| Course | NUR-7020 Nursing Administration Executive Managerial Process |
|---|---|
| Module | Module 4 |
| Paper type | Administration paper: nurse-sensitive indicators and fall prevention |
| Length | About 1,058 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Nursing Administration |
| Updated | October 2026 |
Free sample paper for NUR 7020 Module 4
Above the Benchmark for Two Quarters: Using Nurse-Sensitive Indicators to Lower Falls on a Montclair Medical Unit
Student Name
M.S. in Nursing, Nursing Administration, Thomas Edison State University
NUR-7020: Nursing Administration: Executive Managerial Process
Mentor Name
Month Day, Year
Above the Benchmark for Two Quarters: Using Nurse-Sensitive Indicators to Lower Falls on a Montclair Medical Unit
What the Report Showed
This Montclair hospital and its unit are fictional. A 34-bed adult medical unit at a hospital in Montclair mostly admits older patients with pneumonia, heart failure, urinary and skin infections, often with delirium. Its quarterly report from a national nursing quality database showed total falls and falls with injury above the median for medical units in hospitals of similar size for two quarters in a row. Over six months, the unit recorded 22 falls, seven of them with injury, including a hip fracture and a head laceration that needed sutures. Staff had been completing a fall risk score on admission for years, and nearly every patient scored as high risk.
The manager, an MSN student in nursing administration, was asked by the director of quality to explain the trend and propose a response. She began with the indicator itself, because a program built on misread data would not fix the problem.
Nurse-Sensitive Indicators
Montalvo (2007) described the National Database of Nursing Quality Indicators, created by the American Nurses Association to gather and benchmark measures of how nursing is staffed, practiced and reflected in patient outcomes. Participating hospitals submit unit-level data, including falls, falls with injury, pressure injuries, staffing and skill mix, nurse turnover and nurse satisfaction, and receive quarterly reports comparing each unit with similar units nationally. Falls are reported per 1,000 patient days, and injury falls are classified by severity, from minor to major and death. Comparisons are made within unit types, such as medical, surgical or step-down, so that a medical unit is not judged against a unit with a younger, less frail population.
The manager reviewed the unit's reports with the hospital's database coordinator and found three things. The rise was real, not an artifact of a change in reporting. Most falls happened between 2200 and 0600, during toileting. And the unit's staffing in hours per patient day had fallen over the same period, which the reports also showed.
The Fall TIPS Trial
Dykes et al. (2010) randomized medical units in four urban hospitals to a computer-supported fall prevention tool kit or to usual care. The tool kit used the patient's fall risk assessment to produce a tailored plan, communicated through a bed poster, a patient handout and a care plan, so that patients, families and staff all knew the patient's specific risks and the interventions for each. Falls on tool kit units ran at about 3.15 for every 1,000 patient days, compared with 4.18 where care went on as usual, and patients 65 or older benefited most. Falls with injury did not differ significantly between groups, which may reflect the small number of such events.
The trial showed that the risk score alone does nothing; the tailored plan and its communication to patients and families did the work.
The AHRQ Toolkit
Ganz et al. (2013) prepared a toolkit for the Agency for Healthcare Research and Quality to help hospitals carry out fall prevention programs. It recommends universal precautions for every patient, such as a clear path, a low bed and reachable call light, combined with a risk assessment and a care plan tailored to each patient's risks. It also stresses that fall prevention needs a leadership team, an implementation plan, measurement of falls and injuries and a process for reviewing each fall to learn from it.
| Source | Contribution |
|---|---|
| Montalvo (2007) | Read falls by unit type, severity and time; check staffing alongside |
| Dykes et al. (2010) | Tailor and communicate each patient's plan to patient and family |
| Ganz et al. (2013) | Universal precautions, leadership, measurement and post-fall review |
The Program
The unit replaces its generic high-risk label with a tailored plan for each patient, built from the risk assessment and posted at the bedside in everyday words, translated when the patient prefers another language. The plan names the patient's specific risks, such as confusion, diuretics or unsteady gait, and the matching interventions, such as a toileting schedule, a bed alarm or a walker within reach. Nurses review the plan with the patient and family on admission and at each change in condition.
Because most falls occur at night during toileting, nurses and technicians perform purposeful hourly rounding between 2200 and 0600 that includes an offer of toileting. Universal precautions are checked at every rounding. Each fall is followed within 24 hours by a short huddle at the bedside with the staff involved, using the toolkit's post-fall review questions.
The manager also presented the staffing trend from the indicator report to the director, and an additional technician was added to night shift for six months as a test.
Engaging the Night Staff
Because the program depends on night shift, the manager held three meetings at 0600 and 2300 so night staff could shape it. Night nurses pointed out that bed alarms were often turned off because they sounded for every movement, and that patients on diuretics were given evening doses that sent them to the bathroom at 0200. The first problem led to a short training on alarm sensitivity settings, and the second to a request that hospitalists give diuretics earlier in the day when possible, which the hospitalist group accepted. Night staff also asked that technicians be included in rounding audits, so that the effort would be shared rather than added to nurses alone.
