NUR 400 Final Project Guidelines and Rubric Overview .docx

NUR 400 Final Project Guidelines and Rubric
Overview
Your assessment for this course is a presentation that provides
justified proposals for quality improvement within a specific
organization. The proposal will
address strategies for improving a quality patient indicator
within the healthcare organization, utilizing evidence-based and
peer-reviewed research and careful
analysis of organizational processes, organizational structures,
leadership responsibilities, and value-based reimbursement. In
addition, the presentation will
need to include a concise plan for implementation and
evaluation of the proposal from organizational, financial, and
patient-care perspectives.
Most importantly, this assessment will provide you with the
opportunity to demonstrate sophisticated and critical research,
analysis, and communication skills
by allowing you the opportunity to synthesize your own
research into a qualified, well-articulated presentation to
leadership to improve the quality of patient
care. These skills and abilities are essential for nursing
professionals who hope to drive positive, sound organizational
change within the healthcare industry.
For this presentation, you will have the option of using your
current healthcare organization, a previous employer, an
organization you had experience with
during clinicals as a student, or the provided alternative case

study as the basis for your presentation.
This assessment will address the following course outcomes:
x NUR-400-01: Evaluate tracer methodology as an effective and
sustainable means of measuring quality delivery of care
x NUR-400-02: Assess theories of change for their applicability
and use in promoting performance improvement initiatives in
healthcare organizations
x NUR-400-03: Analyze organizational processes that impact
communication and flow of survey-required quality data
throughout the healthcare
institution
x NUR-400-04: Recommend interprofessional strategies that
improve nursing-sensitive quality indicators
x NUR-400-05: Articulate the role of leadership in the planning,
analysis, and implementation of performance improvement
initiatives within the
organization
x NUR-400-06: Analyze the relationship between quality
outcomes and value-based reimbursement in healthcare for
improvement opportunities
Prompt
Your presentation should answer the following prompt: Present
a proposal for addressing or improving a quality patient
indicator within a healthcare
organization, including evidence-based and peer-reviewed
support, an implementation plan, and considerations of
organizational and leadership roles.

Specifically, the following critical elements must be addressed:
I. Introduction
a) Organization: Analyze the organization to determine the key
characteristics (including organizational values if applicable)
that are important to
consider when developing plans for change and implementation
of quality indicator proposals.
b) Improvement Opportunity: What is the issue(s) involving
patient safety and financial considerations within the
organization that needs to be
addressed? Explain the connection between patient safety and
financial state of the organization in terms of opportunity
presented.
c) Purpose: Articulate the overall purpose of your
proposal/proposed initiative for improving quality of care
within your organization. In other
words, what is your intended initiative for addressing the
issue(s)/improvement opportunity identified?
d) Proposal Initiative: Detail the initiative you are proposing in
terms of its application to your organization. In other words,
what is it that you are
proposing, and why is it relevant for your organization?
e) Leadership: Articulate the role leadership plays in the current
situation/environment that needs to be addressed. In other
words, in presenting

your proposal to leadership, you will need to articulate the
overall role they play in the current environment, such as
whether leadership is
attempting to address the issue, is unintentionally furthering the
issue, or has not yet identified your concerns as an
organizational issue.
II. Research and Support:
a) Proposal Care Support: Summarize the research from
evidence-based studies and peer-reviewed sources that led you
to believe that your
proposal would improve quality delivery of care within your
organization.
b) Value-Based Support: Summarize the research from
evidence-based studies and peer-reviewed sources that led you
to believe that your
proposal would improve value-based reimbursement for your
organization.
c) Data Evidence: Detail the data from the organization or that
you collected yourself that indicated the need for improvement,
and explain how
you drew your conclusions. Note: This data should consist of
tracer data, performance improvement data, benchmarks, and so
on.
d) Strategies: Detail existing interprofessional strategies that
could be applied to your initiative and organization.
e) Strategy Defense: Defend your recommended strategies in
terms of their ability to improve nursing-sensitive quality
indicators based on
relevant, reliable research.

f) Change Theory: Analyze relevant theories of change that
informed your proposed initiative and could help with
implementation.
g) Change Assessment: How applicable are change theories to
promoting your intended initiative and to the type and structure
of your healthcare
organization?
III. Implementation
a) Quality Outcomes: What are the desired quality outcomes
you hope to achieve through implementation of your initiative?
Your outcomes
should be reasonable, measurable, and time-considerate to help
monitor progress.
b) Communication: Analyze the organizational processes for
communicating change initiatives to determine the most
effective paths/methods for
promoting the proposed initiative.
c) Flow of Data: Discuss how the existing organizational
processes will allow for improved or maintained flow of survey-
required quality data that
may be valuable for tracking your initiative.
d) Needed Leadership: Describe the behaviors of leadership and
the role of leadership in implementing these strategies for
change within the
organization. In other words, what responsibilities do leaders
within your organization hold to ensure the implementation of
the initiative?

