NR582NP Week 5 Discussion: Implementing Change

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NR582NP Week 5 Discussion: Implementing Change – Step-by-Step Guide

The first step before starting to write the NR582NP Week 5 Discussion: Implementing Change is to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the paper’s audience and purpose, as this will help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, review its use, including writing citations and referencing the resources used. You should also review the formatting requirements for the title page and headings in the paper, as outlined by Chamberlain University.

How to Research and Prepare for NR582NP Week 5 Discussion: Implementing Change

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify a list of keywords related to your topic using various combinations. The first step is to visit the Chamberlain University library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from the Chamberlain University Library, PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last 5 years and go through each to check for credibility. Ensure that you obtain the references in the required format, such as APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next, create a detailed outline of the paper to help you develop headings and subheadings for the content. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NR582NP Week 5 Discussion: Implementing Change

The introduction of the paper is the most crucial part, as it helps provide the context of your work and determines whether the reader will be interested in reading through to the end. Begin with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NR582NP Week 5 Discussion: Implementing Change

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence collected from the research, and ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance, as well as how it relates to the thesis statement. You should maintain a logical flow between paragraphs by using transition words and a flow of ideas.

How to Write the In-text Citations for NR582NP Week 5 Discussion: Implementing Change

In-text citations help readers give credit to the authors of the references they have used in their work. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

“The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Morelli et al. (2024), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Alawiye (2024) highlights that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.”

How to Write the Conclusion for NR582NP Week 5 Discussion: Implementing Change

When writing the conclusion of the paper, start by restating your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper by restating them. Discuss the implications of your findings and your arguments. Conclude with a call to action that leaves a lasting impression on the reader or offers recommendations.

How to Format the Reference List for NR582NP Week 5 Discussion: Implementing Change

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically, and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Morelli, S., Daniele, C., D’Avenio, G., Grigioni, M., & Giansanti, D. (2024). Optimizing telehealth: Leveraging Key Performance Indicators for enhanced telehealth and digital healthcare outcomes (Telemechron Study). Healthcare, 12(13), 1319. https://doi.org/10.3390/healthcare12131319

Alawiye, T. (2024). The impact of digital technology on healthcare delivery and patient outcomes. E-Health Telecommunication Systems and Networks, 13, 13-22. 10.4236/etsn.2024.132002.

NR582NP Week 5 Discussion: Implementing Change Instructions

Purpose

The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising scholarly literature regarding success strategies for graduate nursing education. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared. This discussion will support the professional formation of the nurse practitioner role.  

Course Outcomes

This discussion enables the student to meet the following course outcomes:   

  • CO 1: Examine essential competencies and underpinnings across advanced nursing practice roles. (POs 2, 5)  
  • CO 5: Demonstrate professional competencies in the formation of the advanced nursing practice role. (POs 1, 2, 3, 4, 5) 

Due Date

Initial posts are due to the discussion forum by Tuesday at 11:59 p.m. MT. Instructor and peer responses are due by Thursday at 11:59 p.m. MT. Students must post on a minimum of two separate days. A 10% late penalty will be imposed for discussions posted after the deadline Wednesday at 11:59 p.m. MT, regardless of the number of days late. NOTHING will be accepted after 11:59 p.m. MT on Sunday (i.e., the student will receive an automatic 0).        

Total Points Possible: 50 points

Preparing the Discussion

Follow these guidelines when completing each component of the discussion. Contact your course faculty if you have questions. Have a look at NR582NP Week 6 Collaboration Café on Nursing Practice Policy.

General instructions:

Review the scenario and address the questions below. 

You are a nurse practitioner employed in a busy primary care office with responsibilities for managing the office staff, including the medical assistants who aid in client care as well as filing, answering calls from clients, processing laboratory results, and taking prescription renewal requests from clients and pharmacies. The office is part of a larger hospital system. One of the medical assistants has worked in the practice for 10 years and is very proficient at her job. She knows almost every client in the practice and has an excellent rapport with all the providers.  

During an office visit, a client requested a refill for an amoxicillin prescription. When examining the empty bottle, you noted that the date on the bottle was 1 week ago. You also noted your name printed on the label as the prescriber though you did not see the client last week. The client explained that she called last week concerned about her cough and spoke to the medical assistant, who assured her that a prescription would be sent to the pharmacy for the concern. You do not recall having discussed this client with the medical assistant; the other providers in the practice deny speaking to or consulting about the client.  

