community health

Remember to submit your work following the file naming convention FirstInitial.LastName_M01.docx. For example, J.Smith_M01.docx. Remember that it is not necessary to manually type in the file extension; it will automatically append.

Start by reading and following these instructions:

1. Quickly skim the questions or assignment below and the assignment rubric to help you focus.

2. Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.

3. Consider the discussions and any insights gained from it.

4. Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling.


Your submission should be a minimum of 2000 words (maximum 2500 words) in length and should completely answer the proposed questions/items as listed under “Overview”. You should have a minimum of three (3) references. APA formatting is required and all responses should be combined into a single document for submission. Use the rubric as a guide for the evaluation method of the project.

The practice experience project hours should be documented in Project Concert. Practice hours relate to time spent on activities for your Community Assessment. (Discussion Board work does not apply). You should have 8-12 hours logged for Module 8. Minimum required hours for Module 8 must be entered into Project Concert. Some states/entities require hour logs for certification or employment. It is the student’s professional responsibility to ensure all hours are entered correctly in order to meet these requirements. Review the document in the Learning Materials on directions on how to enter hours found in Module 7. Access Project Concert.

*Total hours logged in Project Concert for the course is 20-30 hours. Please note, if you hold an RN license in WA you must have submitted a minimum of 20 hours of practice experience into Project Concert. It is the student’s responsibility to accomplish this and log hours into Project Concert.

The Signature Assignment will be worth 500 points.

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Community Health


Program Development 1

Professional Development Paper

Amanda Moran

Walden University

Nursing 6000 Section 23, Success Strategies in the Master of Science Program in Nursing

September 11, 2011

Program of Study and Professional Development Plan

As I begin on this journey towards greater good I need to first develop my program of study and professional development plan. The purpose of this paper is to assist me in broadening my perspective on being a student and enable me to fully understand my personal and professional goals. In addition I will share my professional and educational background as well.

Education and Professional Background

My name is Amanda and I am a BSN, RN working at NuRoc Community Care Center. I teach CNA, psychology, and Medical Terminology classes at NWTC. In addition I field insurance claims from home. I am divorced and recently purchased a house in Northeast WI. I have three beautiful acres of land and love living here.

I started my career at UW Milwaukee and got a bachelor’s degree in Kinesiology. I then went on to Marquette University to obtain my Master’s in Physical Therapy. After completing my MPT I went back to UWM to obtain my bachelor’s in nursing and Masters in business administration. I truly love knowledge and value my education.

I have a lot of diverse experience under my belt as a nurse and prior to being a nurse. I worked for a year in the wound clinic at Freidert Hospital in Milwaukee. Here I treated all different types of wounds as a Physical Therapist. After becoming an RN I began to work at the Nursing home. This has tremendously expanded my critical thinking skills. I also worked at the hospital for two years mostly in oncology but also float/pool. In the midst of this I expanded my experience farther by obtaining my teaching certificate. I teach CNA courses and this semester for the first time I am teaching leadership development for associate degree nurses. I am very excited to start this course.

How do you ever know if one is ready to start school again? I feel I am as I wish to advance in my current field and eventually own a CBRF in the near future. I truly love school and learning more about nursing. In the field I have been in many leadership roles, charge nurse, team leader, facilitator, MDS Coordinator. Being involved in leadership roles confirmed my desire to advance my career in leadership and administration.

Professional Goals

The purpose for my completing a graduate program was originally to take my mind of stress in my life but has evolved into an aspiration in owning a CBRF. I want to become DON at my current job to test out how I will do as a leader and authority figure. I would like to take on a role of staff development coordinator, which will incorporate my teaching skills and nursing skills. I also aim to obtain my MSN and use it to further my career as a nursing professional.

Course Learning Goals

Healthcare finance and budgeting is probably the most important class for me to do well in. This course will assist me in having the necessary tools for eventually starting a CBRF on my own. In addition to this learning APA format will assist me in producing professional documentation and presenting my ideas professionally. In addition it will help me to effectively communicate with my coworkers. My goal is to be able to communicate effectively and be a respected leader in my profession.


I have contacted a local nurse at the local clinic in Wausaukee to shadow her in practicum. I view practicum as the final and key tool in my learning success. It will let me take all, my knowledge and use it to treat patients in a real life setting. This will also teach me aspects of healthcare that you don’t learn online or in a book. The nurse I will be working with is a reputable member of society and she is an excellent leader and mentor. She feels confident that she will still be working at the clinic in two years.


I am already familiar with the online learning curriculum, since that is how I got my teaching certificate. I look forward to moving ahead with my masters at Walden University. This experience should broaden and expand my horizons. On the next few pages I have completed my plan of attack for completing my master s degree in an efficient and timely manner.