IV. Evaluation
a) Plan: What is your plan for evaluation of the strategies using
performance improvement data and tracers? What tracers will
you use? Include
necessary detail to deliver key points and requirements, such as
specific data collection methods, timeframes for evaluation, and
intended re-
evaluation.
b) Plan Evaluation: How effective and sustainable is your plan?
In other words, evaluate the effectiveness and the ease of use,
timeliness, and
efficiency of your plan for the progress and success of your
initiative.
c) Role of Leadership: Given your discussions about the roles
and responsibilities of leadership within the organization,
discuss the importance of
leadership for successful improvement initiatives. In other
words, articulate the role and importance of leadership in the
successful review,
implementation, and continuous improvement of performance
initiatives.
Milestones
Milestone One: Introduction
This milestone is due in Module Two. This milestone is graded
with the Milestone One Rubric.

Milestone Two: Research and Support
This milestone is due in Module Four. This milestone is graded
with the Milestone Two Rubric.
Milestone Three: Implementation
This milestone is due in Module Five. This milestone is graded
with the Milestone Three Rubric.
Milestone Four: Evaluation
This milestone is due in Module Six. This milestone is graded
with the Milestone Four Rubric.
Final Project: Submission
The final project is due in Module Seven. This final project is
graded with the Final Project Rubric.
Final Project Rubric
Guidelines for Submission: Your presentation should be
approximately 15–20 slides, not including reference slides and
introductory slides. You should include

appropriate speaker notes, and you may include an audiovisual
recording of your presentation in your submission.
Critical Elements Exemplary (100%) Proficient (85%) Needs
Improvement (55%) Not Evident (0%) Value
Introduction:
Organization
[NUR-400-03]
Meets “Proficient” criteria and
evidences keen insight into
analyzing organizational nuances
that could influence quality
planning
Analyzes accurately the
organization to determine
important characteristics for
consideration in planning for
change and implementation
Analyzes the organization to
determine important
characteristics for consideration
in planning for change and
implementation, but with gaps in
accuracy or detail
Does not analyze the
important characteristics for
consideration in planning for
change and implementation

5.28
Introduction:
Improvement
Opportunity
[NUR-400-06]
evidences keen insight into the
nuances of the relationship
between patient safety and fiscal
stability of the organization
Accurately identifies and explains
the relationship between patient
safety issues and fiscal stability
of the organization
Identifies and explains the
relationship between patient
of the organization, but with
gaps in accuracy or detail
Does not identify and explain the
relationship between patient
of the organization
3.95
Introduction:
Purpose
[NUR-400-04]

Meets “Proficient” criteria, and
articulation evidences
professional or sophisticated
representation of purpose
Articulates accurately and clearly
the purpose of the proposal for
improving quality of care within
the organization
Articulates the purpose of the
proposal for improving quality of
care within the organization, but
with gaps in accuracy or clarity
Does not articulate the purpose
of the proposal for improving
quality of care within the
organization
5.28
Introduction:
Proposal Initiative
[NUR-400-02]
offers more reflective insight into
the application of the initiative to
the organization
Details accurately the initiative in
terms of its application to the
organization

Details the initiative in terms of
applicability to the organization,
but with gaps in accuracy
Does not detail the initiative in
terms of its application to the
organization
5.28
Introduction:
Leadership
[NUR-400-05]
offers professional insight into
the role of leadership in the
current situation
Articulates accurately the role
that leadership plays in the
current situation to be addressed
Articulates the role of leadership
but with gaps in accuracy or
clarity
Does not articulate the role of
leadership
5.28
Research and
Support:

Proposal Care
Support
[NUR-400-06]
offers greater insight and clarity
when summarizing the research
from evidence-based studies and
peer-reviewed sources that
support quality delivery of care
Summarizes accurately the
research from evidence-based
studies and peer-reviewed
sources that support quality
delivery of care within the
organization
Summarizes the research from
evidence-based studies and
support quality delivery of care
within the organization, but with
gaps in accuracy
Does not summarize the
sources that support quality
delivery of care within the
organization
3.95

