NUR 631 Module 5 Milestone Two Example

Milestone Two: Business Case for an Internal Float Pool and a Virtual Nursing Pilot at Brookfield Regional Medical Center

[Student Name]

Southern New Hampshire University

NUR 631: Strategic Skills for Nurse Executive Leaders

Milestone Two

[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.

Milestone Two: Business Case for an Internal Float Pool and a Virtual Nursing Pilot at Brookfield Regional Medical Center

Finance committees fund numbers, not hopes. A nurse executive who asks for new positions must show what they will cost, what they will save, when the investment will pay for itself and how confident the organization can be in those figures. This milestone builds that case for two of the options identified in Milestone One. It argues that an internal float pool is a sound financial investment that should proceed at full scale, and that virtual nursing, which will not pay for itself on current evidence, should be funded as a small, evaluated pilot because of its potential to reduce first-year turnover.

Option 1: Internal Float Pool

The float pool would employ 24 full-time registered nurses who work across the five medical-surgical units wherever shortages occur. Brookfield's current base rate for an experienced medical-surgical nurse is $52 per hour. Adding 30% for benefits gives a loaded cost of $67.60 per hour, and a float differential of $4 per hour brings it to $71.60. Twenty-four nurses at 2,080 paid hours a year equal 49,920 hours, for an annual cost of about $3.57 million. Recruitment and orientation add a one-time cost of about $12,000 per nurse, or $288,000.

Not every paid hour replaces an agency hour, because staff take vacation, sick time and education. Assuming, as standard nursing budget practice does, that about 90% of paid hours are productive (Finkler et al., 2019), the pool supplies about 44,930 productive hours a year. Brookfield currently pays agencies an average of $115 per hour, so those hours would otherwise cost about $5.17 million. The annual net savings are therefore about $5.17 million minus $3.57 million, or $1.6 million, roughly $133,000 a month once the pool is fully staffed.

Break-Even and Ramp-Up

The pool will not be fully staffed on day one. If hiring proceeds evenly over six months, the pool will average half its capacity during that period, producing about $400,000 in savings in the first six months against the $288,000 one-time cost and orientation time. The cumulative balance turns positive in about the eighth month, and by the end of the first full year the net gain is about $1.1 million. From the second year, the full $1.6 million annual savings applies, before any wage increases. Wage growth matters because agency rates and staff wages do not always move together: if staff wages rise 3% a year while agency rates stay flat, the float pool's annual savings shrink by roughly $100,000 each year, which the finance office should model in the multiyear budget.

Option 2: Virtual Nursing Pilot

A virtual nursing pilot would place six experienced nurses in a remote hub, covering two units on day and evening shifts seven days a week. They would complete admission histories, discharge teaching and medication reconciliation by video and coach new graduates in real time. The video equipment is already installed in patient rooms for remote observation. At a loaded rate of $78 per hour, six nurses cost about $973,000 a year, with one-time integration and equipment costs of $180,000 and software licensing of $60,000 a year, for an annual cost of about $1.03 million.

The main expected benefit is lower first-year turnover. If the pilot units' share of first-year turnover fell from 31% to 18%, about 9 fewer nurses would leave each year; at $58,000 per departure, that saves about $522,000. Brookfield's finance office also estimates $200,000 in reduced overtime from faster admissions and discharges. Together these total about $722,000, leaving a net cost of about $310,000 a year. The published evidence remains thin; in a two-hospital evaluation, only one site saw fewer missed care items, and the other did not (Schuelke et al., 2020). The pilot therefore does not pay for itself on current evidence, and the case for it rests on its potential effect on first-year retention, which the evaluation must measure.

Combined Case and What-If Tests

Together, the two options save about $1.6 million a year from the float pool and cost about $310,000 a year for the pilot, a combined net saving of about $1.29 million a year once the pool is staffed. Two what-if tests show how sensitive this is. If Brookfield fills only 16 of the 24 float pool positions, net savings from the pool fall to about $1.07 million a year, and the combined saving falls to about $760,000. If agency rates fall from $115 to $95 per hour, as they did in some markets after the pandemic peak, the pool's savings fall to about $700,000, still positive but much smaller. In both cases the float pool remains worthwhile, but leaders should not count on the full $1.6 million.

Replacing agency nurses also has quality implications. In linked data from 665 hospitals, agency use looked tied to higher mortality at first, but the association vanished after the quality of the work environment was controlled, suggesting that agency use is a marker of a troubled environment rather than a direct cause of harm (Aiken et al., 2013). The float pool's value, then, lies partly in building a stable workforce that knows Brookfield's units and culture.

Recommendation

Brookfield should fund the internal float pool at 24 positions, with hiring over six months, and fund the virtual nursing pilot on two units for 12 months with a formal evaluation of first-year turnover, missed care and nurse experience. The pilot should expand only if it reduces first-year turnover on its units by at least a third. Savings from reduced agency use should be tracked monthly and a portion reinvested in the residency program.

Conclusion

The float pool is a strong investment that breaks even within a year and saves about $1.6 million annually at full staffing, with savings that remain positive under less favorable assumptions. Virtual nursing is a promising but unproven addition that should be tested before it is scaled. Presenting both honestly, including the option that does not pay for itself, strengthens the credibility of the whole plan.

References

Aiken, L. H., Shang, J., Xue, Y., & Sloane, D. M. (2013). Hospital use of agency-employed supplemental nurses and patient mortality and failure to rescue. Health Services Research, 48(3), 931-948. https://doi.org/10.1111/1475-6773.12018

Finkler, S. A., Jones, C. B., & Kovner, C. T. (2019). Financial management for nurse managers and executives (5th ed.). Elsevier.

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