Program of Study Form



Nursing – MSN (BS to MSN)


Leadership & Management

Full 08/24/2011


Course Title Semester/Term to be Taken Semester Credit Hours
Core Courses: (All core courses must be completed before starting the specialization courses.)
NURS 6000 Success Strategies in the Master of Science in Nursing Online Environment FT1, 11 1
NURS 6110 The Nurse Leader: New Perspectives on the Profession FT1, 11 3
NURS 6101 Policy and Politics in Nursing and Healthcare ST2, 11 3
NURS 6125 Integrating Theory and Research for Evidence-Based Practice ST2, 11 3
NURS 6150 Promoting and Preserving Health in a Diverse Society SUT1, 11 3
Specialization Courses: (Not transferable)
NURS 6200 The Nurse Administrator: Leading and Managing for Excellence FT 2, 12 4
NURS 6210 Health Care Finance and Budgeting FT 2, 12 4
NURS 6220 Human Resources Management ST 2, 12 4
NURS 6230 Case Study: Quality Nursing in a Complex Health Care Organization ST 2, 12 4
Capstone Courses: (Final Courses in the Program.)
NURS 6500 Capstone: Synthesis Practicum I SUT 2, 12 3
NURS 6510 Capstone: Synthesis Practicum II NuRoc community care center 3
Transfer Credit Awarded (if any)


Course Title Institution Walden


Total Transfer Credit

amanda/App8amoran (1).docx



Summary of Community Health Project

Amanda Moran

Walden University 6150

February 24, 2012

Summary of Community Health Project

This is the final summary of my community health project and its intended outcome. I plan to map out for my final conclusions and lead into my PowerPoint presentation created to supplement and summarize my project. I have designed the project with a very diverse population in mind. I am hoping that this paper along with my PowerPoint will present and tie together all three parts of my project.

The setting I designed my PowerPoint for is an online audience. I added very lively sound effects and photos to supplement the information provided and keep a varied and diverse groups interest in the presentation. I hoped to add a level of personal trust by adding personal photos to my PowerPoint along with the information and some very generic pictures. The design of the power is very simplistic to help the learner focus on the facts. The sounds effects were strategically placed to highlight the beginning and the end of the presentation and add a little fun to the presentation.

I plan to place this PowerPoint online along with a recorded lecture to accompany it and have the link to it on my Facebook page. This will give access to a large population at any time. Therefore people will be more apt to participate due to my projects accessibility. The easier it is to get involved the more likely someone will get involved. I am hoping that this will aid in maximum participation.


Running Head: PORTFOLIO 1


Portfolio Paper

Amanda Moran

Walden University

December 23, 2011

Portfolio Paper

One of the biggest eye opening topics we covered in this class was the topic of interprofessionalism. I have learned to respect and assist my fellow healthcare professionals. I now understand that by working together we can provide the most complete and highest quality of care available. This benefits me, my coworkers, my students, and my patients I treat. Collaborative nursing is working together as a team to fully meet the special needs of the individual patient. In reading and researching for this class I have come to the decision that collaborative nursing is essential for effective, safe, competent, and ethical nursing practices. I also learned to seek clarity in my role as a nurse and in the role of other health care providers in order to work effective in a collaborative relationship. If I clearly know my role and understand my coworker’s roles we will be able to understand how each one is helping to aid the patient in seeking and receiving medical treatment.

I have learned so very much this semester about healthcare and healthcare reform. One of the most valuable insights I learned about in this class was the Wisconsin Nurses Association (WNA). After doing much research and using the website for a reference several times I have now joined the WNA and actively am participating in the letter writing campaign for staffing reform in Wisconsin. According to the WNA (2011) they are defined as a professional organization for nurses in Wisconsin to broaden their horizons, obtain details on new happenings in practice, education, research, legislation, and other areas affecting nursing professionals. The WNA website holds many answers to tough nursing decisions faced by nurses every day. There are forms and instructions for reporting things like unsafe staffing, abuse, neglect, workplace violence, and much more. The WNA also works hard to ensure nursing as a valued and growing profession in Wisconsin. There is access to scholarships to further education, question and answer forums, current legislation, and current licensing laws. Four times a year the WNA holds meetings and compiles a Working for You document, providing a snapshot of all we are doing to support WNA’s mission –“nurses caring for nurses and nursing supporting and advancing the profession of nursing.”(WNA, 2011). In addition to the politics there is information and forums for advanced practice nurses, Practical nurses, Registered Nurses, and Graduate Nurses as well. This association in a rich and invaluable tool for all nurses in WI.

Nurses take an ethical oath when we get our license and become caregivers. We have a responsibility to a lot of different affiliations. My view on this is the same as it has been since I took Ethics and Values in the Health Professions as a freshman in college. I live by nonmaleficence, above all do no harm. According to Twomey (2008), this defines a basic part of the nurse-patient relationship as respect for patient’s dignity and self-worth. In any situation the nurse has to make a list of pros and cons and carefully weigh the outcome of all nursing decisions made. You always have a loyalty first to yourself and then each individual nurse will prioritize their loyalties and how they fall in place for them as an individual.

Twomey (2008) defines legal issues as one that has a specific law behind it and if not obeyed to full extent is punishable by legal consequences. Nurses are guided by a strict code of ethics and well defined laws to assist us in abiding by them. There and always a “gray” area in any well set of guidelines. In any situation I have found that with hard work and vast knowledge the ethical and legal aspects of nursing complement each other. In WI we have a very well set of checks and balances in our system.


Wisconsin American Nurses Association. (December, 2011). Support the RN Safe Staffing Act. Retrieved from

Twomey, J. G. (2008). Guide to the Code of Ethics for Nurses. Alexandria, VA: Grammarians, Inc.


