| Course | NR 721 Topics in Healthcare Systems Leadership II |
|---|---|
| Week | 2 |
| Paper type | Post-implementation review |
| Length | About 1,100 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | MSN, Nurse Executive |
| Updated | October 2026 |
Free sample paper for NR 721 Week 2
Post-Implementation Review of the Nurse-Driven Telemetry Discontinuation Protocol: The Version Installed in August 2026 Against the Version Running in October 2027
Student Name
College of Nursing, Chamberlain University
NR 721: Topics in Healthcare Systems Leadership II
Instructor Name
Month Day, Year
Post-Implementation Review of the Nurse-Driven Telemetry Discontinuation Protocol: The Version Installed in August 2026 Against the Version Running in October 2027
Purpose
This review compares two descriptions of the same practice on a 36-bed medical unit: the telemetry discontinuation protocol as it was installed on 12 August 2026 and the protocol as nurses actually run it fourteen months later. The two are kept apart until the end, because a review that reads the policy and calls it current practice can only ever conclude that all is well. The current version was written first, from watching, so that the installed version could not shape what was seen.
The Version in Use, Written From Watching
Over two weeks in September 2027, the manager watched 12 reminders being answered across day and night shifts and followed 9 of the resulting removals to completion. The practice, in the order it happens, runs as follows.
1. At 07:00 the record fires a reminder for each patient who has been monitored for 48 hours.
2. If the reminder fires during handoff, which it does on most days, the night nurse either answers it or leaves it for the day nurse.
3. The nurse checks a paper list taped to the monitor technician's desk, headed "keep on tele," on which hospitalists or night nurses have written names of patients to be left on monitoring.
4. For patients on the paper list, the nurse answers the reminder "continue, provider preference."
5. For others, the nurse opens the order, reads the indication and checks the patient against the criteria card at the charging station.
6. If the criteria are met, the nurse calls the monitor technician to say a box is coming off, so the technician can stop watching that channel.
7. The nurse removes the leads and the box.
8. The box goes back to a charging station or, often, stays in the room until discharge.
9. The nurse documents the removal and the reason.
The Version Installed, From the August 2026 Materials
The education packet dated 1 August 2026 describes six steps. A reminder fires at 07:00 for patients monitored 48 hours. The nurse assesses the patient against the indication-specific criteria in the order. If criteria are met, the nurse removes the box and returns it to a charging station. The nurse documents removal with the reason. The nurse notifies the provider by secure message. If criteria are not met, the nurse documents the reason for continuing.
The Differences, Classified
Table 1
Differences Between the Installed and Current Telemetry Discontinuation Protocol
| Difference | Type | Effect |
|---|---|---|
| Call to the monitor technician before removal | Addition | Stops the technician watching an empty channel; a repair |
| Paper "keep on tele" list | Substitution | Replaces assessment with a list for listed patients |
| Stock answer "continue, provider preference" | Substitution | Replaces a documented reason with a default |
| Box left in the room instead of returned | Subtraction | Box return step often skipped; boxes leave with patients |
| Secure message to the provider after removal | Subtraction | Skipped on nights; providers learn at rounds |
| Reminder answered by the night nurse at handoff | Substitution | Assessment done by the departing nurse, often without seeing the patient that morning |
Note. Note. Addition: a step added by staff. Subtraction: an installed step no longer done. Substitution: an installed step replaced by something else.
How Far Apart the Versions Are
The observations put numbers on the distance. Of the 12 reminders watched, 7 were answered with an assessment against the criteria and 5 with the stock answer "continue, provider preference"; four of those five patients were on the paper list, and one was not on any list. Of the 9 removals followed, all included the call to the monitor technician, 5 ended with the box on a charging station and 4 with the box left in the room, and the provider was messaged after 3. The installed version, in other words, is still the one used for the core decision in a little over half of the reminders observed, while the steps around the edges, returning the box and messaging the provider, have weakened more. The criteria themselves, taken from the national monitoring standards (Sandau et al., 2017), were applied correctly in every one of the assessments watched.
Additions Are Usually Repairs
The one addition, calling the monitor technician before removing a box, was never in the protocol and is plainly an improvement. The technicians had been watching channels for patients who were no longer connected and calling the unit about leads-off alarms for boxes sitting on a bedside table. Nurses added the call themselves within the first month. It should be written into the protocol, not corrected out of it, and the technicians should be credited for prompting it.
Not every subtraction is decay either. Skipping the secure message after removal on nights may be a reasonable adjustment: providers learn of the removal at morning rounds, and none of the nine removals followed had a provider object afterward. The other subtractions are different. Leaving boxes in rooms is linked to transmitters disappearing with discharged patients, and the substitutions replace an assessment with a default, which is the protocol's purpose being bypassed rather than simplified (Debono et al., 2013).
Who Holds It Now
The protocol document names no owner. In practice, the day charge nurse who serves as telemetry champion runs a weekly report of patients past 48 hours, and the monitor technician lead keeps the removal list. Neither role, however, has the authority to remove the paper list, which hospitalists write on, or to move the reminder time, which belongs to the record team.
