| Course | NR 527 Communication and Collaboration for Advanced Nursing Practice |
|---|---|
| Week | 5 |
| Paper type | Escalation memo |
| Length | About 870 words, 2 pages |
| Format | Memo with APA 7 citations |
| School | Chamberlain University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NR 527 Week 5
Memorandum
To: Medical Director, Emergency Department
From: Student Name, APRN, Facility Nurse Practitioner
Date: Month Day, Year
Re: Request to adopt a four-line return sheet for residents returning to nursing facilities at night, with results of a one-month trial
Request
I am asking you to approve a one-page return sheet, completed by the emergency nurse for every resident discharged back to a nursing facility between 1900 and 0700, covering four items: the diagnosis, any new or changed medication with the time the next dose is due, results not yet back with the person responsible for them, and overnight warning signs. A one-month trial with your evening charge nurse, for residents of our facility only, suggests it takes a few minutes per resident and prevents missed doses. I am asking to extend it to all nursing facilities your department serves for a three-month period, reviewed when it closes.
Why This Reaches You
In early spring, a resident of our facility returned from your department at 0145 with a note reading "CT negative, see ED record." She had been started on an antibiotic. Our night nurses cannot see your record, and she missed her evening dose. Your evening charge nurse agreed to a trial but pointed out, correctly, that changing what the department sends back is a physician decision. That is why I am writing to you.
What the Trial Found
During the trial month, 14 residents of our facility returned from your department at night. The return sheet came back completed for 11. For those 11, there were no missed or delayed doses of new medications and no calls from our night staff to your department to ask what had happened. For the three residents who returned without it, two new prescriptions were not known to our night nurse until the next morning. In the month before the trial, three of nine night returns involved a missed dose of a new medication. Your charge nurse reported that her nurses found the sheet took two to four minutes and that two nurses asked for it to be available for all facilities.
These are small numbers from one facility, and they should be read as a signal rather than proof. They are consistent with published work: an audit of transfers from nursing homes to one Canadian emergency department found meaningful gaps in the large majority (Cwinn et al., 2009), and staff interviewed in both settings reported residents traveling without paperwork either way (Terrell & Miller, 2006).
What the Change Would Require
The sheet is already drafted and fits on half a page. Your nurses would complete it for night discharges to nursing facilities, place it on top of the paperwork and, where possible, read the four items to the facility nurse by phone. No change to the electronic record is needed for the trial. Quality improvement programs for nursing homes have built similar structured communication tools into efforts to manage changes in residents' condition (Ouslander et al., 2011); this sheet is the emergency department's half of that exchange.
Alternatives Considered
Three alternatives were considered before this request. Phone calls from your nurses for every night return would carry the same information but take longer and depend on reaching our night nurse, who is often with a resident. Giving our night nurses access to your electronic record would help, but it requires agreements between our organizations that will take months, and it would still leave each nurse searching a long record at 0200 for four facts. An electronic summary sent through the health information exchange is the right long-term answer, and I would like to work with your informatics team on it, but it is not available now. The paper sheet is a bridge: cheap, immediate and easy to stop if it does not help.
What I Commit to Doing
If you approve the three-month extension, I will do five things. I will supply printed sheets to your department weekly and replace them when they run low. I will send the sheet and a one-paragraph explanation to the directors of nursing at the other four facilities you serve within one week of your approval, and ask each to name a contact for returns. I will train our own night nurses to look for the sheet and to call your charge nurse if it is missing. I will count, each month, how many night returns to our facility arrived with a completed sheet and how many new medications were missed, and send you and your charge nurse a one-page summary by the tenth of the following month. And I will attend your department's quarterly quality meeting at the end of the three months to present the results, whatever they show.
What I Am Asking of You
I am asking for three things: approval of the sheet for night returns to all five facilities for three months; a message from you to the emergency nursing staff explaining that the sheet is a department expectation during the trial; and fifteen minutes on the agenda of your quarterly quality meeting when the three months end. I will call your office on Friday to ask whether you would like to discuss this before deciding.
