NR 723 Week 4 Change Leadership Case Example

Change Leadership Case: Replacing the Weekly Care Plan With a Clinical Judgment Reflection Across Nine Sections Taught Mostly by Adjuncts

Student Name

College of Nursing, Chamberlain University

NR 723: Role of the Educational Leader Across Settings

Instructor Name

Month Day, Year

Change Leadership Case: Replacing the Weekly Care Plan With a Clinical Judgment Reflection Across Nine Sections Taught Mostly by Adjuncts

The Change in One Sentence

In the spring 2027 term, the junior-year adult health clinical course replaced its weekly nursing care plan with a weekly clinical judgment reflection, which walks students from noticing cues to judging whether their action worked, following the licensure model's sequence, and graded on one shared rubric across all nine clinical sections. The structure followed the clinical judgment model that the national licensure examination now measures, which nurse educators are being encouraged to weave into their programs (Dickison et al., 2019).

Whose Cooperation, and Whose Payroll

Nine instructors had to grade the new reflection the same way. Two were full-time faculty, whose contracts include course meetings. Seven were adjunct clinical instructors, paid a fixed amount per section for clinical days and grading, with no hours for meetings. Five of the seven also worked as staff nurses, so an unpaid afternoon meeting cost them a shift. Their incentive to learn a new rubric was close to zero: their pay did not change, their evaluations depended on student course ratings, and the old care plan was familiar. The coordinator, who led the change, had no authority over their contracts or their time, which were controlled by the associate dean.

The Model, Used Rather Than Cited

The coordinator used Kotter's account of leading change to plan the work, and the case is told against its stages because they shaped what was done and what was skipped (Kotter, 2012).

Urgency came from data, not exhortation: the fall 2026 care plans showed one criterion, linking assessment data to a nursing diagnosis, rated below standard in 41% of submissions overall but in anything from 18% to 63% depending on the section, which suggested inconsistent grading as much as weak learning. The coordinator shared the section spread, without naming sections, at the December course meeting.

A guiding coalition was small: the other full-time instructor and two adjuncts who had complained about the care plan. They drafted the reflection and rubric with the coordinator in December.

The vision was one sentence, repeated in every message: "Every student, in every section, judged on the same reasoning by the same standard."

Removing obstacles was where the model met the payroll. The main obstacle was unpaid time for calibration, and the coordinator could not remove it alone. The associate dean approved $1,050 to pay for a pair of calibration evenings in January, ninety minutes each; payroll took seven weeks to create the stipend type, and the first session went ahead with payment promised but not yet set up.

Short-term wins were small and real: after the first calibration session, the nine instructors' ratings of ten sample reflections agreed exactly on 61% of rubric items, up from 44% before the session.

Two stages were not reached. The change was not anchored in the program's culture within the term, and it did not spread beyond this course.

The Objection That Was Right

In the first calibration session, an adjunct said plainly that the rubric's language, "prioritizes hypotheses appropriately," meant something different to every instructor in the room and that calibration on ten samples would not fix that. The coordinator had treated this as reluctance in the planning stage. It was correct. Agreement on that criterion stayed at 40% after the session, the lowest of any criterion. The coalition rewrote it in plain terms, "names the most urgent patient problem and gives one reason from the data," and agreement on the rewritten item rose to 72% at the second session. The objection improved the rubric more than any planning had.

What Students Experienced

Students met the change in the first clinical week of spring, with a one-page guide and a worked example of a reflection written about a fictional patient. The first two weeks were rough: about a third of first submissions in every section treated the reflection as a narrative of the day rather than an argument from cues, and instructors returned them with comments rather than grades, which the coalition had agreed in advance. By week five, most submissions followed the structure. In post-conference, several instructors reported that students were more willing to say which cue they had missed, because the reflection asked them to evaluate their own action rather than to complete a care plan template. Students who had found the care plan straightforward were, unsurprisingly, the ones most likely to say the reflection was harder, and the coordinator did not treat that as a reason to reverse the change.

What It Cost to Get

The change cost $1,050 in adjunct stipends, about 30 hours of the coordinator's time in December and January, and goodwill: two adjuncts who had worked the first session before payment was set up were paid five weeks late, and one said so at the next course meeting. It also cost the course its familiar assignment, and three students complained in course evaluations that the reflection was "harder to know how to do well" than the care plan. Against these costs, by the end of the spring term the share of reflections rated below standard on the reasoning criterion varied between sections from 22% to 39%, narrower than the 18% to 63% spread of the fall care plans, though the two assignments are not directly comparable.

The Authority Question

The case turned on authority the coordinator did not hold. The assignment change was the coordinator's to make. Paid time was not, and without the associate dean's approval the change would have produced a shared rubric applied seven different ways. Framing the request as consistency in assessing a required competency, rather than as the coordinator's preference, was what made it fundable, and the associate dean said as much when approving it.

What Remains

The change is in place for one course, for one term so far. Whether it lasts depends on calibration being funded every year from a recurring line rather than from a one-time approval, which is the subject of the next stage of this work. Faculty development that is sustained over time and tied to participants' actual teaching tends to change practice more than single sessions do (Steinert et al., 2016), which argues for making calibration a standing part of the course rather than a launch event.

References

Dickison, P., Haerling, K. A., & Lasater, K. (2019). Integrating the National Council of State Boards of Nursing clinical judgment model into nursing educational frameworks. Journal of Nursing Education, 58(2), 72-78. https://doi.org/10.3928/01484834-20190122-03

Kotter, J. P. (2012). Leading change. Harvard Business Review Press.

Steinert, Y., Mann, K., Anderson, B., Barnett, B. M., Centeno, A., Naismith, L., Prideaux, D., Spencer, J., Tullo, E., Viggiano, T., Ward, H., & Dolmans, D. (2016). A systematic review of faculty development initiatives designed to enhance teaching effectiveness: A 10-year update: BEME Guide No. 40. Medical Teacher, 38(8), 769-786. https://doi.org/10.1080/0142159X.2016.1181851