NURS 834 Week 7 Grant Proposal Exercise for the Practice Initiative Example

Safer Glucose, Shorter Stays: A Grant Proposal to a Regional Health Foundation for $148,500 to Launch a Nurse Practitioner-Led Inpatient Glycemic Management Team

Executive Summary

Our 250-bed community hospital, the only acute care hospital in a rural region of about 180,000 people, requests $148,500 from the foundation's Rural Health Access program to launch an inpatient glucose team led by nurse practitioners. Last year, dangerous lows in our insulin-treated inpatients rose by two-fifths, low-glucose emergencies summoned the rapid response team almost every third day, and diabetic patients stayed more than a day longer than similar patients without diabetes. Many of these patients come from farms and small towns two hours away and return home to communities with limited diabetes care. The grant will fund the start-up year: half the cost of a second nurse practitioner, the order set and reporting build, staff education and an evaluation. The hospital will fund the remaining personnel cost in year one and the full cost thereafter. Within twelve months we expect to halve severe hypoglycemia, reduce hyperglycemia and shorten stays for patients with diabetes, while preparing patients for safe glucose management at home.

Statement of Need

The Problem

Diabetes is present in roughly a quarter of our admissions. In the last fiscal year, severe hypoglycemia, a glucose below 54 mg/dL, occurred at a rate of 3.1 events per 100 insulin patient days, an increase of 40% from the prior year. The rapid response team was called for low glucose about eleven times each month. For pneumonia, heart failure and cellulitis, admissions with diabetes lasted on average 1.2 days more than admissions without it. These problems share a cause: no clinician owns glucose management across the hospital. Insulin practice varies across fourteen hospitalists, correction-scale insulin without basal doses is still widely ordered, and no endocrinologist sees inpatients. One diabetes nurse educator covers the hospital on weekdays.

Why It Matters to Our Region

Our region's residents are older, poorer and more often uninsured than state averages, and the nearest endocrinology practice is ninety minutes away. A hospital stay is often the only time a patient with poorly controlled diabetes sees a clinician with time to adjust insulin and teach. Severe hypoglycemia during a stay causes harm, fear and sometimes falls, and patients discharged on regimens they do not understand return. The problem is therefore both a hospital safety issue and a rural access issue, which is why it fits the foundation's mission of improving health care access in rural communities.

Evidence for the Solution

The proposed solution rests on a consistent body of work. Haque et al. (2021), reviewing what hospital diabetes services accomplish, describe better glucose results together with savings that flow from patients leaving sooner, returning less often and suffering fewer lows. Sheahan et al. (2021) linked a specialist diabetes visit in the first two days of admission to patients going home about a day and a half earlier. Zilbermint (2021) argues that the endocrine hospitalist model brings these gains to small hospitals, not only teaching centers. And Mendelsohn Curanaj et al. (2026) showed that specialists reviewing glucose data from a distance cut the share of patients with readings over 180 mg/dL by almost seven points. Our design combines bedside consults with remote review so that a small team can cover a large hospital.

Goals and Objectives

Goal: Make inpatient glucose management at our hospital safe, consistent and patient-centered, and prepare patients with diabetes to manage glucose safely after discharge.

• Objective 1: By month 12, reduce severe hypoglycemia among insulin-treated inpatients from 3.1 to 1.6 or fewer events per 100 insulin patient days.
• Objective 2: By month 12, lower the share of bedside glucose readings over 180 mg/dL to ten percentage points below the baseline share.
• Objective 3: By month 12, shorten the average stay of patients with diabetes by half a day while holding 30-day readmissions at or below baseline.
• Objective 4: By month 10, ensure that 90% of registered nurses on medical-surgical units complete education on the new hypoglycemia protocol, and that 80% of patients discharged on new insulin receive teach-back education documented in the record.

Program Design

The Team

The team will consist of two nurse practitioners providing coverage seven days a week, the existing diabetes nurse educator and a pharmacist partner who reviews flagged insulin orders. Physician sponsorship comes from the head of the hospitalist group. One nurse practitioner, a member of our group, will lead the team.

