| Course | NR 562 Leadership and Management within Complex Healthcare Systems |
|---|---|
| Week | 2 |
| Paper type | Systems map with narrative |
| Length | About 1,120 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Nurse Executive |
| Updated | October 2026 |
Free sample paper for NR 562 Week 2
Systems Map: Heart Failure Returns, Observation Placements, Decision Unit Occupancy and Emergency Department Boarding as Quantities That Move One Another
Student Name
College of Nursing, Chamberlain University
NR 562: Leadership and Management within Complex Healthcare Systems
Instructor Name
Month Day, Year
Systems Map: Heart Failure Returns, Observation Placements, Decision Unit Occupancy and Emergency Department Boarding as Quantities That Move One Another
Purpose of the Map
This map explains one recurring problem in a 260-bed community hospital: since July 2025, the 14-bed clinical decision unit has run near capacity on weekdays, and patients waiting for it board in the emergency department. The trigger was a heart failure return pathway that places stable patients who come back within 30 days into observation instead of admitting them. The map uses eight nodes, all of them quantities, and argues from the loops they form.
How the Map Was Built
I drew the first version from the hospital's own reports and then tested it with the people who work in each part of the system. The bed board supplied decision unit occupancy by hour and length of stay by patient group. Hallway waits for a decision unit bed came from the emergency department's patient tracking system. The quality dashboard supplied monthly heart failure readmissions, and the finance office confirmed how the penalty is calculated and when it is applied. I then walked the draft through with the emergency department nurse manager, the heart failure nurse practitioner and the quality director in separate 20-minute conversations. Each of them removed a link I had drawn and added one I had missed. The nurse practitioner, for example, pointed out that boarding pressure changed physician behavior, which became the link that closes the reinforcing loop. Building a map with the people inside the system is one way to avoid the narrow view of a single department, which is a common reason improvement efforts in complex systems miss their side effects (Plsek & Greenhalgh, 2001).
The Nodes
Each node is something with a level that a manager can measure: (1) heart failure patients returning to the emergency department within 30 days, per week; (2) returning patients placed in observation, per week; (3) decision unit occupancy, as a weekday percentage; (4) median decision unit length of stay, in hours; (5) emergency department boarding hours for decision unit patients, per week; (6) 30-day heart failure readmissions, per month; (7) management attention on readmissions, measured roughly as agenda minutes and staff time assigned; and (8) the readmission penalty, a payment cut calculated in Baltimore by the federal agency that runs Medicare. Department names do not appear as nodes because a department cannot rise or fall.
The Links and Their Signs
Table 1
Signed Links in the Heart Failure Return Map
| From | To | Direction | Delay |
|---|---|---|---|
| Returning HF patients | Observation placements | Same | Same day |
| Observation placements | Decision unit occupancy | Same | Same day |
| Decision unit length of stay | Decision unit occupancy | Same | Same day |
| Decision unit occupancy | ED boarding hours | Same | Hours |
| ED boarding hours | Observation placements of borderline patients | Same | Weeks |
| Observation placements | 30-day HF readmissions | Opposite | Same month |
| 30-day HF readmissions | Readmission penalty | Same | About two years |
| Readmission penalty | Management attention | Same | Months |
| Management attention | Observation placements | Same | Months |
| Management attention | 30-day HF readmissions | Opposite | Months |
Note. Same means more of the first gives more of the second; opposite means more of the first gives less of the second. ED = emergency department; HF = heart failure.
Each link takes a sign. More returning patients produce more observation placements. More placements, and longer stays, raise occupancy. Higher occupancy raises boarding. One link is less obvious: when boarding rises, emergency physicians under pressure to move patients tend to place borderline cases in observation sooner, which adds to placements. Placements reduce readmissions, because a patient in observation is not counted as readmitted, and observation stays fall outside the measure (Sabbatini & Wright, 2018).
The Closed Paths
Loop R1, reinforcing. Observation placements raise occupancy, occupancy raises boarding, and boarding raises placements of borderline patients. Followed around, more produces more. This loop explains why the decision unit did not settle at a new, higher level but kept climbing through the autumn.
Loop B1, balancing. Readmissions raise the penalty, the penalty raises management attention, and attention lowers readmissions through the return pathway and transitional calls. Followed around, more readmissions eventually produce fewer. This loop is what launched the change, and it is working as intended.
The two loops connect at observation placements. The balancing loop pushes placements up to lower readmissions, and every placement feeds the reinforcing loop in the emergency department. This is a common feature of complex systems, where a fix in one loop becomes a driver in another (Sterman, 2006).
The Slow Links
Two links are slow. The penalty depends on several years of readmission data and is applied to payments well after the period measured, so the link from readmissions to penalty runs on a delay of about two years. The link from boarding to earlier observation placement takes weeks to show, because it reflects gradual changes in physician habits. These delays explain why the executives who approved the change in spring 2025 saw only the readmission gain by autumn: the boarding signal reached a different committee, and the penalty signal had not yet arrived at all.
The Edge of the Map
The readmission penalty formula, set by federal rule, sits at the edge with no arrow leaving the hospital toward it. The hospital can influence its readmission rate but not the formula. Community capacity, such as the number of skilled nursing beds and outpatient cardiology appointments, also sits at the edge. It shapes how many patients return, but the hospital cannot change it in the time frame of this map.