Running head: NURSING



Amanda Moran

Walden University

October 25, 2012


Case study; Poor Hygiene and Improper handling of Patients in Hospital Wards

In St. Francisca hospital, the issue of hygiene and cleanliness within and around the hospital’s wards is a factor that needs to be considered. In this case, there are health risks which are associated with the hygiene of the hospital.

The wards are not regularly cleaned. This leads to unhealthy environment in the wards. Nursing becomes an issue as patients would always seize more time to recover. This is because of infection and re-infection with communicable diseases such as common cold, Tuberculosis, among others (Joan, 2010).

The bedding in the wards is not cleaned often. In some cases patients are given clothing and bedding which had been used by other patients. This poses great risk to both the patients and the nursing staff. This condition can generate a series of infections whereby a patient can be infected with a new disease in the hospital wards apart from the sickness which he or she was already suffering from. In the case of sharing or using unclean bedding, such infections as skin infections are common among patients. Whenever patients use unclean bedding, they would come back to the hospital later with skin infections (Joan, 2010).

Poor hygiene has also caused diarrhea among patients. Hospital cabins where patients keep their stuff are always dirty exposing the patients to high risks of infections. Stomach infections are common among patients being taken care of in improperly cleaned wards. The water used by both patients and the entire hospital is not safe for drinking. This leads to cases of stomach upsets and other difficulties. Patient use untreated water and the wards are rarely cleaned, and when cleaned, contaminated water is used. This water is obtained from the drainage system of the hospital. This is occasioned by the shortage of water in the facility forcing the workers to recycle water. The issue of recycled water leads to poor health conditions in the hospital.

Patients in the hospital share items such as utensils, toilet papers among others. These pose a lot of risks as control of contagious disease becomes so hard to be attained. The hospital management has failed to offer enough of these facilities to ensure that there is no sharing of items. Disease control and quick recovery of patients is not enhanced (Paul, 2007).

The shortage of items in the hospital has compelled the patients and care takers to resort to bringing items from the nearby hotels and other sources of food stuffs. This increases the risks associated with sharing of utensils since most of the food and utensils sourced from outside the hospital do not have guaranteed health conditions. Food and items from outside the hospital increases the health risks associated with hygiene since such sources are not closely monitored and managed (Joan, 2010).

There is shortage of sanitary equipment within the hospital. Such equipment as gloves and disinfectants are not readily supplied to the hospital. This forces the nurses and other individuals to use bare hands most of the time while handling their patients. This poses a great deal of risk to both the nurses and the patients. There are high chances that the nurse can get infected with the diseases which the patients are suffering from. This is very dangerous since such cases can lead to re-infections (Paul, 2007).

The choice of this case study is the magnitude of the risks that the case poses to the individuals around this environment. The level of exposure to health risks in such a condition is too high that it needs to be used to avoid a similar situation in any other health facility.

Actions and Interventions to Solve the Problem

The wards should be cleaned and hygiene maintained at all times. The hospital management should ensure that the environment within and outside the hospital is maintained at high standards always. This will control the level of infection and re-infections among the patients. It will also improve the rate of recovery among patients.

The bedding and clothing used by the patients as well as the nursing staff should be ensured that they are clean and in good state. Whenever a patient is getting admitted, the management should ensure that he or she is given clean bedding and cloths which has not been used by any other patient. The management should ensure that there is enough supply of such facility in the hospital. Patients should not be left to share bedding and clothing. When this is ensured, the level of infection among the patients will greatly be reduced (Paul, 2007).

The hospital management should ensure that there is enough and safe water to be used in the facility by all. The patients should get access to clean and safe water. If this is ensured, cases of diarrhea and other infections related to consumption of unsafe water will greatly decline.

The management should ensure that items as utensils and toilet papers are sufficient in the facility. When the patients are not sharing such personal items as plates, spoons, toilet papers among other items, the rate of recovery is improved greatly and the infection and re-infection rate declines.

The management should discourage the moving of items and utensils in and out of the hospital. Patients should use items which are strictly provided by the hospital. Items and food from outside the hospital should be discouraged as it increases or leads to poor hygiene in the hospital. The management should hence ensure that enough food and other facilities are availed in the health facility (Joan, 2010).

Safety equipment such as gloves, towels, disinfectants among others should be availed in the hospital in sufficient quantities. The nurses should not encounter any challenges related to the shortage of these items and equipment. This enables the nursing stuff to work with minimal challenges and also ensure that cases of infection in the course of duty are greatly minimized. When there are sufficient facilities and equipment at the nurses’ and staff’s disposal, the treatment and care given to patients is highly enhanced. Lack of this equipment may lead to very deadly cases such as infection of the staff with HIV/AIDS, as well as spread of other infectious diseases among the patients and even to the staff. The nurses risk getting infected if they do not use the appropriate measures and equipment. The equipment is hence very crucial in maintaining a good service delivery in the hospital (Joan, 2010).

Patients should also be educated on matters pertaining to health and the manner in which they should conduct themselves while undergoing treatment and care in hospitals. They should be educated on the basic hygienic measures and actions that they should take for a quick recovery.