The Authoritative Version, Declared
Until a revised protocol is approved, the authoritative version is the installed one with a single change: the call to the monitor technician before removal is part of the procedure and should be taught. The paper list and the stock answer are not part of the protocol and are recorded as deviations to be addressed. This declaration matters because a practice with two versions, one written and one performed, leaves new staff to learn whichever version their preceptor uses, and fourteen months is long enough for the performed version to become the one people think is official. Sustained practices often look different from the version installed, and deciding which differences to keep is part of sustaining them (Moore et al., 2017).
References
Debono, D. S., Greenfield, D., Travaglia, J. F., Long, J. C., Black, D., Johnson, J., & Braithwaite, J. (2013). Nurses' workarounds in acute healthcare settings: A scoping review. BMC Health Services Research, 13, Article 175. https://doi.org/10.1186/1472-6963-13-175
Moore, J. E., Mascarenhas, A., Bain, J., & Straus, S. E. (2017). Developing a comprehensive definition of sustainability. Implementation Science, 12, Article 110. https://doi.org/10.1186/s13012-017-0637-1
Sandau, K. E., Funk, M., Auerbach, A., Barsness, G. W., Blum, K., Cvach, M., Lampert, R., May, J. L., McDaniel, G. M., Perez, M. V., Sendelbach, S., Sommargren, C. E., & Wang, P. J. (2017). Update to practice standards for electrocardiographic monitoring in hospital settings: A scientific statement from the American Heart Association. Circulation, 136(19), e273-e344. https://doi.org/10.1161/CIR.0000000000000527
The Chamberlain NR 721 Week 2 instructions
Hold two descriptions of one practice and keep them apart until the end. Write the version in use first, from watching rather than from the policy, step by step and in the order steps happen, including the ones nobody documented. Then write the version installed, from the original materials, with their date. Between them, list the differences and classify each one, for example as an addition, a subtraction or a substitution, with its effect. Do not treat every difference as decay: additions are often repairs, and some subtractions remove steps that were never load-bearing. Put numbers on the distance where you can. Say who holds the practice now and what authority each holder lacks. Close by declaring which version is authoritative until a revision is approved, and which differences are recorded as deviations.
How this NR 721 Week 2 example is built
The sample explains why the current version was written first and describes two weeks of watching reminders and removals. Its nine-step current version includes a paper list at the monitor desk, a stock answer and a call to the technician. The installed version follows from the 1 August 2026 packet. A table classifies six differences, from the technician call as an addition to boxes left in rooms as a subtraction. A section counts the distance: 7 of 12 reminders assessed, 5 answered by default and 4 of 9 boxes left in rooms. The paper treats the technician call as a repair and the night-time skipped message as possibly reasonable. It notes that neither caretaker can remove the list or move the reminder and declares the installed version plus the call authoritative.
Reading the NR 721 Week 2 grading rubric
The most expensive review describes current practice by reading the policy, which produces two identical descriptions and a conclusion that all is well. Ranked below that is a review that finds differences but never classifies them, leaving a list where an argument was wanted. Marks are lost for treating every difference as decay, when an addition may be a repair and a subtraction may remove an unnecessary step. A review with no owner named, and no declaration of which version now governs, leaves the practice in two versions. Graders reward reviews that write the current version from observation first, classify each difference with its effect, count the distance and declare an authoritative version.
Common NR 721 Week 2 mistakes, and how to avoid them
Writing down what people actually do, before rereading the policy, takes discipline, because the installed version shapes what you notice. Share the change, the original materials and what you have seen on the unit, and the review can be built with the current version first, the installed version second, a classified list of differences with their effects and a clear statement of who holds the practice. Declaring an authoritative version is the step that prevents the unit from running two. The observations and judgments are yours.
Get a NR 721 Week 2 example written to your instructions
Send the review template your classroom supplies and the rubric, plus two lines on a change and what it looks like now. A custom Week 2 review returns inside 24-48h with both descriptions written and the differences classified. There is no charge for a first example. If you have no change to hand, ask and a worked scenario arrives with it.
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NR 721 Week 2 questions, answered
How do I describe current practice without observing a real unit?
Work from the scenario your classroom supplies, or from a composite you build and label as one. Write it in the same step-by-step form you would use from observation, then state in a line what the description rests on. A reviewer who is open about that keeps the marks; one implying fieldwork that never happened does not.
Is this the same as an evaluation?
No. An evaluation asks whether the change achieved what it was for. This review asks what the change has become, which can be answered even where outcome data is missing or ambiguous. The two sit in the same course, and rubrics tend to punish a review that quietly turns itself into an outcome report halfway down the page.
How many steps should the current practice be broken into?
Enough that a difference has somewhere to attach, which is usually between six and ten. Fewer, and the two descriptions match at a level too coarse to be useful. More, and the review becomes a procedure manual in which the differences that matter get lost among ones nobody would act on.
Where can I find a free NR 721 Week 2 sample paper?
A complete post-implementation review of a telemetry discontinuation protocol, with installed and current versions kept apart, is available on this page.
Which difference does the NR 721 Week 2 sample treat as a repair?
Nurses' call to the monitor technician before removing a box, which stopped technicians watching empty channels and should be written into the protocol.