| Course | NUR 530 Systems Leadership and Collaborative Practice |
|---|---|
| Module | Module 9 |
| Paper type | Systems change proposal with evaluation and sustainment (project) |
| Length | About 1,480 words, 8 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 530 Module 9
Project Two: The Tomorrow List, a Systems Change Proposal for Earlier Discharges From a Medical Unit
[Student Name]
Southern New Hampshire University
NUR 530: Systems Leadership and Collaborative Practice
Project Two
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Project Two: The Tomorrow List, a Systems Change Proposal for Earlier Discharges From a Medical Unit
Most patients on 6 South leave in the late afternoon, and the hours they spend waiting ripple outward: emergency admissions board downstairs, evening admissions arrive when staffing is thinnest and frail patients lose mobility in beds they no longer need. Over this course, the problem has been assessed as a microsystem, analyzed for its causes, tested against published evidence, planned as a pilot and presented to senior leaders. This proposal brings that work together. It recommends the Tomorrow List, a daily interdisciplinary huddle that names the next day's discharges and moves each department's preparation to the afternoon before, governed by a small steering group and judged by an evaluation able to separate genuine gains from week-to-week noise.
The Problem in Brief
Across three months, fewer than one in ten patients discharged from the unit were off the floor by midday, and the typical departure came shortly before 4:00 p.m. A four-week audit of 60 afternoon departures found that waiting for a facility, waiting for a ride and a discharge order written after midday together explained 68% of them. Following those causes back showed a shared origin: teams settle who will go home only on the morning of departure, so every department begins its part late and in sequence. No role owns the process from end to end, and each department is measured on something other than a timely discharge.
What the Evidence Supports
Appraisal with the Iowa Model found the evidence sufficient to pilot and then decide on adoption (Iowa Model Collaborative, 2017). Two reports from one academic center showed that afternoon interdisciplinary rounds, a checklist and daily feedback more than tripled morning departures, from 11% to 38%, and kept the rate at 35% more than a year later, while emergency admissions began reaching the floors an hour sooner (Wertheimer et al., 2014; Wertheimer et al., 2015). Structured interdisciplinary rounds nearly halved adverse events when tested against a comparison unit in a teaching hospital (O'Leary et al., 2011). Expectations for length of stay should be modest: discharge planning trims less than a day from medical stays (Gonçalves-Bradley et al., 2022), and most ward team interventions have not shortened stays at all (Pannick et al., 2015).
The Proposed Change
The Tomorrow List has three parts. The first is the huddle itself: each weekday at 2:30 p.m., for fifteen minutes, the charge nurse, a case manager, the pharmacist assigned to 6 South and a hospitalist from each of the two teams review every patient and agree which could leave the next day and what each still needs. The second is the afternoon-before bundle. For every patient on the list, the hospitalist drafts the order and summary, the pharmacist starts reconciliation, the case manager sends referrals and authorization requests, and the bedside nurse begins teaching and confirms a morning ride. The third is visibility: the list is posted on the unit board and shared electronically with transport, bed management and housekeeping before the huddle's members leave the station, and the previous day's results are posted each morning.
The design deliberately leaves the hospitalists' rounding order alone. A ten-minute review of listed patients before rounds replaces the earlier, failed request to see discharges first.
Governance and Roles
A steering group of five will govern the change: the 6 South nurse manager as sponsor, the day charge nurse lead as process owner and hospitalist, pharmacy and case management champions. The group meets for thirty minutes each week during the pilot and monthly afterward to review data, resolve blocked items and approve changes to the huddle or checklist. The charge nurse on duty owns the daily list and may escalate any item still blocked at 9:30 a.m. to the nurse manager. Department directors receive the monthly report so that each can see how the change affects its own staff.
Leadership Approach
Two ideas guide the leadership of the change. The order of work comes from Kotter (2012): urgency and a guiding coalition first, then a clear vision, early wins that people can see and, finally, anchoring the huddle in the unit's routines. Both earlier attempts on 6 South skipped straight to instructions and faded. From complexity science, it takes the idea that leaders of complex organizations should set a few simple rules and leave room for local adaptation rather than scripting every step (Plsek & Wilson, 2001). The Tomorrow List rests on three such rules: every likely discharge is named the afternoon before, every department sees the same list, and every blocked item has an owner. Within those rules, each department decides how to do its part.
Evaluation Design
Table 1 lists the measures, their baselines and targets. Data come from time stamps in the electronic record, the charge nurses' daily list and the quality department's readmission reports.
Table 1
Evaluation Measures for the Tomorrow List
| Measure | Type | Baseline | Target at six months |
|---|---|---|---|
| Discharges off the unit by 12:00 | Outcome | 9% | 25% |
| Discharges that were on the prior day's list | Process | Not measured | 70% |
| Median hours from discharge order to departure | Process | 3.1 | 2.0 |
| Median boarding hours for medicine admissions to the unit | Downstream outcome | 5.7 | Monitor |
| 30-day readmissions | Balancing | 15.8% | No increase |
| Day-shift overtime hours per week | Balancing | Unit average | No increase |
| Staff rating of afternoon workload, 1-5 | Balancing | Survey at start | Improve |
Note. Composite baselines. Boarding is monitored rather than targeted because many factors outside the unit influence it.
