Chamberlain College of Nursing NR631 Nurse Executive Track—CGE I Learning Agreement Student name: Student D#: Student e-mail, phone: Mentor name and credentials: Mentor contact information (work phone, cell phone, e-mail and work address): Directions: For Week 1, complete the Learning Agreement with self-identified goals to meet Course Outcomes (COs) and initial plans to meet those self-identified goals; review the TIPS document to help you and discuss your goals and plans with your mentor. Your mentor must sign the Learning Agreement for your Week 1 submission. The agreement should be revised each week to reflect completed goals, additional goals, and changes to the plan dictated by the actual experience or revisions suggested by faculty or the mentor. At the end of the practicum experience, evaluate success with your mentor and obtain the mentor’s signature at the bottom of agreement. Save this form as a Word document and enter required information directly onto it; submit the completed Learning Agreement, signed by your mentor, on the Saturday of Week 8. See the Learning Agreement Grading Rubric for grading details. The Learning Agreement consists of three sections. I. Student Learning Outcomes table (Week 1) II. Signatures approving plan (Week 1) III. Signatures and mentor verification (Week 8) Due Dates: 1. Initial signed Learning Agreement is submitted by 11:59 p.m. MT, Sunday at the end of Week 1 2. Completed signed Learning Agreement is submitted by 11:59 p.m. MT, Saturday of Week 8 A minimum of 144 hours practicum experience is required by the end of NR632. If the 144 hours are not completed by end of term, you will receive a grade of “I” and not be able to graduate until completed. I. Student Learning Outcomes Course Outcomes Student Identified Practicum Goals to Meet COs Plan to Meet Student Identified Practicum Goals Narrative Description of Attainment of Student-Identified Goals Through the End of CGE 1 CO 1: Apply leadership skills concepts of project management as a nurse executive in an organizational setting to develop, implement and evaluate successful project plans. (POs 4 and 5) CO 2: Using current knowledge, standards of practice, and research from evidence-based literature, synthesize a foundation for the nurse executive role. (POs 3 and 4) CO 3: Exemplify professional values and scholarship that support the role of a student in a practicum setting. (PO 4) CO 4: Contribute to the body of nursing leadership and management knowledge through research, planning, evaluation and dissemination of findings. (PO 4) CO 5: Apply professional values characteristic of the competent and caring nurse executive that promote holistic care principles and an appreciation of cultural humility ( POs 1, 3, and 4) CO 6: Apply evidence-based fiscal principles that contribute to the creation of a caring environment characterized by high quality, safe, patient-centered care (PO.

1. Chamberlain College of Nursing NR631 Nurse Executive
Track—CGE I
Learning Agreement
Student name:
Student D#:
Student e-mail, phone:
Mentor name and credentials:
Mentor contact information (work phone, cell phone, e-mail and
work address):
Directions:
For Week 1, complete the Learning Agreement with self-
identified goals to meet Course Outcomes (COs) and initial
plans to meet those self-identified goals; review the TIPS
document to help you and discuss your goals and plans with
your mentor. Your mentor must sign the Learning Agreement
for your Week 1 submission.
The agreement should be revised each week to reflect completed
goals, additional goals, and changes to the plan dictated by the
actual experience or revisions suggested by faculty or the
mentor. At the end of the practicum experience, evaluate
success with your mentor and obtain the mentor’s signature at
the bottom of agreement. Save this form as a Word document
and enter required information directly onto it; submit the
completed Learning Agreement, signed by your mentor, on the
Saturday of Week 8. See the Learning Agreement Grading
Rubric for grading details.
The Learning Agreement consists of three sections.
I. Student Learning Outcomes table (Week 1)
II. Signatures approving plan (Week 1)
III. Signatures and mentor verification (Week 8)
Due Dates:

2. 1. Initial signed Learning Agreement is submitted by 11:59 p.m.
MT, Sunday at the end of Week 1
2. Completed signed Learning Agreement is submitted by 11:59
p.m. MT, Saturday of Week 8
A minimum of 144 hours practicum experience is required by
the end of NR632.
If the 144 hours are not completed by end of term, you will
receive a grade of “I” and not be able to graduate until
completed.
I. Student Learning Outcomes
Course Outcomes
Student Identified Practicum Goals to Meet COs
Plan to Meet Student Identified Practicum Goals
Narrative Description of Attainment of Student-Identified Goals
Through the End of CGE 1
CO 1: Apply leadership skills concepts of project management
as a nurse executive in an organizational setting to develop,
implement and evaluate successful project plans. (POs 4 and 5)
CO 2: Using current knowledge, standards of practice, and
research from evidence-based literature, synthesize a foundation
for the nurse executive role. (POs 3 and 4)