The staff should also be given regular training to ensure that they are at pace with the changing situations such as the utilization of new items. In such cases the management should ensure that regular training and close supervisions are given to the nurses and other staff to make sure that they conform to the expected code of conduct, such as the set ethics and basic rules and regulations of the system (Paul, 2007).

Generally, the management of any health system or facility should ensure that optimum condition and environment is set to enable the stuff to work properly and assist the patients to recover sooner than latter.


Rita, H. (2011). Forensic Nursing: A Handbook for Practice. New York; Jones & Bartlett Publishers.

Susan, B. (2008). Nurse as Educator: Principles of Teaching and Learning for Nursing Practice. New York; Jones & Bartlett Learning.

Paul, K. (2007). Nursing Informatics: The Impact of Nursing Knowledge on Health Care Informatics. California; IOS Press

Sadia, N. (2011). Nursing: The Ultimate Management Guide. Washington DC. Demos Medical Publishing,

Joan, T. (2010). Leadership and Management in Nursing. New York; Jones & Bartlett Publishers.

amanda/PA8Amoran .docx

Running Head: Summary 1

Running Head: SUMMARY 3

Professional Portfolio summary

Amanda Moran

February 25, 2012

Professional Portfolio Summary

The purpose of this paper is to evaluate how my expectation of evidence-based nursing has changed throughout this course. In addition I will explore how to apply research to my nursing practice in the future. Last I will evaluate how this will affect others I work with as well. All of these points will be evaluated and incorporated into this paper.

How have my expectations of evidence-based practice changed?

I have realized how important evidence –based practice is to the nursing profession. I never realized that most of nursing process comes from evidence based practice. We draw on evidence-based research for all types of things in the nursing field from what type of shoes we wear to how to administer medications. I never realized how imbedded in the field the research is. According to Parker and Smith (2010), a theory is an idea that “explains experience, interprets observation, describes relationships, and projects outcomes (p 7)”. This has many implications in the field of nursing. I plan to use evidence- based nursing practice to continue to develop and refine the nursing role.

How will it affect others who work with me?

I already see the effects of my interest in evidence-based nursing at my current job. I never complain about things instead I formulate a plan of action to change what I deem an unfit practice of nursing. I will research the topic in question and explore different proposed solutions to eliminate the issue. Other nurses that I work with have begun to make an effort to solve issues instead of making constant empty complaints. According to Parker and Smith 2010, a discipline offers a unique perspective or view of the problem. Using our judgment, research and practice, we are able to identify this issue and solution highlighting our clinical findings and nursing perspectives.

I hope this paper gave you some insight into how I have grown as a nurse and how I will continue to grow. I plan to make evidence-based research an integral part of my nursing career. It has become an important and well used part of my nursing career. I hope to continue to be a contributing member of my healthcare team.


Burns, N., & Grove, S. K. (2009). The practice of nursing research (6th ed.). St. Louis, MI: Saunders Elsevier. Parker, M. E., & Smith, M. C. (2010). Nursing theories and nursing practice (3rd ed.). Philadelphia, PA: F.A. Davis Company


Empowerment 1


Nursing 6100

Amanda Moran

October 27, 2011

Empowerment 2

This paper is a reflection on empowerment and how my organization empowered is. The first step is to define empowerment. Grossman & Valiga (2009) define empowerment as: “A process through which individuals feel strengthened, in control, and in possession of some degree of power.”(p 167). This is a good start to the idea but empowerment is so much more than a simple definition can provide for us.

I work for NuRoc Community Care Center and on a scale of 1-4 they are a 4 as far as empowerment. Grossman & Valiga (2009) state that,”Nurses are empowered when a shared governance model is in place.”(p 167). This is very true at my job we set our schedules and work independently with one another to cover all shifts. We also are encouraged to actively participate in peer review. I feel peer review is one of the greatest methods of feedback and sources of empowerment a nurse can use. There is even a system in place if we feel we want peer review anonymously. The administrator randomly picks out a few people and has them fill out a peer review form. That form is then typed up and we can read them without knowing who is saying what. This is a great way to look at your work performance unbiased and find ways to improve you as a nurse.

One of the “no” answers that needs to change is my organization should be pushing us to strive for excellence. In theory they think they are but it’s really a gets the job done without disrupting my schedule attitude. They are working on trying to change that and it is clear to staff but in the mean time they do not push excellence. Another no question that goes along with this is that the channels of communication are not always made open and clear. At times when in crisis I’m not always sure who to turn to in the administration. The administration has very poorly defined roles in the company. I’m never really sure who to talk to about things the

Empowerment 3

director of nursing, assistant director of nursing, administrator, human resources etc. This gets discouraging and overwhelming for staff members and some will even give up.

I am taking it into my own hands to empower myself and going to school to get my masters in nursing. As mentioned by Grossman & Valiga (2009) the most significant source of empowerment for nurses is knowledge. We gain knowledge in many ways throughout our lives and careers. The most influential way is through schooling and credentials. Think about how you choose a doctor or a lawyer, you look for their credentials. Well nursing is the same the more credentials the more book smarts a nurse has. Do not forget that a lot of important knowledge comes through experience as well. Learning to communicate effectively with others and handle situations comes from experience.