The weekly before-noon rate will be plotted on a run chart. Six weeks in a row above the baseline median, or a sustained climb, will be read as evidence that the unit has genuinely shifted, not drifted by luck, using standard run chart rules (Langley et al., 2009). Because hospital-wide initiatives or seasonal changes could also move the rate, the same measures will be collected on 5 North, a similar medical unit not using the Tomorrow List, as a concurrent comparison. If both units improve equally, the proposal will not claim the improvement.
Budget
The main cost is staff time. The huddle uses about six staff hours a week, and covering the charge nurse's protected half hour adds about three more. At an estimated blended rate of $55 an hour including benefits, nine hours a week costs about $495, or about $5,940 over a twelve-week pilot. Informatics estimates sixteen hours of internal time to build the shared electronic list, and data support requires about an hour a week. Against these costs, each hour of emergency boarding avoided frees emergency capacity, and each patient spared an unnecessary afternoon in hospital is spared some of the documented harms of delayed discharge, including infections and lost mobility (Rojas-García et al., 2018). The proposal does not claim savings from shorter stays, which the evidence does not reliably support.
Equity and Patient Safeguards
An earlier discharge must never become a rushed one. Patients on the list will be asked the afternoon before whether they feel ready and whether a morning departure is possible for them, and any patient who is not ready stays on the list for another day without penalty to the team. Patients without a ride will be offered the existing transport voucher program rather than being left until a relative finishes work. Morning teaching for patients who need an interpreter will be scheduled with interpreter services the afternoon before, so that a faster process does not shortchange patients whose teaching takes longer.
Sustainment and Spread
At week twelve, the steering group will recommend adopting, adapting or stopping the Tomorrow List. If it is adopted, the huddle will be written into the unit's standard work, added to charge nurse orientation and kept on the monthly operations report, which the Iowa Model describes as integrating and sustaining a practice change before disseminating it (Iowa Model Collaborative, 2017). After six stable months, the format, checklist and electronic list will be offered to the two other medical units, with 6 South's champions available to coach them.
Limitations
The proposal has limits. The strongest timing evidence comes from an academic center with resident teams, and a community unit may respond differently. The unit baselines come from a short period and may not reflect seasonal variation. The comparison unit is similar but not identical, and the evaluation cannot rule out every alternative explanation. These limits are why the proposal begins as a pilot with a comparison and a formal adoption decision.
Conclusion
The Tomorrow List addresses the root cause found on 6 South, a discharge decision made too late for anyone to prepare, by naming tomorrow's discharges this afternoon and giving every department the same list. It asks each discipline for a change in timing rather than more work, puts an owner and a steering group in charge, and measures success, harm and staff experience against a comparison unit. At a cost of about nine staff hours a week, it offers a realistic chance to move a quarter of discharges into the morning and to show the organization what collaborative systems leadership looks like in practice.
References
Gonçalves-Bradley, D. C., Lannin, N. A., Clemson, L., Cameron, I. D., & Shepperd, S. (2022). Discharge planning from hospital. Cochrane Database of Systematic Reviews, 2022(2), Article CD000313. https://doi.org/10.1002/14651858.CD000313.pub6
Iowa Model Collaborative. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223
Kotter, J. P. (2012). Leading change. Harvard Business Review Press.
Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.
O'Leary, K. J., Buck, R., Fligiel, H. M., Haviley, C., Slade, M. E., Landler, M. P., Kulkarni, N., Hinami, K., Lee, J., Cohen, S. E., Williams, M. V., & Wayne, D. B. (2011). Structured interdisciplinary rounds in a medical teaching unit: Improving patient safety. Archives of Internal Medicine, 171(7), 678-684. https://doi.org/10.1001/archinternmed.2011.128
Pannick, S., Davis, R., Ashrafian, H., Byrne, B. E., Beveridge, I., Athanasiou, T., Wachter, R. M., & Sevdalis, N. (2015). Effects of interdisciplinary team care interventions on general medical wards: A systematic review. JAMA Internal Medicine, 175(8), 1288-1298. https://doi.org/10.1001/jamainternmed.2015.2421
Plsek, P. E., & Wilson, T. (2001). Complexity, leadership, and management in healthcare organisations. BMJ, 323(7315), 746-749. https://doi.org/10.1136/bmj.323.7315.746
Rojas-García, A., Turner, S., Pizzo, E., Hudson, E., Thomas, J., & Raine, R. (2018). Impact and experiences of delayed discharge: A mixed-studies systematic review. Health Expectations, 21(1), 41-56. https://doi.org/10.1111/hex.12619
Wertheimer, B., Jacobs, R. E. A., Bailey, M., Holstein, S., Chatfield, S., Ohta, B., Horrocks, A., & Hochman, K. (2014). Discharge before noon: An achievable hospital goal. Journal of Hospital Medicine, 9(4), 210-214. https://doi.org/10.1002/jhm.2154
Wertheimer, B., Jacobs, R. E. A., Iturrate, E., Bailey, M., & Hochman, K. (2015). Discharge before noon: Effect on throughput and sustainability. Journal of Hospital Medicine, 10(10), 664-669. https://doi.org/10.1002/jhm.2412
What the NUR 530 Module 9 instructions ask for
Project Two in NUR 530 is usually the final change proposal, and it pulls the course's earlier work into one document. Typical requirements include a brief statement of the problem and its causes, the evidence supporting the change, a detailed description of the intervention, interprofessional roles and governance, the leadership or change theory guiding implementation, an evaluation plan with measures, resources or a budget, and a plan for sustaining the change. Instructors expect earlier feedback to be reflected throughout. Final proposals often run ten to fourteen pages in APA 7 with tables. Before you start, list every rubric criterion and decide which section answers each, so that nothing is missed when the earlier pieces are combined.