3. CO 3: Exemplify professional values and scholarship that
support the role of a student in a practicum setting. (PO 4)
CO 4: Contribute to the body of nursing leadership and
management knowledge through research, planning, evaluation
and dissemination of findings. (PO 4)
CO 5: Apply professional values characteristic of the
competent and caring nurse executive that promote holistic care
principles and an appreciation of cultural humility ( POs 1, 3,
and 4)
CO 6: Apply evidence-based fiscal principles that contribute to
the creation of a caring environment characterized by high

4. quality, safe, patient-centered care (POs 1 and 2)
II. Signature Section (Week 1)
Submitted by: (Student) Date:
Mentor Signature: Date:
Accepted by: (Faculty) Date:
III. Signature Section (Week 8)
Submitted by: (Student) Date:
Mentor Signature: Date:
Accepted by: (Faculty) Date:
Learning Agreement Guidelines
and Grading Rubric
(Initial—Week 1 and
Mid-CGE—Week 8)Purpose
The purpose of this assignment is to help students individualize
their practicums based on course objectives.
Requirements:
1. Review the Course Outcomes (COs) for NR631.
2. For each CO, in the Practicum Goals column, identify one to
two broad goals using the S.M.A.R.T. model, related to the
project, each related to the CO (Week 1).

5. 3. For each goal in Column 2, in the Plans column, identify
specific tasks related to the goals that can me measured for
progress in Week 7 (Week 1).
4. In week 7, for each CO, goal, and set of plans, write a
reflective summary of your progress (or lack of progress) in that
area.
Directions:
For Week 1, complete the Learning Agreement with self-
identified goals to meet COs and initial plans to meet those
self-identified goals; review the TIPS document to help you and
discuss your goals and plans with your mentor. Your mentor
must sign the Learning Agreement for your Week 1 submission.
The agreement should be revised each week to reflect completed
goals, additional goals, and changes to the plan dictated by the
actual experience or revisions suggested by faculty or the
mentor. At the end of the practicum experience, evaluate
success with your mentor and obtain the mentor’s signature at
the bottom of agreement. Save this form as a Word document
and enter required information directly onto it; submit the
completed Learning Agreement, signed by your mentor, on the
Friday of Week 8. See the Learning Agreement Grading Rubric
for grading details.
The Learning Agreement consists of three sections.
I. Student Learning Outcomes Table (Week 1)
II. Signatures approving plan (Week 1)
III. Signatures and mentor verification (Week 8)
Due Dates:
1. Initial signed Learning Agreement submitted by 11:59 p.m.
MT, Sunday at the end of Week 1
2. Mid-CGE completed signed Learning Agreement submitted
by 11:59 p.m. MT, Saturday of Week 8
A minimum of 144 hours practicum experience is required by
the end of NR632.
If the 144 hours are not completed by end of term, you will

6. receive a grade of “I” and not be able to graduate until
completed.
Total Points: 50 (25 points each week; Weeks 1 and 8)
Assignment Criteria: Week 1
Category
Points
%
Description
Measurable goals developed for each CO
10
40%
For each CO, the student created measurable goals related to the
CGE project and/or attainment of nurse executive competencies.
Plans to meet each stated goal specified
10
40%
For each goal, the student created plans and tasks that describe
how the student will accomplish the stated goal.
Student and mentor signatures present
5
20%
Both the student and the mentor acknowledged reviewing the
Learning Agreement in a format acceptable to the course
instructor.
25
100
A quality assignment will meet or exceed all of the above
requirements.
Assignment Criteria: Week 8

7. Category
Points
%
Description
Narrative summary of progress for each CO present
20
80%
For each CO, the student provided a narrative summary of his or
her progress toward meeting the goal. There is no penalty for
not meeting a stated goal. Points are only deducted if no
summary is provided for a CO category. There is a 2-point
deduction for each CO category not addressed.
Student and mentor signatures present
5
20%
Both the student and the mentor acknowledged reviewing the
Learning Agreement in a format acceptable to the course
instructor.
25
100
A quality assignment will meet or exceed all of the above
requirements.
Chamberlain College of Nursing NR631 Nurse Executive
Concluding Graduate Experience 1
Grading Rubric
Week 1
Week 1

8. Assignment Criteria
Exceptional
(100%)
Outstanding or highest level of performance
Exceeds
(88%)
Very good or high level of performance
Meets
(80%)
Competent or satisfactory level of performance
Needs Improvement
(38%)
Poor or failing level of performance
Developing
(0)
Unsatisfactory level of performance
Content
Possible Points = 10 Points
Develops measurable goals for each CO
10 Points
0 Points
For each CO, the student creates measurable goals related to the
CGE project and/or attainment of nurse executive competencies.

