| Course | NU753 Transforming the Health Care Organization |
|---|---|
| Unit | Unit 2 |
| Paper type | Structure and reporting analysis |
| Length | About 1,090 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | September 2026 |
Free sample paper for NU753 Unit 2
The Chart on the Intranet and the Path a Proposal Travels: A Structure and Reporting Analysis of What an Enhanced Recovery Pathway Must Pass Through at the Flagship of a Composite Two-Hospital System
[Student Name]
Purdue University Global
NU753: Transforming the Health Care Organization
Unit 2 Structure and Reporting Analysis
[Instructor Name]
[Date]
The system, its committees and dates are composite; names of bodies and meeting dates are bracketed.
Why Two Charts
A reporting chart maps lines of authority. It leaves out how a proposal moves, which bodies must agree, or where a proposal can be delayed without anyone saying no. Mintzberg described organizations as made up of several parts, including an operating core, a middle line, a technostructure that designs standards, and support staff, and argued that the way work is coordinated depends on how those parts relate (Mintzberg, 1979). Bolman and Deal added that every organization can be read through several frames, structural, human resource, political and symbolic, and that structural charts alone miss much of what determines whether change happens (Bolman & Deal, 2017). This analysis therefore draws both the formal structure and the path of one proposal through it.
Chart One: The Published Structure
The system's intranet chart, trimmed to the boxes that touch surgical care, shows a president to whom report, among others, a chief nursing officer and a chief operating officer. Inpatient nursing units, including 5 West, sit under the chief nursing officer, through a director of surgical nursing and a nurse manager. Perioperative services, including the preoperative clinic, the operating suite and recovery room, sit under the chief operating officer. Physical therapy reports to a director of rehabilitation services under the chief operating officer. Surgeons are not employees; they are members of the medical staff, organized in a department of surgery with an elected chair, and they report to the medical staff's own governance. Anesthesia is provided by a contracted group whose agreement is managed by the chief operating officer's office.
The chart already shows a split. The patient's path from clinic to operating room to 5 West crosses the line between nursing and operations twice, and the clinicians who make most treatment decisions, surgeons and anesthesiologists, sit outside both lines.
Chart Two: The Path of One Proposal
The proposal is an enhanced recovery pathway for elective colorectal surgery, bundling elements recommended in the ERAS Society guideline, including shorter preoperative fasting, carbohydrate drinks, multimodal pain control that limits opioids, avoidance of routine nasogastric tubes, early feeding and early mobility (Gustafsson et al., 2019). Tracing what each element requires produced a path of seven nodes.
The first node is the 5 West nurse manager, who can change nursing practice on the unit and meets with staff weekly. The second is the director of surgical nursing, who must approve changes that affect staffing, such as a weekend mobility role; the nursing leadership council convenes monthly, next on [February 11]. The third is the director of perioperative services, who controls the preoperative clinic's instructions and would need to change the fasting guidance; the perioperative operations meeting is held on the [first Thursday]. The fourth is the department of surgery, whose chair must bring the pathway to the surgeons, since it changes their order sets; the department meets [quarterly], next in [March]. The fifth is the contracted anesthesia group, whose members would change intraoperative fluids and analgesia; it has no standing meeting with nursing or surgery, and its medical director is contacted through the chief operating officer's office. The sixth is the pharmacy and therapeutics committee, which must approve the new order set defaults, such as multimodal analgesia, and meets on the [fourth Wednesday]. The seventh is the medical executive committee, which approves changes to order sets and clinical pathways that affect more than one department, and meets on the [third Monday].
Where the Pathway Stalls First
Walking the path forward shows where it would stall. The nursing elements can move quickly: the nurse manager and director can approve mobility and feeding practices within a month. The fasting change needs the perioperative director, who reports on a different line but meets regularly. The order set changes need the department of surgery and then the pharmacy committee and the medical executive committee, a sequence that, following the meeting calendars, takes at least [four] months.
The anesthesia group is where the pathway would stall first. Its members control several of the most important intraoperative elements, it has no scheduled forum with nursing or surgery, and its contract is managed by an office concerned with coverage and cost rather than clinical pathways. Nothing in the published chart shows anyone responsible for bringing it into the proposal. A pathway could be approved by every other node and still fail in the operating room. The same gap appeared in interviews: one director assumed the surgeons would bring anesthesia along, and the surgery chair assumed operations would, because it manages the contract.
The node most likely to stop the pathway is not one that can say no; it is one that nobody in the structure is assigned to ask.
Reading the Structure Through Other Frames
The structural frame explains the calendar. The political frame adds that each node has interests: surgeons value discretion over their own order sets, the anesthesia group values predictable case times, and finance values full beds, which a shorter stay may reduce. The symbolic frame adds that 5 West's fall-free banner signals what the unit is rewarded for, and a pathway that pushes early walking may be seen as a threat to that record. These frames do not change the path, but they predict where approval will be slowed by concerns that are not written in any committee's charter.
Implications for the Proposal
Three practical implications follow for anyone carrying this proposal forward. First, the pathway should be split so that nursing elements begin while committee approvals proceed. Second, someone must be assigned to bring the anesthesia group in early, ideally a surgeon champion who already works with them daily, with the chief operating officer's office aware of the request. Third, the proposal should be timed to the calendar, entering the department of surgery's [March] meeting with the pharmacy committee's review already scheduled for the following month.
