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System Change

System Change

Sample Answer 

System Change

Dr. Marilyn Rantz is a renowned nurse leader whose pioneering work in quality improvement in long-term care facilities has transformed the quality of care for seniors. She is currently the executive director of the Aging in Place (AIP) initiative, a product of the AIP model that encourages non-institutional autonomous living among senior adults as far as possible (Marek & Rantz, 2000). Her pioneering work in implementing the model has transformed long-term care, leading to its widespread national adoption and encouraging quality assessment practices in long-term care facilities. AIP has improved the quality of care in these institutions, evidenced by reduced rates of re-institutionalization by encouraging the deployment of Advanced Practice Registered Nurses (APRNs) (Rantz et al., 2017; Popejoy et al., 2017).

Dr. Rantz established the AIP model in 2011, providing a framework for implementing Aging in Place in nursing homes and residential facilities, an idea that had remained elusive since its initial proposal. One of the major driving forces for this Dr. Rantz’s success was the general observation that seniors preferred to live independently in their homes rather than in assisted-living institutions (Sabia, 2008). Additionally, the cost of institutional care was becoming increasingly forbidding (Graybill et al., 2014), paving the way for more cost-effective alternative models of long-term care such as AIP.

One of the major obstacles to the implementation of the AIP model was the absence of evidence to support its effectiveness. The change was also met with resistance from other experts in long-term care and gerontology, who dismissed it as an effect of residential inertia that could imperil the well-being of senior adults because of the health risks of independent living, such as falls. In order to address these concerns, Dr. Rantz engaged in research to generate evidence of the cost-effectiveness of AIP (Marek et al., 2012). The AIP model was subsequently piloted in various assisted-living facilities.


Graybill, E. M., McMeekin, P., & Wildman, J. (2014). Can aging in place be cost effective? A systematic review. PLoS One9(7), e102705.

Marek, K. D., & Rantz, M. J. (2000). Aging in place: a new model for long-term care. Nursing administration quarterly24(3), 1-11.

Marek, K. D., Stetzer, F., Adams, S. J., Popejoy, L. L., & Rantz, M. (2012). Aging in place versus nursing home care: Comparison of costs to Medicare and Medicaid. Research in Gerontological Nursing5(2), 123-129.

Popejoy, L., Vogelsmeier, A., Galambos, C., Flesner, M., Alexander, G., Lueckenotte, A., … & Rantz, M. (2017). The APRN role in changing nursing home quality: the Missouri quality improvement initiative. Journal of Nursing Care Quality32(3), 196-201.

Rantz, M. J., Popejoy, L., Vogelsmeier, A., Galambos, C., Alexander, G., Flesner, M., … & Petroski, G. (2017). Successfully reducing hospitalizations of nursing home residents: Results of the Missouri Quality Initiative. Journal of the American Medical Directors Association18(11), 960-966.

Sabia, J. J. (2008). There’s no place like home: A hazard model analysis of aging in place among older homeowners in the PSID. Research on Aging30(1), 3-35.


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System Change

Discussion Prompt
Discuss an example of how a nurse leader was successful in spearheading change within an organization, institution, or the government that impacted healthcare policy. What driving forces led to the nurse leader’s success? What obstacles were encountered and how were they addressed?

System Change

System Change

Initial Post:

  • Length: A minimum of 250 words, not including references
  • Citations: At least one high-level scholarly reference in APA from within the last 5 years

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