The Business of Nursing and Workforce Improvements: Teach - Analyze - Change

Purpose:
Nursing degree program curricula require few courses in business and resource management. As the novice RN enters the workforce and the experienced RN advances to leadership levels he/she will benefit from programs and tools designed to help the RN drive nursing excellence and business management.

Significance:
Knowledge is key to empowering the RN to be a respected participant in organizational forums chartered to create strategies, develop recommendations and drive change related to nursing and organizational staffing, resource allocation, facility design, workforce activities and program development.

Strategy and Implementation:
To develop all nurses as leaders Children's National provides "Budget Boot Camp" programs at the staff nurse and manager/director level. The program teaches basic budget concepts, components and terminology. It also speaks to: 1)the relationship of the hospital's Strategic Plan to budget development; 2)the role of the CNO in communicating nursing resource needs to the highest level of the organization; and 3)the voice of the staff nurse in communicating resource needs to nursing leadership. Furthermore, a monthly unit level CNO Dashboard is required from each nursing director. The Dashboard focus includes: recruitment and retention, productivity, cost performance, clinical indicators and patient/parent satisfaction. Quarterly working sessions are held to mentor unit directors in the identification of opportunities for operational and process improvements. Through SBAR presentations, directors share areas identified for improvement and measurable indicators pre and post process change.

Evaluation:
Dashboard related improvements show: 1)up to 26% contract RN reduction per patient day; 2)up to 10% HPPD increase; and, 3)up to 40% increase in SNL participation. Recent NDNQI measures show improvements in PIV infiltration rate (<3%), pain assessment (>93% compliance) and RN turnover (<10%).

Implications for Practice:
Use of key measures has empowered all nurses to drive and sustain improved safety, quality, workforce and financial outcomes. Involvement of bedside nurses in data collection, interpretation and performance improvement facilitates ownership, nursing excellence and mentoring of future nurse leaders.