NURS 834 Week 3 Practice Initiative Project Part I Work Plan Example

Practice Initiative Work Plan: Covenant, Topic, Organization and a Twelve-Month Plan for a Nurse Practitioner-Led Inpatient Glycemic Management Team at a 250-Bed Community Hospital

Overview

Our group, three DNP students who work as a hospitalist nurse practitioner, a medical-surgical nurse manager and a diabetes nurse educator at the same community hospital, proposes a nurse practitioner-led inpatient glycemic management team. Over the past year, the hospital recorded a 40% increase in severe hypoglycemia, defined as a glucose below 54 mg/dL, among inpatients with diabetes, along with frequent rapid response calls for low glucose and repeated delays in discharge while insulin regimens were adjusted. This work plan sets out how our group will work together, what the initiative will accomplish, the organization in which it will operate and the twelve-month plan for building it.

Covenant of Expectations

Purpose and Values

We commit to producing work we would be proud to present to our own hospital's leaders, to treating one another with respect and to sharing the work fairly. We will begin each meeting with a brief prayer, as all three members requested.

Communication

We will meet by video every Tuesday at 7:00 p.m. for no more than one hour, with an agenda posted by Monday evening. Between meetings we will use a shared group message thread and answer within 24 hours on weekdays. Documents will live in one shared folder with a single file per assignment and tracked changes on.

Division of Work and Deadlines

Each assignment will be divided at the first meeting after it opens, with sections assigned by expertise and rotated so that no member always writes the hardest part. Drafts are due to the group four days before the course deadline, and comments are due two days before. One member, rotating by assignment, serves as editor for voice and APA and submits the final version.

Decision-Making

We will aim for consensus. If we cannot reach it within one meeting, the member who owns the section decides, and the decision is recorded in the meeting notes.

Resolving Conflict

If a member misses a deadline or disagrees with a decision, the first step is a direct private conversation within 48 hours. If that does not resolve it, the issue is raised at the next group meeting. If it remains unresolved, we will ask the course instructor for guidance before submission, not after. Each member will complete the peer evaluation honestly.

Practice Initiative Topic

Problem Statement

Inpatient glucose management at our hospital is fragmented. Insulin orders are written by many different hospitalists, sliding-scale insulin alone remains common, meal delivery and insulin timing are poorly coordinated, and there is no clinician whose job is to manage glucose across the hospital. In the last fiscal year, severe hypoglycemia occurred in about 3.1 per 100 patient days of insulin therapy, rapid response calls for low glucose averaged eleven a month, and patients with diabetes stayed a mean 1.2 days longer than patients without diabetes admitted for the same conditions.

Aims

Within twelve months of launch, the initiative aims to reduce severe hypoglycemia among insulin-treated inpatients by 50%, to reduce the proportion of glucose values above 180 mg/dL by 10 percentage points, and to reduce mean length of stay for inpatients with diabetes by half a day, without increasing 30-day readmissions.

Evidence

The evidence for dedicated inpatient glycemic teams is consistent. Haque et al. (2021) concluded from their review that hospital diabetes services improve glucose control and save money, mostly by shortening stays and preventing readmissions and hypoglycemia, and they suggested that this literature be used in business cases for administrators. In 11,477 general medicine stays, an early diabetology consult was associated with a stay 1.56 days shorter (Sheahan et al., 2021). Zilbermint (2021) reports that endocrine hospitalist models raise the quality of inpatient diabetes care, including in hospitals without academic affiliations. And when diabetes specialists at a New York center reviewed glucose results remotely and sent recommendations, hyperglycemia on the participating units fell from 72.2% to 65.5% of patients (Mendelsohn Curanaj et al., 2026), which suggests that a small team can extend its reach with remote review, an important point for a rural hospital with only two nurse practitioners to start. The problem is not that clinicians lack knowledge about insulin; it is that no one owns glucose across the hospital.

The Practice Initiative Organization

Mission and Structure

The initiative will operate at a 250-bed nonprofit community hospital serving a mostly rural region of about 180,000 people. Its mission is to provide compassionate, high-quality care close to home. The hospital has 160 medical-surgical beds, a 20-bed intensive care unit and a hospitalist group of fourteen physicians and six nurse practitioners. The chief nursing officer leads nursing and reports to the chief executive officer, and quality and patient safety report to a board quality committee.