References
Cwinn, M. A., Forster, A. J., Cwinn, A. A., Hebert, G., Calder, L., & Stiell, I. G. (2009). Prevalence of information gaps for seniors transferred from nursing homes to the emergency department. CJEM, 11(5), 462-472. https://doi.org/10.1017/S1481803500011660
Ouslander, J. G., Lamb, G., Tappen, R., Herndon, L., Diaz, S., Roos, B. A., Grabowski, D. C., & Bonner, A. (2011). Interventions to reduce hospitalizations from nursing homes: Evaluation of the INTERACT II collaborative quality improvement project. Journal of the American Geriatrics Society, 59(4), 745-753. https://doi.org/10.1111/j.1532-5415.2011.03333.x
Terrell, K. M., & Miller, D. K. (2006). Challenges in transitional care between nursing homes and emergency departments. Journal of the American Medical Directors Association, 7(8), 499-505. https://doi.org/10.1016/j.jamda.2006.03.004
NR 527 Week 5 instructions, in plain terms
The Week 5 assignment asks for a memo escalating a practice or safety concern to someone with authority to act. Prompts usually ask for a clear request, background, evidence, proposed actions and expected outcomes, in professional memo format. Address it to the person who can decide, and explain why the issue has reached them. Put the request in the subject line and first paragraph. Present evidence honestly, including its limits. Commit yourself to specific actions as well as asking for action. End with concrete asks and a follow-up. Cite supporting literature in APA 7. Your section may specify length and whether the memo should include attachments or a copy list.
How the NR 527 Week 5 example is put together
The example opens with the request and the scope of the trial. A section explains why the issue reached the director, noting that the charge nurse correctly identified the decision as a physician matter. The findings section reports the trial's counts, compares them with the previous month and cites published evidence, while calling the numbers a signal rather than proof. A section lists three alternatives and why the sheet is a bridge. Another explains what the change requires of nurses. The final two sections are the core: five dated commitments from the writer and three specific requests of the director, with a follow-up call on Friday.
NR 527 Week 5 rubric: what full points look like
The rubric for the escalation memo usually rewards a clear request, appropriate audience, concise evidence, feasible recommendations, professional format and a strong closing. Graders look for memos that state the ask early and close with specific actions and dates. Commitments from the writer are often credited because they show shared responsibility rather than complaint. Honest presentation of evidence, including limits, supports credibility. Alternatives considered show judgment. Format, tone and brevity matter in this genre. Sources should be cited in APA 7. A memo whose last paragraph could be turned into a meeting agenda usually earns full marks for its closing. Five named commitments, each with a date, are the kind of detail that turns a request into a plan in the reader's eyes.
Common NR 527 Week 5 mistakes, and how to avoid them
The biggest mistake is a memo that describes a problem at length and ends with a vague request for support. State the ask first and close with specifics. Another is addressing the wrong person, either too junior to act or so senior that the memo skips levels without reason. Explain why the issue reached this reader. Students also overstate small pilot data; call it a signal and give the numbers. Include what you will do, not only what you want. Consider alternatives. Keep it short enough to read in a few minutes. Finally, plan the follow-up. A memo without a follow-up date is easy to file and forget.
Get a NR 527 Week 5 example written to your instructions
Send the scenario and the rubric your week publishes and a custom memo comes back inside 24-48h, addressed, dated and built to that structure, the first one free. If your section names a required format or a word limit, include it and the example is written inside those limits rather than trimmed to them.
More NR 527 papers and MSN samples
- NR 527 Week 1: Discussion Post on One Lost Message
- NR 527 Week 2: Handover Write-Up for a Transfer
- NR 527 Week 3: Difficult Conversation Script
- NR 527 Week 4: Interprofessional Case Analysis
- NR 527 Week 6: Family Meeting Summary
- NR 527 Week 7: Team Charter
- NR 527 Week 8: Collaboration Case Report
- NR 520 Week 5: Decision Analysis, Morning Labs
- NR 519 Week 5: Patient Teaching Plan, Stiff Lung
- NR 518 Week 5: Outbreak Investigation Write-Up
- NR 516 Week 5: Research Ethics Case on Consent
NR 527 Week 5 questions, answered
How senior should the addressee be?
The lowest person who can actually grant what you are asking for. Writing over that person's head is a specific error most rubrics penalize, because it tells a marker you did not work out who holds the decision. If the case genuinely gives nobody with that power, say so in the memo and address the person who can take it upward.
Is a memo or an email the right format?
Follow whichever your assignment names, and where nothing is specified a memo block is safer, since it forces an addressee, a date and a subject line onto the page. Those three elements carry marks in most rubrics. If you write it as an email, keep the same discipline and treat the subject line as the shortest possible statement of the request.
What if the situation is urgent enough to skip a level?
Then say inside the memo that you have skipped one and why, in a single sentence. Rubrics generally accept a level being bypassed when the reason is stated and the person passed over is on the copy line. What loses marks is jumping a level without saying so, because nothing on the page then separates a considered decision from avoidance.
Where can I find a free NR 527 Week 5 sample paper?
The return-sheet escalation memo above is a complete NR 527 Week 5 sample and can be read at no charge. If your concern needs escalating to a different leader, send the details through the request form for a memo written to it.
How senior should the addressee of the NR 527 memo be?
The person with authority to make the change, reached after the level below has been tried. The sample goes to the medical director because the charge nurse identified the change as a physician decision.