Empowerment 4

Reference page

Grossman, S. C., & Valiga, T. M. (2009). The New Leadership Challenge: Creating the future of nursing (3rd Ed.). Philadelphia: F. A Davis.


Community Health Project Amanda Moran Nursing 6150 February 2012

Drinking In Wisconsin

“ 1 in 4 kids in Wisconsin report having more than a sip of alcohol before the age of 13” Hochstedler (2009). This picture is a “Sunday Fun day” with a mother and daughter starting the day with Bloody Marys’s at the local Tavern.

. Marinette County reports alcohol abuse in 41% of the population. This is almost half of the persons living in Marinette County.

Changing the Culture

According to the WHD (2010) WI has 1 tavern to every 7 people and 30 people to every square mile, that’s four taverns per square mile and that is 4x the national average. Its in the Culture!

Implementing Change

Change behavior

Change culture

Change the examples set

Change education

Change activities

Implement and Carry out

Utilize local resources

Family fun night and alcohol education and outreach program

Alcohol free activities in the community

Promote alcohol education in the school

Facebook page for education and promotion of community events.

Instill a sense of pride in the community and utilize volunteers to assist in execution of family education programs

Increase involvement

Facebook-increase involvement

Respected Community members

Fire department, Rescue squad, School teachers

Local businesses to facilitate


Surveys prior to starting

Evaluate education level of subjects

Evaluate education on subject matter

Post test to evaluate effectiveness and need for change or further education

Continue Change

Spread the WORD!!!!

Flyers, Facebook events, raffle tickets…

Raise donations 50/50 raffles, meat raffles, silent auctions…

Soup walks, dances, bike runs….

Change is always a chance for us to grow and learn ! Accept new ideas and ways of living, learn from it, grow with it, and accept it!


Marinette County Department of Health and Human Services (2011). Census and Statistics. Retrieved from:

McGraw, P., (2011). Parents Set the Example. Retrieved from: Updated August 2011.

Wisconsin Health Department. (2010). Impact of Alcohol on Wisconsin. Retrieved from:


Learning Experience Summary

Amanda Moran


April 17, 2012

Chief Nursing Officer

“There are six themes critical to the work of the CNO that include communication, continuous learning, quality health care, partnerships, relationships, and future orientation. “ (Roussel, 2009, p.10).

All of these elements are what make the CNO an effective leader.

The CNO at my facility definitely fits the role of a transformational leader. Grossman and Valiga (2009) defines this as, “leaders and followers raise one another to higher level of motivation and morality.” (pg. 63).

She motivates but maintains the separation between friend and leader.

Importance of always being on stage and in control.

Employees view you as a role model and a source of guidance.

Must maintain a positive working environment and working relationship and trust with employees.

Director of Environmental Services (DES)

The primary role of the DES is to develop, implement, monitor, and maintain environmental policies and procedures for promoting a sustainable environment for both the public and private sector in the healthcare facility.

This is the framework for all other departments in the facility.

Ensure proper training of the staff and recognize their contribution opt all levels of healthcare.

Learned to budget time by making a detailed list of duties for the day.

Organized leaders are effective leaders and set a positive example

Maintain cleanliness throughout the hospital and order and supply needed ancillary suppliers for nursing staff

Build a strong bond between nursing staff and ancillary staff

Important for building a positive work environment

Clark (2008) pointed out that leadership is not simply handed over to individuals to be used without action, we must embrace our role, envision change and make it happen, and create opportunities that were absent before.

I learned to foresee the present and the future and think of how my decisions will affect now and the future.

I also learned to look at how my decisions affect others. The DES was always getting others input on different changes.

Healthcare compliance specialist (HCS)

Above all I learned to be a follower as well as a leader from the HCS.

They took charge and lead when they needed to but when they did not know they asked and followed.

Employee respect was gained and maintained by being a great follower and leader.

“The quality of medical information is particularly important because misinformation could be a matter of life or death.” (Eysenbach, 1998).

I learned to always check and double check the facts before using any information.

The HCS was constantly using literature and research to make changes and better the working environment.

All sources available should be used to make change

Effective leaders not only make change but justify and support it with research and facts.

HCS taught me to present the proposed idea and then get employee input

Employees will more readily support and adopt change if they are a part of it.

The HCS is the direct link between the recipients and providers of healthcare and how it is being provided in their institutions.

So in order to be effective you have to be respected and trusted.

Getting others involved develops a sense of community and pride and increases compliance.


After taking this class I have learned some important things.

1. A good leader is a respected leader.

2. Respect comes from setting the example and giving it.

3. Making the transition from friend to leader is hard but you have to do it to become a good leader.


Stull, D. N. & Houlder , D. (2005). Do your commitments match your convictions? Harvard Business Review, 83(1), 82–91.

Grossman, S. C. & Valiga, T.M. (2009). The New Leadership Challenge: Creating the Future of Nursing. Philadelphia, PA: E.A. Davis Company.

Roussel, L. (2009). Management and Leadership: For Nurse Administrators. Sudbury, MA: Jones and Bartlett Publishers.

Clark, L. (2008). Clinical leadership: Values, beliefs, and vision. Nursing Management, 15-30.

