NR 703 Week 5 Decision Analysis Example

Decision-Making Analysis: The Approval of a Ninety-Day Report Overlap Pilot, Reconstructed Meeting by Meeting, With the Options Nobody Raised

Student Name

College of Nursing, Chamberlain University

NR 703: Applied Organizational and Leadership Concepts

Instructor Name

Month Day, Year

Decision-Making Analysis: The Approval of a Ninety-Day Report Overlap Pilot, Reconstructed Meeting by Meeting, With the Options Nobody Raised

The Decision

At the 9 September nursing leadership meeting, the medical-surgical director gave approval for a 90-day trial of fifteen paid overlapping minutes from 06:45 on the telemetry unit, to allow bedside report at the night-to-day handoff, starting 14 September.

The Decision, Unwound

29 August: a family member writes to patient experience that their parent, on the telemetry unit, was told at 07:30 by a new nurse that "nobody told me about your blood pressure overnight." Documented: the letter.

30 August: patient experience passes the letter on to the nursing director, flagging that complaints are reported to the executive team in mid-September. Documented: the email.

2 September: the director asks the unit manager and clinical nurse specialist what is known about report on the unit. Documented: the email.

4 September: the clinical nurse specialist sends a one-page summary of summer audits, showing that only about a fifth of summer 07:00 handoffs happened at the bedside, and attaches the 2024 overlap request. Documented.

5 September: the staffing office updates the 2024 cost estimate: about 640 paid hours a year for the unit. Documented.

9 September: nursing leadership meeting. The director presents three options; the pilot is approved. Documented: minutes record the decision and two rejected options. Recalled, by the unit manager: the director said "we can afford 90 days, not a year, until we see numbers."

Options Considered and Rejected, With the Reason Given

Re-educate night staff on the bedside report policy. Rejected: "We did this in 2023 and 2025 and the audits did not move." Documented in the minutes.

Ask day nurses to start at 06:45 without pay. Rejected: the human resources representative noted that unpaid work time is not permitted. Documented.

Make 07:00 report officially at the station, keeping bedside report at 19:00 only. Rejected: "That would go against our own policy and the patient experience goals." Recalled by the clinical nurse specialist; not in the minutes.

Options Never Raised

The most revealing part of a decision is often what was never on the table. Moving the morning medication pass to 07:30 so that day nurses are free during report. Using a brief bedside safety check, a two-minute visit to each patient by both nurses together, instead of full report at the bedside. Letting patients choose whether to be woken. Shortening night shifts to end at 06:45 for some nurses. None appears in the minutes or in anyone's recollection. Each would have addressed part of the problem at lower cost than paid overlap, and each touched another department or policy, which may be why none was raised. The meeting's agenda listed the item as "telemetry report overlap," a title that already assumed the answer. A title such as "07:00 handoff on telemetry" might have invited a wider set of options. The director set the agenda title from the email subject line the clinical nurse specialist had used, so the framing traveled from one email into the decision itself, an example of how small choices early in a process shape what is decided later.

Concepts Aimed at Moments

Concepts are most useful when aimed at specific moments in the timeline rather than at the decision as a whole. Bounded rationality: on 9 September the director chose among three options presented that morning, not among all possible options, and chose the first that was acceptable within budget, a satisficing choice in Simon's terms (Simon, 1955). The unraised options were outside the set the meeting considered.

The garbage can model: the 2024 request, the summer audits and the complaint had existed separately. They came together in one meeting because a deadline, the executive report, created a choice opportunity into which problems and solutions were poured (Cohen et al., 1972). The decision followed the timing of that opportunity more than any analysis of alternatives.

Documented Against Recalled

Reconstructing a decision from documents and memory requires keeping the two apart. The minutes record the decision, two rejected options and the 90-day length. The unit manager's recollection of the director's words and the clinical nurse specialist's recollection of the third option are not documented. The analysis uses recalled material only where documented material is silent, and labels it. Where the two disagree, the documented version is preferred; in this case they did not disagree, but the recalled third option, making 07:00 report officially at the station, does not appear in the minutes, which may mean it was raised briefly and dismissed without discussion.

One Case, Held to One Case

Nothing here suggests the hospital decides every question this way. It describes one decision, reconstructed from a small set of documents and two people's memories.

Who Was in the Room

The director, the unit manager, the clinical nurse specialist, a human resources representative, the patient experience director by phone and two other unit managers whose units were not affected. No night nurse attended; the meeting was at 10:00. The people who would carry the change were represented by their manager and the clinical nurse specialist, which may explain why options touching night workflow, such as shorter night shifts, were never raised.

How the Choice Was Framed

The director framed the decision as cost against patient experience: "Can we afford 90 days?" That framing made the overlap the obvious option, since it was the only one with a known cost and a known link to the complaint. A framing around the 07:00 workflow would have put the medication pass on the table. Framing shapes which alternatives seem relevant, which is one reason bounded rationality matters in practice.

What Bedside Report Is Meant to Achieve

The clinical nurse specialist's summary cited evidence that bedside report can improve patient perceptions of communication and reduce some adverse events (Sand-Jecklin & Sherman, 2014). That evidence entered the meeting as support for the decision, not as a way of comparing options.

What the Decision Leaves Unresolved

Whether the overlap will change practice, which the pilot will test, and whether the unraised options would have worked as well for less. If the pilot succeeds, the cheaper options may never be tried. If it fails, the meeting that approved it will have no record of why other options were set aside, which makes the next decision harder.

References

Cohen, M. D., March, J. G., & Olsen, J. P. (1972). A garbage can model of organizational choice. Administrative Science Quarterly, 17(1), 1-25. https://doi.org/10.2307/2392088

Sand-Jecklin, K., & Sherman, J. (2014). A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation. Journal of Clinical Nursing, 23(19-20), 2854-2863. https://doi.org/10.1111/jocn.12575

Simon, H. A. (1955). A behavioral model of rational choice. The Quarterly Journal of Economics, 69(1), 99-118. https://doi.org/10.2307/1884852