How this NUR 530 Module 9 project two example is built
This sample is a final change proposal for late discharges on a composite medical unit. It compresses the problem and evidence into two paragraphs and describes the intervention, a daily huddle called the Tomorrow List, in three named parts. A steering group, a process owner and an escalation path supply governance. Kotter's steps set the order of work, and complexity science shapes three simple rules. The evaluation table gives each measure a type, baseline and target, and run chart rules plus a comparison unit guard against chance and secular trends. A costed budget, equity safeguards, a sustainment and spread plan and specific limitations complete it, supported by ten real references.
Where the NUR 530 Module 9 rubric puts the points
Final proposals are generally graded on the integration of earlier work, the strength of the evidence base, the clarity and feasibility of the intervention, attention to interprofessional roles, the application of leadership theory, the quality of the evaluation plan, resources and sustainability, and writing. Evaluation plans score highest when they include balancing measures and a way to separate the effect of the change from other influences. Feasibility is judged partly by the budget, so show the arithmetic and label estimates. Sustainability earns full credit when it names the routines, such as standard work or orientation, that will keep the change alive after the project team moves on, rather than simply promising ongoing monitoring.
NUR 530 Module 9 help: the mistakes that cost points
Final projects often lose points by pasting earlier assignments together, which leaves repetition and contradictions, by omitting governance or by describing evaluation only as tracking outcomes. Another common gap is sustainability, which many proposals mention in a single sentence. Rewrite the earlier material in compressed form, add a governance structure, build an evaluation table with balancing measures and a comparison where possible, cost the change honestly and name the routines that will sustain it. Read the finished draft once for repetition alone. If you need a final proposal built from your own milestones and instructor feedback, we can prepare one around your unit and your change.
Get NUR 530 Module 9 written to your instructions
Send your earlier milestones and projects with feedback, the Project Two guidelines and rubric, and any updated data. A complete change proposal with governance, an evaluation design, a budget and a sustainment plan is ready in 24 to 48 hours, and the first one is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
More NUR 530 papers and related MSN samples
- NUR 530 Module 1 Systems Thinking Paper: A Late Discharge as a System Problem
- NUR 530 Module 2 Discussion: Four Leadership Frames on One Discharge Delay
- NUR 530 Module 3 Milestone One: A Clinical Microsystem Assessment of a Medical Unit
- NUR 530 Module 4 Interprofessional Collaboration Paper: What Each Discipline Gains and Gives Up When Discharge Moves Earlier
- NUR 530 Module 5 Project One: A Systems Analysis of Discharge Delays on a Medical Unit
- NUR 530 Module 6 Evidence Appraisal: Appraising the Evidence on Interdisciplinary Rounds and Discharge Planning
- NUR 530 Module 7 Milestone Two: A Draft Implementation Plan for Afternoon Discharge Huddles
- NUR 530 Module 8 Stakeholder Memo: A Memo to Senior Leaders Requesting Support for a Discharge Pilot
- NUR 530 Module 10 Journal: Leading a Change No Single Discipline Owns
- NUR 502 Module 2 Learner Needs Assessment
- NUR 508 Module 1 Role Definition Discussion
- NUR 520 Module 5 Statistical Inference Paper: Confidence Intervals Around County Estimates
- NUR 506 Module 6 Evidence Synthesis Paper
NUR 530 Module 9 questions, answered
Where can I find a free NUR 530 Module 9 Project Two sample?
The complete proposal on this page is free to read: a daily discharge huddle called the Tomorrow List with governance, a leadership approach, an evaluation table, a costed budget, equity safeguards, a sustainment plan and ten real references.
What goes into a NUR 530 final change proposal?
The problem and its causes, supporting evidence, the intervention, roles and governance, the guiding theory, an evaluation plan, resources and a sustainment plan, combined and revised from earlier assignments.
How do I show that a unit-level change caused the improvement?
Use a run chart with standard rules to separate signals from chance and, where possible, a comparison unit that did not make the change.
How do I budget a nursing change project?
Estimate staff hours by role, multiply by a blended hourly rate including benefits, add any build or equipment costs and label all figures as estimates.
What makes a sustainment plan convincing?
Naming the routines that will carry the change forward, such as standard work, orientation, regular reports and an owner, rather than promising to keep monitoring.