Strategic Action Budget

Having adequate staffing is a continual problem in nursing. Having the right quantity of nurses to care for the patients without going over the budget is difficult. According to Roussel, strategic staffing is an approach to analyze the problem. Strategic staffing analyzes the staffing needs based on long-term objectives for the unit and tries to find a combination of permanent and temporary employees with the best skills to meet these needs. Strategic staffing also requires an understanding of the different types of staffing. The purpose of this request is to obtain qualified nurses utilizing in-house or temporary staffing services to fill short-term nursing needs. Finding qualified individuals for interim placement is necessary because of the increased census of this facility as a result of the current hiring freeze. Leaving the facility understaffed is having a negative effect on the staff morale and quality of patient care, and must be addressed. According to Roussel, each patient care unit should have a master staffing plan that includes the basic staff needed to cover the unit for each shift. Basic staff is the minimum number of personnel needed to staff the unit and they need to be fully oriented full and part time employees (Roussel, 2013). Options are a) the staff already in place, b) using a short-term contingency staff or a temporary agency, or c) long term temporary nurses or travel nurses. With limited resources, this facility must use the personnel wisely and efficiently. The budget for this situation will take into consideration the problem at hand and what is best for this organization. The first proposed solution to the nurse shortage is to use the staff already in place and offer incentive pay. Usually incentive pay is overtime plus an additional hourly rate to work, when the census is up at the last minute and little time to get an agency nurse. This can be a good solution using the part-time RNs so the chance of overworking and burnout is less. The advantage of using the in-house staff is that the nurses are already trained and oriented to the facility and the units. There are no worries about finding mentors or preceptors in this case. The increase in the cost for the overtime and incentive pay is less than using other alternatives. Another option mentioned is outsourcing. Outsourcing is a way of providing cost-effective strategic staffing during times when the census is fluctuating. Facilities cannot keep nursing on staff during times low census rates (Henshaw & Kobs, 2001). Using temporary staffing allows flexible use of resources for staffing nurses when a particular expertise is needed or nurses are needed on an irregular basis. This idea works well when there are qualified nurses that can be called on to meet a particular need (Roussel, 2013). Long term and short term solutions should be used to fill temporary nursing needs. Two types of outsourced nurses are the travel nurse and temporary agency nurse. Agency nurses are usually per diem or PRN, and can be canceled without notice if the census is low. Agency nurses are local and can be called on with little notice. The agency keeps a pool of nurses and can fill a request easily. Travel nurses sign a contract to work for a specified periods of time, usually 13 weeks at a time, and a specified number of hours per week. These nurses must go through the new hire orientation just like the new employees. However, they should be seasoned nurses and not need a preceptor. For hospitals, travel nurses offer more flexible staffing options that can be customized to meet their staffing at the time. Temporary nurses are used for the busy season and then they are let go when the demand goes down. This allows hospitals to flex the nursing staff and have a smaller permanent staff. Many hospitals have discovered that well-planned use of staffing companies can help to retain nurses and, in turn, promote patient safety (Hinshaw & Keeing, 2006). It is the responsibility of the nursing mangers to assure each of the temporary staff are competent, well trained nurses and understand the workload for the facility which will be taxing to the manger’s time. It is my recommendation to go with the in house staff option. Since our facility has been dealing with budget constraints, this will be less expensive, and easier to modify. In fact, as you can see on the included budget comparison, this option is $37,000 less than the travel nurse option, since we would be avoiding the 13-week minimum term. If a problem arises with this choice, we will be able to switch to one of the other options quickly.

Budget Comparison

References:

Hinshaw, A. S., (2006). Keeing patients safe: A collaboration among nurse administrators and researchers. Nursing Administration Quarterly(30)4, pp. 309–320

Roussel, L., (2013). Management leadership for nurse administrators, 6th Edition. Jones & Bartlett Learning. Shaffer, F., Kobs, A. (1997) Measuring competencies of temporary staff. Nursing Management (5)28. Pp. 4l-42. 44-45.

Nevidjon, B., Erickson, J. I., (2001). The nursing shortage: Solutions for the short and long term. Online Journal of Issues in Nursing (6)1, Accessed on April 13, 2015 through www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJINta bleofContents/Volume62001/No1Jan01/NursingShortageSolutions.aspx

US Department of Health and Human Services, (2002). Health Care Financing Administration. Appropriateness of minimum nurse staffing ratios in nursing facilities. (1, 2, & 3). Washington, DC: Health Care Financing Administration, Report to Congress.

Wagner, K., (2013). Temporary nurse staffing: Taking a closer look. Healthcare Cost Containment. Accessed on April 14, 2015 through www.hfma.org/hcc