Measures
Quarterly submissions to the national database continue. Inside the unit, the manager will follow falls by hour of day each month, audit tailored plans and night rounding on random shifts and count how many falls were reviewed in a huddle within a day. Hours per patient day will be reviewed with each report.
Limits
The Fall TIPS trial did not show a reduction in injury falls, which are what matter most to patients. Changes in staffing make it hard to know which part of the program caused any improvement. Rounding audits may overstate compliance when staff know they are being watched.
Conclusion
The national indicator report showed a real rise in falls, concentrated at night and during toileting, alongside lower staffing. A trial showed that tailored, communicated plans lower falls, and a federal toolkit supplied the structure. The program combines both, adds night rounding and a test of added staff and keeps watching the same indicators that raised the alarm.
References
Dykes, P. C., Carroll, D. L., Hurley, A., Lipsitz, S., Benoit, A., Chang, F., Meltzer, S., Tsurikova, R., Zuyov, L., & Middleton, B. (2010). Fall prevention in acute care hospitals: A randomized trial. JAMA, 304(17), 1912-1918. https://doi.org/10.1001/jama.2010.1567
Ganz, D. A., Huang, C., Saliba, D., Shier, V., Berlowitz, D., Lukas, C. V., Pogach, L., Neumann, P., Arnold, R., & Rubenstein, L. Z. (2013). Preventing falls in hospitals: A toolkit for improving quality of care (AHRQ Publication No. 13-0015-EF). Agency for Healthcare Research and Quality.
Montalvo, I. (2007). The National Database of Nursing Quality Indicators (NDNQI). OJIN: The Online Journal of Issues in Nursing, 12(3), Manuscript 2. https://doi.org/10.3912/OJIN.Vol12No03Man02
What the NUR 7020 Module 4 instructions ask for
Quality nursing outcomes are the end point of the managerial processes described in TESU's catalog paragraph for NUR-7020, and as TESU posts no syllabus for it, the fourth module turns into a quality indicator paper about one nurse-sensitive outcome. A paper of this kind reads a unit's indicator data carefully, explains how the indicator is defined and compared, selects an intervention with good evidence, adapts it to when and how the problem occurs on the unit and sets up ongoing measurement as part of the manager's controlling function. Some sections focus on pressure injuries, catheter infections or restraint use. Look at whether the brief requires a run chart, a fishbone diagram or a specific quality improvement model, and include any data as a table rather than in the text, with invented figures labeled.
How this NUR 7020 Module 4 example is built
An invented Montclair medical unit with injurious falls above the national comparison for two quarters opens the paper. The national nursing quality database is explained, and a review of the unit's reports shows the rise is real, concentrated at night and paired with lower staffing. The Fall TIPS cluster trial shows that tailored, communicated plans lowered falls in older patients. The AHRQ toolkit supplies universal precautions and post-fall review, and a three-row table separates what each source contributes. Then come the program itself, night rounding, a staffing test, measures and the paper's limits before it closes. Annotations explain the division of questions among sources and matching interventions to the unit's data. A section on night staff shows how the people doing the work shaped the program.
Reading the NUR 7020 Module 4 grading rubric
Quality indicator papers earn credit for accurate reading of the unit's data, a clear explanation of how the indicator is defined and benchmarked, an intervention chosen from strong evidence and adapted to the pattern of the problem, attention to structural factors such as staffing and a monitoring plan using the same indicators. Mentors notice when a paper checks whether a trend is real before acting. Reporting that a trial did not reduce injuries shows honest reading. Post-fall review shows a learning system. Accurate citation of the database, the trial and the toolkit, with authors listed as published, completes the paper.
NUR 7020 Module 4 help: mistakes that cost marks
Falls papers often start with an intervention before reading the data; find out when and how falls happen first. Another frequent gap is treating a risk score as prevention, when the tailored plan is what helps. Check staffing alongside the outcome. Report what the trial did and did not show. Set measures you can audit without much extra work. Plan a quick review after every fall so the unit learns from each one. Meet with night staff at hours they can attend. The Montclair program is one pattern to follow; the desk writes a first draft for your indicator and unit free.
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 Thomas Edison State University 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.
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NUR 7020 Module 4 questions, answered
Where can I find a free NUR 7020 Module 4 sample paper?
The quality indicator paper for an invented Montclair medical unit, from the falls report to the night rounding program, is shown in full above.
What is the NDNQI?
A national database created by the American Nurses Association that collects unit-level nurse-sensitive indicators and compares units with similar units nationally.
Did the Fall TIPS tool kit reduce falls?
Yes. In a cluster trial on medical units, falls were lower with the tool kit, about 3.15 versus 4.18 per 1,000 patient days, most clearly in patients 65 and older.
What does the AHRQ falls toolkit recommend?
Universal precautions for every patient, a tailored plan for each patient's risks, leadership, measurement and review of every fall.
Why is a fall risk score not enough?
The score identifies risk but prevents nothing; the tailored plan and its communication to staff, patients and families do the work.