NR533 week 4,5,6 - September 2018

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NR 533 Week 4: Staffing Ratios

Staffing is one of the largest expenditures for healthcare organizations. It stands to reason that for some organizations a mandatory staffing ratio could negatively impact their financial bottom line. Sometimes ratios can be different within an organization based on acuity of patients or type of unit. Explore your own organization staffing ratio policy. What is/are the ratio(s) and how they are determined? What variables affect the ratios? Have they been mandated by state legislation or organizational policy? How is your operational budget (unit or department) affected by the staffing ratio assigned to it?

NR 533 Week 5: Cost-Benefit Analysis

Consider your PICO(T) and the proposal for your final project. When you think of it as a type of new program development, what specific information will you need to obtain to create the cost-benefit analysis as part of your business plan for the project?

NR 533 Week 6: Business Plan Development: SWOT analysis

The SWOT analysis is a necessary component of planning a project and preparing the business plan. Based on your PICO(T) and project proposal, discuss what information you need for the SWOT in order to provide rationale and validity for your project.

NR533 week 4,5,6 - September 2018
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of     analysis   the change     operational       unit   change in     safety       job   productivity and     and       nurses,   balance and     regards       will   the risks     implementing       in   of 8     whilst       benefits,   will identify     An       whether   12 hour     detrimental       to   patients, the     the       large   is because;     much       might   able to     money,       job   productivity and     deteriorate       and   of overtime     al       such,   is importance     a       delivers   benefits to     ReferencesGriffiths,       C   Simon, M     J       ,   A M     Aiken,       Nurses’   length and     in       the   with perceived     care        Medical   975 doi:     0000000000000233Roy,       “Banana   job satisfaction     interaction       Organisations (pp   Routledge DOI:     18       Week   Business Plan
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quality     management   178 doi:     0000000000000070 ReplyReply       "https://chamberlain   com/courses/32190/discussion_topics/736597?module_item_id=3893634" \o     Unread"       WalkerSep   2018Sep 24     Discussion       reading   your how     is       mandated   ratios       in       New   and we     have       nursing   I wish     put           do need     changes       to   patient ratio     my       is   higher each     When       in   I worked     and       of   or 13     vent       could   imagine handling     of           mentioned that     staffing       there   71% more             of   biggest reasons     is       New   many feels     could       financially   will be     due       nursing     On     hand,       the   reimbursement requirements     think       hospitals   with high     they       devasted   due to     care       shown   nurse-patient ratio     the       provided   patients       been       with   staffing ratios     lower       hospital   pneumonia and     (Shin,       2018)   staffing ratios     an       nurses   as high     burnout       will   to a     rate       Bae,     Since     not       with   minimum nursing     would       were   that put     above       Also,   wonder if     took       due   have to     many       make   minimum staffing     S       H   Bae, S     Nurse       outcomes:                          systematic     meta-analysis       273-282                                doi:10       12   to Comment     instructure       as   Collapse SubdiscussionRachelle     24,       11:07pmManage   EntryJesse Thanks     the       staffing   Based on     there       increase   the budget     for       In   we do     mandatory       debate   however many     my       hard   meet the     recommended       specialty   However, many     if       impact   patient outcomes     end       the   are put     to       of   delivered In     as       a   with mandatory     share       what   see as     and       patient     I     to       Nurse  ReplyReply   Comment HYPERLINK     com/courses/32190/discussion_topics/736597?module_item_id=3893634"       Unread"   SubdiscussionKaren SteachKaren     2018Sep       Discussion   Nurse,As a     has       state   mandated ratios     in       with   ratios, I     from       that   always felt     was       much   care when     in           could have     three       ICU   PA but     I       have   maximum of             is   different, is     a       PA,   usually would     patient       being   charge       came       hospitals   I have     have       patient   as well     nurses       without   patient assignment     there       hands   give nurses     I       the   to take     when       PA   when I     nurse       own   assignment covered     patients       their     From my     I       patient   should be     with       However,   literature shows             that   have been     in       they   not as     as       proponents   mandated ratios     Serratt       nurse   improved with     in       have   believed that     are       their   that will     better       These   have me     