NURS 8100 Discussion: Agenda Setting

NURS 8100 Discussion: Agenda Setting

By Day 3

Post a cohesive response that addresses the following:

  • In the first line of your posting, identify the clinical practice issue you would like to see on your organization’s systematic agenda.
  • What strategies would you use to inform stakeholders and persuade them of the importance of your identified clinical practice issue?

Read a selection of your colleagues’ postings.

RE: Discussion – Week 3

Clinical practice Issue in the Organization’s Systematic Agenda

In today’s technology-driven health care environment, the emphasis on safety and efficiency is becoming increasingly important. The emergence of the outpatient total joint arthroplasty program (TJA) is a measure to lower the cost of health care by converting the patient category from inpatient to outpatient  Mariorenzi et al., 2020). However, a 2015 report by the Centers for Medicare and Medicaid Services summed the cost of joint replacement surgery at over $6.5 billion for beneficiaries under Medicare, making it the most expensive procedure covered by Medicare in 2013 (Mariorenzi et al., 2020). Additionally, outpatient TJA in health care will continue to increase. Lovald et al. (2014) attribute this expansion to myriad factors such as the aging population, the growing obesity epidemic, and increased public awareness of the successful outcomes following joint replacement surgery. This paper aims to discuss the clinical practice issue of implementing a standardized pathway of identifying patients suitable for outpatient TJA. Furthermore, this paper intends to illustrate considerations for effectively getting the buy-in of stakeholders.

One of the recent hallmarks of change in the practice organization is initiating the outpatient TJA program after the team’s redeployment during the COVID-19 pandemic. As the volume of elective surgeries increased, the practice gap of identifying the right patient for same-day discharge TJA highlighted many safety an

NURS 8100 Discussion Agenda Setting

NURS 8100 Discussion Agenda Setting

d quality care issues. The lack of a standardized process or tools to identify these patients caused the increased length of stay, poor care coordination, space capacity issues, readmission, and patient and staff dissatisfaction. Outpatient Arthroplasty Risk Assessment (OARA) score is an effective tool to determine patient optimization for same- and next-day discharge after surgery ( Ziemba-Davis, 2019). In addition, leveraging OARA requires physicians and other stakeholders to establish and implement clear clinical guidelines such as providing the following in advance: home medication prescriptions, assisted devices, or web-based educational materials during preoperative preparations ( Ziemba-Davis et al., 2020). In addition, the success of this modality is a combination of strategies that include comprehensive patient instruction by physicians, nurses, and other stakeholders ( Bodrogi et al., 2020). While many factors are essential in determining the patient’s eligibility for outpatient TJA, such as medical history, physical function, and social determinants, patient safety is vital ( Bodrogi et al., 2020).

                                                      Strategies to inform and persuade stakeholders and persuade them of identified clinical practice issue

The role of DNP-prepared nurses is paramount in getting on the agenda at any level, in shaping clinical pathways, guidelines, and policies that impact patient care delivery ( Executive Producer, 2011). Using data on those outcomes such as length of stay, pain management, space capacity, and others using the outcomes of care due to lack of standardization of patient classification based on the risk factors can provide knowledge to the stakeholders to pilot the Outpatient ORA. It will require a lot of data and communication to share the information at different venues such as the patient safety medical committee, unit practice council, senior leadership meeting, case management, social workers, Rehab professionals, Pharmacy, and the nurses. Currently, I lead the High-Reliability Organization (HRO ) Safety Huddles to talk about safety issues, and we share our findings with the team; it takes a while but the goal of patient safety is worth pursuing




Bodrogi, A., Dervin, G. F., & Beaulé, P. E. (2020, January 13). Management of patients

undergoing same-day discharge primary total hip and knee arthroplasty.CMAJ.


Lovald, S., Ong, K., Malkani, A., Lau, E., Schmier, J., Kurtz, S., & Manley, M. ( 2014 ).

Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty

patients in comparison to standard-stay patients. J Arthroplasty. (29); 510–5.


