| Course | NURS 8002 Foundations and Essentials for the Doctor of Nursing Practice |
|---|---|
| Week | Week 7 |
| Paper type | Systems leadership analysis |
| Length | About 1,040 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | September 2026 |
Free sample paper for NURS 8002 Week 7
Four Systems Behind One Late Discharge: A Leadership Analysis of Delays for Patients Going Home on New Oxygen
Student Name
College of Nursing, Walden University
NURS 8002: Foundations and Essentials for the Doctor of Nursing Practice
Instructor Name
Month Day, Year
Four Systems Behind One Late Discharge: A Leadership Analysis of Delays for Patients Going Home on New Oxygen
The Problem
At a composite 180-bed community hospital, patients who are medically ready for discharge but need home oxygen for the first time routinely stay an extra day or more. The pattern is familiar to every medical unit: the patient is ready in the morning, the team discovers in the afternoon that oxygen has not been arranged and the discharge slips to the next day. Delayed discharge has been defined in several ways, but its costs are consistent across studies: longer stays expose patients to hospital-acquired harm, reduce capacity for new admissions and frustrate patients and families (Micallef et al., 2020). This analysis places the home oxygen delay inside the systems that produce it, identifies who holds each system and argues where a DNP-prepared nurse would have standing to act.
Four Systems That Shape the Delay
1. Clinical qualification. Medicare and most insurers cover home oxygen only when documented testing, usually oxygen saturation at rest or with exertion, meets coverage criteria within a defined window before discharge (Centers for Medicare & Medicaid Services, 2023). On the units, this testing is often done late in the day or not at all, because no one is assigned to order it when discharge becomes likely. A patient who needs an exertional test may wait until a respiratory therapist is free. The American Thoracic Society's guideline on home oxygen notes that assessment and prescribing practices vary widely and that patients often receive little education about their equipment (Jacobs et al., 2020).
2. Payer authorization and paperwork. Once testing qualifies, a physician order, a certificate of medical necessity and insurance authorization must be completed. The case manager assembles these, but orders are often incomplete, missing flow rate, duration or the qualifying test result, and must be sent back.
3. Equipment vendor delivery. The hospital contracts with two durable medical equipment vendors. Both require delivery to the bedside or home before discharge, and both stop accepting same-day requests in the early afternoon. A request sent at three o'clock becomes a next-day delivery.
4. The electronic record's discharge workflow. The discharge order set has no prompt for anticipated home oxygen, so the need is often recognized only when the nurse removes the patient's oxygen for a walk and saturation falls. By then the day's vendor window may have closed.
Who Holds Each System
Table 1 identifies the leadership roles that control each system and what each would need to change.
Table 1
Systems, Leaders and Levers
| System | Who holds it | Lever for change |
|---|---|---|
| Clinical qualification testing | Director of respiratory therapy; hospitalist medical director | Standing protocol for nurse- or therapist-initiated testing when discharge is anticipated |
| Authorization and paperwork | Director of case management | Complete order template; early notification to the case manager |
| Vendor delivery | Supply chain director; vendor account managers | Contract terms for later same-day cutoffs or next-morning early delivery |
| Discharge workflow in the record | Nursing informatics lead; chief nursing officer | Prompt in the discharge planning note when oxygen is in use within 48 hours of expected discharge |
No single leader owns the whole process. Each system is run well by its own standards, and the delay arises in the hand-offs between them. That is the defining feature of a systems problem.
Where a DNP-Prepared Nurse Has Standing
A DNP-prepared nurse in this hospital, for example a clinical nurse specialist or nursing director for the medical service, would have standing in three of the four systems and influence in the fourth. Nursing owns the moment when the need for oxygen is usually discovered, the ambulatory saturation check, and could move that discovery earlier by adding it to the daily assessment of any patient on oxygen whose discharge is expected within two days. Nursing leadership shares the discharge workflow with informatics and could sponsor the prompt. And a nurse leader could convene respiratory therapy and case management to agree on a standing protocol for qualification testing, which falls within the respiratory therapy director's authority but depends on nursing to trigger it.
The same nurse would need to be careful about the limits of that standing. Changing when respiratory therapists test patients is the respiratory therapy director's decision, and a nurse who drafts a protocol without that director risks building a process others will not own. The better approach is to bring the director a shared problem and the unit's data and to draft the protocol together, so that the change carries both departments' authority. The same holds for informatics: nursing can specify what the prompt should do, but the informatics lead decides how it fits the record and which other prompts it might compete with.
Vendor contracts sit outside nursing's authority. There, the nurse's role is to bring data: how many discharges each month are delayed by vendor cutoffs. Evidence of that kind gives the supply chain director a reason to renegotiate that complaints do not.
Standing also comes from what the patient experiences. In a national survey of oxygen users, many reported problems with equipment and insufficient education about their oxygen (Jacobs et al., 2018). A nurse who links the discharge delay to the quality of the patient's first days at home, not only to bed capacity, frames the problem in terms every leader in Table 1 shares.
What the Analysis Suggests Next
The analysis points to a first step that does not require any new authority: measure the delay. For three months, nursing could record, for every patient discharged on new oxygen, when the need was first documented, when qualification testing was done, when paperwork was complete, when the vendor request was sent and when the patient left. Those timestamps would show which hand-off costs the most time and which leader should be approached first. The analysis does not yet choose a change model; that choice should follow the data, since a delay concentrated in one hand-off calls for a different approach than one spread across all four.
The larger lesson is that a problem experienced on one unit is rarely owned by that unit. Seeing the systems behind it, and the people who hold them, is the first act of leadership the practice doctorate asks of its graduates.
