  • Reflection assignment



Topic: Budgeting Basics for Nurses


  1. Chapter 18: “Budgeting Basics for Nurses”
  2. The business of caring: What every nurse should know about cutting costs. Peterson, K. (2017, November 21).
  3. Why Value in Health Care Is the Target. Feeley, T. (2018, June 12).
  4. "Nurse Engagement: What are the Contributing Factors for Success?" Dempsey, C., Reilly, B., (January 31, 2016) OJIN: The Online Journal of Issues in Nursing Vol. 21 No. 1, Manuscript 2.
  5. Hartman, M., & Poisal, J. A. (2021, December 15). National Health Care Spending in 2020: Growth driven by federal spending in response to the COVID-19 pandemic: Health Affairs Journal. Health Affairs.
  • Read assigned chapters
  • Review Lecture
  • Participate in the Discussions
  • Reflection assignment



Topic: Managing Time and Reflection Paper Assignment


  1. Chapter 25: “Managing Time: The Path to High Self-Performance”
  2. Barriers to Work–Life Balance for Hospital Nurses. Mullen, K. (2015). Workplace Health & Safety, 63(3), 96–99.
  3. Robbins, Beverly RN, BSN; Davidhizar, Ruth RN, DNS, ARNP, BC, FAAN Transformational Leadership in Health Care Today, The Health Care Manager: 7/9 2020 - Volume 39 - Issue 3 - p 117-121 doi: 10.1097/HCM.0000000000000296
  • Read assigned chapters
  • Complete Synthesis paper

COSC Accessibility Statement

Charter Oak State College encourages students with disabilities, including non-visible disabilities such as chronic diseases, learning disabilities, head injury, attention deficit/hyperactive disorder, or psychiatric disabilities, to discuss appropriate accommodations with the Office of Accessibility Services at

COSC Policies, Course Policies, Academic Support Services and Resources

Students are responsible for knowing all Charter Oak State College (COSC) institutional policies, course-specific policies, procedures, and available academic support services and resources. Please see COSC Policies for COSC institutional policies, and see also specific policies related to this course. See COSC Resources for information regarding available academic support services and resources.