NURS 6053 Developing Organizational Policies and Practices

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As nurses we’re faced with ethical dilemmas daily. We must not confuse ethics and the actual laws surrounding this profession. Although ethics and the law are very similar and paths overlap, they are not the same. Ethical dilemmas occur quite frequently in the healthcare field, which makes healthcare professionals more aware of how to respond to such events. Ethical issues put all healthcare professionals in the mindset of doing what is best for the patient. A national healthcare issue that is currently on a higher trend seems to be the nursing shortage in the work field. Overwhelming patient assignments ultimately lead to disgruntled staff affecting the overall working environment. The shortage in nursing many organizations are facing seem to have multiple effects on quality improvement or indicators such as customer service scores, increased amount of workloads and a decrease in the quality of care rendered (Buerhaus, Skinner, Auerbach, & Staiger, 2017). As safety is the number one goal inpatient care, polices over time have been revamped to ensure safer working environments for the shortage of nurses ultimately reducing medication errors as well as nurse burnout. Moreover, whereas patient needs dictate that hospitals shpuld hire more nurses, the financial performances of these hospitals is also a factor. Thus, nurisng shorateg is being affected by the need to provide quality healt care services vis-à-vis the need to maintain heallty financial performances by health care facilities. Evidence suggests that hospitals have chosen the latter need hence the existence of nursing shortage.

Findings show that religious engagement among students declines during college, but their spirituality shows substantial growth. “Students become more caring, more tolerant, more connected with others, and more actively engaged in a spiritual quest.” (“Cultivating the Spirit – Spirituality in Higher Education”) The authors also found that spiritual growth enhances other outcomes, such as academic performance, psychological well-being, leadership development, and satisfaction with college. The study also identified a number of college activities that contribute to students’ spiritual growth. Some of these–study abroad, interdisciplinary studies, and service learning–appear to be effective because they expose students to new and diverse people, cultures, and ideas. Spiritual development is also enhanced if students engage in “inner work” through activities such as meditation or self-reflection, or if their professors actively encourage them to explore questions of meaning and purpose. (“Cultivating the Spirit – Spirituality in Higher (Alexander W, 2010)”). By raising public awareness of the key role that spirituality plays in student learning and development, by alerting academic administrators, faculty, and curriculum committees to the importance of spiritual development, and by identifying strategies for enhancing that development, this work encourages institutions to give greater priority to these spiritual aspects of students’ educational and professional development.

Policies and Practices to Address Nursing Shortage

Leaders must strike a balance between retaining nurses by any means necessary and understanding the demands placed on staff with unbearable patient acuities. Finding such balances necessitates the implementation of strict policies, even if they are state-regulated. Within my organizations, we have strict policies in place to determine the patient/nurse ratio at various levels of care (Abhicharttibutra et al., 2017). With higher demands for the patient’s care, they are placed on different units, which also sets the bar for the nurse-patient ratio. A patient receiving medical-surgical care does not and may not require the same level of care as a patient in an intensive care unit. Our hospital follows guidelines for each level, which inform providers, managers, and patient flow coordinators about the patient’s needs and the appropriate floors. This is done to ensure that the acuity levels on that unit are not too high, especially given the nurse-patient ratio. Patient acuity tools are used in addition to setting limits for units and patient level of care. Patient acuity tools have proven useful in determining proper nurse-to-patient ratios and dispersing workloads. Nursing tools are designed to “increase nurse satisfaction with their patient assignment.”

Healthcare policies and procedures aid in the standardization and clarity of addressing challenges as well as activities critical for health and safety, legal liabilities, and regulatory requirements in day-to-day clinical practice. Workforce satisfaction and customer satisfaction are two competing needs that affect organizational nursing shortage. Healthcare institutions are often preoccupied with patient satisfaction and fail to recognize the specific workforce that provides care to clients. When the workforce is unmotivated due to factors such as a lack of recognition by management, it reflects the likelihood of providing low-quality healthcare, which leads to patient dissatisfaction (Anand & Dwivedi, 2019). When patients are dissatisfied, management may choose to relieve some employees of their duties; others may also leave due to dissatisfaction, resulting in a nursing shortage within the organization. The goal of this paper is to look at relevant policies that could be used to address two competing needs related to the issue of nursing shortage as a stressor.

