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1. NURS FPX 8020 Assessment 2 Strategic Plan Development
Student Name
Capella University
NURS-FPX8020
Instructor Name
Date
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NURS FPX 8020 Assessment 2

2. Introduction
Strategic planning is one of the most vital leadership skills for ensuring safe, error-free care
delivery in Doctor of Nursing Practice (DNP) advanced nursing practice. Within NURS FPX
8020, strategic planning emphasizes system-level management that strengthens the quality and
safety of healthcare services across organizations. The development of evidence-based strategic
frameworks, as demonstrated in this assessment, is essential for guiding interventions that align
with national health priorities.
This paper outlines a step-by-step strategic plan focused on reducing hospital readmissions for
patients with heart failure (HF). Given that heart failure remains one of the most common and
costly causes of readmission in the United States, a structured nurse-managed transitional care
program has been designed to address this persistent issue.
Identifying the Organizational Issue
Heart failure is consistently ranked among the highest causes of hospital readmission nationwide,
generating excessive healthcare costs and reducing patient quality of life. Thirty-day
readmissions are a significant problem, with recent organizational data showing a 24.5%
readmission rate for HF patients—exceeding the national average.
Addressing this challenge requires a comprehensive improvement plan. Within the context of
NURS FPX 8020 Assessment 2 Strategic Plan Development, the proposed solution involves
implementing a nurse-led transitional care program (TCP). This program is designed to reduce
fragmentation in discharge planning, strengthen patient education, and improve post-discharge
follow-up.
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3. Strategic Vision and Objectives
The vision for this plan is to ensure excellence in patient outcomes through seamless continuity
of care and prevention of avoidable hospitalizations. The primary objective is to lower the 30-
day HF readmission rate to below 18% within 12 months of program implementation.
Secondary objectives include ensuring follow-up appointments within seven days of discharge,
strengthening patient and caregiver education, and personalizing treatment interventions for
better adherence. These goals are specific, measurable, attainable, relevant, and time-bound
(SMART) and designed to align with both organizational and national priorities.
Stakeholder Involvement
The success of this strategy depends on effective stakeholder engagement across the care
continuum. The DNP practitioner will coordinate efforts among hospitalists, nurses,
cardiologists, pharmacists, case managers, social workers, and home health caregivers.
Stakeholder collaboration will be encouraged through routine meetings, shared accountability,
and transparent feedback systems. Engaging stakeholders ensures that the plan reflects
interdisciplinary insights and fosters collective ownership of outcomes. This collaborative model
strengthens both care transitions and organizational performance.
Intervention Design
At the core of this strategy is a nurse-managed transitional care program (TCP). The
intervention begins at hospital discharge, incorporating individualized assessments, medication
reconciliation, and tailored education for patients and caregivers. Each patient receives written
discharge instructions along with a checklist of warning signs and when to seek help.
This approach ensures patients leave the hospital better prepared to manage their condition,
while caregivers are equipped with the knowledge needed to provide effective support at home.
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4. Post-Discharge Care Strategy
Follow-up care is critical for preventing avoidable readmissions. Patients will receive a 48-hour
post-discharge phone call and a clinic visit within seven days. High-risk patients will also
benefit from telehealth monitoring, which allows real-time tracking of vital signs and enables
nurse practitioners to respond promptly to changes in condition.
The design is informed by the Transitional Care Model (TCM), which has demonstrated
effectiveness in improving outcomes for patients with chronic diseases such as heart failure.
Resource Planning
Implementing this program requires targeted resource allocation. Investments include recruiting
additional nurses trained in transitional care, purchasing telemonitoring devices, and developing
standardized patient education materials. Ongoing training sessions will ensure staff competence
and sustainability of the program.
Digital Health Record Integration
Integration of electronic health records (EHR) is central to coordination. The system will track
discharge planning, follow-up appointments, and patient compliance. Built-in task calendars and
performance dashboards will allow staff to monitor progress, allocate resources, and measure
outcomes efficiently.
Evaluation and Monitoring
Program effectiveness will be monitored through key performance measures, including 30-day
readmission rates, follow-up compliance, patient satisfaction, and medication adherence. Data
will be reviewed monthly to identify trends and adjust strategies as needed.
The Plan-Do-Study-Act (PDSA) cycle will guide continuous quality improvement, ensuring the
program remains responsive to patient needs and organizational goals. Both quantitative metrics
and qualitative feedback from patients and staff will be used to evaluate strengths and areas for
refinement.
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5. Alignment with DNP Essentials
This plan aligns with several AACN DNP Essentials:
Essential II: Organizational and systems leadership is demonstrated by implementing a
structured, evidence-based transitional care program.
Essential III: Clinical scholarship is applied through the integration of research and best
practices.
Essential VI: Interprofessional collaboration is central to the plan, fostering teamwork
among diverse healthcare professionals.
Essential VIII: Quality improvement is advanced through systems-level interventions
and ongoing evaluation.
Through this alignment, the strategic plan reflects the competencies expected of DNP leaders to
transform care delivery.
Conclusion
This strategic plan demonstrates how nurse-led interventions, combined with interprofessional
collaboration, resource optimization, and digital integration, can significantly reduce heart failure
readmissions. By prioritizing patient education, follow-up care, and monitoring, the program
fosters better patient outcomes while promoting organizational sustainability.
As a product of NURS FPX 8020 Assessment 2 Strategic Plan Development, this initiative
illustrates the impact of evidence-based leadership in addressing complex healthcare challenges.
Ultimately, the plan supports safer, more effective, and patient-centered care delivery, benefiting
both patients and the broader healthcare system.
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6. References
American Heart Association. (2016). Heart failure management guidelines.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000000438
Centers for Medicare & Medicaid Services. (2023). Telehealth and heart failure.
https://www.cms.gov/About-CMS/Story-Page/Telehealth-Heart-Failure
Agency for Healthcare Research and Quality. (2022). Plan-Do-Study-Act (PDSA) cycle.
https://www.ahrq.gov/health-literacy/improve/precautions/pdsa-cycle.html
American Association of Colleges of Nursing. (2006). The essentials of doctoral
education for advanced nursing practice. https://www.aacnnursing.org/DNP/DNP-
Essentials
Feltner, C., Jones, C. D., Cené, C. W., Zheng, Z. J., Sueta, C. A., Coker-Schwimmer, E.
J., & Middleton, J. C. (2014). Transitional care interventions to prevent readmissions for
people with heart failure. Annals of Internal Medicine, 160(11), 774–784.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733667/
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