| Course | NU 651 Leading and Managing in Complex Organizations |
|---|---|
| Unit | Unit 8 |
| Paper type | Organizational change dossier |
| Length | About 770 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN |
| Updated | October 2026 |
Free sample paper for NU 651 Unit 8
Change Dossier: Opening a Discharge Lounge, From Approvals and Money to the Day the Last Workaround Stops
Student Name
Department of Nursing, Herzing University
NU 651: Leading and Managing in Complex Organizations
Instructor Name
March 13, 2026
Change Dossier: Opening a Discharge Lounge, From Approvals and Money to the Day the Last Workaround Stops
1. The Change
Open a 12-chair, nurse-staffed discharge lounge at a composite 300-bed community hospital, so that about 14 patients a day who have a discharge order but are waiting for a ride, medications, or paperwork can leave their inpatient beds three to four hours earlier, reducing afternoon boarding in the emergency department.
2. Who Must Approve, and What Each Approval Needs
The hospital's structure puts the pieces of this change under different authorities. The system capital committee approves the $380,000 renovation. The chief financial officer and president approve the roughly $180,000 in yearly running costs. The Nursing Practice Council approves the eligibility criteria and the lounge nursing standard, since these are nursing practice. The Medical Executive Committee does not need to approve the lounge, because eligibility depends on an existing physician discharge order, but it will be informed, and the hospitalist group has agreed in writing that its physicians' orders determine eligibility. Under the re-chartered governance structure, the Patient Flow Committee owns implementation and monitoring.
3. Where Support Came From
Conversations followed the order set in the stakeholder map. The chief nursing officer sponsored the request and reallocated a vacant float pool position. Charge nurses on the four busiest units wrote the eligibility criteria, which gave the proposal their support and addressed their concern that patients would be moved before they were ready. The emergency department medical director carried the proposal to the hospitalist group. The chief financial officer agreed to fund operating costs after seeing the comparison with the cost of new beds. The vice president of support services released the space in exchange for help moving storage off site.
4. Agreements Reached Along the Way
Two negotiated agreements make the lounge work. The environmental services vendor agreed to move two cleaners from overnight to afternoon shifts, cost-neutral, and to a new afternoon cleaning service level in the contract; without faster cleaning, beds freed by the lounge would sit dirty. The hospitalist group agreed to a target of 40% of expected discharges having orders written by 11 a.m., since the lounge cannot receive patients without orders. Both agreements have named owners and are reviewed monthly at the Patient Flow Committee.
5. Money
Capital: $380,000, approved by the system capital committee on April 15, ranked second of four requests after intensive care monitor replacement. Operating: $172,000 a year in staffing and $8,000 in supplies, in the hospital's fiscal year budget beginning July 1. Commitment made to the committee: results at six and twelve months, and a promise to cut staffed hours if average daily use stays under eight for a full quarter.
6. Implementation Timeline
Each step has an owner and a date.
| Step | Owner | Date |
|---|---|---|
| Renovation design approved | Facilities, patient flow director | May 1 |
| Construction | Facilities | May 15 to August 15 |
| Nurse and technician positions posted and filled | Chief nursing officer | By August 1 |
| Eligibility criteria and lounge standard approved | Nursing Practice Council | June meeting |
| Pharmacy delivery of discharge medications to the lounge | Pharmacy director | Process tested by August 30 |
| Staff education on all units | Unit educators | August 18 to September 5 |
| Lounge opens | Patient flow director | September 8 |
| Six-month report to capital committee | Patient flow director | March |
7. The Workarounds That Must Stop
Departments have built workarounds for slow discharges, and the change is not complete until they stop. Each has a date and a way to confirm it has stopped.
Holding discharged patients in their beds until a ride arrives: stops at lounge opening; confirmed by the weekly count of patients remaining in beds more than one hour after a discharge order.
Placing discharged patients in hallway chairs on units: stops at opening; confirmed by charge nurse report at the bed huddle.
Case managers calling families to ask them to come earlier to free the bed: continues only where appropriate for the patient, not to free the bed; confirmed by case management review in October.
Boarding admitted patients in emergency department hallway spaces at 4 p.m.: expected to decline rather than stop; tracked daily.
The last workaround is the one leaders use: the daily 3 p.m. phone call from the house supervisor to each unit asking who can be discharged. It will stop when the lounge census and bed board show the same information on screen, planned for December. Keeping that call running after the lounge opens would signal that no one trusts the new process.
8. How the Parts Agree
The approvals match the structure: each decision is made by the body that has authority over it. The money matches the commitments made to the committee. The negotiated agreements supply what the lounge depends on, faster cleaning and earlier orders, and the governance review gave implementation an owner. Change efforts often stall because the organization declares success early and old ways of working return (Kotter, 1996); the workaround list is the plan against that. The lounge itself is one of several flow measures, and it works only if the departments involved coordinate around it (Gittell et al., 2000; Woods et al., 2020).
References
Gittell, J. H., Fairfield, K. M., Bierbaum, B., Head, W., Jackson, R., Kelly, M., Laskin, R., Lipson, S., Siliski, J., Thornhill, T., & Zuckerman, J. (2000). Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay: A nine-hospital study of surgical patients. Medical Care, 38(8), 807-819. https://doi.org/10.1097/00005650-200008000-00005
Kotter, J. P. (1996). Leading change. Harvard Business School Press.