Relevant Organizational Policy or Practice Impacting Nursing Shortage

Healthcare organizations are required to be innovative in attaining the needs of the workforce, while at the same time ensuring the provision of safe and quality care to the patients. An effective practice to address the issue of nursing shortage as adopted by my organization is the use of the Magnet Certification for assessing the effectiveness and quality of nursing within it (Haddad & Toney-Butler, 2020). My organization can use the policy to remove issues related to competition between the needs of the nurses and patients’ satisfaction (Rodriguez-Garcia et al., 2020). This is because the policy encompasses involvement of nurses in decision-making processes for effective clinical outcomes as well as effective grievance resolution measures. This in turn ensures nurses’ job satisfaction with low rates of turnovers as well as their delivery of top patient outcomes.

Ethical Concerns of Magnet Certification

The Magnet Recognition Program for adoption by the organization has sound ethical considerations, and no noteworthy ethical concerns or challenges. The strength of the policy in promoting ethics is founded on the rigorous approach that involves several months of evaluations for evidence of excellence in terms of nurse satisfaction, patient satisfaction, and care outcomes within the given institution (Haller et al.). The documentation strategy for the Magnet Certification Strategy involves transformational leadership, structural empowerment, exemplary professional practice, and new knowledge, innovation as well as enhancements. This is done for purposes of compliance of certification together with ethical considerations.

Magnet Program certification necessitates the need for describing the healthcare institution, practice settings for the nurses, and undertakings for upholding patient-centered care, sound ethical considerations, continued EBP research projects, and the Chief Nursing Officer’s (CNO) work description as well as their resume. The aspect of ethics is incorporated within various courses in the program that necessitates addressing social conducts via continued educational research on core cultural behaviors. Every year, mandatory, updated computer-tests are carried out on social conduct alongside ethical content and education is given by leaders to the clinical staff who fail to attain competent scores (Van Bogaert et al., 2018). The program’s robustness in engagement and commitment of the clinical staff in inspiring excellent patient outcomes within every day interdisciplinary practice is overseen through clear frameworks, methodologies as well as resources upheld by governance and policy contexts that attains visible and accountable outcomes.

Recommendation of Policy or Practice Changes for Addressing Competing Needs of Resources, Workers, and Patients

I enjoyed reading your post. Before the class, I did not understand that there were additional factors contributing to the shortage besides burnout and underappreciation. The lack of educational resources such as instructors and, clinical sites is a major cause of the nursing shortage. My research led me to the Title VII and VIII education and training programs of the Public Health Service Act. “The Titles VII and VIII education and training programs of the Public Health Service Act are federal programs that help shape the supply, diversity, and distribution of the physician and health professions workforce to address current and emerging health care quality and access challenges/opportunities. (aamc.org, 2022) Although this Act deals with expanding resources for health professionals across cultures, I believe this act can aid in the provision of clinical sites for nursing students and, loan reimbursement. “Further, the impact of reimbursement, legislation, regulation, and technological advances must also be considered. Failure to consider the relationships among these aspects limits the full appreciation of the nursing workforce shortage complexity.” (aacnnursing.org, 2022) The nursing shortage needed to be dealt with head-on. Organizations are dealing with their shortages, but the government needs to do more.

AAMC. (2019). Increase funding and reauthorize the Title VII and VIII Health Professions Training Programs. Retrieved September 17, 2022, from https://www.aamc.org/news-insights/increase-funding-and-reauthorize-title-vii-and-viii-health-professions-training-programs#:~:text=The%20Titles%20VII%20and%20VIII%20education%20and%20training,and%20emerging%20health%20care%20quality%20and%20access%20challenges%2Fopportunities.

American Association of the Colleges of Nursing. (2022) Strategies to reverse the new nursing shortage. Retrieved on September 17, 2022 from https://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/Reverse-Shortage.

A practice change may be fixated on a change of governance for transparency, accountability, and putting in place effective mechanisms for tackling the challenges. These may include the need for the conflicts arising from the competing needs to be encompassed as a key item within the agendas of relevant committees. This is then followed by making reports on the set needs for attaining the desired outcomes (Harris et al., 2017). There should also be the aspect of quality improvement initiatives within decision-making structures for ensuring a process of review for pinpointing where the issues lie and coming up with effective strategies for addressing them.

