Running head: BUSINESS CASE ANALYSIS

Business Case Analysis

Ashley Conner Stone
Old Dominion University

Business Case Analysis

In the business case analysis, it will identify the problem at hand in a hospital setting as it
is related to staffing issues. This analysis will help to discover staffing issues, how it affects the
business on an operational and financial standpoint. It will also look at ways that it can be
resolved and what will be beneficial to the business to make it run effectively and efficiently.
Background
The background information in this scenario includes a hospital that is understaffed
during the 2nd shift (3:30pm- 11:30pm). The debate is on what would be the best situation as far
as being able to provide adequate staffing during this time to make sure that the patients are
being taken care of in an efficient, safe, and effective manner. The choices include hiring

additional permanent staff, hiring temporary staff, pulling from other departments, or paying
overtime and bonuses to current employees. All of these choices have to be evaluated to
determine which would be the best as far as a financial and operational standpoint.
Business/Operational Impacts
It has been shown that a larger number of patients per nurse were significantly associated
with a greater incidence of administration of the wrong medication or dose, pressure ulcers, and
patient falls with injury (Cho, Chin, Kim, & Hong, 2016). One of the big financial impacts in
the hospital setting would be the high turnover rates that occur when the floors are short staffed.
This is a global healthcare management issue because nurses are expensive to replace and the
nursing shortage has an impact of patient safety, the ability to detect complications early and
nurses well-being (Brunetto et al., 2013). This fact alone can cause the hospital to spend more
money on complications with the patients that lead to further treatment, related to injury or
longer lengths of stay in the hospital. The institute of Medicine (IOM) recommend nurses work
no more than 12 hours in a 24-hour period and no more than 60 hours in a 7-day period to avoid
error-producing fatigue. Working long hours can lead to adverse nurse and patient outcomes
(Bae, 2012). The errors that are made from being over-worked alone can cost the hospital a lot
of money, and not only that but lead to an increase in mortality rates (Bae, 2012). If nurses are
overworked, it may also lead to a decrease in morale, as well as, an un-pleasant environment.
Nurses may tend to have increased stress and an increase in call outs may occur do to the
shortages, which in turn make the situation worse on the unit and may put the unit in a critical
staffing situation.
Options and Cost/Benefit Analysis

BUSINESS CASE ANALYSIS

There are options to ensure that each unit is staffed accordingly. Each unit has to have
adequate staff to care for the patients and the level of acuity that the patients are categorized.
The two options that seem to make the most sense, are hiring additional permanent staff, as well
as pull staff from underutilized units. As noted before, high turnover rates and hiring new staff
can be costly. The use of floating nurses from other units is often used to offset the effects of
staffing shortages and struggling budget. Floating can reduce overtime costs and use of
expensive agency staff (Bates, 2013). Unfortunately, floating is a sensitive issue to nurses, many
who say that it is frustrating and gives them anxiety (Bates, 2013). The benefits to pulling from
other units is that nurses that are sent home do to low census, can stay and work their shift
without having to be sent home without pay or use their vacation time to ensure that their
paycheck is not affected. Yes it can be uncomfortable to work on another unit that you are not
familiar with, but it does allow you to work your hours and you will not be required to take on
any patients that you do not have a skill set for. The benefit to the unit is that they do not have to
pay overtime to staff or outside agencies. They are able to utilize staff that is already employed
by the company, and it is a quick fix to the situation at hand, but may not be the best solution for
long-term. Another option is to hire permanent staff for the unit. As with floating staff there can
be some hostility or even turnover rates from being pulled. If there are permanent staff that are
hired for the unit the cost for overtime will decrease and frustration and turnover rates for
employees would also decrease. Normally it takes a long time and a lot of effort to hire
replacement staff (Kusserow & Boateng, 2015). Although, it may take longer for training and
the cost associated with hiring staff may increase for a short time. The overall benefit is much
better with hiring adequate staff for the unit versus paying overtime and outside agencies to make
sure that patients are cared for.

BUSINESS CASE ANALYSIS

4
Conclusions and Recommendations

My recommendation would be to hire permanent staff for the unit, and use nurses from
underutilized units in the mean time. Being able to staff the unit with permanent nurses will help
in the long run with turnover rates as well as staff morale. Having the adequate staff for the unit
will also ensure that patients are being provided with the care that they need to recover and have
shorter hospital stays. This will also provide staff with the confidence that errors will be reduced
due to having adequate staff, lower nurse to patient ratios, as well as a team that can help when
there is a critical situation with a patient happens on the unit. The staff will have less stress and
fatigue, and be able to enjoy coming to work versus stressed about being understaffed on the
unit. With adequate staff the hospital as a whole will save money that would have been spent on
overtime, cost associated with morbidity and mortality rates, patient length of stay in the
hospital, and paying outside agencies for coverage.
Implementation Strategy and Review and Approval Process and Summary
To implement these recommendations there would need to be ads placed in newspapers,
online job sites, as well as on the hospital website advertising for the job positions that are
available. With this there would need to be competitive pay and benefits that would compensate
for that acuity level of patient on the unit. Utilizing Human Resources (HR) to conduct the
initial interviews and recruiting of nurses. HR could help to streamline the process of the
applicants and work with them on their compensation packages. The managers and directors of
the hiring unit would need to be involved with the hiring process as well, with interviews and
determining what skills the nurses need to have to be a complementary fit for that unit. Also,
they would be utilized for an action plan for floating nurses from other units and how to make
sure that the nurses that are being floated are comfortable with the unit, as well as knowing that

BUSINESS CASE ANALYSIS

they have a team that will be there to help them when needed. Even though they are nurses, their
skills will be different and this may cause frustration. By implementing a plan to provide these
nurses with confidence and support, they will be less frustrated and more productive. Once the
manger, director, and HR have determined the best candidate for the position, they will make an
offer and provide their compensation package. All parties must be an agreement for the position
to be filled. It will be very important to provide adequate training for the new employees to
ensure that they have adequate training and that the turnover rates will stay low.
Even though floating staff from other units can be cost effective for the company, it is not
the best choice long term. The best solution for the unit would be to hire staff to fill the vacant
positions. In the long run the morale of the nursing staff and unit will increase and the safety and
efficiency of patient care will be increased. This will decrease cost of the hospital by decreasing
overtime pay, expensive agency use, and cost that are associated with healthcare related injury
and illness.
References
Bae, S. (2012, March-April). Nursing Overtime: Why, How Much, and Under What Working
Conditions? Nursing Economics, 30(2), 60-72.
Bates, K. J. (2013, May-June). Floating as a Reality: Healping Nursing staff Keep Their Heads
Above Water. Medsurg Nursing, 22(3), 197-199.
Brunetto, Y., Xerri, M., Shriberg, A., Farr-Wharton, R., Shacklock, K., Newman, S., & Dienger,
J. (2013). The impact of workplace relationships on engagement, well-being,
commitment and turnover for nurses in Australia and the USA. Journal of Advanced
Nursing, 69 (12), 2786-2799. http://dx.doi.org/10.1111/jan.12165

BUSINESS CASE ANALYSIS

Cho, E., Chin, D. L., Kim, S., & Hong, O. (2016). The Relationships of Nurse Staffing Level and
Work Environment With Patient Adverse Events. Journal of Nursing Scholarship, 48(1),
74-82. http://dx.doi.org/10.1111/jnu.12183
Kusserow, R. P., & Boateng, C. (2015, July-August). Filling a Gap between Permanent
Compliance Officers: Hiring Outside Experts versus Using Internal Staff. Journal of
Health Care Compliance, 37-38, 54.