Mariorenzi, M., Levins, J., Marcaccio, S., Orfanoz, A., & Cohen, E. (2020, April). Outpatient

total joint arthroplasty: A review of the Current Stance and Future Direction. Rhode

Island Medical Journal.


Walden University, LLC. (Executive Producer). (2011). Healthcare policy and advocacy:

Agenda setting and the policy process. Baltimore: Author.


Ziemba-Davis, M., Caccavallo, P., & Meneghini, R. M. (2019, January 15). Outpatient joint

arthroplasty-patient selection: Update on the Outpatient Arthroplasty Risk Assessment

Score. The Journal of Arthroplasty.

As the chair of the Nurse Peer Review Council at my institution, we review many problems that arise from clinical practice issues that are unresolved. In the first two months of 2022, we have reviewed clinical practice issues with the nurse-to-nurse handoff, staffing shortages, and failures to escalate the chain of command.

I have been a perinatal services director for over 10 years and in my time as a leader, I have often felt that the patient ratios in the perinatal services arena are not in alignment with the Association of Women’s Health and Neonatal Nursing (AWHONN) staffing acuity guidelines. Although these guidelines were created in 2010 to promote caring for patients in the perinatal period in a safe manner based on the acuity of the patient (Simpson et al., 2019) hospital financial colleagues do not understand the importance, and frequently these guidelines have to be overlooked to maintain compliance financially. The guidelines break down different types of diagnosis and acuity of specific clinical care scenarios and rank them into categories. This information is further broken down into the number of FTEs that would be appropriate to care for this type of patient. An example would be that any patient that is pushing while in labor would require a 1:1 patient ratio whereas three patients in triage could be cared for by one nurse. The problem with this is that patients can move in and out of different levels of acuity based on their course of labor up to and after delivery. From a financial and productivity perspective this does not make sense. Staffing for a patient that begins at the lowest level of acuity then turns into the highest level of acuity, and then back to a moderate level of acuity after delivery is hard to measure from a productivity standpoint. This is even harder to maintain if departments are held to a productivity standard that is not in alignment with the patient ratios that mirror actual care a patient needs to receive during their hospital stay. The result is less safe care for patients, poor outcomes for mothers and infants, and staff dissatisfaction and burnout (Simpson, 2016).

I am currently working with an internal PI specialist piloting a program for the health care system that involves assessing the AWHONN staffing acuity guidelines and how often my labor and delivery unit is overstaffed or understaffed based on the AWHONN staffing acuity guidelines. We have collected eight months of data and have now created a presentation for the senior leadership team to help inform them of the need to deploy additional resources at a certain time of the day and on certain days of the week. This additional resource would increase the safety of care being provided to mothers and infants.

Some of the strategies I have used up to this point are in an agency for healthcare and research quality toolkit (AHRQ). The strategies include having a well-outlined plan that involves getting the right people on the team for the project, identifying a champion, communicating regularly with the stakeholders, and moving systematically through the stages of a project ( By doing this the end-user has a well-developed objective presentation to support the need for a change. The importance of presenting a proposal that not only includes the need for change based on safety, but needs to include the financial, and operational impacts also.


Agency for Healthcare Research and Quality. (October, 2014). Designing and Implementing Medicaid Disease and Care Management Programs. Retrieved from


Simpson, K. R., Lyndon, A., Spetz, J., Gay, C. L., & Landstrom, G. L. (2019). Incorporation of the AWHONN Nurse Staffing Guidelines into Clinical Practice. Nurse Women’s Health, 23(3), 217–233.


Simpson, K. R., Lyndon, A., & Ruhl, C. (2016). Consequences of inadequate staffing include missed care, potential failure to rescue, and job stress and dissatisfaction. Journal of Obstetric, Gynecologic & Neonatal Nursing, 45(4), 481–490.

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Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.


Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • Student paper example
  • Citing Sources
  • The Writing Center is a great resource