| Course | NUR-8420 Organizational and Systems Leadership II |
|---|---|
| Module | Module 3 |
| Paper type | Leadership paper: stakeholder analysis |
| Length | About 1,109 words, 7 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | Doctor of Nursing Practice |
| Updated | October 2026 |
Free sample paper for NUR 8420 Module 3
Who Holds a Stake in Where Babies Are Born: A Salience Analysis of a Sussex County Maternity Consolidation
Student Name
Doctor of Nursing Practice, Thomas Edison State University
NUR-8420: Organizational and Systems Leadership II
Mentor Name
Month Day, Year
Who Holds a Stake in Where Babies Are Born: A Salience Analysis of a Sussex County Maternity Consolidation
The Decision
The system in this paper is invented. Its 120-bed hospital in Sussex County, a rural county in northwest New Jersey, delivers about 310 babies a year. The system's regional center, 40 minutes away by car in good weather, delivers about 3,800. The small unit has trouble covering anesthesia and pediatric call, has lost two of its four obstetricians to retirement and runs at a loss of about $2.4 million a year. The finance committee has proposed closing labor and delivery and moving births to the regional center. The system's top nurse, who earned her DNP four years ago, has been asked to lead the analysis before the board votes.
She framed her task not as defending or opposing the closure but as making sure every group affected by the decision is known, understood and heard before it is made, and that whatever is decided includes protections for the families who would lose a nearby unit.
Stakeholder Theory and Salience
Stakeholder theory holds that an organization owes attention to the groups that affect it or are affected by it, not only to its owners. The difficulty is deciding whose claims come first. Mitchell et al. (1997) proposed that managers notice stakeholders according to three attributes. Power is a group's capacity to get its way. Legitimacy is a claim that others accept as proper. Urgency is a claim that cannot wait and matters greatly to whoever makes it. A group with only one attribute is latent, a group with two is expectant, and a group with all three is definitive. The model also explains how groups move. A stakeholder with a legitimate and urgent claim but no power, whom the authors called dependent, can gain power through alliances with others or through the media.
Doing a Stakeholder Analysis
Brugha and Varvasovszky (2000) reviewed how stakeholder analysis moved from management and political science into health policy. They described it as a method for finding everyone with something at stake in a policy, assess their positions, interests and influence and use that knowledge to plan. They warned that the analysis reflects the analyst's own position and the time it was done, that positions shift as a decision unfolds and that groups with little organized voice are easily missed.
Following that guidance, the chief nursing officer gathered information from interviews, community meetings, public comments and the unit's own staff, rather than from leadership's views of what others thought.
The map made one risk visible. Pregnant patients and the county's emergency medical services had legitimate and urgent claims but little power, and both had begun to find allies: an advocacy group had formed after a news story, and a state legislator had asked for a briefing. Treating these groups as latent would be both unfair and, in the model's terms, a mistake about where power was heading.
| Stakeholder | Power | Legitimacy | Urgency | Salience |
|---|---|---|---|---|
| Pregnant patients in the county | Low | High | High | Dependent |
| Obstetric nurses and midwives | Moderate | High | High | Definitive |
| Remaining obstetricians | High | High | Moderate | Definitive |
| County officials and legislators | High | High | Low | Dominant |
| Emergency medical services | Low | High | High | Dependent |
| System finance committee | High | High | Moderate | Definitive |
| Local newspaper and advocacy group | Moderate | Moderate | High | Dangerous if unheard |
What the Evidence Says About Closures
Kozhimannil et al. (2018) studied rural counties in the United States from 2004 to 2014, years in which hospital obstetric care disappeared from 179 rural counties. In rural counties not next to an urban area, losing the service was followed by more babies born outside any hospital, more born in hospitals with no obstetric unit and more born early, when compared with rural counties whose services stayed open. The effects were clearest in rural counties that were not next to an urban area. Sussex County borders more urban counties, which suggests its risks may be smaller than in the most remote places, but its northern towns are farther from the regional center than the county average suggests.
The evidence does not mean the unit must stay open. It means that a closure without planning for travel, emergencies and prenatal care is likely to shift risk onto families and onto an emergency department that no longer delivers babies routinely.
The Engagement Plan
Each stakeholder group is engaged according to its position on the map. Definitive stakeholders, the nurses, obstetricians and finance committee, join a working group that develops the options. Dependent stakeholders receive more than information. Two patients who delivered at the unit, a doula and the county's ambulance coordinator join the working group, and three evening community meetings are held in the towns farthest from the regional center. County officials receive the analysis before it reaches the board. The advocacy group is invited to present its concerns to the board directly.
The working group produced three options rather than one: keep the unit with a shared call model and a midwifery-led staffing plan, close the unit with safeguards or close it after an 18-month transition while safeguards are built.
