| Course | NR 718 Topics in Advanced Practice Leadership I |
|---|---|
| Week | 1 |
| Paper type | Discussion post with two replies |
| Length | About 540 words |
| Format | Discussion post with APA 7 citations |
| School | Chamberlain University |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | October 2026 |
Free sample paper for NR 718 Week 1
Week 1 Discussion: Initial Post
Weighing Every Child in Kilograms in a Community Emergency Department: A Change I Want to Lead Without Authority Over Anyone Who Would Have to Do It
Initial Post
The setting. I am the clinical nurse educator in a 26-bed emergency department at a community hospital with about 38,000 visits a year. Children make up 17% of them, roughly 6,460 visits, and we have no pediatric unit; seriously ill children are stabilized and transferred to a children's hospital an hour away.
The problem, as staff put it. "We just ask the parent." At triage, children are often weighed on a scale set to pounds and the nurse converts the number, or a parent's estimate is typed in instead. When I audited 400 pediatric triage records from May to July 2026, 228 weights, 57.0%, were measured in kilograms, 61 were measured in pounds and converted by hand, 88 were stated by a parent and 23 were missing. Nine of the 61 hand conversions were off by more than 10%. In the past year we filed three safety reports in which a pound figure was treated as kilograms; one was a fluid bolus of more than twice the intended volume, caught by the nurse at the pump.
The Change in One Sentence
Every child seen in our department is weighed on a scale that reads only in kilograms, and the weight is entered in a record field that accepts only kilograms, before any weight-based medicine is ordered. This is what national guidance on pediatric readiness in emergency departments already recommends (Remick et al., 2018), and weight errors of exactly this kind have been documented in general emergency departments as well as children's hospitals (Hirata et al., 2019).
Authority I Do Not Hold
I hold no authority over anyone this change touches. The 22 triage nurses report to the nurse manager. The scales belong to biomedical engineering. The record field belongs to the information technology team, whose request queue runs about ten weeks. Registration staff sometimes weigh children when triage is busy, and they report to patient access. What I can do is teach, audit, ask and persuade, and borrow authority from the manager and the medical director if they agree to lend it.
What will be hard is not the scales. It is the door-to-provider time posted on the whiteboard every morning. Weighing a frightened toddler takes two or three minutes that asking a parent does not, and the triage nurses are measured on speed.
My question for the group: has anyone led a change where the people who had to do it were judged on a measure the change would make worse? How did you handle the measure?
Reply to Teresa
Teresa, your change, a new delirium screening routine for the whole hospital, sounds like more than one person could start in a quarter. Could you name the one unit, and the one shift, where you would begin? That would also tell us whose routine changes first.
Reply to Jordan
Jordan, you wrote that your team will follow your lead on bedside handoff. Do they report to you? If not, whose authority would you be borrowing, and have you asked for it yet?
References
Hirata, K. M., Kang, A. H., Ramirez, G. V., Kimata, C., & Yamamoto, L. G. (2019). Pediatric weight errors and resultant medication dosing errors in the emergency department. Pediatric Emergency Care, 35(9), 637-642. https://doi.org/10.1097/PEC.0000000000001277
Remick, K., Gausche-Hill, M., Joseph, M. M., Brown, K., Snow, S. K., Wright, J. L., American Academy of Pediatrics Committee on Pediatric Emergency Medicine and Section on Surgery, American College of Emergency Physicians Pediatric Emergency Medicine Committee, & Emergency Nurses Association Pediatric Committee. (2018). Pediatric readiness in the emergency department. Pediatrics, 142(5), Article e20182459. https://doi.org/10.1542/peds.2018-2459
The Chamberlain NR 718 Week 1 instructions
Before any theory, give three concrete things. Describe the setting by type, size and patient mix. State a practice problem in the words staff on that unit actually use. Name a change small enough that one person could carry it through a single quarter, in one sentence. Then turn to leadership: say which roles would have to alter a routine, what authority you hold over each of them, which is usually none, and whose authority you might borrow. Name what will be hard, especially anything the people involved are measured on that the change would make worse. Keep citations for where they support a specific point rather than opening with them. End by asking the group something they can answer from their own units. When you reply, press a classmate on scope or on an authority they have assumed over a team.
