| Course | NU708 Advanced Systems Leadership: Transforming the Health Care Organization |
|---|---|
| Unit | Unit 9 |
| Paper type | Conflict and negotiation analysis |
| Length | About 1,160 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | October 2026 |
Free sample paper for NU708 Unit 9
Ready When Medically Ready, or Ready When Taught? A Unit 9 Conflict and Negotiation Analysis Between Hospitalists and Nursing
[Student Name]
Purdue University Global
NU708: Advanced Systems Leadership: Transforming the Health Care Organization
Unit 9 Conflict and Negotiation Analysis
[Instructor Name]
[Date]
The hospital, its people, the conflict and the figures are composite and illustrative; the frameworks and studies cited are real.
The Conflict
The spread plan includes a readiness rule: a patient starting insulin should not leave until the return demonstration with the patient's own pen is complete and a prescription or bridge supply is in hand. On the pilot units, holds under the rule were rare, five in six months, and averaged about 70 minutes. But the hospitalists, who were not part of the pilot design, heard about the rule from a bed meeting summary that described it as "nursing holds on insulin discharges." Their medical director wrote to the chief nursing officer objecting to any rule that lets nurses hold a medically ready patient. Nursing leaders, in turn, read the objection as a refusal to take discharge teaching seriously.
Both sides now hold positions. Hospitalists: discharge orders are a medical decision and must not wait for nursing tasks. Nursing: no patient starting insulin leaves without being able to inject safely.
Positions and Interests
Fisher et al. (2011) argue that negotiators who bargain over positions dig in, while those who look behind positions to interests find that the underlying needs often conflict far less. The analysis therefore asks what each side's position protects.
The hospitalists' interests, drawn from two conversations with the hospitalist co-lead and the group's own metrics, are four. They are measured on length of stay and discharge timing. They want predictability, since an unexpected hold at 1600 disrupts the next morning's admissions. They want their professional judgment respected. And, the co-lead said, they also do not want patients coming back; a readmission is a mark on their record too.
Nursing's interests are also four. Nurses want patients safe at home. They want time to teach that does not depend on luck. They want their judgment about readiness to count. And they want to stop the moral distress of discharging patients they know are not ready, which a unit survey in the ethics course showed was common.
Both sides want the patient not to come back, and neither wants a surprise at 1600.
What Each Side Fears
The hospitalists fear a rule that grows. Their experience with discharge initiatives is that targets added work and sometimes made stays longer. Evidence supports their caution. Among more than 38,000 hospitalizations at one academic center, patients discharged before noon had modestly longer stays after adjustment, and the authors could not rule out that some were simply kept until the next morning (Rajkomar et al., 2016). Nursing fears that without a rule, teaching will stay squeezed into the last hour, as the system map in Unit 2 showed.
Objective Criteria
Fisher et al. (2011) recommend that parties agree on fair standards before discussing outcomes. Three criteria are proposed. First, the pilot data: five holds in six months, about 70 minutes each, and no patient held overnight. Second, published experience with discharge timing: when two medical units began naming tomorrow's discharges in afternoon rounds, the share leaving before noon climbed to about four in ten from about one in ten, with stays shorter relative to expected (Wertheimer et al., 2014), which shows that earlier planning can reduce delay rather than add it. Third, outcomes both sides track: length of stay and 30-day returns for patients starting insulin.
Options
The analysis generated five options with the co-lead, before any were evaluated.
1. Teach earlier, not hold later. The readiness flag is set on the day insulin starts, and teaching begins then, so that the demonstration is usually done before the patient is medically ready.
2. Predicted discharge date. Hospitalists enter an expected discharge date the day before; nurses complete teaching before that date.
3. Pen on day one. Pharmacy dispenses the patient's own pen when insulin starts, removing the main reason demonstrations slipped to the last hour.
4. Time-limited hold with escalation. If a demonstration is incomplete when the order is written, the nurse may hold for up to two hours, after which the charge nurse and hospitalist decide together.
5. Shared measure. Length of stay and returns for patients on new insulin are reported jointly to both departments every month.
What the Patients Would Say
The negotiation has a third party who is rarely at the table. Two people from the hospital's advisory council of former patients and relatives were asked how they would settle the question. Their answers matched: they would rather stay two more hours than go home afraid of the needle, and they would rather the teaching had started on day one so that neither was necessary. Their view does not decide the conflict, but it supports the options that move teaching earlier, and it gives both departments a shared reason to try them.
Evaluation of Options
Options 1, 2 and 3 serve both sides' interests without a hold at all: they move teaching earlier so that readiness and medical readiness arrive together. Option 4 gives nursing a defined action while giving hospitalists the predictability and the joint decision they want, and it caps the cost. Option 5 aligns incentives by making the two departments look at the same numbers.
The language matters as much as the content. "Nursing holds" frames the rule as nurses overriding physicians. "Readiness for insulin at home," decided jointly when a hold is needed, frames it as a shared standard.
