| Course | NR 307A Advancing Equity, Inclusion, and Diversity in Healthcare |
|---|---|
| Week | 5 |
| Paper type | Access barrier brief |
| Length | About 940 words, 3 pages |
| Format | Memo with APA 7 citations |
| School | Chamberlain University |
| Program | RN-to-BSN |
| Updated | October 2026 |
Free sample paper for NR 307A Week 5
Memorandum
To: Cardiac Rehabilitation Program Manager; Director, Cardiovascular Service Line
From: Student Name, RN, telemetry staff nurse and BSN student
Date: Month Day, Year
Re: Access barrier brief: night-shift workers stop at the first phone call to cardiac rehabilitation
Purpose
This brief is written for the cardiac rehabilitation program manager and the cardiovascular service line director at a 240-bed regional hospital. It traces how adults who work night shifts move from a heart attack or heart procedure to their first cardiac rehabilitation session, identifies the stage at which most of them stop, and names the arrangement responsible at each stage. It ends with two requests.
Why It Matters
Cardiac rehabilitation improves outcomes after a heart attack, bypass surgery or a stent, yet participation is low nationally. Among more than 366,000 eligible Medicare beneficiaries in 2016, only 24.4% attended even one session, and participation was lower among women, Hispanic patients and Black patients (Ritchey et al., 2020). The national road map to raise participation to 70% calls for automatic referral and for changes in how programs are delivered (Ades et al., 2017). Our program's own report for last year, shared at the service line meeting, showed a similar pattern among patients under 65.
The Group
Adults under 65 who work night shifts, meaning any regular shift that ends between midnight and 8:00 a.m., and who are eligible for cardiac rehabilitation after discharge. In our region that includes warehouse and distribution staff, hospital and nursing home staff, security officers, and factory workers on the third shift. The group is defined by a circumstance, not an identity, because that is what the scheduling system can see.
The Route, Stage by Stage
Stage 1: Hearing that the program exists. What has to happen: the patient is told before discharge that rehabilitation is recommended and covered. What commonly goes wrong: the referral is ordered, but the conversation about it happens at 10:00 a.m. on discharge day, when a night worker admitted after a shift may be asleep or distracted. Arrangement responsible: discharge teaching is scheduled on day shift only.
Stage 2: The first phone call. What has to happen: the program calls within five business days to schedule an intake visit. What commonly goes wrong: calls are made from 9:00 a.m. to 3:00 p.m., during the hours a night worker is asleep. After two missed calls and one voicemail, the referral is closed as "unable to reach." Arrangement responsible: the program's call-back policy, set by the program manager.
Stage 3: The intake visit. What has to happen: a one-hour intake with a nurse and an exercise physiologist. What commonly goes wrong: intake slots are offered only on Tuesday and Thursday mornings, when a night worker has just come off shift or is sleeping. Arrangement responsible: the program schedule.
Stage 4: The sessions. What has to happen: 36 sessions, three times a week, over 12 weeks. What commonly goes wrong: sessions run from 7:30 a.m. to 3:00 p.m., Monday, Wednesday and Friday. A worker coming off a 7:00 a.m. shift can attend at 7:30 a.m. only if the drive is short and they skip sleep. Arrangement responsible: program hours, set around staff shifts.
Stage 5: The trip. What has to happen: travel to the hospital's outpatient building three times a week. What commonly goes wrong: the building's parking garage charges by the hour, and the nearest bus stop is a 12-minute walk. Arrangement responsible: parking and site decisions made by facilities.
Stage 6: Staying. What has to happen: attending 36 sessions. What commonly goes wrong: missed sessions due to schedule changes are not rescheduled; after three missed sessions in a row, the patient is discharged from the program. Arrangement responsible: the attendance policy.
Where They Stop
In the three months I tracked referrals for patients on our telemetry unit who told me they worked nights, seven were referred to rehabilitation. Four referrals were closed at Stage 2 as unable to reach, two patients attended intake but stopped within the first three weeks, and one completed the program. This is a small count from one unit and cannot stand for the hospital, but it matches what staff describe: the phone call is where the route ends for most night workers, before they ever meet the program staff.
The Ask
To the cardiac rehabilitation program manager: change the call-back policy to include at least one call attempt between 4:00 p.m. and 7:00 p.m. and one text message before a referral is closed, and ask about shift work at the first contact. Cost: about one hour of staff time a week, based on current referral volume.
To the cardiovascular service line director: approve a pilot of one late-afternoon session block, 4:00 to 6:00 p.m. three afternoons a week for six months, or a home-based option for eligible low-risk patients who cannot attend during current hours. A scientific statement from three cardiology and rehabilitation organizations concluded that home-based cardiac rehabilitation can be a reasonable option for selected clinically stable low- to moderate-risk patients (Thomas et al., 2019).
Measure: the share of referred night-shift workers who attend a first session, compared before and after the change.
What This Brief Does Not Claim
The count above comes from one unit and my own tracking, not a formal study, and shift work was self-reported. The national data describe Medicare beneficiaries, who are mostly older than the group in this brief. The brief does not claim that the current program is unfair by intent. It was built around the working hours of its staff and the patients who could attend during them, and it serves those patients well.