Ethical shortcomings that can be tackled within the present policies include autonomy that necessitates for patients to be involved in the decision-making process of healthcare that they receive. Another ethical concern is nonmaleficence that aids in the evaluation of probable harms within the existing clinical systems. The principle of beneficence can also be addressed to ensure the attainment of the objectives of offering as well as inspiring positivity in the realization of the best healthcare outcomes and satisfaction (Ramsom & Olsson, 2017). The ethical consideration of justice can be fulfilled by ensuring a full analysis of the limits of the available healthcare resources within the set healthcare organization.

Conclusion

Policies within healthcare are crucial as they help devise the overall plans of action utilized in leading required results, and are also key for helping in decision-making. They help create clear communication to the workforce the intended outcomes within the institution. The healthcare personnel is in turn able to comprehend their set roles combined with responsibilities within the settings. They help set the foundation for the provision of safe, and cost-effective care to patients.

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Competing needs arise within any organization as employees seek to meet their targets and leaders seek to meet company goals. As a leader, successful management of these goals requires establishing priorities and allocating resources accordingly.

Within a healthcare setting, the needs of the workforce, resources, and patients are often in conflict. Mandatory overtime, implementation of staffing ratios, use of unlicensed assisting personnel, and employer reductions of education benefits are examples of practices that might lead to conflicting needs in practice.

Leaders can contribute to both the problem and the solution through policies, action, and inaction. In this Assignment, you will further develop the white paper you began work on in Module 1 by addressing competing needs within your organization.

NURS 6053 Developing Organizational Policies and Practices

To Prepare:

Review the national healthcare issue/stressor you examined in your Assignment for Module 1, and review the analysis of the healthcare issue/stressor you selected.
Identify and review two evidence-based scholarly resources that focus on proposed policies/practices to apply to your selected healthcare issue/stressor.
Reflect on the feedback you received from your colleagues on your Discussion post regarding competing needs.

The Assignment (4-5 pages):

Developing Organizational Policies and Practices

Add a section to the paper you submitted in Module 1. The new section should address the following:

Identify and describe at least two competing needs impacting your selected healthcare issue/stressor.
Describe a relevant policy or practice in your organization that may influence your selected healthcare issue/stressor.
Critique the policy for ethical considerations, and explain the policy’s strengths and challenges in promoting ethics.
Recommend one or more policy or practice changes designed to balance the competing needs of resources, workers, and patients, while addressing any ethical shortcomings of the existing policies. Be specific and provide examples.
Cite evidence that informs the healthcare issue/stressor and/or the policies, and provide two scholarly resources in support of your policy or practice recommendations.
Due to the nature of this assignment, your instructor may require more than 7 days to provide you with quality feedback.

By Day 7 of Week 3

Submit your revised paper.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK3Assgn+last name+first initial.(extension)” as the name.
Click the Week 3 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 3 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK3Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.
Due to the nature of this assignment, your instructor may require more than 7 days to provide you with quality feedback

Competing needs arise within any organization as healthcare workers seek to meet their targets and leaders seek to meet hospital goals. Either targets or goals require establishing priorities and allocating resources. For example, a policy addressing adequate nurse staffing is essential to meet the patient and workforce needs while minimizing hospital cost. However, utilizing in more nursing staff might result in economic inefficiencies along with misallocated resources.

The shortage of staff is connected with negative impacts; including lower quality and quantity of care because there are few resources to offer. Work overload to the existing nurses lead to burnout, and eventually compromising patient safety. Nursing shortage policies are constantly supported by current literature and they vary from country to country. However, there is continuous effort to modify certain aspect such as pay agreements, emergency hiring plans and RN residency programs to improve working environment for nurses (Park & Yu, 2019). Nurses should also voice their opinion on ways to resolve competing needs; the culture of silence creates a culture of acceptance and continues to suppress nursing professional knowledge (Kelly & Porr, 2018).

Competing needs that may impact nursing shortage is aging population in which baby boomer entering the age of increased need for health services. Which would require more students to enroll into the nursing program today and hire more educators to provide students with proper training. Another contributing factor is nurse burnout, statistics shows a national turnover rates is 8.8% to 37% (Lisa et al., 2020). Nurses are experiencing burnout daily and leaving the profession for better opportunities or advancing in their career. Ensure an optimal nurse to patient ratios to improve nurse staffing and improve quality of care delivered. Lastly, workload and work environment has forced hospitals to reduce staffing and implement mandatory overtime polices to ensure nurses would be available to work when the number of patients admitted increased unexpectedly. Furthermore, increase the workload to decrease on health care costs.

