| Course | DNRS 6211 Finance and Economics in Healthcare Delivery |
|---|---|
| Week | Week 6 |
| Paper type | Discussion post with two peer replies |
| Length | About 560 words, 4 pages |
| Format | Discussion post, APA 7 citations |
| School | Walden University |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | October 2026 |
Free sample paper for DNRS 6211 Week 6
Week 6 Discussion: Initial Post
Keep the Labor and Delivery Unit at the Rural Site Open, and Say What Would Change My Mind
The service is the labor and delivery unit at our system's composite 25-bed rural hospital, 58 miles from the system's main campus, which delivers about 170 babies a year. My position is that the system should keep it open for at least the next 3 years, while accepting that it loses money.
The financial case against the unit is real, and most of it is the cost of readiness. The unit must have two registered nurses with obstetric skills on duty every hour of the year, plus a physician and anesthesia coverage on call, whether one woman is in labor or none. That standby cost is about $2.4 million a year and barely changes if births rise or fall by 30. The volume-driven portion, supplies, extra nursing hours, and medicines, is only about $2,100 per birth, or $357,000 a year. With about half of births paid by Medicaid, net revenue averages roughly $7,800 per birth, about $1.33 million a year, leaving a loss near $1.4 million. Closing the unit removes almost all of the readiness cost at once, which is why low-volume units close (Reiter & Song, 2021).
The unit also generates activity elsewhere in the system: newborn care, pediatric visits at the rural clinic, gynecologic surgery, and families who stay with the system for other care. I think that downstream value is real, but I mark it as contested. It is difficult to measure, and some of those families might stay with the system anyway, so I do not count it in the loss above.
The access argument is where my position rests. More than half of rural U.S. counties had no hospital obstetric services by 2014, and 9% lost them in the decade before (Hung et al., 2017). In rural counties not adjacent to urban areas, losing hospital obstetric services meant that, in the following year, more babies were born at home or en route, more were delivered at hospitals lacking a labor unit, and slightly more arrived preterm (Kozhimannil et al., 2018). Our rural site is in exactly that kind of county. If the unit closes, women in labor face a drive of nearly an hour, and some will arrive at the rural emergency department anyway, where staff would no longer keep their obstetric skills current.
I would change my position if births fell below 120 a year for 2 consecutive years. At that volume, nurses could not maintain their skills, and the safety argument that supports keeping the unit would begin to cut the other way.
Reply to Amanda
Amanda, you argued for closing the unit because the loss could fund two rural health clinics. Your financial paragraph treats the whole $2.4 million as savings, but some readiness cost moves rather than disappears: the rural emergency department still needs staff able to handle births that arrive anyway. How much of the saving remains once that is counted?
Reply to Robert
Robert, you support keeping the unit because of downstream revenue, and I agree it exists. But your access paragraph is where I would push. You cite distance only; the Kozhimannil study looked at what happened to births after units closed, not just how far women drove. Would including outcomes make your argument stronger than the revenue claim does?
References
Hung, P., Henning-Smith, C. E., Casey, M. M., & Kozhimannil, K. B. (2017). Access to obstetric services in rural counties still declining, with 9 percent losing services, 2004-14. Health Affairs, 36(9), 1663-1671. https://doi.org/10.1377/hlthaff.2017.0338
Kozhimannil, K. B., Hung, P., Henning-Smith, C., Casey, M. M., & Prasad, S. (2018). Association between loss of hospital-based obstetric services and birth outcomes in rural counties in the United States. JAMA, 319(12), 1239-1247. https://doi.org/10.1001/jama.2018.1830
Reiter, K. L., & Song, P. H. (2021). Gapenski's healthcare finance: An introduction to accounting and financial management (7th ed.). Health Administration Press.
The Walden DNRS 6211 Week 6 instructions
The DNRS 6211 Week 6 thread wants a stated position on a service that is financially weak but tied to the organization's mission, such as a rural obstetric unit, a behavioral health program or a clinic in an underserved area. You are expected to commit to keep, close or restructure, and to support the position with financial reasoning and with evidence on access or outcomes. Most sections want two or more scholarly sources and the course text in the initial post, and the prompt often asks what would change your view. Two replies follow later in the week. Each reply should challenge a specific part of a classmate's argument and bring its own citation.