References
Ades, P. A., Keteyian, S. J., Wright, J. S., Hamm, L. F., Lui, K., Newlin, K., Shepard, D. S., & Thomas, R. J. (2017). Increasing cardiac rehabilitation participation from 20% to 70%: A road map from the Million Hearts Cardiac Rehabilitation Collaborative. Mayo Clinic Proceedings, 92(2), 234-242. https://doi.org/10.1016/j.mayocp.2016.10.014
Ritchey, M. D., Maresh, S., McNeely, J., Shaffer, T., Jackson, S. L., Keteyian, S. J., Brawner, C. A., Whooley, M. A., Chang, T., Stolp, H., Schieb, L., & Wright, J. (2020). Tracking cardiac rehabilitation participation and completion among Medicare beneficiaries to inform the efforts of a national initiative. Circulation: Cardiovascular Quality and Outcomes, 13(1), Article e005902. https://doi.org/10.1161/CIRCOUTCOMES.119.005902
Thomas, R. J., Beatty, A. L., Beckie, T. M., Brewer, L. C., Brown, T. M., Forman, D. E., Franklin, B. A., Keteyian, S. J., Kitzman, D. W., Regensteiner, J. G., Sanderson, B. K., & Whooley, M. A. (2019). Home-based cardiac rehabilitation: A scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation, 140(1), e69-e89. https://doi.org/10.1161/CIR.0000000000000663
NR 307A Week 5 instructions, in plain terms
The Week 5 assignment asks for a short brief on a barrier to accessing care for a specific group, written for a decision maker. Expect the instructions to set a length and format, often a memo or one-to-two page brief, and to ask for the group, the barrier, evidence, a recommendation and how success would be measured, with APA references. Define the group narrowly enough to trace one route through the system. Follow every stage, including dull ones such as the phone call and the trip. Attach each obstacle to the arrangement that produces it. Send each request to the role with authority over that stage, and price it. State what the brief does not claim.
Inside the NR 307A Week 5 example
The memo header names two decision makers at a 240-bed hospital. The purpose section states the brief's scope. Why it matters cites Ritchey et al. (2020) on low participation. The group is defined as adults under 65 whose shifts end between midnight and 8:00 a.m. Six stages follow, each with what has to happen, what goes wrong and the responsible arrangement: a discharge-day conversation, calls made while night workers sleep, morning intake slots, sessions ending at 3:00 p.m., a garage charging by the hour and discharge after three missed sessions. Seven tracked referrals show where people stop. The ask uses Ades et al. (2017) and Thomas et al. (2019).
NR 307A Week 5 rubric: what full points look like
Policy brief rubrics usually grade a clearly defined group and barrier, credible evidence, analysis that links obstacles to decisions, an actionable recommendation with cost and measure, appropriate format and length, and APA. Linking obstacles to arrangements carries the most weight, so every stage names the policy that produces the problem. The group row scores when it is narrow enough to trace. Evidence earns credit from national data and local tracking with its limits stated. Recommendations are graded on addressee, cost and measure, all present here. Format points depend on a memo short enough to read at a meeting. Language respectful enough for the group to read protects professionalism.
NR 307A Week 5 help from the desk
The costliest brief lists hardships without attaching any to a decision. Next is a group so broad that no route can be traced. Length is marked too: an eight-page brief is no longer a brief. An ask with no addressee, obstacles invented rather than sourced, a stage skipped because it seemed obvious, language that would embarrass the reader if the group saw it and no measure attached all cost points. A brief differs from a paper in length and audience. Real local data helps but should be labeled as informal. Make the ask specific enough to approve. Tell us the group and service you are tracing, and an NR 307A brief can be drafted for the right decision maker.
Get a NR 307A Week 5 example written to your instructions
Send the Week 5 instructions with the rubric and the brief template your classroom uses, and a custom example is written to that format and returned inside 24 to 48 hours, free the first time. Tell us the group and the setting type you want it built around, and it will be traced through a comparable service.
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NR 307A Week 5 questions, answered
Is a brief the same as a paper?
No, and sections mark the difference. A brief assumes a busy reader who may stop at any point, so the group, the problem and the request all appear early and the supporting detail sits underneath them. Full paragraphs of background, a literature review and a reflective conclusion all belong to other assignments and cost format marks when they turn up here.
Do I need real data about the group?
Published figures help, but the route itself is the evidence this brief runs on and much of it is observable without any data at all. Opening times, the phone menu, the location, the wording of the appointment letter and the queue at registration can all be checked by anybody. Where you have a published figure, use it for the size of the problem.
How specific should the ask be?
Specific enough that somebody could say yes on the spot. One clinic opened until seven on one evening, one line added to the booking script, one alternative to the parking requirement. Sections reward a request that names its owner, its cost and the date it could start, because that is what turns an assignment about equity into something an organization could actually do.
Where can I find a free NR 307A Week 5 sample paper?
The complete Week 5 memo on night-shift workers and cardiac rehabilitation, with the six stages and the addressed ask, is published on this page.
Where do night-shift workers stop in the NR 307A Week 5 brief?
Most stop at the first phone call: four of seven tracked referrals were closed as unable to reach because the program calls between 9:00 a.m. and 3:00 p.m., while night workers sleep.