| Course | NR 446 Collaborative Healthcare |
|---|---|
| Week | 1 |
| Paper type | Discussion post with two replies |
| Length | About 690 words |
| Format | Discussion post with APA 7 citations |
| School | Chamberlain University |
| Program | RN-to-BSN |
| Updated | October 2026 |
Free sample paper for NR 446 Week 1
Week 1 Discussion: When a Team Stalls
The Vancomycin Dose That Waited Two Hours
Initial Post
The shift I keep thinking about was a Sunday night on a 30-bed medical unit. A man in his sixties with a leg wound had spiked a fever and met sepsis screening criteria at 2100. Blood cultures were drawn and vancomycin was ordered for 2200. At 2150, the pharmacist on the overnight shift called to ask me to hold the dose until a trough level came back, because the patient had received vancomycin in the emergency department that morning and his creatinine had risen from 1.1 to 1.6 during the day. I wanted to give the dose on time, because a delay in antibiotics for a patient who may be septic is exactly what the sepsis bundle exists to prevent. The trough was drawn at 2215 and resulted at 2340. The dose went in at 0005, two hours late.
Looking back, neither of us was wrong. The pharmacist was protecting the kidneys of a man whose creatinine was climbing on a drug known to injure them. I was protecting against the harm of delayed treatment in possible sepsis. Both priorities were legitimate, and both were ours to hold. What failed was not a person but the way the two priorities met: we spent forty minutes on the phone and paging the covering physician, who was admitting in the emergency department, because neither of us had a known way to settle a disagreement like this at night.
The condition that was missing was what Salas et al. (2005) call a shared mental model: an agreement, before the moment arrives, about how the team will make a particular kind of decision. We had no shared plan for what happens when a time-critical dose collides with a safety check. If our unit had agreed that in suspected sepsis the first dose goes on time and the level is drawn before the second dose, or the reverse, either of us could have acted in two minutes instead of waiting two hours. I could not have fixed that at 2150; I am a staff nurse and I do not write pharmacy protocols. What I could have done was ask the pharmacist, once the dose was finally in, whether we could bring the question to the unit's practice council together.
I am curious whether others have had a similar stall where two disciplines were both right. What was missing on your shift?
Reply to a Classmate
Your story about the physical therapist who wanted to walk your patient while you were waiting for a pain dose to take effect sounds a lot like mine, two correct priorities and nobody to break the tie. I would add a second missing condition, though. In your case, it sounds like the plan for the day was never said out loud to both of you. The therapist was following the mobility goal on the care plan and you were following the pain plan, and each of you only found out about the other's plan at the bedside. A short interprofessional huddle in the morning, even two minutes, could have put the two plans in the same room. The Interprofessional Education Collaborative (2023) describes this as communicating with team members in a way that supports a shared goal, and in your case the goal was shared, getting the patient up safely, but the timing was not.
Reply to a Second Classmate
I think your stall came from a missing route for raising a concern rather than a personality clash, even though it felt personal. The respiratory therapist disagreed with the plan to wean the oxygen, but the only way to say so was to page the same resident who had written the order, which put her in the position of challenging a decision to the person who made it. A known escalation route, even just knowing that the charge nurse or rapid response nurse can be called for a second opinion, would have let her raise the concern without it becoming a confrontation. Did your unit end up changing anything?
References
Interprofessional Education Collaborative. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3.
Salas, E., Sims, D. E., & Burke, C. S. (2005). Is there a "big five" in teamwork? Small Group Research, 36(5), 555-599. https://doi.org/10.1177/1046496405277134
NR 446 Week 1 instructions, in plain terms
The first NR 446 discussion has you describe an experience where team collaboration broke down and analyze what caused it. Graders look for one real situation, the perspectives of the professions involved, a team concept that explains the breakdown, a source from the course and replies that add something. Tell one shift with times, values and roles, but no names. Show what each profession was protecting, so the reader sees two correct priorities. Explain the stall with one named team condition rather than a character judgment. Stay honest about what you, as a staff nurse, could and could not have changed. In your replies, give each classmate's story a structural cause, such as a missing escalation route.