Woods, R., Sandoval, R., Vermillion, G., Bates-Jackson, B., Nwankwo, A., Canamar, C. P., & Sarff, L. (2020). The discharge lounge: A patient flow process solution. Journal of Nursing Care Quality, 35(3), 240-244. https://doi.org/10.1097/NCQ.0000000000000469
What the NU 651 Unit 8 instructions ask for
Unit 8 is the capstone of the course: one organizational change documented from approval to finish. Expect to describe the change, identify approvals and the authority behind each, show how support was built, record agreements, set out the budget, give an implementation timeline and explain how you will know the change is complete. Many versions ask you to draw on earlier units, such as structure, stakeholders, negotiation and capital. Check whether your section expects a narrative or a structured document with numbered sections. Owners and dates for each step make the plan credible. A change is often not finished when it opens; it is finished when the old workarounds stop, so define that endpoint and how you will confirm it has been reached.
Inside the NU 651 Unit 8 example
The dossier uses eight numbered sections, so each element of the change can be found quickly. The approvals section matches each decision to the body with authority over it, drawing on the structure assessment. The support section follows the stakeholder map's order of conversations. Agreements reached through negotiation are recorded with their terms. The money section reports capital and operating figures as approved. The timeline is a table with owners and dates. The workarounds section is unusual and valuable: it names each informal fix departments built for slow discharges and sets a date and a check for ending it. The final section confirms that approvals, money, agreements and timeline are consistent with one another.
Where the points sit in the NU 651 Unit 8 rubric
Herzing's rubric for the closing dossier usually scores integration of course concepts, the description of the change, approvals and governance, stakeholder engagement, resources, implementation plan, evaluation and writing. Integration tends to count most here, so the analysis from earlier units should visibly shape each section rather than sit in an appendix. Approval points require each decision matched to the body with authority over it. Resource criteria look for capital and operating figures that agree with the capital memo. The implementation row rewards a table with owners and dates. Evaluation points go to defined endpoints, such as named workarounds ended by a set date. The last criterion checks that the numbered sections read cleanly and that Kotter's Leading Change and Gittell's coordination research appear in an APA 7 list.
NU 651 Unit 8 help before you submit
Students in Unit 8 usually lose credit by pasting earlier assignments together without making them consistent. Another frequent problem is a timeline without owners, which leaves no one responsible for a step. Approvals are sometimes listed without the authority behind them. Budgets that differ from the capital request undermine trust in the whole dossier. The endpoint of the change is often the opening day, missing the workarounds that will continue unless someone stops them. Change models are cited without application to any step. Some dossiers grow far beyond the expected length by repeating earlier papers. Finally, check that every part agrees, because graders compare the money, approvals and timeline across sections and notice when one section contradicts another.
Get a NU 651 Unit 8 example written to your instructions
Send the Unit 8 instructions and the rubric from your NU 651 classroom, plus the change your dossier has to carry. We write a custom example with the parts built to inherit from each other, the funding aimed at the named approvers and adoption written as changed behavior, returned in 24 to 48 hours. The first custom sample is free.
More NU 651 papers and MSN samples
- NU 651 Unit 1: Organizational structure assessment
- NU 651 Unit 2: Coordination mechanism selection
- NU 651 Unit 3: Stakeholder power and interest map
- NU 651 Unit 4: Negotiation preparation document
- NU 651 Unit 5: Competing capital bid
- NU 651 Unit 6: Service integration analysis
- NU 651 Unit 7: Governance and committee review
- NU 726 Unit 8: Leadership philosophy reflection
- NU 730 Unit 8: Outcome evaluation plan
- NU 760 Unit 8: Peer review response
- NU 780 Unit 8: Population outcome evaluation
NU 651 Unit 8 questions, answered
Can I reuse work from earlier units?
Usually yes, and most sections intend it, since the point of a closing submission is that the pieces finally have to fit together. Check what your instructions say about citing yourself, rewrite rather than paste, and expect the earlier parts to need changing: a stakeholder map drawn before the price was known is almost always wrong about who objects.
How long should a closing submission be?
However long the instructions set, and the risk is padding rather than brevity. A dossier of short dense parts that agree with each other outscores a longer one that restates the course. If you find yourself explaining change management theory at length, move it into the reasoning behind a decision, where it earns application credit instead of occupying space.
Does the final unit always ask for an integrative piece?
Not in every section, and no public list exists of what a given Herzing unit will ask for. What a last unit commonly asks is that the separate instruments of the course be pointed at one situation, which is why this example is built as a set rather than as an essay. Read your own instructions and let them settle the format.
Where can I find a free NU 651 Unit 8 sample paper?
The complete NU 651 Unit 8 discharge lounge dossier is free to read on this page, all eight sections from approvals to workarounds. A custom dossier can integrate your own earlier units around the change you plan.
When is an organizational change actually complete?
When the old workarounds stop, not when the new process opens. This sample lists each informal fix departments built for slow discharges, such as holding beds, and gives each one a date and a way to confirm it has ended.