Eysenbach, G. (July, 1998). Towards quality management of medical information on the internet: evaluation, labeling, and filtering of information. Retrieved from Business Management journal website:

HCCA (2012). Compliance oversight for health care leaders training video. Retrieved from


Running head: Quality Improvement 1

Running head: Quality Improvement 2

Quality Improvement Strategies

Amanda Swenty

October 23, 2015

Walden University

Quality Improvement strategies

According to, (Boone, 2006), quality can be defined as the standard or rather the characteristics of a product or a service that makes it suitable to satisfy the needs is meant to fulfill. Every product and services quality determines it worth to whatever it is meant to do. As technology and as days go by, the needs a product or service needs to fulfill get more complex and urgent hence the need for improvement is necessary so as to improve the quality of product or services offered.

Health care is one of the most urgent and most important part in a human life hence needs to be handled with caution and expertise. Regular update and quality improvements on noted issues that drag the quality of healthcare services are of essence. In recent past, over-use and under-use of services are two dominant issues that have been noted to be so rampant in health care units that have been a thorn in the backbone of quality service production. Over-use of services occur where a patient receive unnecessary services that are not really needed which may actually endanger their life. Based on research and news, (quality, 2002), in America, it was discovered that at least one out of six operations conducted on patients is usually unnecessary.

On the other hand, under-use of services is where the patients do not receive adequate healthcare and intervention as required which leads to further complications, added healthcare cost or even death. According to research, it was realized that in America, among all the patients who experienced heart attack, only 21% received beta blockers. A whole of 79% didn’t receive the beta blocker services hence endangering their life or condemning them to future complications which means added healthcare problems and cost.

This two issues cause a huge drag on the quality of healthcare qualities and hence need to be addressed systematically to avoid future recurrences. There are two quality improvement strategies that have proved to be quit outstanding in addressing such issues, the six sigma and the PDSA improvement strategies. The PDSA, Plan-Do-Study-Act model is a quality improvement strategy that aims at encouraging positive changes in health care services and processes in order to effect favorable positive outcomes. This is a method that uses a cyclical model to impact change.

The cycle starts by identifying the nature and scope of an issue. It evaluates what changes can or rather should be made and then it formulates a plan for a specific change. The plan allocates resources to be involved, it determines ways to determine the impact this issues cause the heath sector and how to counter the issue. The measure set implement set changes that collect any necessary information on the issue and an analysis of how to counter it and the results are assessed and interpreted. The feedback from the assessment are then used to take action on the issue and implement change, (Lohr KN, 2006).

On the other hand, the six sigma model involves, improving, designing and monitoring a process to minimize errors and issues so as to increase satisfaction. It’s a model that uses inspection process to count and detect issues in a process and uses a statistical table converter to convert defect rate to a sigma. This method identifies the project, it reviews its historical data and defines the projects scope of expectations, it detects any flaw in the scope and measures its intensity and effects on the project (healthcare services), analyzes it and finds a way to improve the nature of the problem and if not possible to improve it, it tries to control the issue and its effects, (Report, 2006).

Application of any of this two model strategies in a healthcare organization would aid minimize or totally eliminate the threat to quality, over-use and under-use of services.

References Boone, L. E. (2006). quality. Lohr KN, S. S. (2006). PDSA model. quality, A. f. (2002). improving healthcare quality. Report, N. H. (2006). six sigma model. Rockville, MD.

identify nature and scope of project

evaluate changes

formulate plan

implement plan

get implementation feedback

action depending on feedback


Running Head: BUSINESS PLAN 1


Business Plan

Amanda Moran

Nursing 6210

June 20, 2012


The Select Specialty Hospital (SSH) is a business oriented unit aimed at improving the life quality by drawing its focus on:

· Treatment options

· Prognosis

· Advance care planning and goal care

· Psychological, emotional and physical suffering

· Bereavement needs

· Functionality capacity

Select Specialty Hospital will improve the life quality of the individuals that are seriously suffering life threatening illness. For this to be enhanced, the organization will address their unique and diverse needs through compassionate, multidisciplinary and comprehensive care. The physicians, nurses and other healthcare providers will be the main beneficiaries of this additional service by becoming more comfortable and familiar with the issues pertaining end of life and due to the role of the consulting service in fulfilling the critically significant, yet unmet patients’ needs.

The financial impacts and budget implications

By the employment of the appropriate model for projecting the total consult volume, the total number of patients that are appropriate for consultation into palliative care will be identified. By the end of the second financial year, a total of 700 patients are projected to be contacted. The consult volume projections will continually be made for the first financial year all through the year 5 of the service operations on the basis of the assumed capture rate in the initial year. In addition, these patients are expected to encounter high cost of stay in the hospital.

Staffing financial projection

The staffing for service in Select Specialty Hospital will be based on the other projections such as patients expected admissions. For the first financial year, full support will be required from a chaplain, full time nurse practitioner as well as a social worker. The continuing support for the director is also proposed. By the year 1, the total salary increment is going to be $1.02 million. After addition of the year funding towards outreach and education ($18,605), as well as the supplies and office space ($13,234), the total funding will be $ 345,000 for the first financial year.