How the NR 446 Week 1 example is put together
The first paragraph sets out the Sunday night, the sepsis screen at 2100, cultures, the 2200 order, the pharmacist's call at 2150 and the creatinine rise, then the trough drawn at 2215 and the long wait for the result. The second argues that the pharmacist was protecting the kidneys and the nurse was protecting against delayed antibiotics. The third names the shared mental model from Salas and colleagues and describes the agreement that would have let either act in two minutes, while admitting a staff nurse does not write pharmacy protocols. The question asks classmates what was missing. The first reply attaches a different condition to a story about a physical therapist and pain medicine. The second reply names a missing escalation route in a respiratory therapy disagreement.
Reading the NR 446 Week 1 grading rubric
Discussion grading for NR 446 usually covers addressing the prompt, analysis of team dynamics, use of interprofessional concepts, application to the writer's role, substantive replies and APA, with timely posting. Analysis of team dynamics is the deciding row, and the post earns it by showing two correct priorities and explaining the stall with a structural condition. Concept use is credited through Salas and colleagues' shared mental model, applied to this shift. The role row scores because the writer stays a staff nurse and names what was within reach. The IPEC core competencies frame collaboration. Replies earn their points by adding a cause to each classmate's story instead of endorsing it. Two references complete APA.
Common NR 446 Week 1 mistakes, and how to avoid them
Posts lose points first by answering with character judgments, such as a dismissive physician or an overloaded aide, which read as testimony rather than analysis. Another loss is a story with no times or values, so the reader cannot see the competing priorities. Students also cite a teamwork concept without applying it, claim fixes no staff nurse could make or reply with "I had the same experience." Use a real shift from your own unit with details changed. The prompt may look like introductions, but it expects an argument about cause. If you have a shift where two disciplines both seemed right, describe it and an NR 446 Week 1 post can be built around the missing condition.
Get a NR 446 Week 1 example written to your instructions
Send us the Week 1 prompt, the number of replies your classroom expects, and the rubric if you have it. We write a custom example to those instructions and return it inside 24 to 48 hours. The first one is free, and if your prompt names a particular collaboration model we build the post around that model.
More NR 446 papers and RN-to-BSN samples
- NR 446 Week 2: Communication Self-assessment
- NR 446 Week 3: Sample Paper, in Real Form
- NR 446 Week 4: Delegation Scenario Analysis
- NR 446 Week 5: Interprofessional Team Analysis
- NR 446 Week 6: Leadership Style Analysis
- NR 446 Week 7: Change Project Proposal
- NR 446 Week 8: Reflection
- NR 447 Week 1: Discussion Post
- NR 442 Week 1: Public Health Authority Discussion
- NR 449 Week 1: Discussion Post
- NR 441 Week 1: Global Health Missing Step Post
NR 446 Week 1 questions, answered
Does the example use a real shift from my own unit?
No. The example is written from a composite situation that fits the prompt, with the setting given by unit type rather than by employer, and no colleague identifiable. Details from your own workplace are yours to add if your classroom asks for them, and most writers find that swapping in one true detail is enough to make the post theirs.
How many replies come with the sample?
Tell us the number your classroom expects and we write that many. Two is common, though sections differ, and we would rather match yours than guess. Each reply is written to do something, usually pushing a peer's explanation toward a cause it stopped short of, because replies that only agree are where posts lose easy points.
Week 1 feels like introductions. Is there really an argument to make?
There is, and posts that treat the week as warm up read that way to a marker. The opening week sets the frame the rest of the course uses, so a post that already locates a failure in team structure rather than in a person is doing what later weeks will demand and is graded accordingly.
Where can I find a free NR 446 Week 1 sample paper?
The complete Week 1 post on the vancomycin dose that waited, with the shared mental model, the question for classmates, two replies and two references, is shown on this page.
What condition does the NR 446 Week 1 post say was missing?
A shared mental model: an agreement made in advance about what happens when a time-critical dose collides with a safety check, which would have let either the nurse or pharmacist act in minutes.