| Course | NURS 3021 Professional Nurses as Change Agents |
|---|---|
| Week | Week 5 |
| Paper type | Practice problem analysis |
| Length | About 760 words, 5 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Bachelor of Science in Nursing (BSN) |
| Updated | October 2026 |
Free sample paper for NURS 3021 Week 5
Practice Problem Analysis: Late Discharges on One Orthopedic Unit, a Sequencing Problem Rather Than a Staffing One
Student Name
College of Nursing, Walden University
NURS 3021: Professional Nurses as Change Agents
Instructor Name
Month Day, Year
Practice Problem Analysis: Late Discharges on One Orthopedic Unit, a Sequencing Problem Rather Than a Staffing One
Part 1: Discussion Post
On my 28-bed orthopedic unit, patients who are medically ready to go home in the morning routinely leave in the late afternoon, and I want to argue that the cause is sequencing, not headcount. When staffing is discussed at unit meetings, late discharges are treated as proof that we need more nurses. But on days when we are fully staffed, discharges are still late. What I see instead is a chain of steps each requested only after the one before finishes. Physical therapy clears the patient for stairs, then the nurse asks for medication reconciliation, then the pharmacist reviews the list, then the nurse calls transport or the family. Each step waits on the last, and each wait is 30 to 90 minutes.
The two explanations predict different things, which is what makes the argument testable. If staffing were the cause, discharges would be later on short-staffed days and earlier on fully staffed ones. If sequencing is the cause, discharge times would be late on both kinds of day, and the delay would sit in the gaps between steps rather than in any one step. A two-week log of when each step was requested and completed, kept by the nurses discharging patients, would show which pattern our unit follows. I expect the log to show that most of the afternoon is spent waiting between requests, not waiting for a nurse.
If that is right, adding a nurse would not help much, because the nurse is not the bottleneck; the handoffs between steps are. Hospitals that set a goal of discharging before noon and started discharge tasks earlier and in parallel moved discharges earlier in the day, and one reported the average discharge time moving about an hour and a half earlier (Wertheimer et al., 2014). The template below narrows this into a problem I can analyze.
Part 2: Problem Statement
On the orthopedic unit, patients with a planned morning discharge after joint replacement or fracture repair are discharged, on most days, in the afternoon, several hours after the time the team planned the day before. The routine that produces the gap is a sequential discharge process in which therapy clearance, medication reconciliation, pharmacist review, and transport are each requested after the previous step is complete. No unit-level data are currently collected on planned versus actual discharge times, which is itself part of the problem.
Part 2: Significance
The delay matters beyond the unit. Beds held into the afternoon are not available for patients waiting in the emergency department or recovery, and later discharge times have been associated with emergency department crowding and poorer flow performance (Khanna et al., 2016). A simulation study found that spreading discharges more evenly through the day, rather than concentrating them late, reduced emergency department congestion (Wong et al., 2010). For patients, a planned morning discharge that becomes an afternoon of waiting affects rides home, pain control timing, and the experience of the last day in the hospital.
Part 2: Contributing Factors
Table 1 groups contributing factors in the categories of a fishbone diagram.
Table 1
Contributing Factors to Late Discharges, Fishbone Categories
| Category | Contributing factor |
|---|---|
| People | Physical therapy has one therapist for the unit in the morning; nurses do not know the therapy schedule |
| Process | Medication reconciliation is started only after therapy clearance; transport is booked only after the pharmacist signs off |
| Process | Discharge prescriptions are written on the morning of discharge rather than the evening before |
| Communication | The planned discharge time is not written anywhere the whole team can see |
| Communication | Families are told "sometime tomorrow" and arrive in the afternoon |
| Equipment | Walkers and other equipment are delivered by an outside vendor with a window of several hours |
Part 2: Ownership
Each factor is marked by who could change it. Within the staff nurse's reach: writing the planned discharge time on the room whiteboard and the handoff sheet; telling families a specific target time; and starting medication reconciliation the evening before instead of after therapy clearance. Within the charge nurse's reach: a 9:00 a.m. check of every planned discharge to see which steps are not yet requested. Needing others: the discharge prescription timing belongs to the surgical team, the therapy schedule to the rehabilitation manager, and the equipment delivery window to case management and the vendor. The ownership column shows that the first changes, the ones I could propose next week, do not require any extra staff at all, which is the practical point of the sequencing argument.