9. One or more COs do not have measurable goals developed.
Content Subtotal
_____ of 10 Points
Format
Possible Points = 10 Points
Develops specific plans that detail how the student will attain
the stated goal(s)
10 Points
For each goal, the student created plans and tasks that describe
how the student will accomplish the stated goal.
0 Points
One or more goals do not have plans or tasks associated with
them.
Content Subtotal
_____ of 10 Points
Both student and mentor acknowledge reviewing Learning
Agreement by placing signatures in appropriate signature spaces
5 Points
0 Points
Both the student and mentor signatures are present.

10. Either the mentor or student signature is missing.
Format Subtotal
_____ of 5 Points
Total Points
_____ of 25 Points
Week 8:
Week 8
Assignment Criteria
Exceptional
(100%)
Outstanding or highest level of performance
Exceeds
(88%)
Very good or high level of performance
Meets
(80%)
Competent or satisfactory level of performance
Needs Improvement
(38%)
Poor or failing level of performance
Developing
(0)
Unsatisfactory level of performance
Format
Possible Points = 20 Points

11. Narrative summary of progress for each outcome is present
20 Points
For each CO, the student provided a narrative summary of their
progress toward meeting the goal. There is no penalty for not
meeting a stated goal. Points are only deducted if no summary
is provided for a CO category.
0 Points
One or more goals do not have a reflective summary evaluating
progress or lack of progress toward meeting plans and goals.
Content Subtotal
_____ of 20 Points
Both student and mentor acknowledge reviewing Learning
Agreement by placing signatures in appropriate signature spaces
5 Points
0 Points
Both the student and mentor signatures are present.
Either the mentor or student signature is missing.
Format Subtotal
_____ of 5 Points
Total Points
_____ of 25 Points
Learning Agreement Guidelines

12. and Grading Rubric
(Initial—Week 1 and
Mid-CGE—Week 8)Purpose
The purpose of this assignment is to help students individualize
their practicums based on course objectives.
Requirements:
1. Review the Course Outcomes (COs) for NR631.
2. For each CO, in the Practicum Goals column, identify one to
two broad goals using the S.M.A.R.T. model, related to the
project, each related to the CO (Week 1).
3. For each goal in Column 2, in the Plans column, identify
specific tasks related to the goals that can me measured for
progress in Week 7 (Week 1).
4. In week 7, for each CO, goal, and set of plans, write a
reflective summary of your progress (or lack of progress) in that
area.
Directions:
For Week 1, complete the Learning Agreement with self-
identified goals to meet COs and initial plans to meet those
self-identified goals; review the TIPS document to help you and
discuss your goals and plans with your mentor. Your mentor
must sign the Learning Agreement for your Week 1 submission.
The agreement should be revised each week to reflect completed
goals, additional goals, and changes to the plan dictated by the
actual experience or revisions suggested by faculty or the
mentor. At the end of the practicum experience, evaluate
success with your mentor and obtain the mentor’s signature at
the bottom of agreement. Save this form as a Word document
and enter required information directly onto it; submit the
completed Learning Agreement, signed by your mentor, on the
Friday of Week 8. See the Learning Agreement Grading Rubric
for grading details.
The Learning Agreement consists of three sections.

13. I. Student Learning Outcomes Table (Week 1)
II. Signatures approving plan (Week 1)
III. Signatures and mentor verification (Week 8)
Due Dates:
1. Initial signed Learning Agreement submitted by 11:59 p.m.
MT, Sunday at the end of Week 1
2. Mid-CGE completed signed Learning Agreement submitted
by 11:59 p.m. MT, Saturday of Week 8
A minimum of 144 hours practicum experience is required by
the end of NR632.
If the 144 hours are not completed by end of term, you will
receive a grade of “I” and not be able to graduate until
completed.
Total Points: 50 (25 points each week; Weeks 1 and 8)
Assignment Criteria: Week 1
Category
Points
%
Description
Measurable goals developed for each CO
10
40%
For each CO, the student created measurable goals related to the
CGE project and/or attainment of nurse executive competencies.
Plans to meet each stated goal specified
10
40%
For each goal, the student created plans and tasks that describe
how the student will accomplish the stated goal.
Student and mentor signatures present
5

