An Innovative Approach to Fiscal Stewardship: Collaboration Between the CNO and Clinical Nurses to Acquire Nursing Resources

Purpose:
In the midst of a financial turnaround, a CNO successfully advocated for 47.81 FTEs through the development of a team of experts including clinical nurses to aid her in preparation for the budget. Prior to this Exemplary Professional Practice Team nurses had not been involved in the budget process.

Relevance/Significance:
An EPP team including clinical nurses is an innovative way to drive quality in health care delivery and improve the work environment through an improvement in nurse staffing. The team highlights creative methods used to improve outcomes in nurse staffing, and work environment. The EPP team allowed for a direct line of communication between the CNO and nurses so that the CNO was able to focus on what truly mattered to the nurses, or as the CNO affectionately says “the leaders at the bedside”.

Strategy and Implementation:
The purpose of the EPP team was to aid the CNO in developing an evidence based framework to prioritize and advocate for additional nursing resources. The team's goal was to design and implement a multiyear nursing workforce plan which reflects the ANA principles for Nurse Staffing and future state of patient care needs across the continuum. Through review of various benchmarks, the EPP team determined that comparing the hospital's HPPD to the NDNQI benchmarks using a quarterly staffing effectiveness tool best demonstrated the greatest need for resources and opportunities to improve outcomes. A “Staffing Effectiveness Report” was created that compared Staffing with patient outcomes and satisfaction. The data proved that there was correlations between staffing and outcomes. The tool was formatted to highlight areas in red or green depending if the data was outperforming the benchmark. The tool was the foundation of the team's work and became an active document to be adjusted quarterly.

Evaluation:
The staffing effectiveness tool was presented to the CEO and later approved by the Hospital Board. As a result, the department of nursing was granted an additional 47.81 RN and PCT FTEs. As a result, one unit has had 50% decrease in HAPU. This is one example of the impact of the additional resources,This is one example of the plans' effectiveness at improving HPPD and in turn improving outcomes.

Implications for Practice:
An EPP Team can be translated in order to advocate for nursing resources and the tool that became the foundation of the work of the EPP team is also replicable. The success depends on a transformational CNO who sees the impact that nurses can have on a process that has only included executives.