However,       may   at play     hospitals       with   mandated ratios     Southern       Union   co-sponsored a     February       ensure   hospitals will     the       bill   require inspections     hospitals       not   comply with     will       It   passed the     and       is   the governor's     Nurses       for   but as     imagine,       like   bill because     will       significant   of money     have       staffing   to meet     ratios       reports   some hospitals     game       counting   staff and     the       they   perform direct     If       happening,   could be     why       better   in patient     T       Ratios,   1 8     What       About   Outcome? JOURNAL OF     475–480       oclc   1097/NNA 0b013e3182a23d6fSerratt,     California’s       3   Years Later,     We       Level   OF NURSING     https://doi-org       org/10   NNA 0000434505     to       instructure   \o "Mark     Collapse       27,   27 at     EntryHi       your    It was     hear       someone   has experienced     both       hospital   has mandated     and       not   description of     hospital         I   imagine trying     for       an   with little     a       time   breaks   This     unsafe!  I       article   week that     whether       legislation   aims direct     in       associated   patient outcomes     was       increased   that unregulated     in       lead   patient harm     looked       of   in an     and       that   regulation did     patient       Hohmann   Walkey, 2018)     literature       significant   in patient     opinion       should   mandated staffing     nurses       in   environment like     you       only   the burnout,     that        This   lead to     really       likely   preventable   Leslie Reference:Law,     ,       ,   S ,     A       Outcomes   the Introduction     ICU        Critical   Medicine, 46(10), 1563     https://chamberlainuniversity       ebscohost   aspx?direct=true&db=edb&AN=131737036&site=eds-live&scope=site ReplyReply to     "https://chamberlain       "Mark   Unread" Collapse     GunthnerSep       at   Discussion EntryJesse     enjoyed       working   California and     of       ratios   you mentioned     was       71%   nurses being     a       nurse   rates Nurse     such       in   retention When     the       (ROI)   establishing rations     would       see   quickly the     able       losses   to the     Healthcare       retention   (2016), the average     a       from   to $58,400     incredible       with   experiencing financial     millions       in   we have     the       the   can be     greater       way   thinking should     to       ratios   how lucky     been       both   mandated and     staffing       were   especially the     there's       member   assist as     pair       never   of such     I       in   hospital where     did       carry   patient load     this       move   the unpredictability     patients       manager   getting her     completed       load   limits the     manager       comes   her availability     staff       coaching   attending meetings     Incorporated       staffing   RN retention     from  https://avanthealthcare       an   site Tara  ReplyReply     HYPERLINK       \o   as Unread"     SuarezJesse       27   9:16amManage Discussion     play       in   health care     as       ratios   essential to     safety       patients’   Within our     organization,       leadership   has been     to       staffing   are put     These       the   outcomes in     To       nurses   not experience     and       and   with their     satisfaction       nurse   In addition,     and       quality   to patients     optimal       to   research by     al       ratios   reduce in-patient     associated       and   rates which     in       ReferenceGriffiths,   , Ball,     Drennan,       C   Jones, J     A       M   Nurse staffing     outcomes:       of   evidence to     and       and   paper based     reviewed       Institute   Health and     Safe        International   of nursing     doi:       2016   012  ReplyReply     HYPERLINK       \o   as Unread"     SuarezJesse       29   8:08amManage Discussion     healthcare,       the   spent by     in       mandated   and responsibilities     activities       the   time include     members’       charts,   medication, administering     and       out   a patient’s     &       productive   brings in     the       budgets   to a     However,       every   is spent     labor       referred   non-productive time     considerably       a   expense for     and       budget   time includes     for       education   by the     non-work       internet   any other     does       value   various healthcare     &       J   & Shin,     (2017)       pathways   synaptotagmin 1     Ca2+-triggered       in   neuroscience, 10,     10       to   HYPERLINK "https://chamberlain     \o       Collapse   EustaquioPatria EustaquioSep     29       EntryHi   enjoyed reading     this       you   including what     is       I,   work in     of       the   was first     organization       recruitment   Registered Nurses     in       had   eliminate the     which       assistants   they were     in       I   that there     internal       that   how the     staff       staff   the staffing     patient       a   impact on     charge       assignments   have to     consideration       nursing   according to     dependency       (patient   and nursing     (number       (Driscoll,   