NU420 Unit 3 Sample Paper

Turnover, Overtime and Missed Care on a 32-Bed Medical-Surgical Unit: A Nurse Leadership Analysis and a Committed First-Year Retention Change

[Author Name]

School of Nursing, Purdue University Global

NU420 Leadership and Management in the Changing Health Care Environment

Unit 3 Assignment

[Instructor Name]

August 11, 2026

4 West and Brookhaven Regional Medical Center are composites written as a model document. No real unit, hospital or employee is described.

What this page is doingThe title names the unit type, the problem and the fact that the paper ends in a committed change, so a reader knows the shape before the first paragraph. The course line uses Purdue Global's own vocabulary, Unit 3 Assignment, rather than a deliverable name the school does not publish. The final line marks the hospital and the unit as composites, which is what lets the paper carry specific numbers without pretending to describe a real employer. A generic title such as Leadership Analysis Paper would rank on nothing and promise nothing.

The Unit and Its Numbers

4 West is a 32-bed medical-surgical and telemetry unit inside Brookhaven Regional Medical Center, a composite 240-bed community hospital. The unit runs twelve-hour shifts with a target assignment of one nurse to five patients on days and one to six on nights, supported by four patient care technicians on days and three on nights. Average daily census for the twelve months ending June 30, 2024 was 27.4 patients, and the unit recorded 11,640 patient days across that period. One nurse manager holds 68 direct reports over three shifts and has worked without an assistant manager since March 2023. The charge nurse carried a full patient assignment on 21 of the 30 night shifts sampled in May 2024.

Staffing has been eroding for two years. Of 44.6 budgeted RN full-time equivalents, 37.2 were filled on June 30, 2024, a vacancy rate of 16.6 percent. Twelve registered nurses left the unit during the twelve months ending on that date against an average of 41.5 employed, a turnover rate of 28.9 percent, well above the national hospital figure of roughly 18 percent reported for the same period (NSI Nursing Solutions, 2024). Overtime reached 3,180 RN hours, or 7.6 percent of the unit's 41,800 productive RN hours. Contract nurses covered an average of 4.8 full-time equivalents across the year. Median tenure at exit was 14 months, and 7 of the 12 leavers had been on the unit under 18 months.

Care quality moved with the staffing. In a missed care survey administered on the unit in May 2024, 34 of 37 eligible nurses responded, or 91.9 percent, using the instrument developed by Kalisch and Williams (2009). Respondents reported that ambulation three times a day was missed on 58.8 percent of their recent shifts, turning every two hours on 41.2 percent, and medication administration within thirty minutes of the scheduled time on 26.5 percent. Patient falls totaled 48 across the 11,640 patient days in the same twelve months, a rate of 4.1 per 1,000 patient days. Top-box scores for responsiveness of staff averaged 58 percent across the four quarters ending June 30, 2024, against 66 percent hospital-wide.

What this page is doingEvery figure arrives with its denominator and its period: 12 leavers against an average of 41.5 employed, 3,180 overtime hours against 41,800 productive hours, 48 falls across 11,640 patient days. The national comparison is attributed rather than asserted. Reporting the survey response rate, 34 of 37, tells a reader how much weight the missed care findings can carry. Managers who write turnover as a bare percentage lose the ability to argue about it later; managers who write it as a fraction keep that ability.

Analysis: Where the Losses Come From

The turnover figure hides its own shape. Five of the fourteen nurses hired onto 4 West during the twelve months ending June 30, 2024 had left by that date, a first-year separation rate of 35.7 percent, while only 2 of the 23 nurses with more than three years on the unit left in the same period, or 8.7 percent. The unit is not failing to hold experienced staff; it is failing to turn new hires into experienced staff. Exit interviews, completed by human resources for 9 of the 12 leavers, named three reasons more than once: no reliable preceptor once orientation ended, no forum for questions that did not feel like an admission of incompetence, and schedules published too late to plan a life around.

Three structural conditions explain most of that pattern. First, preceptors carry a full assignment while precepting, so teaching happens in the gaps of an ordinary shift and stops entirely when census rises. Second, a manager with 68 direct reports and no assistant cannot hold regular one-to-one contact; the nurse leader core competencies place communication and relationship management at the center of the role, and a span of control this wide makes both aspirational (American Organization for Nursing Leadership, 2023). Third, the night charge nurse carries patients, which removes the one person positioned to redistribute work when an admission arrives at 2:00 a.m. Each condition is a decision the unit made, not a fact of nursing.

The evidence points at the same lever. Structured transition support for newly licensed nurses is a standing national recommendation for building and holding the workforce (National Academies of Sciences, Engineering, and Medicine, 2021), and a routine, low-stakes structure for speaking up is the mechanism that makes such support work rather than an ornament on top of it (Agency for Healthcare Research and Quality, 2024). A transformational stance fits this problem better than a transactional one: the unit does not need tighter attendance monitoring, it needs a leader who makes the first eighteen months survivable and says so in public. The earlier retention push on 4 West was announced without a guiding coalition and without protected time, which is the classic failure pattern (Kotter, 1996).

What this page is doingThis analysis does the thing most staffing papers skip: it breaks one rate into two populations and finds that first-year separation, not overall attrition, is the real problem. That split alone determines the intervention. Causes are then written as structural decisions with evidence attached rather than as attitudes, so each one can be reversed by another decision. Naming the earlier effort that failed, and why, reads as judgment rather than defensiveness, and it earns the proposal that follows a hearing.