Include the following sections: 

  1. Application of Course Knowledge:  Answer all questions/criteria with explanations and detail. 
    1. Based on the situation above, what are the ethical and legal implications for the practice at the micro-, meso-, and macro-level of the system? 
    1. What changes do you recommend to prevent further episodes of the problem behavior? What coaching and feedback skills can be used to discuss the event with the medical assistant? 
    1. Which change model would you use to implement the identified change and why: Lewin’s Theory of Planned Change, Plan-Do-Study-Act (PDSA), or Kotter’s 8-Step Process for Leading Change?  
    1. Identify and discuss one barrier to implementing the change process. Identify and discuss one factor that facilitated the change process. 
  3. Integration of Evidence: Integrate relevant scholarly sources as defined by program expectations:
    1. Cite a scholarly source in the initial post.
    1. Cite a scholarly source in one faculty response post.
    1. Cite a scholarly source in one peer post.
    1. Accurately analyze, synthesize, and/or apply principles from evidence with no more than one short quote (15 words or less) for the week.
    1. Include a minimum of two different scholarly sources per week. Cite all references and provide references for all citations.
  5. Engagement in Meaningful Dialogue: Engage peers and faculty by asking questions, and offering new insights, applications, perspectives, information, or implications for practice.
    1. Peer Response: Respond to at least one peer.
    1. Faculty Response: Respond to at least one faculty post.
    1. Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice.
  1. Professionalism in Communication: Communicate with minimal errors in English grammar, spelling, syntax, and punctuation.
  2. Reference Citation: Use current APA format to format citations and references and is free of errors.
  3. Wednesday Participation Requirement: Provide a substantive response to the graded discussion topic (not a response to a peer or faculty), by Monday, 11:59 p.m. MT of each week.
  4. Total Participation Requirement: Provide at least three substantive posts (one to the initial question or topic, one to a student peer, and one to a faculty question) on two different days during the week.

NR582NP Week 5 Discussion: Implementing Change Example

Implementing Change

Good evening, Professor and Class,

In the provided scenario, a nurse practitioner at a primary care office discovers that a prescription for amoxicillin was filled under their name without authorization. The client explained that the medical assistant (MA), who had been with the practice for 10 years, assured her that the prescription would be sent after a phone consultation regarding her cough. This situation raises significant ethical and legal concerns within the healthcare system.

At the micro-level, this incident indicates a breakdown in communication between the nurse practitioner and the MA. Ethically, the nurse practitioner is responsible for ensuring accurate medical records and prescriptions, which are compromised when medications are prescribed without proper consultation. This jeopardizes patient safety and trust in the provider-patient relationship. Legally, using the nurse’s name without consent could be considered malpractice, especially if adverse effects result. Unauthorized prescribing exposes the practice to potential disciplinary action and lawsuits.

At the meso-level, which refers to the organizational structure, the medical assistant acted outside her scope by assuring the patient of a prescription. Medical assistants are legally bound to operate within defined boundaries, and failure to adhere to these limits could expose the entire practice to liability. This situation reveals systemic issues with delegation and communication protocols. If staff members are unclear about their roles, incidents like this could recur, threatening the clinic’s operational integrity and potentially leading to regulatory penalties or loss of accreditation.

At the macro-level, this incident could reflect poorly on the larger healthcare system to which the practice belongs. Repeated errors like these could lead to regulatory scrutiny or lawsuits, damaging the organization’s reputation and legal standing. Systemic issues within the healthcare system could lead to broader legal implications, including regulatory penalties for failing to maintain appropriate oversight over prescription authorization.

To prevent future incidents, it is essential to establish clearly defined protocols for prescription refills, especially when requests involve medical assistants. These assistants need to be fully aware of their professional limitations, particularly regarding clinical decisions. Regular training and clear communication policies should be implemented to reinforce these boundaries and ensure compliance.

To prevent this from happening again, there are a few changes that could be implemented. First, there should be a more clearly defined protocol for prescription refills, mainly when a medical assistant handles the request. Medical assistants need to be fully aware of the limitations of their role, particularly when it comes to making clinical decisions. To enforce this, regular training sessions and clear communication policies should be put in place.

When addressing this issue with the medical assistant (MA), it is crucial to use coaching and feedback that encourages improvement without creating defensiveness. One approach could be to say, “I noticed a prescription went through last week that was not discussed with me, and I would like to understand how we can prevent that from happening again.” This opens the door for a collaborative discussion about the importance of maintaining ethical and legal standards in practice (Crilly et al., 2023).

To implement these changes effectively, Lewin’s Theory of Planned Change offers a valuable framework. This theory consists of three stages: unfreezing, moving, and refreezing (Crilly et al., 2023).

Unfreezing: The first step is to raise awareness of the need for change. A team meeting could be held to discuss the incident and the ethical and legal issues surrounding unauthorized prescription refills. It is crucial to clarify the roles and responsibilities of all staff members, particularly medical assistants.