A policy might address these competing needs by ensuring an optimal nurse to patient ratio which can improve care outcomes for patients and ensure patient safety. Healthcare policymakers’ involvement in developing a staffing policy in every organization to improve working conditions (such as working hours, violence in workplace, managing workload) for the nurses staff to improve competencies and better job satisfaction. Ensure adequate government funding to allocate resources for training and clinical skills without causing strains on the government and organization budget. Also, devote resources toward increasing nurses wages; a token of appreciation for their dedicated and hard work.

References

Haddad, L.M., Annamaraju, P., & Toney-Butler, T.J. (2020). Nursing Shortage. Retrieved June 15, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK493175/

Kelly, P., & Porr, C. (2018). Ethical nursing care versus cost containment: Considerations to enhance RN practice. OJIN: Online Journal of Issues in Nursing, 23(1), Manuscript 6. doi: 10.3912/OJIN. Vol23No01Man06. Retrieved from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No1-Jan-2018/Ethical-Nursing-Cost-Containment.html

Park, H., & Yu, S. (2019). Effective policies for eliminating nursing workforce shortages: A systematic review. In Health Policy and Technology, 8(3), 296-303. https://doi.org/10.1016/j.hlpt.2019.08.003

Cost of medication determines whether the patients will be willing to seek healthcare services from an institution or not. The goal of the quadruple Aim is to reduce the cost of education and increase the access to healthcare services by the population. The cost of medication depends on various factors including the changing economic times and the need to increase the number of healthcare providers in an organization. From the business perspective, institutions operate with the aim of making profits. Therefore, in the call for improving the quality of the healthcare services the patients receive, the healthcare institutions may require to increase their staffs and other equipment necessary for efficient operations. Addition of the resources result in the increased cost which must be transferred to the patients who are the consumers. Therefore, the current study explores the conflicting perspective of the mandatory overtime as a way of meeting the needs of the patients without increasing the cost of medication.

Competing Needs

The increasing number of patients in the healthcare institution requires an additional human resource. However, conventionally, the ratio of healthcare providers to the patients have remained low because of the limited resources. Healthcare providers are forced to attend to many patients beyond the standard requirements. Alternatively, the healthcare institution may opt to recruit more staff and this will result in additional costs which may be transferred to what patients pay. Some leaders may opt make full of their current staffing in responding to the rising costs and change in the payment policies by the federal government.

The introduction of the pay-for-value compensation method meant that healthcare institution would improve the quality of healthcare services to the patients (Kominski et al., 2017). Besides, the policy aimed at eliminating all the unnecessary health interventions that could otherwise increase the cost of medication. Furthermore, the hospital institutions are forced to utilize their existing staff accordingly to improve both the quality of care and minimize the treatment costs. Nurses and other healthcare providers may be forced to work for long hours since they have to spend lots of time understanding the need of their patients to meet the quality threshold (Bernstrøm et al., 2019). On the other hand, the increasing number of patients also force them to work overtime. Therefore, the need to lower the cost of medication and at the same time maintain the quality.

Relevant Policy Practice

The healthcare organization introduced the mandatory overtime as a way of dealing with increasing demand for the quality healthcare services as well as maintain the cost low. Eliminating the mandatory overtime means that the institution may have to employ more staff and this will result in additional cost of medication. The nursing staffs are expected to work for about 2 hours extra per day to meet the demand for healthcare delivery. The policy was introduced after recognizing that the nurses and clinicians spent little time with the patients and so did not identify all their needs. As a result, the healthcare providers were required to spend enough time and so they would have to work overtime depending on the patients’ flow. Therefore, all the employees recruited in the organization were made aware of the mandatory overtime requirement whenever requested.

Critique of the Policy

The policy was developed to respond to the need to improve the quality of healthcare services to the patients. The introduction of the pay-for-performance means that the healthcare institutions would be compensated based on the patients outcome and not the services offered. As a result, the institution had to develop an approach of responding to the need without increasing the costs of medication to the patients. Nurses and clinicians would spend more time with their patients and understand all understand the underlying factors that could impact their treatment outcomes and this would lead to better outcomes.

However, exposing the healthcare providers to long-working hours could leads to injuries and emotional exhaustion. Studies have indicated that burnout among the employees in healthcare sector is attributed to the long working hours (Kowalczuk et al., 2020). It is ethically wrong to expose the healthcare providers to health risks with the intention of reducing the medication costs (Moon et al., 2020). The quadruple Aim advocate for both the better outcomes for the patients and improved quality of life for the healthcare providers. Mandatory overtime for the healthcare providers does not improve their quality of life but instead increases their risk of developing burnout.