14. 20%
Both the student and the mentor acknowledged reviewing the
Learning Agreement in a format acceptable to the course
instructor.
25
100
A quality assignment will meet or exceed all of the above
requirements.
Assignment Criteria: Week 8
Category
Points
%
Description
Narrative summary of progress for each CO present
20
80%
For each CO, the student provided a narrative summary of his or
her progress toward meeting the goal. There is no penalty for
not meeting a stated goal. Points are only deducted if no
summary is provided for a CO category. There is a 2-point
deduction for each CO category not addressed.
Student and mentor signatures present
5
20%
Both the student and the mentor acknowledged reviewing the
Learning Agreement in a format acceptable to the course
instructor.
25
100
A quality assignment will meet or exceed all of the above

15. requirements.
Chamberlain College of Nursing NR631 Nurse Executive
Concluding Graduate Experience 1
Grading Rubric
Week 1
Week 1
Assignment Criteria
Exceptional
(100%)
Outstanding or highest level of performance
Exceeds
(88%)
Very good or high level of performance
Meets
(80%)
Competent or satisfactory level of performance
Needs Improvement
(38%)
Poor or failing level of performance
Developing
(0)
Unsatisfactory level of performance
Content
Possible Points = 10 Points

16. Develops measurable goals for each CO
10 Points
0 Points
For each CO, the student creates measurable goals related to the
CGE project and/or attainment of nurse executive competencies.
One or more COs do not have measurable goals developed.
Content Subtotal
_____ of 10 Points
Format
Possible Points = 10 Points
Develops specific plans that detail how the student will attain
the stated goal(s)
10 Points
For each goal, the student created plans and tasks that describe
how the student will accomplish the stated goal.
0 Points
One or more goals do not have plans or tasks associated with
them.
Content Subtotal

17. _____ of 10 Points
Both student and mentor acknowledge reviewing Learning
Agreement by placing signatures in appropriate signature spaces
5 Points
0 Points
Both the student and mentor signatures are present.
Either the mentor or student signature is missing.
Format Subtotal
_____ of 5 Points
Total Points
_____ of 25 Points
Week 8:
Week 8
Assignment Criteria
Exceptional
(100%)
Outstanding or highest level of performance
Exceeds
(88%)
Very good or high level of performance
Meets
(80%)
Competent or satisfactory level of performance
Needs Improvement

18. (38%)
Poor or failing level of performance
Developing
(0)
Unsatisfactory level of performance
Format
Possible Points = 20 Points
Narrative summary of progress for each outcome is present
20 Points
For each CO, the student provided a narrative summary of their
progress toward meeting the goal. There is no penalty for not
meeting a stated goal. Points are only deducted if no summary
is provided for a CO category.
0 Points
One or more goals do not have a reflective summary evaluating
progress or lack of progress toward meeting plans and goals.
Content Subtotal
_____ of 20 Points
Both student and mentor acknowledge reviewing Learning
Agreement by placing signatures in appropriate signature spaces
5 Points
0 Points
Both the student and mentor signatures are present.

19. Either the mentor or student signature is missing.
Format Subtotal
_____ of 5 Points
Total Points
_____ of 25 Points
Chamberlain College of Nursing NR630 Executive
Practicum
Sample Learning Agreement
This sample is offered to assure that you understand the
difference between course outcomes and practicum outcomes.
Note that practicum goals should parrallel and evolve from the
course outcomes and the plans should specify, specifically,
what you will do to meet your practicum goal. Example:
Providing an "Introduction to nursing" session in the simulation
lab for high school students interested in nursing.
I. Student Learning Outcomes
Course Outcomes
Student Identified Practicum Goals to Meet Course Outcomes
Plan to Meet Student Identified Practicum Goals
Narrative Description of Attainment of Student Identifed Goals
CO1. Synthesize knowledge from evidence-based educational
and nursing literature as a foundation for the executive role

20. Synthesize knowledge from evidence-based educational and
nursing literature as a foundation for a management practicum
related to a staffing plan.
· Complete a review of literature on research related to staffing
plans
· Complete a review of state and national regulations related to
staffing plans.
· Research best practices in staffing plans.
CO2. Demonstrate the leadership skills of a nurse executive in
an organizational setting.
Note that these are similar to the CO but more specific
Demonstrate developing leadership skills in planning and
executing a staff meeting.
· Determine course objectives for the practicum experience.
· Select communication strategies to use during the practicum
experience.
· Review techniques for effective meeting strategies.
Note that these are specific steps you would take to meet your
practicum goals.
NR630 Learning Agreement Sample.docx
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