The Change This Analysis Commits To, and How It Will Be Judged

This analysis commits to one change on 4 West, starting October 1, 2024, owned by the nurse manager with the director of medical-surgical services as sponsor: a structured first-year support model in three parts. Every nurse inside the first twelve months on the unit is assigned a named preceptor who receives four hours of non-assignment time per pay period for that purpose. The cohort meets twice a month for a forty-five minute debrief run on the team debrief structure the agency publishes, held on paid time and never canceled for census. The manager holds a stay interview with each first-year nurse at 30, 90 and 180 days, asking the same four questions each time and recording what was asked for and what was done about it.

Two things are deliberately not changing, because a commitment that quietly depends on unavailable resources is not a commitment. Budgeted ratios stay at one to five on days and one to six on nights; this model is not a staffing increase and does not require one. Budgeted full-time equivalents stay at 44.6. One prerequisite does have to be funded: the night charge nurse comes off the patient assignment on the eight highest-admission nights of each pay period, an estimated 0.4 full-time equivalents, drawn from contract coverage the unit is already buying. Preceptor protected time totals roughly 0.6 full-time equivalents across the year, from the same source.

Judgment rests on measures the unit already collects, with baselines from the twelve months ending June 30, 2024. The primary measure is first-year separation on 4 West: from 5 of 14 hires, or 35.7 percent, to no more than 2 of the next 14 hires, or 14.3 percent, by June 30, 2025. Secondary measures are RN vacancy, from 16.6 percent to 10.0 percent or lower; overtime, from 7.6 percent of productive hours to below 5.0 percent; and missed ambulation on the repeat survey in May 2025, from 58.8 percent to below 40.0 percent, using the same instrument and the same census-day method so that the two administrations can be compared. Responsiveness top-box is tracked from 58 percent as a supporting measure rather than a target.

Two guards keep the model honest. The balancing measure is preceptor separation: if the nurses carrying the teaching begin to leave, the model is consuming the people it depends on, and more than two preceptor departures in twelve months triggers a redesign rather than a recruitment drive. The stop rule is dated. At the interim review on March 31, 2025, first-year separation among the cohort hired since October must stand below 20 percent; if it does not, the model is revised at that point instead of being carried to June on the argument that it needs more time. Both rules were written before the first cohort started, which is what makes them rules.

What this page is doingA commitment counts as one only when it names an owner, a start date, a cost and a source for that cost. This one does, and it also states what is not changing, which stops a staffing increase from hiding inside a retention program. Targets sit against baselines that already exist and against instruments that will be run the same way again, so the comparison will be legitimate. The balancing measure and the dated stop rule are what separate a plan from a hope.

References

Agency for Healthcare Research and Quality. (2024). TeamSTEPPS 3.0. U.S. Department of Health and Human Services. https://www.ahrq.gov/teamstepps/

American Organization for Nursing Leadership. (2023). AONL nurse leader core competencies. https://www.aonl.org/resources/nurse-leader-competencies

Kalisch, B. J., & Williams, R. A. (2009). Development and psychometric testing of a tool to measure missed nursing care. The Journal of Nursing Administration, 39(5), 211-219.

Kotter, J. P. (1996). Leading change. Harvard Business School Press.

National Academies of Sciences, Engineering, and Medicine. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity. The National Academies Press. https://nap.nationalacademies.org

NSI Nursing Solutions. (2024). 2024 NSI national health care retention and RN staffing report. https://www.nsinursingsolutions.com

How this NU 420 Unit 3 example is structured

In many sections this unit asks for a leadership or staffing analysis of a unit the writer knows; your classroom's instructions decide the exact form, so read the unit assignment page and the rubric before you use this NU420 Unit 3 example as a shape. The order here is the order a nurse leader has to argue in. The unit and its numbers come first, so nothing later rests on an impression. Analysis follows, separating the shape of the turnover from its causes, because a rate alone does not tell a manager where to spend attention. The change comes third, carrying an owner, a start date, what is not changing, and what it costs. Measures close the paper. Leadership and Management in the Changing Health Care Environment sits in the RN-to-BSN sequence at Purdue Global, where the reader is usually already a working nurse.

NU420 Unit 3 questions, answered

What does NU420 Unit 3 usually ask for?

In many sections this unit asks for an analysis of a leadership or staffing problem on a real unit, with data, a change the writer would make, and a plan for evaluating it. Your classroom's instructions decide the exact form, so read the unit assignment page and the rubric first. Some sections also ask you to tie the analysis to a named leadership style or change model.

Where do I get staffing numbers if I cannot use my employer's data?

Build a composite unit, as this paper does, and say so on the title page. Give it a bed count, a census, budgeted full-time equivalents and a vacancy figure that hold together arithmetically, then use published national benchmarks for comparison. Never put an identifiable employer's internal figures into classroom work, and never present a composite as if it were a real report.

How specific does the evaluation plan have to be?

Specific enough that someone could tell you were wrong. That means a baseline with its denominator, a target number, a date, and the instrument that will produce the follow-up measurement. Add a balancing measure, so improvement in one place is not quietly paid for somewhere else, and a stop rule that says when the change gets revised instead of extended.

Write yours, or have the desk draft it

This paper is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.

NU420 Unit 3: sample paper, in real form