NUR 631 Module 9 Final Project Example

Final Project: Brookfield Regional Medical Center's Three-Year Strategic Plan for Staffing Its Medical-Surgical Units

[Student Name]

Southern New Hampshire University

NUR 631: Strategic Skills for Nurse Executive Leaders

Final Project

[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.

Final Project: Brookfield Regional Medical Center's Three-Year Strategic Plan for Staffing Its Medical-Surgical Units

Brookfield Regional Medical Center exists, in its own words, to give the community safe, compassionate care without a long drive. On its medical-surgical units, that mission is under pressure: nurses leave faster than they can be replaced, agency staff fill the gaps at a premium and night shifts regularly run short. This plan is the nursing division's three-year response. It draws on a year of analysis, an environmental scan, a framed strategic issue, a business case, a change analysis, a stakeholder map and a scorecard, and it argues that Brookfield should invest in its own nurses and in how their work is supported rather than continue to rent capacity it cannot control.

Situation Summary

Across five medical-surgical units, Brookfield employs about 410 registered nurses. Last year 90 left, and 22 of 70 new graduates departed within a year of hiring. Agency spending has grown from $2.1 million five years ago to $9.8 million. On nights, one nurse commonly cares for six patients against a budget of five. Exit interviews point mainly to workload, lack of support for new nurses and inflexible scheduling, not pay. A competing system nearby offers large bonuses that Brookfield, with a 38% Medicaid payer mix, cannot match. The hospital does have assets: a steady supply of graduates from the state university, a shared governance council and video equipment in patient rooms that could support virtual care. Research ties heavier nurse workloads to higher patient mortality and nurse burnout (Aiken et al., 2002), which makes the staffing gap a safety concern as well as a financial one.

Strategic Issue and Goals

The strategic issue is that nearly a third of Brookfield's newly hired medical-surgical nurses leave within twelve months, and the hospital replaces departing nurses with costly agency labor and understaffed shifts, spending more than $5 million a year on turnover and $9.8 million on agency staff while exposing patients to staffing levels linked to harm. Replacement cost was estimated at $58,000 per departure, consistent with published guidance on calculating turnover costs (Jones, 2008).

Three goals follow. By the end of year two, first-year turnover will fall from 31% to 18%. By the end of year three, agency spending on medical-surgical units will fall by 40%, to about $5.9 million. Throughout, the proportion of night shifts meeting the budgeted one-to-five ratio will rise from 58% to at least 90%, a balancing goal that prevents savings from coming out of patient care.

Strategy

The four candidate options were scored on five yardsticks: likely impact on the targets, cost and payback period, quality of the supporting evidence, practicality with current resources and how staff would receive them. The chosen strategy combines three elements. First, an internal float pool of 24 Brookfield-employed nurses will cover shortages across the medical-surgical units, replacing agency hours with nurses who know the hospital. Second, the first year for new graduates will be redesigned: preceptors will carry reduced assignments during orientation, new nurses will stay on day shift for at least six months and flexible schedule options, including 8-hour shifts, will be offered. Third, a virtual nursing pilot on two units will place experienced nurses in a remote hub to complete admissions and discharge teaching by video and to coach new graduates in real time. Flexible scheduling alone was rejected as insufficient to close the coverage gap, and a sign-on bonus was rejected because Brookfield cannot win a bidding war and exit data show pay is not the main reason nurses leave.

Financial Case

The float pool will cost about $3.57 million a year in salary, benefits and differentials, plus $288,000 in one-time recruitment and orientation. At 90% productivity it will supply about 44,930 hours a year that would otherwise be bought from agencies at $115 an hour, or $5.17 million, leaving roughly $1.6 million a year in net savings. With a six-month hiring ramp, the investment turns cash-positive in its eighth month. The virtual nursing pilot will cost about $1.03 million a year against expected savings of about $722,000 from lower turnover and overtime, a net cost of about $310,000, which is justified as a test of whether it reduces first-year turnover. The first-year redesign costs about $240,000 a year in preceptor time, recovered if it prevents four or five departures. The combined plan is expected to save about $1.29 million a year at full implementation. Savings remain positive if only 16 float pool positions are filled or if agency rates fall to $95 an hour, though they shrink considerably. Replacing agency staff is not expected to harm quality; after accounting for work environment, agency use has not been independently linked to higher mortality (Aiken et al., 2013).

Implementation

Implementation runs over 18 months. In months one to three, a design team drawing union delegates, frontline nurses from every unit, the scheduling office, a hospitalist champion and finance together will write float pool rules and the first-year redesign, and the staffing software will be configured. In months three to nine, float pool nurses will be hired in cohorts of four, each completing orientation to every unit they cover. The first-year redesign begins with the next graduate cohort in month four. The virtual nursing pilot will launch on two units in month six and run for 12 months, with an evaluation at month 18. The earlier change analysis found that Brookfield's 2022 staffing pilot faded because it lacked urgency, a broad coalition, protected roles and permanent funding (Kotter, 2012). This plan addresses each: data are shared with every unit before launch, new roles are written into policy and job descriptions and funding comes from the operating budget with agency savings reinvested.

Stakeholder Commitments

Bedside nurses and the union have the greatest interest and influence, so the plan includes written commitments: each float nurse is limited to three units with orientation on all of them, assignments must match documented competencies, the remote nursing roles sit inside the bargaining unit and the room cameras are barred from use in judging any individual nurse's performance. Managers will help set rules for requesting float coverage. The chief financial officer and board will receive monthly and quarterly reports.

Evaluation

Progress will be tracked on a twelve-measure balanced scorecard organized in four perspectives, following Kaplan and Norton's approach (Kaplan & Norton, 1996). Key measures include agency spending, float pool fill rate, night shifts at the budgeted ratio, first-year turnover, burnout on the annual survey, injurious falls and pressure injury prevalence. Each has a baseline, target and owner, and results will be reported as trends against targets. The virtual nursing pilot will continue beyond 12 months only if first-year turnover on its units falls by at least a third; published evidence on virtual nursing is limited, with one evaluation finding fewer missed care items at only one of two sites (Schuelke et al., 2020).

Risks

Four risks could derail the plan. Slow float pool hiring would delay savings; the sensitivity analysis and monthly reporting provide early warning. Launching floating before rules are agreed would provoke staff and union opposition; no float nurse will be deployed until the design team's rules are adopted. Leadership turnover could leave the plan without a sponsor; embedding roles in policy and budget reduces that dependence. And the virtual nursing pilot may not work; it has been designed as a test with a clear stopping rule.

Conclusion

Brookfield can continue to buy temporary capacity at a rising price, or it can invest in nurses who stay and in a first year that helps them stay. This plan chooses the second path, with a float pool that pays for itself within a year, a redesigned first year, a carefully tested virtual nursing model and a scorecard that will show the board whether nurses and patients are better off. It asks for investment now in exchange for a more stable, safer and less expensive nursing division within three years.

References

Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987-1993. https://doi.org/10.1001/jama.288.16.1987

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

Jones, C. B. (2008). Revisiting nurse turnover costs: Adjusting for inflation. Journal of Nursing Administration, 38(1), 11-18. https://doi.org/10.1097/01.NNA.0000295636.03216.6f

Kaplan, R. S., & Norton, D. P. (1996). The balanced scorecard: Translating strategy into action. Harvard Business School Press.

Kotter, J. P. (2012). Leading change. Harvard Business Review Press.

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