The service cost saving is determined on the basis of the validated model (Hearn, 1998). On the basis of this method, we project a net gain of $6, 465 by the end of the first financial year. In the third year of operations (FY3), despite the requirement of an increased salary support, service is expected to result to a net gain of $192, 717.

The consult service financial impact was also evaluated with an aim of determining the radiology utilization, use of high cost pharmaceuticals as well as the total number of patients required for the inpatient hospice. Out of the 789 identified patients, a total of $1.3M was observed to fall in the high cost pharmaceuticals, a total of 1,398 MRI’s and CT’s and 351 performer intervention radiology procedures. By incorporation of this model, the fist financial year is expected to result in 189 fewer inpatient CT’s, as well as 50 lesser patient for the interventional procedure of radiology. The revenue resulting from increasing radiology availability and increased usage of inpatient hospice combined with the physician billing revenue results in added revenue of $81, 654 for the first year (FY1).

Projects volumes of service units

Costing and pricing

The total starting capital for this business is $ 454, 647. This amount is expected to be repaid by the end of the third financial year. For the break-even analysis, the calculation of the fixed costs is done as a day to day running expense with the averaging being done at the course of the year. For this business, fixed costs will be inclusive of the owners’ salary, technical and legal support, the necessary insurance cover, employee salary and benefits as the continuous training and education. The variable costs are inclusive of direct costs per chiropractic care patient (Schmidt, 2011).

Projecting the sales and loses

The sales are projected to increase from less than $450, 000 to more than $1.1 million by the end of the fourth financial year. Based on the nature of the business (service oriented with no need for expensive inventory or costing), modest profits are expected in the end of the FY1. Based on the fact that the year round residents are expected, the growth is hence projected to be linear as opposed to the cyclical trend. This growth is projected to level out somewhere in the middle of the FY3 as the maximum capacity is reached. Before this point, the business plan will be reviewed with an aim of determining if viability and need for space addition.

When it comes to the breakeven, there is conservative projection in terms of cost of sales, fixed costs, as well as gross margin. The costs of sales and fixed costs have to be marginally lower in reality, with the gross margin being higher in comparison to the projection. Conservative projection is preferable as a way of ensuring adequate cash flow.

Salary expense

Description Expense per year

Chaplain $250,000

Registered Nurse (RN) $108,000

Physician $180,000

Case Manager $121,000

Part time RN $98,000

The financial projections

The management projects continuous profitability in Select Specialty Hospital (SSH), with an ability to generate more than $300, 000 by the end of the third financial year (FY3). The patients coming from the other services (trauma surgery, neurology, general medicine, cardiology, pulmonary, oncology and neurosurgery) are expected to be continuously transferred to the unit after clarification of goals has been facilitated by the Select Specialty Hospital team. Treatment of these transfers will incur lower costs in comparison to the previous services. Based on this understanding, the SSH projects an average of $750, 000 in cost-avoidance annually by the end of the fourth year of operations.

For example, assuming that everything will constantly remain as projected, the management projects that the hospital will be able to welcome more than 200 transfers of patients from other units to Select Specialty Hospital. Given the adjustment to inflation and economic condition four years from the onset of this business, the average costs in Select Specialty Hospital be approximately $1200 on a daily basis less in comparison to the to the other units. Even by taking a conservative approach whereby direct cost is used as opposed to the total cost, almost $400, 000 is still projected in cost avoidance per transfer. This savings are projected to increase to $1.2 million in direct cost avoidance by the end of the fifth financial year.


· The growth towards the end of the FY3 will prompt addition of 4 more consults on a weekly basis in the second quarter, 12 more consults in the fourth quarter

· The FY3 is expected to record an increase in admission of 300 more admission by the end of the financial year

· The projected total expenditure encompasses $90, 000 that will be spent in hiring additional personnel by the end of the FY5.


Hearn, J. (1998). Do specialist palliative care teams improve outcomes for cancer patients? A systematic review of the literature. Palliative Medicine, 12: 319-332.

Miller, S. (2010). A Model for Successful Nursing Home–Hospice Partnerships. Journal of Palliative Medicine. 13 (5): 525-533.

Miller, R. (2012). Chapter 22: Hospice & Palliative Care. Healthcare Business Market Research Handbook. 131-133.

Schmidt, K. (2011). Pediatric Palliative Care: Starting a Hospital-Based Program. Pediatric Nursing. 37 (5): 268-274.




Staffing Development

Amanda Moran

Walden University

Nursing 6220

August 14, 2012

The process of staffing a hospital is an important matter because it has tremendous effects on the quality of care and patient health outcomes. Hospitals with good staffing ratios generally record better patient health outcomes compared to the hospitals with poor staffing ratios. Hospitals with low staffing levels have a high rate of bad patient health outcomes and experience high levels of preventable diseases like pneumonia, shock, cardiac arrest and urinary tract infections (Ramey & Sefani, 2010).

Staffing is always a costly feature in a hospitals budget. The justification of staffing needs in health care settings is based on the number of patients, the list of activities that are performed on the patient that need to be considered in the entry in the budget and the hospital standards of care (Joint Commission Resources ,2007).