Furthermore, studies show that fatigued employees are prone of making errors and this means that the patients could suffer more from the medication errors (Salen & Norman, 2018). The policy in the institution is only suitable for short-term goal but destructive in the long-run. All healthcare providers must be treated with dignity and be given enough time for rest. Therefore, while the goal of the policy was to address the issue of rising costs, it could increase the costs because of the frequent recruitment requirement due to high employees’ turnover in the organization. High turnover rates could compromise the quality of the healthcare delivery to the patients farther.

Recommendation

The healthcare organization can use other policies to improve the quality of healthcare services in the organization other than the mandatory overtime. The healthcare institution can introduce the electronic health system that will allow the healthcare providers to interact with their patients virtually and so reduce their need to go to the hospitals. The electronic health system will increase interaction between the healthcare providers and their patients as well as improve the level of patients’ commitment in managing their health (Sprivulis, 2020). Eventually, the pressure to attend to many patients in the hospital will reduce as the quality of treatment improves. In addition, the cost of medication ill improve significantly (Sanyal et al., 2018).

The healthcare providers will work with the community health volunteers in offering the healthcare services to the patients at home. The policy will promote better treatment outcomes which will improve the quality of life for the healthcare providers. Furthermore, the healthcare providers will be motivated to offer their best in interacting with the patients.

Conclusion

The rising cost of medication following the Medicaid and Medicare programs present a significant challenge to the healthcare delivery process. The introduction of pay-for-value compensation aimed at making the medication costs affordable. However, the increase in the number of patients seeking healthcare services exerts a significant pressure on the limited number of healthcare staff. The introduction of the mandatory overtime is one of the ways of ensuring the healthcare providers offer quality services to all patients. However, the policy presents more harm to the healthcare providers’ health. The electronic health systems can be deployed by healthcare institutions to minimize the need for the patients to visit the hospital and improve the treatment outcomes.

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References

Bernstrøm, V. H., Alves, D. E., Ellingsen, D., & Ingelsrud, M. H. (2019). Healthy working time arrangements for healthcare personnel and patients: A systematic literature review. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-3993-5

Kominski, G. F., Nonzee, N. J., & Sorensen, A. (2017). The Affordable Care Act’s impacts on access to insurance and health care for low-income populations. Annual Review of Public Health, 38(1), 489-505. https://doi.org/10.1146/annurev-publhealth-031816-044555

Kowalczuk, K., Krajewska-Kułak, E., & Sobolewski, M. (2020). Working excessively and burnout among nurses in the context of sick leaves. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.00285

Moon, S., Mariat, S., Kamae, I., & Pedersen, H. B. (2020). Defining the concept of fair pricing for medicines. BMJ, l4726. https://doi.org/10.1136/bmj.l4726

Salen, P., & Norman, K. (2018). The impact of fatigue on medical error and clinician wellness: A vignette-based discussion. Vignettes in Patient Safety – Volume 2. https://doi.org/10.5772/intechopen.70712

Sanyal, C., Stolee, P., Juzwishin, D., & Husereau, D. (2018). Economic evaluations of eHealth technologies: A systematic review. PLOS ONE, 13(6), e0198112. https://doi.org/10.1371/journal.pone.0198112

Sprivulis, P. (2020). Connecting health care through information technology. Patient Safety First, 299-317. https://doi.org/10.4324/9781003116677-14