References
Centers for Medicare & Medicaid Services. (2023). National coverage determination: Home use of oxygen (240.2).
Jacobs, S. S., Krishnan, J. A., Lederer, D. J., Ghazipura, M., Hossain, T., Tan, A.-Y. M., Carlin, B., Drummond, M. B., Ekström, M., Garvey, C., Graney, B. A., Jackson, B., Kallstrom, T., Knight, S. L., Lindell, K., Prieto-Centurion, V., Renzoni, E. A., Ryerson, C. J., Schneidman, A., ... Holland, A. E. (2020). Home oxygen therapy for adults with chronic lung disease: An official American Thoracic Society clinical practice guideline. American Journal of Respiratory and Critical Care Medicine, 202(10), e121-e141. https://doi.org/10.1164/rccm.202009-3608ST
Jacobs, S. S., Lindell, K. O., Collins, E. G., Garvey, C. M., Hernandez, C., McLaughlin, S., Schneidman, A. M., & Meek, P. M. (2018). Patient perceptions of the adequacy of supplemental oxygen therapy: Results of the American Thoracic Society Nursing Assembly Oxygen Working Group survey. Annals of the American Thoracic Society, 15(1), 24-32. https://doi.org/10.1513/AnnalsATS.201703-209OC
Micallef, A., Buttigieg, S. C., Tomaselli, G., & Garg, L. (2020). Defining delayed discharges of inpatients and their impact in acute hospital care: A scoping review. International Journal of Health Policy and Management. Advance online publication. https://doi.org/10.34172/ijhpm.2020.94
Reading the NURS 8002 Week 7 instructions
Systems analyses in Week 7 usually ask you to examine the organizational context of your practice problem: the systems that shape it, the leaders who control those systems and the role a DNP-prepared nurse could play. Papers of four to six pages are common. Restate the problem as a pattern on the unit. Identify the systems that contribute, a small number with distinct roles, and describe how each creates part of the delay or failure. Name leaders by role and say what lever each holds. Be honest about where nursing has standing and where it must persuade with data. Suggest a first step that requires no new authority, and hold the choice of change model until evidence shows where to act.
How this NURS 8002 Week 7 example is built
The problem section describes the pattern and cites Micallef and colleagues on the costs of delayed discharge. Four systems follow: qualification testing, citing the federal coverage determination and Jacobs and colleagues' ATS home oxygen guideline; authorization; vendor delivery; and the discharge workflow. Table 1 maps each system to its leaders and a lever. A section on standing explains nursing's role in three systems, the limits of that role and the need for data on vendor delays, citing Jacobs and colleagues' survey of oxygen users. A closing section proposes timestamps for each hand-off. No change model is chosen yet, and the paper explains why.
NURS 8002 Week 7 rubric: what earns full marks
Systems analyses are commonly scored on the identification of systems, understanding of leadership roles, realism about the nurse's standing and the logic of next steps. Systems earn credit when each contributes distinctly and the analysis shows how hand-offs between them create the problem. Leadership credit goes to roles described by authority rather than by name. Realism is rewarded when the writer distinguishes influence from authority. Next steps that begin with measurement before change are often valued at this stage. Evidence should support both the problem and the patient experience. A clear table and APA formatting help reviewers follow the argument. Graders often credit analyses that show how a problem arises in the hand-offs between systems rather than inside any one of them.
NURS 8002 Week 7 help: mistakes that cost marks
Systems analyses lose marks when they list departments without explaining how each contributes to the problem. Another common loss is assuming the nurse can change systems outside nursing's authority. Some analyses name individuals rather than roles. Others jump to a solution before the hand-offs have been measured. Describe the pattern, identify distinct systems, map leaders and levers, be honest about standing, frame the problem in terms all leaders share and propose measurement first. The desk can prepare an analysis for the problem in your own organization. Leave individual names out, even when you know them. Ask each leader what data would persuade them, and gather that first.
Get a NURS 8002 Week 7 example written to your instructions
Provide the Week 7 prompt and rubric, plus any required headings, and a systems analysis following them is drafted. The first one is free, delivered in 24 to 48 hours. The hospital, its departments and every leader in the table are fictional; naming the real roles in your organization, and judging who holds authority there, is work that stays with you.
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NURS 8002 Week 7 questions, answered
Can the analysis name real people in leadership?
It is safer and more scholarly to name roles rather than people, as the example does. Faculty assess whether you understand a role's authority, not whether you know the individual, and naming colleagues in coursework creates avoidable privacy concerns. If your prompt asks for an organizational chart, a role-based version usually satisfies it without identifying anyone at your workplace.
Does this analysis require a change model?
Not usually at this point. The example names a system where change could be led but does not plan the change, which belongs to later courses. Some sections ask for a brief mention of a change framework here, and if yours does, one paragraph connecting it to the chosen system tends to be enough without turning the analysis into an implementation plan.
Where can I find a free NURS 8002 Week 7 sample paper?
The complete systems analysis, four systems, the leadership table, standing and next steps, is shown here in full and is free. The desk can write one for the organization where you work.
Where does a DNP-prepared nurse have standing in the NURS 8002 Week 7 analysis?
In when the need for oxygen is discovered, in the discharge workflow shared with informatics and in convening respiratory therapy and case management; vendor contracts need data, not authority.
How many systems does the NURS 8002 Week 7 analysis cover?
Four: qualification testing, payer authorization, equipment vendor delivery and the discharge workflow in the record, because each contributes a distinct part of the delay.