Research and
Support:
Value-Based Support
[NUR-400-06]
offers greater detail when
summarizing the research from
support value-based
reimbursement for the initiative
Summarizes accurately the
sources that support value-based
Summarizes the research from
support value-based
reimbursement for the initiative,
Does not summarize the
sources that support value-based

3.95
Research and
Support:
Data Evidence
[NUR-400-01]
more precisely details the data
that was collected to indicate the
need for the quality initiative
Accurately identifies the data
that was collected that indicated
the need for the quality initiative
Identifies the data that was
collected and indicated the need
for the quality initiative, but with
gaps in accuracy
Does not identify the data that
was collected that indicated the
need for the quality initiative
5.28
Research and
Support:
Strategies
[NUR-400-04]
offers greater description

concerning the interprofessional
strategies that exist within the
organization
Accurately articulates
interprofessional strategies that
exist within the organization
Articulates interprofessional
strategies that exist within the
organization, but with gaps in
accuracy
Does not articulate
interprofessional strategies that
exist within the organization
5.28
Strategy Defense
[NUR-400-04]
evidences keen insight into
pulling quality information and
support from academically and
professionally sound sources
Defends recommended
strategies in terms of their ability
to improve nursing-sensitive
quality indicators based on
relevant, reliable research
Defends recommended

quality indicators, but does not
draw on relevant and reliable
research
Does not defend recommended
quality indicators
5.28
Research and
Support:
Change Theory
[NUR-400-02]
offers more detailed descriptions
of change theories as they
inform the quality initiative and
are able to help with
implementation
Accurately analyzes relevant
theories of change as they
implementation
Analyzes relevant theories of
change as they inform the
quality initiative and are able to
help with implementation, but
with gaps in accuracy or detail

Does not analyze relevant
theories of change as they
implementation
5.28
Research and
Support:
Change Assessment
[NUR-400-02]
offers greater professional
insight into the applicability of
change theories to promoting
the initiative within the
organization
Accurately assesses applicability
of change theories to promoting
organization
Assesses applicability of change
theories to promoting the
initiative within the organization,
but with gaps in accuracy or
detail
Does not assess applicability of
change theories to promoting

organization
5.28
Implementation:
Quality Outcomes
[NUR-400-6]
offers greater depth of
explanation about the expected
quality outcomes resulting from
the performance improvement
initiative
Articulates accurately the
measurable quality outcomes
expected as a result of the
performance improvement
initiative
Articulates the measureable
quality outcomes expected as a
result of the performance
improvement initiative, but with
gaps in clarity and accuracy
Does not articulate the
measureable quality outcomes
expected as a result of the
initiative
3.95

Implementation:
Communication
[NUR-400-03]
evidences keen insight into the
processes of communication
within the organization that will
best determine the success of
the quality initiative
Accurately analyzes the
processes of communication
within the organization to
determine the most efficient
methods for promoting the
proposed initiative
Analyzes the processes of
communication within the
proposed initiative, but with
gaps in accuracy, or methods
identified are not the most
efficient
Does not analyze the processes
of communication within the
proposed initiative

5.28
Implementation:
Flow of Data
[NUR-400-03]
offers keen insight into
organizational processes that
enhance the flow of
performance improvement data
Accurately articulates how
organizational processes allow
for flow of survey-required data
that is necessary for the
initiative
Articulates how organizational
processes allow for survey-
required data, but with gaps in
detail or accuracy
Does not articulate how
organizational processes allow
for survey-required data
5.28
Implementation:
Needed Leadership
[NUR-400-05]

offers professional insight into
leadership roles that are needed
for successful implementation of
the initiative
Accurately describes the roles
and behaviors of leadership
within the organization that
serve to ensure successful
implementation of the initiative
Describes the roles and
behaviors of leadership within
the organization that serve to
ensure successful
implementation of the initiative,
Does not describe the roles and
behaviors of leadership within
the organization that serve to
ensure successful
implementation of the initiative
5.28
Evaluation:
Plan
[NUR-400-01]
offers insightful detail
concerning the data collection
methods and processes for re-