References
Khanna, S., Sier, D., Boyle, J., & Zeitz, K. (2016). Discharge timeliness and its impact on hospital crowding and emergency department flow performance. Emergency Medicine Australasia, 28(2), 164-170. https://doi.org/10.1111/1742-6723.12543
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
Wong, H. J., Wu, R. C., Caesar, M., Abrams, H., & Morra, D. (2010). Smoothing inpatient discharges decreases emergency department congestion: A system dynamics simulation model. Emergency Medicine Journal, 27(8), 593-598. https://doi.org/10.1136/emj.2009.078543
NURS 3021 Week 5 instructions, in plain terms
The fifth NURS 3021 week often asks for an analysis of a practice problem on your unit, sometimes paired with a short discussion post. You write a focused problem statement, explain its significance, analyze contributing factors with a cause-and-effect diagram, and identify who owns each factor. Faculty treat the problem statement as the foundation and penalize broad ones. Cite quality improvement sources in APA 7. A fishbone diagram may be optional but helps. The analysis usually stops short of proposing a solution, which comes next week. The problem should be narrow enough for one unit to address. NURS 3021 faculty want the problem quantified where possible, such as the average discharge hour for ready patients.
How the NURS 3021 Week 5 example is put together
Two linked pieces. The post runs near four hundred and fifty words and claims that late discharges on the unit come from sequencing, not headcount: therapy clearance, medication reconciliation and transport are each requested only after the one before finishes. The templated analysis follows in four labeled sections over two pages. The problem statement is a single paragraph naming the unit, the routine and the gap between planned and actual discharge time, described without invented figures. Significance ties the delay to bed flow and patient experience through two published sources. A fishbone diagram, rendered as a table, groups contributing factors under people, process, communication and equipment. The final section, ownership, marks each factor as within the staff nurse's reach, the charge nurse's, or a department outside the unit.
Where the marks sit in the NURS 3021 Week 5 rubric
Problem analyses lose most often at the problem statement, which rubrics tend to treat as the foundation for everything after it. A statement that names a broad topic, discharge delays in hospitals, leaves the analysis rows reading as general commentary. Many sections then credit the quality of the cause analysis, looking for factors that are specific and plausibly linked to the problem rather than a list of every difficulty in health care. Evidence for significance is often scored on currency and relevance, so a source on emergency department boarding cited for an inpatient discharge problem reads as a near miss. The discussion post carries its own credit for argument, and a post that restates the template in paragraph form has given up that portion. Diagrams need labels and a sentence of interpretation, or they read as decoration.
NURS 3021 Week 5 help: mistakes that cost marks
Problem analyses lose the most at the problem statement, when it names something as broad as poor communication. Narrow it to one process on one unit. Another common gap is blaming staffing without evidence. Look at sequence and timing. Writers also list contributing factors without owners. Say who controls each one. Avoid proposing a solution before the analysis is done. Use a fishbone or similar tool if allowed. Quantify the problem if you can, such as average discharge time. Close with the factor most within nursing's control. Writers also forget to say how the problem looks from the patient's side, such as waiting dressed for hours. Add it.
Get a NURS 3021 Week 5 example written to your instructions
Send both halves of Week 5, the discussion prompt and the analysis template, along with the rubric. The NURS 3021 practice problem analysis comes back as a linked post and a filled template. First one free, 24 to 48 hours. The problem in the sample belongs to a composite orthopedic unit; any problem your section assigns can replace it.
More NURS 3021 papers and BSN samples
- NURS 3021 Week 1: Professional Stance Post
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- NURS 3021 Week 7: Stakeholder Buy-In Analysis
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- NURS 3021 Week 10: Integrated Change Synthesis
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NURS 3021 Week 5 questions, answered
How narrow should a practice problem be?
Narrow enough that its causes can be listed and sorted on one page. The example limits itself to discharge timing on one orthopedic unit, which lets the fishbone stay specific and the ownership section stay honest. A problem framed at hospital or national scale can still be discussed, but the analysis becomes a literature summary and loses the unit-level detail these rubrics credit.
Is a fishbone diagram required?
Not always. Some templates ask for a root cause tool by name, others only for contributing factors. The example uses a fishbone because its categories force a spread of causes beyond staffing, which supports the post's claim. Where a template names a different tool, such as the five whys, the same factors can be arranged that way without changing the argument.
Does the analysis propose a solution?
Only a direction. Week 5 in most sections is about understanding the problem, and the full proposal usually arrives a week later. The example ends by naming the factor a staff nurse could most plausibly address, requesting therapy clearance earlier in the day, and stops there. Offering a finished solution this early can read as skipping the analysis the week is actually grading.
Where can I find a free NURS 3021 Week 5 sample paper?
The late discharge analysis is printed here with the discussion post, the narrow problem statement, its significance, contributing factors and ownership.
What problem does NURS 3021 Week 5 analyze?
Late discharges on an orthopedic unit, argued as a sequencing problem rather than a staffing one.