How this NR 718 Week 1 example is built
The sample's first paragraph places the writer as clinical nurse educator in a 26-bed department with 38,000 visits, 17% of them children, and no pediatric unit. The problem appears in staff words, we just ask the parent, followed by audit figures: 228 of 400 weights measured in kilograms, 61 converted by hand with nine off by more than 10%, 88 stated by a parent and three safety reports in a year. The change is stated in a single sentence and linked to national readiness guidance. A section lists the triage nurses, biomedical engineering, information technology and registration, none reporting to the writer. The hard part, the sample says, is the door-to-provider figure written on the board each morning. Replies ask one classmate to narrow a hospital-wide change and another whether the team really reports to them.
Where the points sit in the NR 718 Week 1 rubric
The most expensive opening post is an essay about leadership with no project in it, and because every later week builds on the change named here, a vague start costs points twice. Next is a change too large for one person to begin, such as a culture or an entire documentation system. Marks are also lost when theory arrives before anyone knows what is being changed or where, and when a writer grants themselves authority they do not have over a team that does not report to them. Graders reward posts that describe the setting concretely, name the problem in floor language and say plainly whose cooperation the change needs. Replies earn their share by testing scope or authority rather than offering encouragement.
NR 718 Week 1 help from the desk
Choosing a change small enough to lead in one quarter, and being honest that you hold no authority over the people who must do it, is harder than writing about leadership in general. Send us a description of your unit, the complaint staff keep repeating and the change you are considering. From that, a first draft can narrow the change to a single sentence, list who controls each piece, name the measure that will push back and suggest two replies that test a classmate's scope or assumed authority. Your setting, your audit figures and your choice of change stay entirely your own throughout.
Get a NR 718 Week 1 example written to your instructions
Send the discussion prompt your section published, the rubric if one came with it, and two lines about the unit and the change you have in mind. A custom example post gets written to those instructions and comes back inside 24-48h, the first one free, for reading against your own draft.
More NR 718 papers and DNP samples
- NR 718 Week 2: Leadership Self-assessment
- NR 718 Week 3: Leadership Theory Analysis
- NR 718 Week 4: Organizational Readiness Assessment
- NR 718 Week 5: Stakeholder Analysis
- NR 718 Week 6: Change Model Application
- NR 718 Week 7: Implementation Position Paper
- NR 718 Week 8: Project Proposal Presentation
- NR 717 Week 1: Outcome and Cost Post
- NR 716 Week 1: Model Placement Post
- NR 702A Week 1: DNP Trouble Post
- NR 715 Week 1: Testable Belief Post
NR 718 Week 1 questions, answered
My project topic is not approved yet. What does the post say?
It says so plainly, then commits anyway. The strong version names the change it expects to pursue, adds a sentence on what would make that shift, and carries on. Faculty expect movement in the early weeks. What loses points is a post that waits for approval before saying anything specific, because then classmates have nothing to reply to.
Does the example name a real hospital?
No. It describes a unit by type, size and patient mix, which is all any argument in the post requires. You swap your own setting into the opening two lines and everything after it still stands, because the post hangs on the stated problem and the proposed change rather than on the institution behind them.
How is this different from leadership discussions earlier in the program?
Earlier posts usually ask you to discuss leadership as an idea. This one attaches to a change you intend to make somewhere real, and every later assignment in the course refers back to what you named here. That is why marking rewards specificity in this week far more heavily than it rewards the range of your reading.
Where can I find a free NR 718 Week 1 sample paper?
A complete Week 1 post proposing kilogram-only weights for children in a community emergency department, with two replies, is on this page.
What does the NR 718 Week 1 sample say will be hardest about the change?
The posted door-to-provider time, because weighing a frightened toddler adds two or three minutes and triage nurses are measured on speed.