evaluation of the initiative
Accurately articulates the
strategies for evaluation of the
initiative by specifying data
collection methods, time frames,
and processes for re-evaluation
Articulates the strategies for
evaluation of the initiative by
specifying data collection
methods and time frames, but
with gaps in accuracy or detail
Does not articulate the strategies
for evaluation of the initiative by
specifying data collection
methods and time frames
5.28
Evaluation:
Plan Evaluation
[NUR-400-01]
offers keen insight into the
processes that affect timeliness
and sustainability of the plan
Logically evaluates the plan for
its effectiveness, ease of use, and
efficiency within the context of
initiative progress and success
Evaluates the plan for its

effectiveness, ease of use, and
efficiency, but with gaps in detail
or logic, or not within the
context of initiative progress and
success
Does not evaluate the plan for its
effectiveness, ease of use, and
efficiency
5.28
Evaluation:
Role of Leadership
[NUR-400-05]
offers professional insights into
roles of leadership that
contribute positively to the
planning, implementation, and
evaluation of performance
improvement initiatives
Accurately articulates the role of
leadership in the planning,
execution, and evaluation of
initiatives
Articulates the roles of
initiatives, but with gaps in

accuracy or detail
Does not articulate the roles of
initiatives
5.28
Articulation of
Response
Submission is free of errors
related to citations, grammar,
spelling, syntax, and organization
and is presented in a
professional and easy-to-read
format
Submission has no major errors
spelling, syntax, or organization
Submission has major errors
that negatively impact
readability and articulation of
main ideas
Submission has critical errors

that prevent understanding of
ideas
5
Earned Total 100%
Feedback for 4 Milestone Two: Research and Support
Please address Milestone two’s feedback and include these
changes when working on your Milestone 3 assignment.
1)Proposal Care Support
The data you cite in this section supports that there is a nursing
shortage. However, I would have liked to see you add more
insight into what research shows on the impact this shortage has
on patient safety and quality care. What does the research say
about the nursing shortage and its connection with quality care,
thus leading you to believe a change was necessary?
2) Value-Based Support
While you discussed financial impacts of your proposal, you did
not touch on value based reimbursement. How does short
staffing effect patient care and then ultimately reimbursement
rates received by your institution?Top of Form
Bottom of Form
3) Data Evidence
You listed an example of a quality indicator that MAY be
effected by the nrusing shortage. However, you need to include
data that the nursing shortage itself is an issue. How many
nurses is your facility short? What is the nurse to patient ratio?

How many openings are there? etc.
4) Strategies
While you gave great examples of strategies that could be used
to help improve the nursing shortage, are there any
interprofessional strategies currently in use that would also be
helpful?
5) Strategy Defense
So what nursing indicators will be affected with the
implementation of your proposal? See
http://ojin.nursingworld.org/MainMenuCategories/ANAMarketp
lace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No
3Sept07/NursingQualityIndicators.html for a list of the Nursing
Sensitive Indicators Additionally, while you wrote your own
professional insight, I would have liked to see you utilize
research to add support to these views and ideas.
6) Articulation of Response
Submission has errors related to citations, grammar, spelling, or
syntax
Mile Stone 1 Feedback!
Topic: Nursing Shortage and the Need for More Nurses
Organization

Great job detailing the organization that will be the setting of
your milestone assignments. I appreciated the professional
insight you added into the characteristics that are of importance
in regard to your topic choice, especially it’s values!
Improvement Opportunity:
Great job detailing where your organization could improve,
specifically regarding the nursing shortage and patient safety.
You also addressed that your institution is in good financial
standing so should address the issue. Additionally, I would have
liked to see you detail what financial considerations there would
be if they don't! What financial impact can all of the negative
consequences of nursing shortage cause on your institution?
Purpose:
I would have liked a little more insight here – How exactly is
your proposal going to help improve patient safety?
Proposal Initiative
So what if your organization's benefits are better then
surrounding competitors? What then will you change?
Determining if a change is necessary would have been more the
prep for this assignment - determining that an
adjustment/improvement is NEEDED and suggesting that
change would then be your proposed initiative.
Running Head: EVALUATION
1
Evaluation
4

