| Course | NR 720 Topics in Healthcare Systems Leadership I |
|---|---|
| Week | 8 |
| Paper type | Leadership briefing memo |
| Length | About 850 words, 3 pages |
| Format | Memo with APA 7 citations |
| School | Chamberlain University |
| Program | MSN, Nurse Executive |
| Updated | October 2026 |
Free sample paper for NR 720 Week 8
Memorandum
To: Chief Nursing Officer; Chief Medical Officer; Chair, Department of Radiology
From: Nurse executive student, Medical Intensive Care Unit project
Date: 15 April 2027
Re: Central lines in the medical intensive care unit wait a median of two hours before first use; two low-cost changes requested for a three-month test
The Finding
In the medical intensive care unit, half of all new central lines go unused for more than two hours after placement; the median is 122 minutes. In the surgical intensive care unit, using the same radiologists, technologists, machines and record, the median is 43 minutes. The difference is not effort or skill in either department. It comes from two arrangements: confirmation films default to routine priority, so they wait in the reading queue behind urgent studies, and no role in the medical unit is assigned to clear the line and tell the bedside nurse.
What It Costs, in Terms This Group Tracks
The medical unit places about 256 central lines a year. About two thirds are placed so a vasopressor can be started or transferred, and until clearance that drug keeps flowing through a peripheral vein in the arm; at current timing, that is roughly 170 patients a year receiving a vasopressor peripherally for about an hour and a half longer than necessary. No extravasation was documented in the three months reviewed, so the briefing does not claim harm, but the exposure is real, it is avoidable and it falls on the sickest patients in the unit. Bedside nurses check for the result a median of five times per placement, which adds up to some 40 nurse hours annually spent hunting for information already sitting in the record.
Where the Work Stalls
The work stalls at two crossings between departments, and both departments meet their own targets at the moment it stalls. Radiology reads routine inpatient films within its two-hour target; the film itself is read in a couple of minutes once opened, but it sits about an hour before that happens. After the read is posted, no procedure assigns anyone to tell the nurse, and a median of about 20 minutes passes before the line is cleared and another 10 to 15 before it is used. No department is at fault; the time sits in the space between their measures.
The Evidence, Briefly
Three figures carry the case, each from the hospital's own records for January to March 2027. The same radiologists turned around urgent line films in a median 13 minutes and routine ones in 74. The surgical unit, where a 2022 protocol lets the credentialed placing clinician clear the line on a documented personal reading, reached first use in a median of 43 minutes. And the radiologist's over-read disagreed with a surgical unit clinician's clearance in 1 of 33 lines, with no harm, which shows the safety check that any change must keep. Published evidence that bedside clinicians, especially with ultrasound, detect malposition and pneumothorax accurately and faster than radiography supports clinician clearance in principle (Ablordeppey et al., 2017).
The Request
Three approvals would allow a three-month test starting 1 May 2027.
First, from the Chair of Radiology: a line confirmation priority in the central line order set, placing these films ahead of routine studies but behind emergency studies, which would add a couple of minutes of radiologist time per film, a few films a day.
Second, from the Chief Medical Officer: a credentialing pathway allowing medical unit clinicians who complete ten supervised line film readings to clear lines on their own documented reading, with the radiologist's read continuing as an over-read, as in the surgical unit.
Third, from the Chief Nursing Officer: a unit rule that the clinician who clears the line tells the bedside nurse directly, with a field in the clearance note recording that the nurse was told.
How the Test Will Be Judged
The unit and radiology analysts will report monthly from existing systems. Success is a median line-to-first-use time below 60 minutes. The test pauses if emergency department reading times rise by more than five minutes or if more than 1 in 20 clinician-cleared lines is found malpositioned on over-read. Results will come back to this group in August, with a recommendation on whether each of the three changes should continue, change or stop, and the views of both department managers. The measurement plan and the full diagnosis are attached for anyone who wants the detail; this briefing does not repeat them.
Why Now
A new group of advanced practice providers joins the medical unit in May and completes orientation that month, which makes it the simplest time to introduce a credentialing step. A decision later in the year would mean credentialing an established group mid-rotation. Changing an order set default and assigning a task are among the least expensive changes a hospital can make, and the diagnosis shows they act on the arrangements that produce the delay rather than on anyone's effort (Carayon et al., 2006), and relieving a constraint of this kind usually costs far less than adding capacity (Goldratt & Cox, 2004).