Current Practice

Glucose is checked by point-of-care meters and managed by the admitting hospitalist. The hospital has an insulin order set that includes basal and prandial options, but it is used in fewer than half of insulin orders. Endocrinology is available only by outpatient referral; there is no inpatient endocrine consultation service. One diabetes nurse educator covers the entire hospital weekdays.

Stakeholders and Resources

Key stakeholders include the chief nursing officer, who sponsors the initiative; the hospitalist medical director, whose support is essential because the team will manage insulin for hospitalist patients; pharmacy; nutrition services, which control meal timing; nursing staff on medical-surgical units; information technology, which maintains the order set and glucose reports; and finance, which will evaluate the business case. Resources include the existing order set, the electronic health record's glucose data, the diabetes educator and a hospitalist nurse practitioner willing to lead the team. Waxman (2018) presents strategic alignment as part of the business planning a DNP undertakes, and the alignment here is direct: reducing hypoglycemia is already one of the hospital's patient safety priorities for the year.

Group Roles

Each member brings a different view of the problem, and the work plan assigns tasks accordingly. The hospitalist nurse practitioner leads clinical design, the order set and the business case, and will lead the team once it launches. The medical-surgical nurse manager owns the charter, staffing and the relationship with nursing leadership, and is responsible for reporting to the board quality committee. The diabetes nurse educator owns data, protocols and staff education. All three share responsibility for the literature, the budget and the final editing of each assignment, which the covenant's rotating editor role makes explicit.

Measurement Plan

The initiative will be measured from the start. Outcome measures are severe hypoglycemia per 100 insulin patient days, the proportion of glucose values above 180 mg/dL and mean length of stay for patients with diabetes. Process measures are the share of insulin orders using basal and prandial components, how many qualifying patients the team reaches within a day of admission and the time from a low glucose value to treatment. Balancing measures are 30-day readmissions and nurse-reported workload. Baseline data for six months before launch will be plotted on run charts and updated weekly during the pilot.

Project Work Plan

Risks and Assumptions

The plan assumes that the hospitalist group will accept nurse practitioner management of insulin for its patients under a consult model, that funding for a second nurse practitioner will be approved and that the information technology department can build the daily glucose report within two months. The largest risk is hospitalist resistance; we will address it by including the hospitalist medical director in the charter and by beginning with a consult model in which the team recommends and, with agreement, writes insulin orders. A second risk is data quality, since baseline hypoglycemia rates depend on how low values are captured; we will validate the report against a manual chart review of fifty cases.

Next Steps

Part II will present the business case for the initiative's first-year funding to the hospital's executive leadership, and Part III will evaluate that business case and its budget. Before Part II, the group will meet with the finance department to obtain the hospital's cost per patient day, the fully loaded cost of a nurse practitioner position and the cost of a rapid response call, so that the business case uses the hospital's own figures rather than estimates from the literature.

References

Haque, W. Z., Demidowich, A. P., Sidhaye, A., Golden, S. H., & Zilbermint, M. (2021). The financial impact of an inpatient diabetes management service. Current Diabetes Reports, 21(2), Article 5. https://doi.org/10.1007/s11892-020-01374-0

Mendelsohn Curanaj, F. A., Rajan, M., Snead, J., McCullough, P., & Lee, J. I. (2026). Delivery of guideline directed care for inpatient glycemic management: Quality improvement implementation. Journal of Diabetes Science and Technology. Advance online publication. https://doi.org/10.1177/19322968261417369

Sheahan, K. H., Atherly, A., Dayman, C., & Schnure, J. (2021). The impact of diabetology consultations on length of stay in hospitalized patients with diabetes. Endocrinology, Diabetes & Metabolism, 4(1), Article e00199. https://doi.org/10.1002/edm2.199

Waxman, K. T. (2018). Financial and business management for the doctor of nursing practice (2nd ed.). Springer Publishing.

Zilbermint, M. (2021). The endocrine hospitalist: Enhancing the quality of diabetes care. Journal of Diabetes Science and Technology, 15(4), 762-767. https://doi.org/10.1177/19322968211007908