Recommended Resolution
The analysis recommends that the chief nursing officer and the hospitalist medical director agree to a 60-day trial on two units, 4 West and 5 East, of options 1 through 5 together, renamed the insulin readiness pathway. Before the trial, they agree on what success means: median length of stay for patients starting insulin no more than 0.2 days longer than the prior year, no patient held overnight for teaching and holds under the two-hour rule in fewer than one in ten discharges. At 60 days, both departments review the data at one table, and the pathway is kept, changed or ended on that evidence.
If they cannot agree, the analysis recommends escalation to the two executives who oversee physicians and nurses, meeting together, with the same data, rather than either side acting alone.
Conclusion
The conflict looked like a contest over who decides when a patient leaves. Underneath, both sides want the patient to stay home and neither wants a surprise late in the day. By moving teaching earlier, dispensing pens on the first day, limiting and sharing any hold and agreeing in advance on how the trial will be judged, the two departments can meet each other's interests and turn a rule one side resisted into a pathway both can own.
References
Fisher, R., Ury, W., & Patton, B. (2011). Getting to yes: Negotiating agreement without giving in (3rd ed.). Penguin Books.
Rajkomar, A., Valencia, V., Novelero, M., Mourad, M., & Auerbach, A. (2016). The association between discharge before noon and length of stay in medical and surgical patients. Journal of Hospital Medicine, 11(12), 859-861. https://doi.org/10.1002/jhm.2529
Wertheimer, B., Jacobs, R. E. A., Bailey, M., Holstein, S., Chatfield, S., Ohta, B., Horrocks, A., & Hochman, K. (2014). Discharge before noon: An achievable hospital goal. Journal of Hospital Medicine, 9(4), 210-214. https://doi.org/10.1002/jhm.2154
Reading the NU 708 Unit 9 instructions
The Unit 9 assignment asks students to analyze a conflict their change has created or is likely to create and propose a way through it. Prompts commonly want the conflict described from both sides, the parties' positions and underlying interests, a negotiation approach applied, options generated and evaluated and a recommended resolution with a fallback. Instructors expect fairness: the analysis should be written so that both parties would recognize their own view in it. Interest-based negotiation is a frequent choice, though some sections allow other conflict models. Objective standards for judging a solution, agreed before outcomes are discussed, often separate strong papers from average ones. Where patients are affected, including their perspective, even briefly, strengthens the analysis and gives the parties a shared reason to settle.
How this NU708 Unit 9 example is built
The paper opens with the medical director's line and the summary that provoked it. The conflict section states each side's position. Fisher and colleagues' distinction between positions and interests structures the next section, which lists four interests for each department, under a highlighted line about what both want, with a margin note on overlap. A section on fears brings in Rajkomar's large cohort. Objective criteria follow, then five options generated before evaluation. A short section reports what two advisory council members said. The evaluation shows that three options remove the need for holds and that renaming the rule changes its meaning, flagged by a second note. The recommendation sets a 60-day trial with three success criteria, and a fallback names joint escalation.
Where the points sit in the NU708 Unit 9 rubric
Negotiation analyses earn their largest share of credit from the interests section: each party's interests identified fairly and in their own terms, with overlaps shown. Correct application of the negotiation approach is scored next, including generating options before judging them. Objective criteria agreed in advance are often a distinct rubric line. The recommended resolution is judged on whether it serves both sides' interests and includes a way to evaluate it. Graders reward attention to framing and language, which can decide a conflict between professions. A fallback if agreement fails shows realism. Evidence supporting the criteria, clear organization and APA 7 complete the grade, and analyses that would read as fair to the opposing side tend to score highest in NU708.
Common NU708 Unit 9 mistakes, and how to avoid them
Conflict papers most often lose points by taking one side and calling it analysis. Another frequent problem is listing positions twice and labeling the second list interests. Some writers jump to a solution without generating options, so the recommendation looks like the writer's original preference. Leaving out objective criteria makes any agreement look like a concession. Students also forget the fallback, or propose escalation as the first step. Ignoring how the issue was framed, such as calling a rule "nursing holds," misses one of the easiest fixes. Begin by writing what the other side would say they need, in their words, and check it with someone from that side if you can. A custom analysis can be written for the conflict your own change has stirred.
Get an NU708 Unit 9 example written to your instructions
Send the conflict, the parties and the analysis instructions with the rubric. A custom analysis separates positions from interests and proposes options both sides can accept. It comes back within 24-48h, and the first is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU708 Unit 9 questions, answered
What is interest-based negotiation?
An approach that looks behind each side's stated position to the interests it serves, then looks for options that meet the interests of both.
Should the analysis take a side?
It should be fair to both parties and recommend a resolution, not simply argue one side.
What if the conflict cannot be resolved?
The analysis can recommend a process, such as escalation or a trial period, and say how it will be judged.
Where can I find a free NU708 Unit 9 sample paper?
This page holds a complete NU708 Unit 9 conflict and negotiation analysis of a dispute between hospitalists and nursing over discharge readiness for patients starting insulin, with interests, options and a 60-day trial.
How does the NU708 Unit 9 sample avoid holding patients at all?
By moving teaching earlier: a readiness flag set on the first insulin day, a predicted discharge date the day before and pens dispensed when insulin starts, so the demonstration is usually done before the patient is medically ready.