The Link I Would Cut
The link I would cut is the one from decision unit occupancy to boarding, by giving stable heart failure observation patients their own space instead of sharing the decision unit with short-stay chest pain patients. A dedicated four-chair diuresis area in the cardiac outpatient clinic, open twelve hours a day, would absorb most of the heart failure placements. Occupancy in the decision unit would fall back toward its earlier level, boarding would drop and the reinforcing loop would weaken, while the balancing loop that lowered readmissions would keep working. National data suggest that observation stays and readmissions moved in opposite directions after the penalty program began, though hospitals with larger observation increases did not show clearly larger readmission falls (Zuckerman et al., 2016). Cutting this link tests that finding locally: if readmissions stay low once observation patients leave the decision unit, the gain came from the care, not from the status.
References
Plsek, P. E., & Greenhalgh, T. (2001). The challenge of complexity in health care. BMJ, 323(7313), 625-628. https://doi.org/10.1136/bmj.323.7313.625
Sabbatini, A. K., & Wright, B. (2018). Excluding observation stays from readmission rates: What quality measures are missing. New England Journal of Medicine, 378(22), 2062-2065. https://doi.org/10.1056/NEJMp1800732
Sterman, J. D. (2006). Learning from evidence in a complex world. American Journal of Public Health, 96(3), 505-514. https://doi.org/10.2105/AJPH.2005.066043
Zuckerman, R. B., Sheingold, S. H., Orav, E. J., Ruhter, J., & Epstein, A. M. (2016). Readmissions, observation, and the Hospital Readmissions Reduction Program. New England Journal of Medicine, 374(16), 1543-1551. https://doi.org/10.1056/NEJMsa1513024
What the NR 562 Week 2 assignment asks for
The systems map assignment generally asks you to draw the parts of a system that respond when one part changes, then explain what the drawing shows. Expect the prompt to ask for nodes, links, loops and some written interpretation. Write every node as a quantity with a level, such as hours, counts or percentages, never as a department name or an event. Put a sign on each link to show whether more of one gives more or less of the other. Follow the arrows until at least one path closes on itself, and label each closed path as reinforcing or balancing. Mark any link that takes weeks or months to respond. Put what you cannot influence at the edge. Underneath, name one link you would cut and predict what the rest of the map does.
How the NR 562 Week 2 example is put together
The sample begins by stating the recurring problem: since July 2025 the decision unit has run near capacity and patients board while they wait for it. A section on how the map was built lists the reports used and the three staff conversations that changed it. Eight nodes follow, each a measurable quantity, from returning heart failure patients per week to management attention. A table lists ten links with signs and delays, and a note explains the less obvious link from boarding to earlier observation placement. The closed paths are labeled: a reinforcing loop through occupancy and boarding, and a balancing loop through the penalty. Slow links are explained, the penalty formula sits at the edge, and the final section proposes a separate diuresis area and predicts its effect on both loops.
Where the points sit in the NR 562 Week 2 rubric
Systems maps tend to be judged on whether they contain a closed loop, whether nodes are quantities, whether links are signed, whether delays are marked and whether the narrative argues from the map. A drawing without a closed path is a hierarchy and earns little, so the two labeled loops carry much of the credit. Nodes written as measurable levels allow every link to take a sign, which shows the writer understands what a map is for. Marking the penalty link as a two-year delay explains why executives saw only the gain. Keeping the map to eight nodes, instead of an entire service line, shows judgment. Testing the draft with frontline staff adds credibility. A closing paragraph that cuts one link and predicts the result turns the drawing into an argument. Correct APA 7 citations complete the work.
Common NR 562 Week 2 mistakes, and how to avoid them
Maps most often lose marks for having no closed path, only arrows radiating outward from a central change. Another frequent problem is writing nodes as events, such as go live or new policy, which cannot rise or fall and make every arrow touching them meaningless. Unsigned links leave a reader unable to tell an amplifying relationship from a damping one. Some maps grow to forty nodes and explain less than eight would. Many show no delays, implying that every part of a hospital responds at the same speed. Others end without saying which link the writer would change. Keep the map small, sign everything, find the loop and mark the slow parts. If your system problem comes from a different setting, outline the change and the quantities involved, and a map can be built from them.
Get a NR 562 Week 2 example written to your instructions
Send the assignment page, the rubric, or a sketch of the problem you want mapped, and we will build the map and the prose that goes under it. It comes back inside 24-48h, first one at no charge. If your section names a particular drawing tool, tell us and the file will match it.
More NR 562 papers and MSN samples
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- NR 562 Week 8: Leadership Decision Paper
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NR 562 Week 2 questions, answered
Does the map have to contain a loop?
In practice yes, because a map with no closed path has not described a system that reacts. If your problem genuinely runs in one direction, the usual reason is that the map stops too early: add the node representing what the affected group does next, and the return path tends to appear. Staff responses are almost always the missing arrow.
What belongs on the map from outside the organization?
Only what actually pushes on your nodes: a local labor market, a payer rule, a school calendar that empties your float pool in August. Draw those at the edge with arrows coming in and none going out, which tells the reader you cannot influence them. Everything else outside is context for the prose, not a node.
Can a systems map be marked without any numbers on it?
Often it can, since Week 2 is generally testing whether the relationships and directions are right. Rough magnitudes still help, mainly because they stop you from drawing a link that is real but tiny beside one that dominates everything. Where you have no figures, mark the links you believe are large and say in the prose why you think so.
Where can I find a free NR 562 Week 2 sample paper?
The heart failure return map above, with its signed link table and two labeled loops, is the complete NR 562 Week 2 sample. A map of your own system problem can be drafted from the quantities you track.
Can the NR 562 Week 2 systems map be submitted as a table?
Check your prompt, since many sections want a drawing. A signed link table, as in this sample, carries the same information and can sit beside the diagram.