Nursing Shortage and the Need for More Nurses
Plan
The use of the tracer method is vital in evaluating implemented
strategies and to track their progress. These tools will be
employed on the individual employees, the entire organization
and on the individual new strategy. This project will use three
main tracers; patient readmission rates for the first thirty days,
patient satisfactory levels and through internal employee
surveys on the newly implemented strategy.
In a survey conducted in 2014, three researchers found out that
majority of health administrators use readmission records as
insights into taking action and improving their internal systems
(Kvedar et al., 2014). With the new staff revitalization project,
Mary Manning Walsh has the goal of reducing patient
readmissions by 35%. To evaluate the new implementation’s
effectiveness, the organization will check on the readmission
rates of patients for the four weeks. This will inform the number
of patients on whom medical interventions have failed.
Although the final record will focus on the thirty days, the
implementing team will follow this in small bits, after every one
week. Here, data will be captured from patient records keyed in
the facility registry.
Patient satisfaction rate is the most genuine determination of
the performance of hospital programs as patients are the
primary beneficiaries of these new strategies. In a study
conducted in India, the more positive patients feel about an
intervention, the more they are likely to respond well to medical
treatment (Batbaatar et al., 2017). Data of how patients feel
about the changes will be conducted from each patient upon
being discharged. This therefore means that information will be
given every day as we have many patients being released on a
daily basis. Patients will give their information through patient
feedback forms issued by the front office department, through
our website, through phone calls and through our online patient
forums.

Second to the patients, health workers are key beneficiaries of
efficient working systems and staff motivation schemes. Our
strategy will therefore have a great impact on them and getting
feedback from the operatives will accurately tell on its
effectiveness. This feedback from employees will be collected
through our internal chat groups and through departmental
meetings. The data will be collected weekly. Satisfaction of
healthcare was attributed to successful interventions in
Savannah in 2016 (Bohman et al., 2017).
Plan Evaluation
This plan is effective and is bound to help Mary Manning Walsh
realize its goal of reducing hospital readmissions through
successful health interventions based on a motivated staff. Its
effectiveness is based on several key features. First, the plan
provides for the collection of feedback from the primary
beneficiaries of the new strategy, the patients and the healthcare
givers. This means that feedback will be accurate and the
corrections suggested beneficial to the satisfaction of the two
parties.
Secondly, the frequency of the feedback, collection data of data
every day with regards to the patients discharged and employees
as well as the review of medical details of patients and, the
appropriateness of feedback channels ensure that feedback
collected is timely. This results into appropriate corrective
actions by the implementing teams. For instance, patient
satisfactory rates collected through the various platforms will
inform the agenda of the weekly departmental meeting of staff
members.
Additionally, the evaluation plan laid above is not complicated
and is therefore easy to use. This is based on the fact that most
of our patients who come in are familiar with our social
platforms where they can air their concerns. There is also an
existing culture of openness in communication and teamwork
making it easy for the staff to cooperate on the evaluation goals
especially on giving their genuine feedback over the newly
implemented strategy.

References
Batbaatar, E., Dorjdagva, J., Luvsannyam, A., Savino, M. M., &
Amenta, P. (2017). Determinants of patient satisfaction: a
systematic review. Perspectives in public health, 137(2), 89-
101.
Bohman, B., Dyrbye, L., Sinsky, C., Linzer, M., Olson, K.,
Babbott, S., & Trockel, M. (2017). Physician well-being: the
reciprocity of practice efficiency, culture of wellness, and
personal resilience. NEJM Catalyst.
Kvedar, J., Coye, M. J., & Everett, W. (2014). Connected
health: a review of technologies and strategies to improve
patient care with telemedicine and telehealth. Health
Affairs, 33(2), 194-199.
Running head: IMPLEMENTATION 1
Implementation 4
Implementation of Proposed Changes
Implementing a new model within a healthcare facility very
sensitive. The implementation process has to be well structured
to avoid any negative impact to the existing service delivery
process and mechanism already implemented. The change being

implemented must be consistent with existing policies and
services at the healthcare institution, (Allen, 2016). In this case,
implementing a new compensation system at Mary Manning
Walsh must be done while considering the current workforce,
and the impact of the change on the quality of care extended to
patients. The institution must ensure that the change strategy
will fall within its financial capabilities. Implementing the
proposed change strategy would be a viable intervention to curb
the problems associated with the nurse shortage.
Quality Outcomes
The major problem that is noted at Mary Manning Walsh is the
poor quality of care extended to patients. On analyzing the ratio
of caregivers to patients, it is evident that nurses at the
institution are overwhelmed hence the quality of care
deteriorates. Therefore, it becomes necessary to increase the
total number of nurses at the health care facility to make the
ratio of nurses to patients much better. The first thing that the
change strategy is expected to achieve is to reduce the number
of patient readmissions. In recent times, the healthcare facility
has had so many patient readmission cases which are mostly due
to hospital-associated infections (HAI) such as CAUTI, (Marć,
et.al., 2019). Implementation of the proposed compensation and
reward system is expected to lower the patient readmission
cases by 35% within the first four months after implementation.
As more nurses become interested to work at Mary Manning
Walsh, it is expected that the ratio of nurses to patients will be
1:6. Attracting more nurses to the facility will eventually
translate to better care for all patients. It will also reduce the
expenses incurred to handle re-admission cases at the facility.
Communication
The success of a change implementation proposal in any
healthcare facility is largely dependent on the information
relayed to all stakeholders before its implementation.
Furthermore, all persons who would be affected by the proposed
change should be engaged in the process of implementation.
With this in mind, it becomes necessary to analyze and select

