In my organization, the most significant challenge right now is the lack of staff. The COVID-19 pandemic has simultaneously created a sudden upsurge in the volume and acuity of patients and led to a mass exodus of staff. The staffing shortage has been created by a perfect storm where sick nurses required extended quarantine time to prevent disease spread, and others left full-time positions to take highly lucrative travel assignments (Catton, 2021). The most impactful workforce deficit is nurses within the intensive care units. Typically, an ICU nurse requires extensive training and many of our units have few experienced nurses to precept and train our inexperienced nurses. The patient needs and the experienced nursing availability have never been more unbalanced.

As a DNP-prepared nurse, this financial challenge cannot be fixed easily. The primary strategies that I would employ will focus on retaining the staff who remain in the workforce, and upskilling nurses to a level above that of their current unit. The hiring, training, and onboarding of new staff require a significant financial investment by the health care organization, and staff retention prevents the loss of this investment that has already been made (Yoder-Wise, 2018). Budgeting is a question of balancing supply and demand, and although many ICU nurses left full-time positions, other service lines such as the operating room and procedural areas were left with lower than usual demands. These nurses present an available resource that can be used to augment the clinical areas with more need. Redeployment of these nurses is a cost-neutral strategy to provide work hours for the staff and supports the inpatient service lines. Upskilling the med/surg nurses into progressive care, and progressive care nurses into intensive care units will allow the provision of care for the patient population, whilst lowering the need to pay the onboarding costs and time to train new nurses directly into the intensive care unit. Nurses who are already familiar with the facility, the charting, and the organizational workflow will be quicker to prepare for a higher acuity of patient care.

Careful analysis of the operational budget begins with determining the workload for the unit. The number of patients and the number of admissions discharges and transfers factor into the number of worked hours per patient day (HPPD). The HPPD can be compared to historical data and proportionate needs of staffing ratios can be calculated (Waxman, 2018). The educational department can be tasked with creating fast-track education to upskill nurses that can include virtual classes, self-guided education modules, and recording of classes that are typically offered periodically so that nurses can receive this training without waiting for class offerings. The realignment of all trained staff is a strategically intelligent way to support the existing staff and meet the needs of the unit.

References

Catton, H. (2021). Covid‐19: The future of nursing will determine the fate of our health services. International Nursing Review, 68(1), 9–11. https://doi.org/10.1111/inr.12673 (Links to an external site.)

Waxman, K. (2018). Financial and business management for the doctor of nursing practice, second edition (2nd ed.). Springer Publishing Company.

Yoder-Wise, P. (2018). Leading and managing in nursing (7th ed.). Mosby.

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