Knowing and showing your value is about more than just budgeting. It's about alignment with the organization's mission and vision and contributing to the achievement of its strategic goals (Harper & Maloney, 2022). Most organizations have strategic initiatives related to high-quality care; being a workplace of choice by ensuring employee safety, satisfaction, and retention; and financial stability. Nursing professional development (NPD) initiatives can be instrumental in achieving each of these organizational goals. What is your organization's strategic plan? Are your NPD initiatives contributing to achieving strategic goals? If not, what can you do to align with your organization's strategic plan more closely?
Let's face it-budgets are important. They are indicators of our organization's financial health. The heat of summer is here, and many of us have never faced such budgetary challenges. After 2 years of pandemic pandemonium and the Great Resignation, we are all feeling the heat. The good news is that we have data and strategies to help!
While budgeting might not be your favorite activity, it is critical and starts with knowing your organization's annual budget cycle. Every NPD practitioner, not just the department head, should provide input into the budgeting process to ensure the final budget reflects your department's needs. Advocating for the resources the NPD department needs can be a daunting task if you are not prepared and not aligning your budget to the organization's strategic activities. Preparation requires knowing and showing your department's value. What has your department done to contribute to the organization's financial health? Although your department might not be revenue producing, what has it done to promote income for the organization? Are your NPD initiatives enhancing patient satisfaction? Patient satisfaction impacts patients' choice of service providers and potentially increases volume for the organization, especially with patient satisfaction data so easy to find on the Internet (Medicare.gov, n.d.). However, volume without value is not enough. Patient satisfaction impacts your organization's Centers for Medicare & Medicaid (CMS) rebate, which is value based (CMS, 2021a). Rebates mean income!
What have you done to help the organization avoid costs? Like income, cost avoidance increases the bottom line and strengthens the organization's fiscal health. Are your NPD initiatives promoting staff retention? In 2021, turnover of a single bedside nurse costs an organization over $46,000, and a 1% reduction can result in an estimated savings of over $262,000 per year (NSI Nursing Solutions Inc., 2022). In addition, the highest rate of turnover for RNs and all healthcare staff is during the first year of employment. What initiatives can you develop to minimize this turnover? Think about your nurse residency program for new graduates. Evidence indicates that these programs significantly decrease first-year turnover and yield as much as a 300% return on investment (ROI; Knighten, 2022). If your nurse residency program is decreasing turnover, you're saving your organization money that far exceeds the cost of providing the program.
Next, let's consider patient outcomes. What NPD initiatives do you have that prevent hospital-acquired infections, surgical site infections, falls, pressure injuries, or postoperative deep vein thrombosis? How are you preparing staff to follow guidelines to prevent hospital readmissions? Hospital payments are reduced for each of these untoward events (CMS, 2021b, 2021c). Not only are payments reduced, the cost of caring for these patients is increased. Hospital-acquired infections alone cost hospitals over $28 billion per year (Centers for Disease Control and Prevention, 2021). As you teach staff about discharge care bundles or other evidence-based guidelines, are you watching your hospital rates to determine the impact of these initiatives?
It's easy to get caught up in day-to-day tasks. It might be difficult to take time to calculate the impact of your NPD initiatives, but being able to know and show your value is worth the effort. The Association for Nursing Professional Development (ANPD) has resources to help. For example, the Known Costs Table, available on the Tools and Resources tab under NPD Practitioner Resources, provides a review of literature on common healthcare costs that NPD practice initiatives can impact (ANPD, 2020). In addition, a newly added ANPD report includes the results from the 2021 Organizational Value of Nursing Professional Development Practice study commissioned by ANPD, which will also be published in the next issue of this journal.
Maybe you're not prepared to provide evidence of your department's value in this upcoming budget cycle. That's where the NPD practice value analysis study comes in. As you'll see in the forthcoming September/October issue, we have evidence to demonstrate our specialty's collective impact on patient satisfaction, patient outcomes, and staff retention and turnover. We also have NPD staffing metrics that allow you to compare with the hospitals that participated in the study. Use these findings to advocate for the resources you need. Then commit to collecting and analyzing the data to demonstrate your organization-specific data that will enable you to know and show your value. Based on our study, the following actionable items will position you to approach the budgeting process with confidence.
* Develop a spreadsheet or worksheet for routine data collection that allows you/your department to easily evaluate changes in organizational metrics.
* Read your organization's strategic plan to ensure you are informed about the organization's direction. As a department, determine how NPD initiatives can contribute to the organization's strategic goals.
* Obtain data from your human resources department at least annually about the number of employees and nurses (individuals and full-time equivalents), turnover rate for all employees and for nurses, the number hired and retention rates for newly licensed nurses, total number of individuals hired in the last fiscal (i.e., budget) period, and number of contract nurses (i.e., agency and travelers) used for the previous fiscal period.
* Determine the number of nurses certified in any specialty in your organization. Identify areas that need more certified nurses and provide certification preparation opportunities.
* Visit the HCAHPS/Hospital Compare website quarterly (see Medicare reference in reference list) and note your hospital's publicly reported patient satisfaction and quality data. Use these data for needs assessment and evaluation.
* If your hospital participates in the National Database of Nursing Quality Indicators, obtain quarterly reports. If you are unsure of how to interpret the reports, which can be confusing, meet with the leader of your quality department.
* Calculate ROI for your NPD initiatives that potentially impact your organizational outcomes, such as a nurse residency program or quality improvement initiatives. If you don't know how, read Opperman et al.'s (2016) article that teaches how to calculate ROI. Then, read Garrison and Beverage's (2018)Journal for Nurses in Professional Development article to learn how they made measuring ROI an expectation in their department.
* Prepare an elevator speech that reflects your department's contributions to the organization's quality and financial metrics.
While you might be thinking you're too busy to obtain these metrics, we suggest that you cannot afford not to stay abreast of your organization's data. Unless you know and show your value, you are unlikely to obtain the resources you need.
References