NUR 5133 Module 6 Strategic Response to an Environmental Force Example

Grow Them Here and Share Them Out: A Three-Year Strategic Response to the Pediatric Nursing Workforce Shortage at a Regional Children's Hospital

Student Name

American College of Education

NUR5133: Knowledge of the Healthcare Environment

Module 6 Assignment

Instructor Name

October 12, 2027

The Force and Why It Was Chosen

The earlier modules of this course examined several forces acting on a composite 210-bed regional children's hospital: dependence on state Medicaid policy, the regionalization of pediatric inpatient care, accreditation standards for suicide prevention, a rising demand for adolescent psychiatric care and changes in the nursing workforce. Of these, the workforce is the one that limits the hospital's response to all the others. The market analysis in Module 4 concluded that an adolescent psychiatric unit is viable only if the hospital can staff it. The workforce analysis in Module 5 found that 41% of the medical-surgical nurses have less than two years of experience, that first-year turnover reached 27% and that travel nurse spending on four floors reached about $3.4 million a year. Every other strategy the hospital might choose passes through the same narrow gate: enough experienced pediatric nurses to carry it out.

Strategic Options

Workforce strategy is often framed as a choice among buying, borrowing and building talent. Buying means paying the market for experienced nurses, through higher wages, sign-on bonuses and travel contracts. It works quickly but is expensive, draws nurses from other hospitals in the region, including the community hospitals whose pediatric readiness matters to the children's hospital, and leaves the hospital exposed when market rates rise. Borrowing means sharing staff with partners, such as float pools shared with an adult system or contracted nurses from agencies; it adds flexibility but rarely brings pediatric expertise. Building means developing nurses from within: attracting students to pediatrics, training new graduates well and keeping nurses long enough to become experts. It is slower and requires investment years before the return, but it is the only option that increases the supply of pediatric nurses in the region rather than moving the existing supply around.

The hospital's position favors building. As Module 5 showed, the region no longer produces experienced pediatric nurses in community hospitals, so the market has few to buy, and borrowing from adult settings brings nurses who need the same pediatric training as new graduates. The strategy therefore makes building its core, uses buying only to bridge the transition and adds one element of sharing, described below, that strengthens the region's pediatric care as a whole.

The Strategy

Grow the pipeline. The hospital will form an academic-practice partnership with the state university's school of nursing to create dedicated education units on two medical-surgical floors. In this model, staff nurses trained as clinical instructors teach small groups of students on their own unit throughout a semester, with faculty support. An integrative review found that the dedicated education unit model was associated with better student outcomes in clinical self-efficacy and confidence, teamwork, knowledge and competency and satisfaction, although its effect on clinical judgment has not yet been established (Musallam et al., 2021). Students who complete the unit will receive a guaranteed interview and priority placement in the hospital's 12-month nurse residency, proposed in Module 5.

Keep the middle. Mid-career nurses, the group most likely to become preceptors and charge nurses, will be offered a clinical ladder that pays more at each step for taking on precepting, clinical instruction and charge roles, self-scheduling on every floor and funded certification in pediatric nursing. Clinical instructors on the dedicated education units will have reduced patient assignments while teaching, which addresses the precepting burden that experienced nurses named as a reason for leaving.

Share out. The hospital will fund a regional pediatric nursing network for the 12 community emergency departments in its referral area, each of which will be supported to designate a nurse pediatric emergency care coordinator. In a national assessment of emergency department pediatric readiness, having both a physician and a nurse coordinator was associated with higher readiness scores, yet the presence of coordinators had declined since the previous assessment (Remick et al., 2023). Higher readiness has in turn been associated with markedly lower mortality among critically ill children (Ames et al., 2019). Community emergency nurses will spend paid two-week pediatric fellowships at the children's hospital, and the hospital's nurses will provide simulation training on site. The network improves care for children who arrive at those emergency departments, and it builds relationships with nurses who may later choose to work in pediatrics.

Timeline, Resources and Measures

In year one, the partnership agreement, the first dedicated education unit, the residency and the clinical ladder will launch, and travel contracts will continue at a declining level. In year two, the second dedicated education unit and the regional network will start, with the first four community emergency departments. In year three, the network will extend to all 12 departments, and travel use should fall to a small reserve. The strategy's added cost is about $1.4 million a year at full operation, mainly for instructor time, the residency, ladder pay steps and the network's staff, against current travel spending of $3.4 million on the medical-surgical floors alone.

Six results will show whether the strategy is working: how many residency graduates come through the partnership, first-year turnover, retention of mid-career nurses, the experience mix on the floors, travel full-time equivalents and, for the network, the number of community emergency departments with a nurse coordinator and their pediatric readiness scores on the next national assessment. The strategy will also be judged by whether the hospital can staff the adolescent psychiatric unit if the certificate of need is approved.

How the Strategy Fits the Hospital's Other Plans

A strategic response to one force should strengthen the organization's response to others, and this one is designed to. The adolescent psychiatric unit considered in Module 4 depends on nurses with psychiatric skills; the residency will include a psychiatric track, and the clinical ladder will recognize psychiatric nursing certification, so that the medical-surgical nurses who already care for boarding adolescents can move into the new unit with preparation. The suicide prevention standard examined in Module 2 depends on nurses who can assess risk and de-escalate crises; the dedicated education units will include that content from the start. The regional network responds directly to the regionalization of pediatric care described in Module 1: as community hospitals close pediatric beds, the children's hospital helps keep their emergency departments ready for the children who still arrive there. And the strategy's reduction in travel spending helps the hospital absorb the Medicaid pressures described in Module 3. Taken together, the course's analyses point to one conclusion: the hospital's capacity to meet children's needs in the coming decade will be set less by its buildings or its payer contracts than by how many skilled pediatric nurses it can develop and keep.

Risks

The strategy's main risk is time. Its benefits arrive over years, while its costs start at once, and a budget crisis could cut the parts whose payoff is furthest away. To protect it, the nursing executive team will report the avoided travel cost each quarter, so the strategy's savings are visible as they appear. A second risk is that the university's faculty shortage limits the partnership; the dedicated education unit model is partly an answer to that, since it relies on staff nurses as instructors. A third is that a regional network could be seen by community hospitals as recruitment in disguise. The hospital will commit not to recruit coordinators away from their home emergency departments during their first two years in the role, and will say so in the partnership agreements.

References

Ames, S. G., Davis, B. S., Marin, J. R., Fink, E. L., Olson, L. M., Gausche-Hill, M., & Kahn, J. M. (2019). Emergency department pediatric readiness and mortality in critically ill children. Pediatrics, 144(3), Article e20190568. https://doi.org/10.1542/peds.2019-0568

Musallam, E., Ali, A. A., & Nicely, S. (2021). The impact of dedicated education model on nursing students' outcomes: An integrative review. Nurse Educator, 46(5), E113-E116. https://doi.org/10.1097/NNE.0000000000001022

Remick, K. E., Hewes, H. A., Ely, M., Schmuhl, P., Crady, R., Cook, L. J., Ludwig, L., & Gausche-Hill, M. (2023). National assessment of pediatric readiness of US emergency departments during the COVID-19 pandemic. JAMA Network Open, 6(7), Article e2321707. https://doi.org/10.1001/jamanetworkopen.2023.21707