The factors that will determine the composition of the staffing for the health care project are the number of patients, the services to be offered at the hospital and the specific patient functions that the hospital needs to perform on its patients. The staff required for the Operationalization of the hospital includes,

1) A hospital manager (one position)

The hospital manager acts as the business manager or the chief executive officer of a hospital. The hospital manager is responsible for watching over the day-to-day activities of a hospital. The hospital manager coordinates the setting of the priorities for the hospital (Simone, 2009). Since the hospital is average, sized one hospital manager can effectively be responsible for overseeing the day-to-day running of the hospital.

2) Hospital technicians

Various types of hospital technicians are required to assist doctors, nurses and hospital administrators in the provision of care.

The technicians that are required at the hospital include,

Health information technicians Health information technicians keep track of the health records of patients like medical history and insurance using coding systems and other specialized software. Health information they help keep track of the diagnosis, the medical procedures and prescriptions (Swanburg & Richard, 2002). The hospital requires two health information technicians; one for the day and one for the night shift.

Laboratory technician

Laboratory technicians conduct tests for diagnosis for planning the treatment of patients. They also collect and prepare laboratory samples for testing and operate testing equipment (Simone, 2009). The hospital requires two laboratory technicians: one to work during the day and the other to work at night.

Pharmacy technicians

Pharmacy technicians are useful in hospitals because they assist pharmacists in labeling, preparing medications and keeping inventory of patients (Ramey & Sefani, 2010). The hospital requires three technicians to simplify the process of issuing medication and alternating between night and day shifts.

Registered nurses

Registered nurses help families and individuals to promote health and prevent diseases. Registered nurses care for the patients in hospitals, coordinate the care of patients and provide patients with emotional support. Registered nurses are trained to degree level (Simone, 2009). The hospital requires 20 registered nurses so that there can be a reserve of registered nurses for alternating between night and day shifts.

Practical nurses

Practical nurses work in providing nursing care to patients under the guidance of the registered nurses and doctors (Simone, 2009). The hospital’s requires 15 registered nurses to be able to achieve adequate staffing for both night and day shifts.

Nursing aides and nursing attendants

Nursing assistants and attendants help nurses in providing basic care for patients in hospitals. They visit patients, move patients around hospitals and offer emotional support to patients. They also provide care to patients with physical disabilities and other health care needs. They usually do not hold any mandatory professional requirements to practice (Joint Commission Resources, 2007). The hospital requires ten nursing assistants so that they can be alternating well in the night and the day shift.

Secretary/administrative assistant

A secretary or administrative assistant performs duties like correspondence, typing and arranging for meetings. Secretaries also do bookkeeping, update websites and arranging travel arrangements (Simone & Sefani, 2010). The hospital requires two secretaries, one to work during the night and the other secretary to work during the day.


Receptionists are the employees that take up office and administrative positions usually done in a waiting area. Receptionists are needed in hospital to be able to welcome and direct patients answering from patients and directing patients to the appropriate room (Simone, 2009). The hospital requires two receptionists, one to work during the day and the other to work at night.

Doctors and physicians

Since the hospital will be operating on a 24-hour basis and serving a substantial number of patients per day, the hospital requires three full time doctors at the hospital facility.

Recruitment process

The process of recruitment of new staff at the hospital is not an easy one. The hospital has stringent criteria of making sure that it hires the competent physicians and other health practitioners that cannot put the lives of people in danger. The plan for the hiring staff at the hospital will be done in stages.

The first step is the preparation for hiring staff at the hospital. The hospital will evaluate its requirements of staff and then determines the positions that should be filed. If there are vacancies to be filled, the hospital management will grant permission for the advertisement of the vacant positions.

The next step is making a request for submission of applications for the position from various potential employees. The hiring process then begins with a medical recruitment team evaluating the potential candidates on three aspects, the possession of the required qualifications, their attitudes to work and the experience level of the potential employees. The medical recruitment team will also perform some background checks of the candidates to ensure that the medical staff backgrounds are very clean.

When a suitable candidate is identified, the employee will be made to sign a contract that binds the medical personnel and makes them responsible for their own actions. An orientation process is then carried out to familiarize the employee with the working processes and the culture of the hospital.

A summary of the projected working schedule of staff at the hospital and expected salaries

position Number of hours of work per day Expected salary and other perks per year Provision for overtime
Hospital manager 8-10 $80000 20 $ per hour
Registered nurse 8-10 $ 66095 $ 18 per hour
Practical nurse 8-10 $41546 per year $16 per hour
secretary 8-10 $33411 $10 per hour
receptionists 8-10 $32411 $10per hour
Lab technician 8-10 $36000 $15 per hour
Pharmacy technician 8-10 $37000 $12 per hour
Nurse assistants 10 hours $ 26500 $10 per hour
Doctors and physicians 8-10hours $180-200,000 $50 per hour


Joint Commission Resources (2007) Staffing effectiveness in hospitals. New York: Author.

Ramey, M., & Sefani, D., (2010). The Leaders Guide to Hospital Case Management. London:

John & Barlet Learning

Simone, K., (2009). Hospital recruitment and retention building a hospital medicine program.

New York: John Wiley & Sons.

Swanburg, R., & Richard, S., (2002) Introduction to management and leadership for nurse

Managers. London: John Bartlett learning.

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