References
Ablordeppey, E. A., Drewry, A. M., Beyer, A. B., Theodoro, D. L., Fowler, S. A., Fuller, B. M., & Carpenter, C. R. (2017). Diagnostic accuracy of central venous catheter confirmation by bedside ultrasound versus chest radiography in critically ill patients: A systematic review and meta-analysis. Critical Care Medicine, 45(4), 715-724. https://doi.org/10.1097/CCM.0000000000002188
Carayon, P., Schoofs Hundt, A., Karsh, B. T., Gurses, A. P., Alvarado, C. J., Smith, M., & Flatley Brennan, P. (2006). Work system design for patient safety: The SEIPS model. Quality and Safety in Health Care, 15(Suppl. 1), i50-i58. https://doi.org/10.1136/qshc.2005.015842
Goldratt, E. M., & Cox, J. (2004). The goal: A process of ongoing improvement (3rd rev. ed.). North River Press.
The Chamberlain NR 720 Week 8 instructions
Write for readers who will not reach an appendix, so put everything important first. Open with the finding in a few sentences. State the cost in units your audience already tracks, such as patients exposed, staff hours or a performance measure they report, and say plainly what you cannot claim. Describe where the work stalls without placing any department at fault, since cooperation from both will be needed. Choose two or three figures this audience would accept, with their sources, rather than every figure from the term. Make requests that each recipient can grant, addressed to the person who holds that authority, with the cost of each. Say how a test will be judged and when results will return. Let the attachments carry the detail, and explain why now is the right time.
How this NR 720 Week 8 example is built
The memo header names three executives and puts the finding and request in the subject line. The finding section gives 122 against 43 minutes and the two arrangements behind the gap. The cost section estimates about 170 patients a year receiving a vasopressor peripherally for longer than needed and about 40 nurse hours spent checking for results, and states that no harm was documented. The stall section describes both departments on target as the work waits. Three figures follow: urgent against routine read times, the surgical unit's median and its one over-read disagreement. Three requests go to the radiology chair, the chief medical officer and the chief nursing officer. Success and pause rules, a report-back in August and the timing of new staff orientation close the memo.
Reading the NR 720 Week 8 grading rubric
Writing the briefing as a shortened paper is the biggest and most common loss: background first, findings last, and an executive who stops reading before the point. The next worst version reads as an accusation, which ends the conversation with the department whose cooperation any change will need. Marks are also lost for evidence dumped rather than selected, so no figure carries enough weight to act on, and for requests no one in the room can grant. Graders reward briefings that open on the finding, express cost in the audience's own measures, keep every department out of the dock and address each request to the person who can approve it.
Common NR 720 Week 8 mistakes, and how to avoid them
A leadership briefing reverses academic habit, putting the finding and the request ahead of the background. Share your finding, the leaders who will read it and what each of them controls, and the briefing can open on the conclusion, state the cost in measures they already follow, choose the few figures that carry the case and direct each request to the right person. Keeping every department out of the dock is often the difference between a meeting and a stalemate. The finding and the requests are yours.
Get a NR 720 Week 8 example written to your instructions
Send the Week 8 instructions, the rubric and whatever format the classroom requires, whether a one page memo, a slide set with notes or a short report, and a custom briefing comes back inside 24-48h, first one free. Tell us the stated audience, since a nursing council and a finance committee need different briefings.
More NR 720 papers and MSN samples
- NR 720 Week 1: Cross-Department Occurrence Post
- NR 720 Week 2: Process Map Write-Up
- NR 720 Week 3: Observation Summary
- NR 720 Week 4: Bottleneck Analysis
- NR 720 Week 5: Cross-Department Comparison
- NR 720 Week 6: Measurement Plan
- NR 720 Week 7: Systems Diagnosis Paper
- NR 711 Week 8: Capital Funding Recommendation
- NR 529 Week 8: Management Philosophy Statement
- NR 703 Week 8: Synthesis Analysis
- NR 531 Week 8: Executive Briefing for Decision
NR 720 Week 8 questions, answered
Slides or a memo?
Whatever the classroom specifies, and where it specifies nothing the choice can be defended in a line at the top. A memo suits a reader working alone, slides suit a meeting where you will be present to talk. If slides are required, put the actual argument into the speaker notes, because a deck of headings alone cannot be graded on reasoning and this week is graded on reasoning.
How do I brief leaders whose departments are the problem?
By making the arrangement the subject rather than the people. The strongest briefings show each department performing well against what it was asked to deliver, then show that the work between them was never asked of anyone. That lets every leader in the room agree with the description before conceding anything, which is close to the only condition under which one of these problems gets picked up.
Do I recommend a solution?
Read the prompt closely, because classrooms split on this and the course sequence matters. This first half concerns establishing what is wrong and why, so many briefings are asked to end at a request for attention or a decision rather than at a plan. Where your instructions do call for recommendations, keep them short, tie each to a named finding, and leave the design work to whoever will own it.
Where can I find a free NR 720 Week 8 sample paper?
A complete leadership briefing memo on central line clearance, addressed to three executives, is available on this page.
Why does the NR 720 Week 8 memo avoid blaming radiology?
Both departments met their own targets while the line waited, and the changes requested need radiology's cooperation, so the memo locates the delay in the arrangement.