How the Service Works

Each morning an automated report from the electronic health record flags every inpatient with a glucose value below 70 or above 250 mg/dL in the previous 24 hours. The team reviews the list remotely by 9:00 a.m., triages patients and sees those who need bedside assessment within 24 hours. Hospitalists may also request consults. In the first phase, the team recommends changes and, with the hospitalist's agreement, writes insulin orders; as trust grows, the hospital may move to a comanagement model. On weekends, remote review continues with in-person consults for urgent cases.

Supporting Changes

The program includes a revised insulin order set that makes basal and prandial insulin the default and retires sliding-scale-only orders, a nurse-driven hypoglycemia treatment protocol that allows nurses to treat low glucose immediately, coordination with nutrition services so that prandial insulin follows meal delivery, and discharge education using teach-back for patients going home on insulin. Waxman (2018) treats grants as one of the routes by which a DNP can finance a practice initiative, and because funders generally favor projects that leave lasting systems behind, these supporting changes are designed to remain in place regardless of future funding.

Evaluation Plan

Baseline data from the six months before launch will be compared with months 7 through 12. Results will be displayed on run charts, reviewed monthly by the team and the nurse manager, reported quarterly to the board quality committee and summarized for the foundation at months 6 and 12. We will also collect brief satisfaction surveys from hospitalists and nurses to assess acceptance. An objective that has no line in the evaluation table is a promise no one will check.

Organizational Capacity

The hospital has operated for 70 years and serves as the region's trauma and referral center. It has an established quality department with experience reporting to state and federal programs, an electronic health record capable of automated glucose reports, an active diabetes education program and a hospitalist group that has supported nurse practitioner practice for a decade. Executive sponsorship comes from the chief nursing officer, and the hospital's finance department reviewed the budget. The three authors bring complementary expertise: hospital medicine practice, unit management and diabetes education.

Timeline

Budget and Justification

The grant pays for start-up costs the hospital cannot easily absorb in the current year: half of the second nurse practitioner's first-year cost, the one-time build, education, the first-year software license, evaluation and bilingual patient materials. The hospital contributes the lead nurse practitioner's position and half of the second, $253,125, or 63% of the total. Each nurse practitioner position is costed at a $135,000 salary with benefits at a quarter of salary. The indirect amount stays within the foundation's published cap on overhead.

Risks and Mitigation

Three risks could limit results. The first is physician acceptance: if hospitalists do not use the service, flagged patients will not be seen. The physician sponsor, the consult model and early sharing of pilot results address this risk. The second is recruitment: rural hospitals often struggle to hire nurse practitioners, so we have identified an internal candidate and budgeted for per diem coverage during onboarding. The third is data quality: hypoglycemia rates depend on how glucose values are captured, so we will validate the automated report against fifty chart reviews before reporting baseline figures to the foundation.

Dissemination

Results will be shared with the foundation, the hospital board and staff, the regional rural hospital network and, if outcomes warrant, at a state nursing conference. Other rural hospitals face the same absence of inpatient endocrine services, and a model that works here with two nurse practitioners and remote review could be replicated at modest cost.

Sustainability

After the grant year, the hospital will fund both nurse practitioner positions from its operating budget, supported by projected savings from shorter stays and avoided hypoglycemia and by professional billing for consults, as presented in our business case to executive leadership. The order set, protocol, report and education will remain in place without further cost except the software license, which the hospital has agreed to fund. If outcomes fall short of objectives at month 12, the hospital will review the model with the team rather than discontinue it, because the system changes alone are expected to retain part of the benefit. The foundation will receive the month-12 report regardless of results, along with the team's plan for the second year.

Our Motivation

Our group works in this hospital and lives in this region. We have treated patients shaking and sweating at two in the morning with glucose in the thirties, sat with families frightened by a confused parent whose sugar had dropped overnight, and we have discharged patients on insulin they did not understand to homes an hour from the nearest pharmacy. Scripture calls those who have been given much to faithful stewardship, and teaches that whatever is done for the least is done for Christ (English Standard Version Bible, 2001/2016, Matthew 25:40). This proposal is our attempt to steward the skills we have been given for the patients our hospital exists to serve.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

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