Keep the Beds, Change the Unit: A Nurse Manager's Position Against Converting a Critical Access Hospital to a Rural Emergency Hospital, and a Plan to Advocate for It
[Student Name]
University of Phoenix
HSN/476: Healthcare Policy and Financial Management
Week 5 Assignment
[Instructor Name]
[Date]
The hospital, the board and all figures are a composite written for a model paper.
In Week 4, I traced the rural emergency hospital designation from federal law to the bedside of my critical access hospital, whose board is studying conversion. This paper takes a position on that decision and plans how to advocate for it. My position is that the hospital should keep its inpatient and swing-bed beds as a critical access hospital, and should change how the inpatient unit is staffed and used so that it is financially sustainable, rather than convert. In its code of ethics, the American Nurses Association (2015) holds that the profession must work for social justice in health policy as well as at the bedside, and a decision that would move rural patients 60 miles from home falls squarely within that responsibility.
The Argument
The financial case for conversion rests on the assumption that inpatient care is where the hospital loses money. At a critical access hospital, that assumption needs testing. Medicare pays critical access hospitals on the basis of reasonable cost for inpatient, outpatient and swing-bed services (Medicare Payment Advisory Commission, 2023), and Medicare pays for 58% of our unit's days. The budget analysis in Week 2 showed that most of the unit's staffing cost is a fixed safety floor, a large share of which is returned through the cost report in proportion to Medicare's share of days. Conversion would give up that cost-based payment for inpatient and swing-bed care in exchange for enhanced outpatient payment and a monthly facility payment. Whether that trade helps depends on figures the board has not yet seen: the unit's actual net margin after cost report settlement, not its gross expenses.
The clinical case is stronger. Our swing beds serve patients who need skilled nursing and rehabilitation after a hospital stay, and our county has few skilled nursing beds. Without swing beds, those patients would stay longer in distant hospitals or go home before they are ready. Our acute patients, mostly older adults with pneumonia, heart failure and dehydration, would be transferred 60 miles, often at night and in winter weather. Transfers separate older patients from families, and the emergency department would need to hold them, sometimes for many hours, with staff who must also care for new arrivals. A conversion that saves the hospital money by moving the cost and risk of inpatient care onto patients, families and a distant hospital is not a saving for the community.
The staffing case matters too. In Week 3, a shared night staffing pool across the inpatient unit and the emergency department reduced agency costs by about $104,000 a year while keeping both units safely staffed. Improvements like this lower the cost of keeping beds open without closing them.
The Strongest Counterargument
The strongest argument for conversion is survival. Rural hospitals have closed at a steady rate, and a hospital that closes entirely leaves the community with no emergency care at all. If the board's analysis shows that the hospital cannot survive as a critical access hospital even with better staffing and a stronger swing-bed program, conversion would preserve the emergency department, which is the service the community needs most. Chatterjee et al. (2022) found that hospitals eligible for the designation differ in their finances and services, which means conversion will be the right choice for some hospitals.
I accept this argument as a condition on my position. If an honest financial analysis, using net figures after cost report settlement and including the savings from staffing changes, shows that the hospital cannot survive with inpatient beds, conversion is better than closure. My position is that the analysis has not yet been done that way, and that the board should not decide until it has.
The Advocacy Plan
Audience 1: the hospital board. Message: decide on net figures, not gross expenses, and weigh patient transfers as a cost. Action: I will ask the chief nursing officer to request that the board's consultant report the inpatient unit's margin after cost report settlement and model the staffing pool savings. I will prepare a two-page brief with the Week 2 budget and Week 3 staffing analysis. Timeline: before the board's next quarterly meeting.
Audience 2: the medical staff and community. Message: what conversion would mean for local patients. Action: with the chief nursing officer's approval, I will speak at the hospital's community advisory council and share transfer data, such as the number of acute and swing-bed admissions last year that would have required transfer. Timeline: within three months.
Audience 3: state policymakers. Message: rural hospitals need financial options between cost-based inpatient care and closure, including better payment for swing-bed and post-acute care. Action: I will contact our state nurses association's government affairs staff, offer testimony from a rural nurse's view and meet our state representative during the association's legislative day. Timeline: the next legislative session.
Audience 4: my own staff. Message: what is being considered, what is known and how they can take part. Action: I will hold open staff meetings, share accurate information and invite nurses to join the community presentations. Timeline: ongoing, beginning this month.
Protecting the Staff While Advocating
Advocating on a decision that could eliminate my own unit carries a risk of looking self-interested, and my staff are anxious about their jobs. I will keep the two concerns separate. My brief to the board will say plainly that I manage the unit, and it will rest on patient and financial data rather than on job protection. Separately, I will ask the administration to commit, whatever the board decides, to offer every inpatient nurse a role in the emergency department, outpatient services or the staffing pool before any position is eliminated. Separating the case for patients from the case for staff makes each more credible.
Measuring Success
Advocacy succeeds here if the board's decision uses net financial figures and a full account of patient impact, whatever it decides. Specific markers are a revised consultant report, the staffing pool implemented, a community council presentation delivered and one legislative contact made.
Conclusion
My position is to keep the hospital's inpatient and swing-bed beds, make the unit less costly through smarter staffing and insist that any decision rest on net financial figures and patient impact. If that analysis shows the hospital cannot survive with beds, conversion is better than closure. Nurse advocacy on this decision means bringing the bedside, the budget and the community into the same room.
References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements.
Chatterjee, P., Klebanoff, M. J., Huang, Q., & Navathe, A. S. (2022). Characteristics of hospitals eligible for rural emergency hospital designation. JAMA Health Forum, 3(12), Article e224613. https://doi.org/10.1001/jamahealthforum.2022.4613
Medicare Payment Advisory Commission. (2023). Critical access hospitals payment system (Payment basics).
How this HSN 476 Week 5 example is structured
The HSN/476 description ties policy and finance to practice and presents the nurse as a leader, and many sections close with a position on a reform issue and a plan for nurse advocacy. This paper states a position in its first section, argues it with evidence from the course's earlier weeks, gives the opposing case a fair hearing, and ends with a concrete advocacy plan with audiences, messages and a timeline. Students search this week as HSN 476 Week 5, HSN476 Wk 5 or HSN/476 Wk 5; all three are the same assignment.
HSN/476 Week 5 questions, answered
What does HSN/476 Week 5 usually ask for?
The course description presents the nurse as a leader in health policy and finance. Many sections close by asking students to take a position on a reform issue and explain how a nurse would advocate for it.
How should a position paper handle opposing views?
State the strongest opposing argument fairly and answer it with evidence. A position that ignores the best counterargument is less persuasive to decision makers who have heard it.
Why should nurses advocate on policy?
Nurses see the effects of policy on patients directly, and their professional code describes a responsibility to shape social and health policy. Decision makers often lack that bedside view.
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 University of Phoenix 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.