Limits
The meeting dates and authorities are drawn from the system's published schedules and interviews with two directors; informal routes, such as a surgeon calling the chief operating officer directly, may be faster. The analysis covers only the flagship; the community hospital has its own structure, examined in later units.
References
Bolman, L. G., & Deal, T. E. (2017). Reframing organizations: Artistry, choice, and leadership (6th ed.). Jossey-Bass.
Gustafsson, U. O., Scott, M. J., Hubner, M., Nygren, J., Demartines, N., Francis, N., Rockall, T. A., Young-Fadok, T. M., Hill, A. G., Soop, M., de Boer, H. D., Urman, R. D., Chang, G. J., Fichera, A., Kessler, H., Grass, F., Whang, E. E., Fawcett, W. J., Carli, F., . . . Ljungqvist, O. (2019). Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations: 2018. World Journal of Surgery, 43(3), 659-695. https://doi.org/10.1007/s00268-018-4844-y
Mintzberg, H. (1979). The structuring of organizations. Prentice-Hall.
Reading the NU 753 Unit 2 instructions
For Unit 2 you analyze how your organization's structure shapes a change you want to make. Plan to describe the formal structure, map the path a specific proposal must travel, identify each approving body's authority and schedule, find where the proposal is most likely to stall, and draw implications for timing and strategy. Around 1,700 words with two diagrams is common. Faculty reward analyses that distinguish the published chart from the working approval path, include medical staff governance when a change touches orders or medications, and ground recommendations in the calendar. Where the approval path is not written down, ask people who have recently moved a proposal through it, and say in the paper that you did.
How this NU753 Unit 2 example is built
The analysis explains why an organization chart and an approval path are different and introduces two structural frameworks. Chart one describes the published structure, showing nursing and operations as separate lines and surgeons and anesthesia outside both. Chart two lists the pathway's elements and traces seven nodes with their authority and next meeting. A section walks the path forward, estimates the time needed and identifies the anesthesia group as the first stall point, with the highlighted sentence on the node nobody is assigned to ask. The structure is then read through political and symbolic frames, three sequencing implications follow, and a limits section names informal routes.
NU753 Unit 2 rubric: what earns full points
Structure analyses are generally assessed on accuracy of the formal structure, mapping of the approval path, identification of barriers, use of frameworks and implications. Accuracy earns credit when reporting lines are described correctly and trimmed to what matters. Mapping rewards a path with every node's authority and schedule. Barrier identification is judged on whether the analysis finds a specific point where the proposal could stall and explains why. Frameworks are credited when used to interpret the structure, not only named. Implications score well when they are practical, such as splitting the proposal or timing it to meetings. Diagrams should be readable and consistent with the text.
Common NU753 Unit 2 mistakes, and how to avoid them
A common weakness is reproducing the full organization chart, which buries the finding. Another is omitting medical staff committees, which approve most clinical changes. Some papers describe structure without following a real proposal through it. Others find barriers only in people, missing gaps in structure such as a contracted group with no forum. Many recommendations are generic, such as build buy-in. And meeting schedules are often left out, though they decide the timeline. Trim the chart to what the proposal touches, draw the path with dates, find the node nobody owns, and let the calendar shape your recommendations. Remember also that a proposal's first reader is often an assistant who decides when it reaches the agenda, so knowing that person matters.
Get an NU753 Unit 2 example written to your instructions
Name the change your paper will follow and the organization it lives in, keeping identifying details as general as you like, and add your prompt and rubric. A free first custom sample, written to those instructions within 24-48h, maps the path that change would travel and dates the places it would wait. 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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NU753 Unit 2 questions, answered
Where do I find the approval path if it is not written down?
Usually by asking the people who have moved a proposal through recently: a manager who added a position, an educator who changed a policy, a clinician who revised an order set. Committee charters and meeting calendars fill in the rest. The sample's map was assembled that way for its composite system, and it says which nodes rest on interviews.
Should medical staff committees appear on a nursing structure analysis?
Yes, whenever the change touches orders, privileges or medications, which most clinical changes do. Medical staff governance runs parallel to hospital management, and a nursing analysis that stops at the chief nursing officer usually misses the committee most likely to delay the work. The sample includes two such committees and explains what each can refuse.
How detailed should the organizational chart be?
Detailed enough to show every box the change passes through and no more. A complete system chart buries the finding. The sample trims its chart to surgical care and adds what the published version leaves out, the contracted anesthesia group and the committees, because those are where this particular change would wait.
Where can I find a free NU753 Unit 2 sample paper?
This page holds the full NU753 Unit 2 structure analysis, with the published structure, a seven-node approval path, the first stall point, political and symbolic readings, three implications and limits, with three references. Help mapping how a proposal moves through your own organization is available.
Why does the anesthesia group stall the pathway in NU753 Unit 2?
It controls key intraoperative elements, has no standing forum with nursing or surgery, and its contract is managed by an office focused on coverage and cost. No one in the published structure is assigned to bring it into the proposal.