the most effective communication channels through which
information would be disseminated. Acceptance of the proposed
compensation and rewards systems will depend on how well the
stakeholders are persuaded, (O'Connor & Wickramasinghe,
2017). Therefore, it would be necessary to schedule several
meetings with all the nurses currently operating at the
institution. The nurse practitioners at Mary Manning Walsh
should individually be informed via mails on the implications of
the proposed changes. Also, it would be appropriate to draft
internal memos addressed to all members of staff to increase
awareness of the changes being implemented at the facility,
(O'Connor & Wickramasinghe, 2017). Nurse supervisors should
be called into official meetings and requested to discuss the
change implementation with all junior nurses at the facility. The
communication should be spearheaded by departmental
managers; human resources, finance, and operations managers.
Data Flow
The existing organizational structure is well designed to
facilitate effective monitoring and supervision of processes
undertaken at Mary Manning Walsh. The executive managers
should be the first to approve the implementation of the change
strategy. Finance officers at the institution should then verify
the viability of the proposal and ensure the institution is well in
range of its financial capabilities. The human resource
department, in charge of hiring and staffing, should then
advertise for the number of positions that need to be filled
within the institution. In doing so, the nurses operating at the
facility should be accorded the priority to apply for a new
position in which they are qualified. This would not only
improve the quality of care given to patients but also save time
that would otherwise be spent on inducting new nurse recruits.
The executive managers should then adopt a culture of
preparing weekly audit reports to establish the progress being
made after the proposed change is implemented, (Lim, et.al.,
2016). By so doing, it would be possible to identify areas that
still need improvement.

Needed Leadership
Healthcare managers play a vital role in policy formulation and
implementation in different healthcare organizations. Their
expertise in the field of healthcare enables them to effectively
facilitate change implementation without disrupting normal
operations or affecting service delivery. Therefore, the
executive managers at Mary Manning Walsh should take up the
responsibility of effective management and control to ensure the
change implementation is a success. Most importantly, the
leaders at the institution should adopt a servant leadership style.
A servant leadership style will motivate the nurses to embrace
change and aspire to deliver better quality of service to patients,
(Allen, 2016). Monitoring and evaluation of the impact of the
implementation can best be done by leaders at the healthcare
facility. Responsible leaders and mangers often conduct
appraisal to ensure strengths and weaknesses are identified to
enhance service delivery.
In conclusion, implementing the proposed change strategy
would be a viable intervention to curb the problems associated
with the nurse shortage. However, all the stakeholders should
cooperate to facilitate smooth implementation. Also, effective
communication is necessary throughout the implementation
process. Leaders at the healthcare institution should motivate
their subordinate staff to perform better and generally improve
the quality of care extended to patients, (Lim, et.al., 2016).
References
Allen, B. (2016). Effective design, implementation, and
management of change in healthcare. Nursing Standard, 31(3).
Lim, F., Nelson, N., Stimpfel, A. W., Navarra, A. M., & Slater,
L. Z. (2016). Honors programs: Current perspectives for
implementation. Nurse educator, 41(2), 98-102.
Marć, M., Bartosiewicz, A., Burzyńska, J., Chmiel, Z., &
Januszewicz, P. (2019). A nursing shortage–a prospect of global
and local policies. International nursing review, 66(1), 9-16.
O'Connor, L., & Wickramasinghe, N. (2017). Investigating the
mediating role of nursing information systems using activity

