NUR 631 Module 2 Environmental Scan Example

Environmental Scan and SWOT Analysis: Medical-Surgical Nurse Staffing at Brookfield Regional Medical Center

[Student Name]

Southern New Hampshire University

NUR 631: Strategic Skills for Nurse Executive Leaders

Module Two Environmental Scan

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Environmental Scan and SWOT Analysis: Medical-Surgical Nurse Staffing at Brookfield Regional Medical Center

A strategy is only as good as the picture of the situation behind it. Nurse executives often move directly from a painful problem, such as agency spending, to a favored solution, such as a sign-on bonus, without examining the forces inside and outside the organization that created the problem. An environmental scan slows that step down. This paper scans the internal and external environment of medical-surgical nurse staffing at Brookfield Regional Medical Center, a composite 280-bed hospital, and organizes the findings in a SWOT analysis. It argues that the scan points away from pay-based fixes alone and toward changes in how nursing work is organized and supported.

Internal Environment

Brookfield operates five medical-surgical units with 146 beds. Over the past fiscal year, the registered nurse vacancy rate on these units averaged 14%, against 9% for the hospital's other inpatient units. Annual turnover was 22%, and among nurses in their first year it was 31%, meaning that nearly one in three new graduates left before their first anniversary. Agency and traveler spending reached $9.8 million, up from $2.1 million five years earlier. Night shifts typically run at one nurse to six patients, compared with a budgeted one to five. Twenty-eight percent of the medical-surgical registered nurses are aged 55 or older.

The organization also has assets. A partnership with the state university brings about 120 baccalaureate graduates into the region each year, and Brookfield hosts many of their clinical placements. A shared governance council has been active on the medical-surgical units for four years. The electronic health record and a recently installed video system used for remote patient observation could support virtual care. Exit interviews most often cite workload, inflexible 12-hour scheduling and feeling unsupported as a new nurse; pay is cited less often.

External Environment

The national workforce is under strain. In the 2022 National Nursing Workforce Survey, 62% of registered nurses reported an increase in workload during the pandemic, and roughly 45% described burnout at least several times weekly, hitting nurses with ten or fewer years in the profession hardest, and the workforce shrank by an estimated 3.3% over two years (Smiley et al., 2023). A survey of more than 15,000 nurses in 60 hospitals found that 47% reported high burnout, that nurse burnout was associated with higher turnover and that improved staffing was the intervention nurses most often ranked as important (Aiken et al., 2023).

Locally, a competing health system opened a new tower 20 miles away last year with sign-on bonuses of $15,000. Brookfield's payer mix includes 38% Medicaid, which limits revenue growth. At the same time, early reports describe virtual nursing models in which experienced nurses support bedside teams remotely with admissions, discharges and education; one evaluation found a reduction in some missed nursing care at one of two sites studied (Schuelke et al., 2020). A new state program will fund retention projects, and Brookfield is eligible to apply.

SWOT Analysis

Table 1 organizes the findings. Each entry is tied to a number or a source so that the analysis can be checked and updated.

Table 1. SWOT Analysis of Medical-Surgical Nurse Staffing

Note. Internal figures are composite values for Brookfield Regional Medical Center. National figures from Smiley et al. (2023) and Aiken et al. (2023).

Reading the SWOT Strategically

A SWOT becomes useful when its quadrants are read against each other. Matching strengths to opportunities suggests using the university pipeline and the existing video system to build a supported first year for new graduates, including virtual nurse mentoring on nights. Matching weaknesses to opportunities suggests that flexible scheduling options, funded in part by a state grant, could address the scheduling complaints that appear in exit interviews. Matching strengths to threats suggests that Brookfield cannot win a bidding war with its competitor on bonuses but can compete on support and flexibility, which its own exit data say matter more. Matching weaknesses to threats identifies the greatest risk: if first-year turnover remains at 31% while the competitor recruits aggressively, agency dependence will deepen and night staffing will worsen, which the research links to worse patient outcomes and more burnout.

Strategic Questions for the Plan

The scan leads to three questions that the strategic plan must answer. First, how can Brookfield reduce first-year turnover, where the loss is greatest and the organization has the most influence? Second, can the $9.8 million spent on agency staff be redirected into internal capacity, such as a float pool or virtual nursing roles, at lower cost? Third, which scheduling and support changes can be offered within the budget constraints of a hospital with a large Medicaid population? Each question will be framed with data in the first milestone.

The scan also exposes gaps in what Brookfield knows. Turnover is tracked by unit but not by shift, so it is unclear whether night nurses leave at higher rates. Exit interviews reach only about half of departing nurses, and those who leave for the competitor may be underrepresented. Agency spending is reported as a total rather than by unit, which hides where replacement labor is concentrated. Patient outcome data, such as falls and pressure injuries, have not been linked to staffing levels by shift. Closing these gaps is part of the plan, because a strategy aimed at the wrong unit or shift would spend scarce money where it helps least, and the board will ask how the organization knows the problem is where it says it is.

Conclusion

The environmental scan shows a hospital losing new nurses to workload and inflexibility while spending heavily on replacement labor, in a market where it cannot outbid a competitor. Its strengths, a steady graduate pipeline, shared governance and technology already in place, point toward strategies that change how nursing work is supported rather than how much it pays.

References

Aiken, L. H., Lasater, K. B., Sloane, D. M., Pogue, C. A., Fitzpatrick Rosenbaum, K. E., Muir, K. J., & McHugh, M. D. (2023). Physician and nurse well-being and preferred interventions to address burnout in hospital practice: Factors associated with turnover, outcomes, and patient safety. JAMA Health Forum, 4(7), Article e231809. https://doi.org/10.1001/jamahealthforum.2023.1809

Schuelke, S., Aurit, S., Connot, N., & Denney, S. (2020). The effect of virtual nursing and missed nursing care. Nursing Administration Quarterly, 44(3), 280-287. https://doi.org/10.1097/NAQ.0000000000000419

Smiley, R. A., Allgeyer, R. L., Shobo, Y., Lyons, K. C., Letourneau, R., Zhong, E., Kaminski-Ozturk, N., & Alexander, M. (2023). The 2022 National Nursing Workforce Survey. Journal of Nursing Regulation, 14(1 Suppl.), S1-S90. https://doi.org/10.1016/S2155-8256(23)00047-9