NURS_6053_Module02_Week03_Assignment_Rubric

	Excellent	Good	Fair	Poor
Add a section to the paper you submitted in Module 1. In 4–5 pages, address the following: · Identify and describe at least two competing needs impacting your selected healthcare issue/stressor.	Points Range: 23 (23%) – 25 (25%) The response accurately and clearly identifies at least two competing needs impacting the healthcare issue/stressor selected.	Points Range: 20 (20%) – 22 (22%) The response identifies at least two competing needs impacting the healthcare issue/stressor selected.	Points Range: 18 (18%) – 19 (19%) The response identifies at least two competing needs impacting the healthcare issue/stressor selected that is vague or inaccurate.	Points Range: 0 (0%) – 17 (17%) The response describes at least two competing needs impacting the healthcare issue/stressor selected that is vague and inaccurate, or is missing.
· Describe a relevant policy or practice in your organization that may influence your selected healthcare issue/stressor. · Critique the policy for ethical considerations and explain the policy’s strengths and challenges in promoting ethics.	Points Range: 27 (27%) – 30 (30%) The response accurately and thoroughly describes in detail a relevant policy or practice in an organization that may influence the healthcare issue/stressor selected. The response accurately and thoroughly critiques in detail the policy for ethical considerations and explains in detail the policy’s strengths and challenges in promoting ethics.	Points Range: 24 (24%) – 26 (26%) The response accurately describes a relevant policy or practice in an organization that may influence the healthcare issue/stressor selected. The response accurately critiques the policy for ethical considerations and explains the policy’s strengths and challenges in promoting ethics.	Points Range: 21 (21%) – 23 (23%) The response describes a relevant policy or practice in an organization that may influence the healthcare issue/stressor selected that is vague or inaccurate. The response critiques the policy for ethical considerations and explains the policy’s strengths and challenges in promoting ethics that is vague or inaccurate.	Points Range: 0 (0%) – 20 (20%) The response describes a relevant policy or practice in an organization that may influence the healthcare issue/stressor selected that is vague and inaccurate, or is missing. The response critiques the policy for ethical considerations and explains the policy’s strengths and challenges in promoting ethics that is vague and inaccurate, or is missing.
· Recommend one or more policy or practice changes designed to balance the competing needs of resources, workers, and patients while addressing any ethical shortcomings of the existing policies. Be specific and provide examples. · Cite evidence that informs the healthcare issue/stressor and/or the policies and provide two scholarly resources in support of your policy or practice recommendations.	Points Range: 27 (27%) – 30 (30%) The response provide one or more accurate, clear, and thorough recommendations for policy or practice changes designed to balance the competing needs of resources, workers, and patients while addressing any ethical shortcomings of the existing policies. Specific and accurate examples are provided. Accurate and detailed evidence is cited that informs the healthcare issue/stressor selected and a specific synthesis of at least two outside scholarly resources in full support of the policy or practice recommendations is provided. The response integrates at least 2 outside resources and 2 or 3 course-specific resources that fully support the healthcare issue/stressor selected.	Points Range: 24 (24%) – 26 (26%) The response provides one or more recommendations for policy or practice changes designed to balance the competing needs of resources, workers, and patients while addressing any ethical shortcomings of the existing policies. Specific examples may be provided. Evidence is cited that informs the healthcare issue/stressor selected and a synthesis of at least one outside scholarly resource that may support the policy or practice recommendations is provided. The response integrates at least 1 outside resource and 2 or 3 course-specific resources that may support the healthcare issue/stressor selected.	Points Range: 21 (21%) – 23 (23%) The response provides one or more recommendations for policy or practice changes designed to balance the competing needs of resources, workers, and patients while addressing any ethical shortcomings of the existing policies that is vague or inaccurate. Examples may be provided. Vague or inaccurate evidence is cited from 2 or 3 resources that informs the healthcare issue/stressor selected and may support the policy or practice recommendations provided.	Points Range: 0 (0%) – 20 (20%) The response provides one or more recommendations for policy or practice changes designed to balance the competing needs of resources, workers, and patients while addressing any ethical shortcomings of the existing policies that is vague and inaccurate, or is missing. Examples are missing. Vague and inaccurate evidence is cited that informs the healthcare issue/stressor and may include at least 1 scholarly resource that vaguely and inaccurately supports the policy practice recommendations is provided, or is missing.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.	Points Range: 5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.	Points Range: 4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment is stated, yet is brief and not descriptive.	Points Range: 3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.	Points Range: 0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion was provided.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	Points Range: 5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.	Points Range: 4 (4%) – 4 (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors.	Points Range: 3.5 (3.5%) – 3.5 (3.5%) Contains several (3 or 4) grammar, spelling, and punctuation errors.	Points Range: 0 (0%) – 3 (3%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.	Points Range: 5 (5%) – 5 (5%) Uses correct APA format with no errors.	Points Range: 4 (4%) – 4 (4%) Contains a few (1 or 2) APA format errors.	Points Range: 3.5 (3.5%) – 3.5 (3.5%) Contains several (3 or 4) APA format errors.	Points Range: 0 (0%) – 3 (3%) Contains many (≥ 5) APA format errors.

Total Points: 100