Moving: Next, new protocols for handling prescription requests can be introduced, along with regular training sessions to ensure all staff understand their responsibilities. During this stage, it is important to offer support as staff adjust to these changes, ensuring they feel comfortable asking questions or addressing concerns.  

Refreezing: Once the new procedures are in place, the goal is to ensure that these practices become routine. Periodic check-ins or evaluations can help reinforce adherence to the new system and allow for any necessary adjustments (Crilly et al., 2023).

One potential barrier to implementing this change could be resistance from the medical assistant or other staff members who may feel that they have been doing their jobs just fine for years. To overcome this, clearly communicate why the change is necessary and how it benefits everyone—especially the patients. A factor that could facilitate the change is the medical assistant’s long-standing relationship with the office and her willingness to adapt. Since she has a good rapport with both clients and providers, she is likely invested in the success of the practice and will be motivated to avoid future mistakes that could harm her reputation or the practice’s reputation.

Reference:

Crilly, E., Harrison, C., Maahs, J., Beijlevelt, M., Ramsay, B., Githinji, C., Sisdelli, M., & Dsouza, A. (2023). Change management and haemophilia care: A framework for introducing innovations in treatment. Journal of Haemophilia Nursing, 5(2), 123-130. https://doi.org/10.1111/hae.15003

NR582NP Week 5 Discussion: Implementing Change Example 2

Hello everyone,

The scenario described in this week’s discussion can have negative implications on many levels. At the micro level, this situation can impact the medical assistant in legal ways. Medical assistants do not have the medical training or licensure to refill prescriptions. This is beyond their scope of practice and can elicit legal action against that person. Although the medical assistant is an expert in her field and has 10 years of experience, it is still not ethical or legal for her to be refilling medications.

At the meso level, this situation can be escalated to other members of the team. If another medical assistant sees this senior medical assistant refilling medications for patients, they may also think it is okay for them to do so. This makes the problem spread and puts more patients in danger. The ethical implications of this scenario are massive. There is a huge patient safety risk in this situation. At the macro level, this scenario causes many problems at the leadership and management level. The management team now must spend time on disciplinary action and ensure the patient is safe and there are no bad outcomes. This can also make the practice look bad if the public were to find out about this.

This scenario should not have been allowed to happen in the first place. An important change that should be implemented is giving access to specific computer program actions on a need basis. Medical assistants should not have access to the part of the computer system that allows them to enter or refill medications. Staff members should only have access to the parts they need to complete their job. This would have mitigated the problem before it started. Another change I would suggest is reviewing each staff member’s scope of practice.

Although this medical assistant has 10 years of experience and has extensive knowledge, the scope of practice is still significant. Even as an RN, we are not allowed to refill medications. Ensuring each staff member knows their roles and responsibilities would also be helpful. This issue will have to be addressed with the medical assistant and especially the provider under whom the medication was refilled.

Some coaching and feedback skills that can be used are open communication, active listening, being truthful and straight forward, give feedback as close to the incident as possible, using encouraging words such as “can you tell me what happened?”, and being aware of body language to name a few (van Blankenstein et al., 2021). These skills will make the employee feel more comfortable telling the truth and can foster effective communication amongst the leadership team and the employee.

To implement the changes discussed above, I would implement the Plan-Do-Study-Act (PDSA) model because it allows stakeholders to develop a plan for change, implement the plan, assess its effectiveness, and then adjust elements to improve the plan if needed (Connelly, 2021). In this scenario, if management wanted to give the medical assistant another chance since she has been a long-time loyal employee, this method would work great.

The leadership team can come up with a plan to ensure this does not happen again, along with disciplinary action that will take place. Then the medical assistant will be given time to implement the discussed plan and assess any improvements. If there are systematic problems identified, they can be easily fixed because this cycle can be done repeatedly. This model gives the medical assistant a chance to learn from her mistakes and allows for system errors to be improved.

One barrier to implementing the changes above could be the willingness to accept change. If the medical assistant does not see anything wrong with their actions, the change model will prove challenging to implement. Another barrier could be on a system level. If the computer system cannot accommodate different access levels for people based on their job title requirements, there could be a problem implementing change. One factor that can facilitate the change process is the fact that the medical assistant has been an employee there for some time and would most likely want to do whatever she could to regain leadership’s trust. Utilizing the correct feedback skills can also facilitate change because it makes the medical assistant feel heard and not attacked.

References:

Connelly, L. M. (2021). Using the PDSA model correctly. Medsurg Nursing, 30(1), 61–64.

van Blankenstein, F. M., O’Sullivan, J. F., Saab, N., & Steendijk, P. (2021). The effect of peer modelling and discussing modelled feedback principles on medical students’ feedback skills: a quasi-experimental study. BMC Medical Education, 21(1), 332–332. https://doi.org/10.1186/s12909-021-02755-z