How this DNRS 6211 Week 6 example is built
The post names an obstetric service at a rural site in its first line and states its position in the second, which is unusual and deliberate. The financial paragraph handles the cost of readiness directly, the standby staffing a service carries whether or not anyone arrives, and separates that from the volume-driven portion. A second paragraph brings in downstream activity the service generates elsewhere in the system, and marks the claim as contested rather than settled. The access paragraph deals in travel distance and transfer risk, cited to health services literature rather than asserted. A final sentence says what evidence would make the writer change sides, which is the sentence most posts in this thread never include. Replies run shorter and each attacks one paragraph.
Where the marks sit in the DNRS 6211 Week 6 rubric
Rubrics for this thread reward a stance that could turn out wrong. A post presenting both sides evenhandedly and declining to land collects the participation area and forfeits most of the analysis credit, which surprises writers who were taught balance as a virtue. Financial reasoning is graded on whether it survives contact with fixed cost behavior, so an argument built only on revenue per case reads as incomplete. The access side is graded on sourcing rather than on conviction, and posts that turn ethical at that point lose ground quickly. Currency of citation matters, since service closure literature moves. The reply area rewards a response that concedes something real before it disagrees, and quietly penalizes the reply that restates the peer's post before adding a paragraph of agreement.
Common DNRS 6211 Week 6 mistakes, and how to avoid them
Posts on this question lose marks for sitting on the fence; graders want a position that could be wrong. Treat fixed and variable cost separately, because closing a unit rarely saves its whole budget when standby staffing and shared overhead remain. Label downstream revenue claims as uncertain unless you have data. Support access arguments with published research on travel distance or outcomes, not with moral language alone. Make sure your sources are current, since closure studies age fast. In replies, grant the classmate's strongest point first, then disagree, then point to one paragraph and explain your objection. Avoid restating the classmate's post at length; the reply is graded on what it adds.
Get a DNRS 6211 Week 6 example written to your instructions
Send over the thread prompt, whatever position your section requires and the reply count it grades, and an initial post plus responses come back written to those terms. First custom one is free, turned around in 24 to 48 hours. No contract language from any organization is requested, reproduced or paraphrased in what returns to you.
More DNRS 6211 papers and DNP samples
- DNRS 6211 Week 1: Discussion Post
- DNRS 6211 Week 2: Concept Analysis
- DNRS 6211 Week 3: Budget Worksheet
- DNRS 6211 Week 4: Variance Analysis
- DNRS 6211 Week 5: Cost-Benefit Analysis
- DNRS 6211 Week 7: Capital Request
- DNRS 6211 Week 8: Payer Mix Analysis
- DNRS 6211 Week 9: Business Case
- DNRS 6211 Week 10: Executive Summary
- DNRS 6211 Week 11: Reflection Paper
- DNRS 6630 Week 6: Treatment plan
- NURS 8750 Week 6: Conference Poster Draft
- DNRS 6800 Week 6: Case formulation
- NURS 8740 Week 6: Tables and Figure Set
DNRS 6211 Week 6 questions, answered
Is it safer to argue for keeping the service?
Neither position is safer. What gets graded is whether the financial reasoning holds and whether the access claims are sourced, and both positions can be argued well or badly. This example argues for keeping the service and concedes real costs along the way; a closing argument built on the same discipline would score the same in most sections.
How long should an initial post in this course run?
The example lands near the length most sections set for a doctoral thread, but nothing published fixes a word count and prompts differ substantially. Read the participation instructions in your classroom, because they usually specify both a floor for the initial post and a separate expectation for replies, and the rubric follows those numbers rather than any convention.
Do replies need their own citations?
In most sections they do, and the two here each carry one. A reply that disagrees on evidence and cites nothing is asking a classmate to accept an opinion, which is the same failure the initial post is graded against. The citation does not have to be new work, only relevant to the specific paragraph being contested.
Where can I find a free DNRS 6211 Week 6 sample paper?
The rural labor and delivery post, together with the replies to Amanda and Robert, appears here in full; the margin notes show the argument each one makes.
Should I argue to keep or close the service in DNRS 6211 Week 6?
Either side can earn full marks. Graders check that the financial reasoning handles fixed costs correctly and that access claims rest on cited research.