1. Murray, Kathleen RN, CNA, MSN

Article Content

Q All of the nurse vacancies are filled on my unit, so my CNO won't approve the hiring of additional staff, even though I know I'll have several nurses leave in the next year. How can I convince her that by hiring an extra nurse now, it'll be a cost avoidance rather than an additional expenditure?

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Start with a review of the current literature on the financial implications of nursing turnover. An article I find particularly useful is in the Journal of Nursing Administration, titled "The Costs of Nurse Turnover, Part 2."1 Next, present a financial proposal to the CNO addressing the unitspecific need and justification for the request. Your plan should address:


* current overtime usage


* the organization's time to fill an RN position


* how many nurses are planning to leave in the next year, what shift they work, their years of employment, and the reasons they're leaving


* the sources of coverage for the vacancies (overtime or agency use)


* the cost of orientation orientation for replacement staff.



For example, if there are two tenured nurses who are relocating and planning to leave in March and April, propose to start the hiring process in September because the organization's time to fill an RN night position is generally 4 months. The new hire may potentially start in January and complete orientation by March 1. The benefits of the plan are that no overtime or premium labor is used and the two seasoned night nurses can participate in the orientation process prior to their last day of employment.


When you've completed the written proposal, schedule your meeting with the CNO. Your discussion should be well planned and rehearsed. End the session with your commitment to manage the overall budgeted hours per patient day and salaries so that you remain budget neutral.


Q I recently scored low on my evaluation because I didn't achieve my targeted admission goal for the year. How can I increase the amount of volume of admissions to my unit?


Begin by reviewing your unit's patient days, length of stay, and admission and discharge statistics. If your patient days are below budget and your length of stay is above budget, investigate the specific areas increasing your length of stay. For example, are you using disease-specific care pathways and procedures to improve patient flow? Do you have a formalized discharge planning process that includes the predicted discharge date early in the admission process? Are there delays in testing? It's crucial for discharge planning to start at the time of admission to ensure that the patient only remains in the hospital for the time necessary for treatment and recovery.


Additionally, you should obtain feedback from the physicians on staff members regarding their perception of quality of care, patient satisfaction, or process issues that deter them from admitting to your unit. Meet with the emergency department manager, house supervisor, or bed placement coordinator to identify any throughput issues.


Finally, it's crucial to meet with staff members and allow them to be part of the initiative to increase admissions. Better outcomes occur from having an engaged and enthusiastic staff.




1. Jones CB. The costs of nurse turnover, part 2. J Nurs Adm. 2005;35(1):41-49. [Context Link]