theory.
Running head: RESEARCH & SUPPORT 1
Research and support 5
Research and Support
Proposal Care Support
Nurses are a very critical part of a health care facility. Nursing
shortage is not just a problem experienced in the United States
but globally. The shortage is as a result of high turnover,
unavailability of potential educators and unfair distribution of
the workforce. Healthcare organizations are therefore competing
to acquire the scarce nurses in order to improve their delivery of
quality care. According to the US Bureau of Labor Statistics,
more than 1.1 million additional nurses are required to address
the shortage problem (Haddad, 2019). For an organization to
effectively compete for the scarce nurses, acquire top talent and
reduce employee turnover, it must offer an enticing
compensation and benefits package. Organizations that offer
great wages and benefits easily attract applicant and maintain
the nurses they already have. My proposal to offer a better
compensation and benefits package would therefore lead to an
increase of the pool of applicants and retain the existing nurses
thus addressing the nursing shortage problem that the
organization is experiencing. This would ultimately lead to
greater quality care.
Value Based Support
Value based reimbursement is a model that pays attention on
quality not quantity. The main aim of value based
reimbursement to reduce the significantly rising healthcare
costs. While at first glance, increasing the wages and benefits of
nurses might seem like an expensive affair, the organization
will cut down on its costs after a while. This is because with

enough nurses in the organization, patients will be effectively
cared for therefore reducing cases of readmission and infections
such as the Central line-associated bloodstream infections.
Offering a greater compensation and benefits package will lead
to an increase in the number of nurses therefore leading to
shorter patient stays and decreased hospital bills. According to
the American Nurses Association, optimal nurse staffing is
entirely necessary in order to achieve the objectives of value-
based care (Alghamdi, 2016).
Data Evidence
They’re very high rates of readmission in Mary Manning Walsh
home and this was the first indicator that there might be a
nursing shortage because patients are not receiving quality care.
In addition, coordination of activities within the facility is very
low. For instance, a patient who is about to get admitted takes
hours before being assigned to a ward and a bed. This is
because it is only two nurses handling the high number of
patients admitted each and every day. While talking to patients
in the organization, it was very evident that they are
dissatisfied. This is due to the fact that nurses are not spending
enough time with a single patient because of the high number of
patients who require care.
Strategies
Developing a new compensation and benefits package for an
organization is not just a walk in the park and various factors
must be considered. In this case, Mary Manning Walsh home’s
management needs to first analyze the current wages and
benefits that organizations within New York are offering to
their nurses. Through this, the organization will be able to
determine to what level it should increase its wages and benefits
to be competitive with those of other organizations. The
organization also needs to analyze the professional and personal
needs of nurses in order to determine the benefits it should
offer. Finally, the organization should engage nurses’ leaders
while developing the package in order to ensure that nurses
have a seat at the table in the decision making process. Through

this, nurses will have a chance to communicate the professional
and personal needs which are very important while developing
the package.
Strategy Defense
The recommended strategies are generally aimed at developing
a competitive compensation and benefits package. The final
package should be able to attract top talent and retain the
current nurses. For an organization to determine the wages and
salaries it should offer employees, it is always important to
evaluate other organizations in the region and engage
employees. Engaging nurses in the process is the most effective
way for the organization to ensure the final package meets their
personal and professional needs. Meeting the professional and
personal needs of nurses will improve their employee morale
and boost their productivity therefore they will offer greater
quality care.
Change Theory
The Lewin’s change theory informed my proposed initiative and
could be very helpful with implementation. The theory is based
on both driving and resistant forces. In this case, the driving
force is nursing shortage and the resistant forces are fear of
indicating the dissatisfaction that nurses have to the
management, fear that greater benefits and wages will be
accompanied by more work and fear of the organization to
increase its operating cost. The unfreezing, moving and
refreezing stages can be utilized in implementing the initiative
(Cummings, 2016).
Change Assessment
The Lewin’s change theory is very applicable to the intended
initiative and the entire organization. In the unfreeze stage, the
organization will determine the need for change and why the
current compensation and benefits package for the nurses is not
competitive. In the moving stage, the organization will
determine the adjustments that are required to make the package
competitive. In the refreezing stage, the organization will now
utilize the new package to attract more nurses, reduce turnover,

improve morale and productivity.
References
Alghamdi, M. G. (2016). Nursing workload: a concept analysis.
Journal of nursing management, 24(4), 449-457.
Cummings, S., Bridgman, T., & Brown, K. G. (2016).
Unfreezing change as three steps: Rethinking Kurt Lewin’s
legacy for change management. Human relations, 69(1), 33-60.
Haddad, L. M., & Toney-Butler, T. J. (2019). Nursing shortage.
In StatPearls [Internet]. StatPearls Publishing.
Running head: NURSING SHORTAGE
1
NURSING SHORTAGE 2

