NUR 631 Module 6 Stakeholder Analysis Example

Stakeholder Analysis: The Float Pool and Virtual Nursing Strategy at Brookfield Regional Medical Center

[Student Name]

Southern New Hampshire University

NUR 631: Strategic Skills for Nurse Executive Leaders

Module Six Stakeholder Analysis

[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.

Stakeholder Analysis: The Float Pool and Virtual Nursing Strategy at Brookfield Regional Medical Center

Strategies fail less often because the idea is wrong than because the people affected were not considered. The earlier change analysis showed that Brookfield's 2022 staffing pilot was designed by three managers and faded without anyone deciding to end it. Stakeholder analysis is a structured way of avoiding that outcome: identifying who is affected, what they care about, how much influence they have and how to engage them (Bryson, 2004). This paper applies stakeholder analysis to Brookfield's float pool and virtual nursing strategy. It argues that the strategy depends on two groups with the most influence and the most at stake, bedside nurses and the nurses' union, and that engaging them as designers rather than recipients is the key to success.

Method

Stakeholders were identified by asking who would be affected by the strategy, who controls resources or approvals and who could delay or block it. Each group was then placed on a grid of interest, meaning how much the strategy affects them, and influence, meaning their power over whether and how it proceeds, a common approach in both public management and health policy (Bryson, 2004; Brugha & Varvasovszky, 2000). For each group, the analysis records what it stands to gain or lose, its likely position and an engagement approach. Positions were estimated from past behavior, conversations with unit leaders and the exit interview themes in the environmental scan.

Stakeholder Map

Table 1 summarizes the analysis for the seven groups with the greatest stake or influence.

Table 1. Stakeholder Interest, Influence and Likely Position

Note. Composite organization. Positions estimated from past behavior, interviews with unit leaders and exit interview data.

The Two Groups That Decide

Bedside nurses and the union sit in the high-interest, high-influence quadrant, and their concerns are closely linked. Nurses want the support that stable internal staff would bring, but floating to unfamiliar units is one of the most disliked features of hospital work, and a float pool can be perceived as a way to move nurses around rather than to help them. The union will share that concern and will want floating rules, orientation to each unit and competency requirements written into policy or the contract. It will also ask whether virtual nursing positions are bargaining-unit jobs and whether remote monitoring will be used to evaluate bedside nurses. These are legitimate questions, and ignoring them would invite a grievance or a stalled rollout.

There is also common ground. The union's central goal is safe staffing, and the strategy's goal of reducing short-staffed shifts aligns with it. Research on union presence and outcomes is limited, but one study of California hospitals found an association between registered nurse unions and lower heart attack mortality, although the design could not establish cause (Seago & Ash, 2002). Framing the strategy around safe staffing, rather than cost savings alone, speaks to what the union values.

Engagement Plan

The plan engages each group according to its position on the grid. For bedside nurses and the union, the approach is to collaborate: invite union representatives and two staff nurses from each unit to a design team that writes the float pool rules, including a cap on the number of units each float nurse covers, a unit-specific orientation and a guarantee that float nurses are not assigned beyond their competencies. Virtual nurse positions will be posted as bargaining-unit jobs, and a written agreement will state that video monitoring will not be used for individual performance evaluation. For managers, the approach is to consult: they will help set the rules for requesting float nurses and will receive monthly reports on coverage. For hospitalists, the approach is to inform and involve a physician champion who will help design how virtual nurses communicate with physicians. For the chief financial officer and the board, the approach is to keep them closely informed with monthly dashboards tracking agency spending, float pool fill rates and first-year turnover. Staffing agencies will be informed of reduced demand with appropriate contract notice.

Risks

The greatest risk is that the float pool is launched before floating rules are agreed, which would confirm nurses' fears and invite union opposition. A second risk is that the chief financial officer withdraws support if the pool fills slowly and early savings fall short of projections; the monthly dashboard and the sensitivity analysis from the business case address this. A third is that hospitalists experience virtual nurses as another source of interruptions, which the physician champion should help prevent.

Stakeholder positions also change over time, and the analysis should be repeated at key points rather than filed away. Positions will be reviewed at three moments: after the design team finishes the float rules, at the 90-day report on float pool fill rates and at the six-month evaluation of the virtual nursing pilot. At each review, the design team will ask whether any group has moved on the grid, whether new stakeholders have appeared, such as patients and families who notice virtual nurses in their rooms, and whether commitments made to the union and staff have been kept. A broken commitment, even a small one such as a float nurse assigned to an unfamiliar unit without orientation, can undo months of trust, so the review includes a simple log of exceptions to the float rules.

Conclusion

The staffing strategy's success depends most on bedside nurses and their union, who have the greatest interest and influence and legitimate concerns about floating and remote roles. Engaging them as co-designers, with written rules and protections, turns potential opposition into ownership, while regular reporting keeps finance and the board committed.

References

Brugha, R., & Varvasovszky, Z. (2000). Stakeholder analysis: A review. Health Policy and Planning, 15(3), 239-246. https://doi.org/10.1093/heapol/15.3.239

Bryson, J. M. (2004). What to do when stakeholders matter: Stakeholder identification and analysis techniques. Public Management Review, 6(1), 21-53. https://doi.org/10.1080/14719030410001675722

Seago, J. A., & Ash, M. (2002). Registered nurse unions and patient outcomes. Journal of Nursing Administration, 32(3), 143-151. https://doi.org/10.1097/00005110-200203000-00007