Safeguards if Births Move
Any closure would include prenatal care staying in the county, with ultrasound and fetal monitoring; emergency department training for unplanned births each quarter, with a neonatal resuscitation team on call by telehealth; a transport protocol agreed with emergency services; lodging near the regional center for patients from the northern towns in late pregnancy; and a guaranteed role at the regional center for each obstetric nurse who wants one.
Measures
Whichever option the board chooses, the system will report births outside hospitals and in its emergency department, preterm births and prenatal visits in the first trimester among county residents, transport times and maternal and newborn transfers, each year for five years.
Limits
A stakeholder map is a snapshot. Positions will move as the board's options become public, and the analysis will need to be repeated before any final vote. The national study measured counties, not individual hospitals, and Sussex County's mix of towns may not match the counties that drove its findings. The engagement plan also costs time and money, and a delay of several months means the unit keeps losing money while the options are worked out. The chief nursing officer judged that cost smaller than the cost of a closure that families and their legislators would fight.
Conclusion
The salience model showed that the groups with the most at stake had the least formal power but were gaining it. A careful analysis brought them into the work early. National evidence on rural closures turned their concerns into specific safeguards that the board can require whatever it decides.
References
Brugha, R., & Varvasovszky, Z. (2000). Stakeholder analysis: A review. Health Policy and Planning, 15(3), 239-246. https://doi.org/10.1093/heapol/15.3.239
Kozhimannil, K. B., Hung, P., Henning-Smith, C., Casey, M. M., & Prasad, S. (2018). Association between loss of hospital-based obstetric services and birth outcomes in rural counties in the United States. JAMA, 319(12), 1239-1247. https://doi.org/10.1001/jama.2018.1830
Mitchell, R. K., Agle, B. R., & Wood, D. J. (1997). Toward a theory of stakeholder identification and salience: Defining the principle of who and what really counts. Academy of Management Review, 22(4), 853-886. https://doi.org/10.5465/amr.1997.9711022105
Reading the NUR 8420 Module 3 assignment instructions
Stakeholder theory is listed among the core concepts in TESU's catalog paragraph for NUR-8420, and with the syllabus available only inside the course, the third module is planned as a stakeholder analysis of a contested system change. A DNP leadership paper of this kind sets out the decision and its stakes, explains a stakeholder model accurately, identifies stakeholders from evidence rather than assumption, maps them by influence and interest or by salience, weighs research on the likely effects of the change and plans engagement suited to each group. Some sections pick a merger, a service line closure or a new care model as the decision under study. Look at the brief to see if a particular grid is required, whether a table counts toward the page limit and whether a recommendation must be made.
How the NUR 8420 Module 3 example is put together
An invented system's proposal to move births from its Sussex County hospital opens the paper, with the nurse executive's decision to analyze before arguing. Stakeholder theory and the power, legitimacy and urgency model are explained, followed by guidance on doing an analysis well. A seven-row table maps each group by salience. National evidence on rural obstetric closures is weighed against the county's geography. The engagement plan, three options, safeguards and five years of measures follow, and the conclusion closes. Two annotations point out why patients appear as dependent stakeholders and how the safeguards match the evidence. A short limits section admits that the map will change as the decision becomes public.
Reading the NUR 8420 Module 3 grading rubric
Stakeholder papers are judged on an accurate, sourced explanation of the model, a stakeholder list built from real inquiry, a map whose ratings are explained, use of evidence about the effects of the change and engagement matched to each group's position. Mentors give weight to papers that notice groups with little power and plan to hear them. Presenting options rather than one predetermined answer shows good faith. Safeguards that respond to known risks show that the analysis changed the decision. The model's terms, such as dependent and definitive, should be used as the authors defined them, and each salience rating should come with a sentence of evidence.
NUR 8420 Module 3 help from the desk
Avoid a stakeholder map built from leadership's guesses; interview the groups or cite how their views were gathered. A second problem is rating every group high on everything, which makes the map useless. Explain each rating in a sentence. Do not treat engagement as a single information session. Tie safeguards to evidence about what the change is likely to cause, and say who will be accountable for each one. The Sussex County analysis can serve as a model, and a first draft on your own decision, written to your mentor's brief, is 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 8420 Module 3 questions, answered
Where can I find a free NUR 8420 Module 3 sample paper?
The stakeholder analysis of an invented Sussex County maternity consolidation, from the salience map to the safeguards, is printed in full above.
What makes a stakeholder salient?
Mitchell, Agle and Wood proposed three attributes: power, legitimacy and urgency. The model calls a group with power, legitimacy and urgency together definitive.
What is a dependent stakeholder?
In the salience model, a group whose claim is proper and pressing but who lacks power, so it must borrow influence from allies or advocates.
What happened after rural hospitals lost obstetric services?
In remote rural counties, more babies were born at home or on the way, more were born in emergency departments of hospitals with no maternity unit, and more arrived preterm.
What are common mistakes in stakeholder analysis?
Relying on leaders' assumptions, missing groups with little voice and treating positions as fixed when they shift during a decision.