Organization
Mary Manning Walsh Nursing Home is located in Manhattan
New York and it offers short term rehabilitation and residential
skilled nursing. The short term rehabilitation is aimed at
speeding the recovery and improves the transition of individuals
from hospital to home after undergoing an intensive disease or
surgery. The organization mainly serves the upper East Side of
Manhattan and has been in existence for more than sixty years.
The organization has a religious order in approaching various
issues including caring for the elderly. It takes care of all
people regardless of their faith in an environment that can
rarely be found in the traditional nursing facilities. The mission
of the organization is to offer holistic care to every resident in
an environment of Christian understanding and faith. It bases it
values and ethics on the teachings of the Roman Catholic
Church. All the activities that the organization conducts are
aimed at portraying respect for life through love and
compassion. It offers residential skilled nursing care for
patients that require 24-hour care with a singular mission of
helping all patients and improving patient outcomes. The
organization has maintained a great reputation over the years
for the quality patient care it provides.
Improvement opportunity
The organization receives very many patients each and every
day and it does not have enough nurses to take care of the high
number of patients. The availability of enough nurses is a
quality patient indicator. Due to the nursing shortage, the
available nurses work for very long hours which leads to fatigue
and job dissatisfaction. Nurses in the facility are also more
prone to making medical errors and mistakes (Steege, 2017).
They do not spend enough time with patients in order to create
meaningful nurse-patient relationships which are very important
in improving patient outcomes. Patient quality has been greatly
compromised due to the shortage of nurses in the health facility.
Other effects of the nursing shortage include overcrowding in

emergency rooms, increased mortality rate and increased
turnover among the nurses. Some of the nurses have quit the
organization because of the extensive duties laid on them as a
result of not having adequate nurses. The organization is
majorly funded by the Catholic church and it at times gets
federal grants. It is in a great financial state therefore it should
address the nurses’ shortage issue in order to optimize patient
safety. For it to achieve this, all the stakeholders within the
organization must be involved. Patient safety is based on
adequate and efficient care which is majorly provided by
nurses. Without enough nurses, the safety of patients in the
organization is in jeopardy.
Purpose
The purpose of this proposal is to outline the measures the
organization can take to address the nursing shortage problem.
The proposal suggests that the organization should focus on the
wages and benefits of the nurses in order to attract more nurses
and retain the existing ones. Just like any other professional,
nurses are always looking for organizations that greatly value
them and offer better wages and salaries. Adjusting the current
compensation and benefits package for the nurses is the best
way to address the nursing shortage in both the short and long
term.
Proposal initiative
My initiative entails evaluating current compensation and
benefits package for nurses and determining whether it levels
with that of other organizations or whether it is better. The only
way the organization will be able to attract new nurses and
retain the current ones is by offering a package that is better
than those ones of other organizations in the region (Snavely,
2016). The first step in this initiative is conducting research in
various institutions in the region and country wide to see the
packages they offer their nurses. The next step is comparing the
package the organization offers with the other packages
investigated. The final step is making adjustments and
improving the package to ensure it is very competitive not only

on the regional but also on the national level. Through this, the
organization will be able to attract more nurses regionally and
nationally.
Leadership
The management is responsible of ensuring that the organization
provides optimal patient care therefore it must address the
nursing shortage problem. The management has tried to address
the issue by advertising the nurses’ positions but there are
minimal applicants therefore it must do something to increase
the pool of applicants. The most effective way to do this is to
offer a very competitive compensation and benefits package that
individuals can hardly resist. Leadership is very important in
ensuring this initiative is successfully adopted. Firstly, the
management should come up with a team to investigate the
compensation and benefits packages that other organizations
regionally and nationally offer. The management should offer
all the resources required to conduct the investigation
nationally. The results from this investigation should be utilized
in developing a competitive package that will ensure the current
nurses have no reason to leave the organization and increase the
pool of applicants. By improving the compensation and benefits
package, the organization will be able to attract and retain
nurses therefore addressing the nursing shortage in both the
short and long run.
References
Snavely, T. M. (2016). A brief economic analysis of the
looming nursing shortage in the United States. Nursing
Economics, 34(2), 98-101.
Steege, L. M., & Rainbow, J. G. (2017). Fatigue in hospital
nurses—‘Supernurse’culture is a barrier to addressing problems:
A qualitative interview study. International Journal of Nursing
Studies, 67, 20-28.

NUR 400 Final Project Guidelines and Rubric Overview .docx

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