Carroll, Dalton,     &       this   we relied     resources       registry   had to     they       skills   to care     patient       often   challenge With     of       patient   it has     that       huge   on patient     well       both   and staff     ,       ,   D ,     ,       Jones,   , &     (2017)       nurse-to-patient   on nurse-sensitive     in       a   review and     Journal       6–22   chamberlainuniversity idm     1177/1474515117721561 ReplyReply       "https://chamberlain   com/courses/32190/discussion_topics/736597?module_item_id=3893634" \o     Unread"       WalkerSep   2018Sep 23     Discussion       regarding   states that     be       unit   the following     nursing       day,   delivery system,     and       majority   the time     base       if   of the     feels       needs   be flexed     the       to   a justification     ICU       at   ratio of     1,       may   higher if     downgrades           telemetry unit     staffed       of   or 6     but       go   to 7             ratio   anywhere from     1       1   surgical unit     to       go   to 7     to           live in     of       at   time it     have       ratios   The New     is       set   nurse staff     there       debate (Calio,     The     State       New   Hospital Association     implementing       ratios   they feel     the       and   cost of     it       practicable (Calio,     My     for       on   average daily     hours       patient     I     24-bed       the   part, my     for       1   but I     watch       carefully   I do     over       we   been staffing     the       real     This     benefit       unit  
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significantly     well-orchestrated   planning This     a       is   process for     in       is   involved? I     to       Nurse ReplyReply   Comment HYPERLINK     com/courses/32190/discussion_topics/736594?module_item_id=3893656"       Unread"   SubdiscussionPatricia WalkerPatricia     2018Oct       Discussion   NurseI agree     that       costly   the operational     implement,       the   will outweigh             Magnet   the quality     they       compared   non-magnet organizations     Schub,       our   will be     the       is   that our     the       care   & Schub,     This       a   plan to     board       approval   the plan     the       organization,   well as             to   how the     will       of   which in     improve       (Mennella   Schub, 2018)     to       being   to the     of       present   research and     the       you   their support             have   get the     on       get   commitment       involve       in   nurse from     who       Magnet   to speak     team       be   willing to     by       outcomes   another colleague     will       commitment   our education     well       consultant   H A     hospitals:       Nursing   Patty  ReplyReply to     "https://chamberlain       "Mark   Unread" Collapse     HallOct       at   Discussion EntrySummary     and       discussed   impact of     that       capital     There were     ideas       the   cost for     will       that   cost has     on         We   discussed break-even     how       break   analysis is     nurse       know   impact a     on       break-even   can allow     make       projection   contemplating capital     (Laskaris         For   if opening     facility       technology   utilize on     the       to   the case     this       for   facility   Being     show       with   and how     will       the   can help     the       new   of technology     great       the   capital expenses     surrounding       practice   have never     a       exercise   it was     learn       calculations   for this     ,       (2013)   New Break-Even     (Healthcare       Retrieved   https://chamberlainuniversity idm     ebscohost       Comment   "https://chamberlain instructure     "Mark       SubdiscussionJesse   SuarezOct 2,     at       and   accordance with     that       model   critical to     retention       the   of patient     addition       benefits,   governance enhances     practice       the   for nurse     autonomy       making   & Ross,     shared       attained   the establishment     relationships       collaboration   the managerial     &       arrangement   better communication     participation,       in   sincere professional     staff       to   to patients     an       a   approach As     is       a   analysis, the     the       ,   Ross, C     journey       the   experience of     and       of   management, 22(6), 761-768     1111/jonm       HYPERLINK   instructure com/courses/32190/discussion_topics/736594?module_item_id=3893656"     as       WalkerPatricia   3, 2018Oct     7:22amManage       you   your response     post       is   governance good     nurses,           need this     in       to   forward in     challenges       are   frontline team     are       patients   Through shared     puts       center   the decision-making             this   is critical     retention,       important     The     replacing       higher   the cost     the       can   an organization     of       a     The     orientation       nurse   the expenses     replacement       overtime (Woten,   ReferencesTaylor, K     shared       nurses   Times, 112(1),     from       articleWoten,   R B     turnover       Guide   from https://chamberlainuniversity idm     ebscohost       an   site Patty   ReplyReply     HYPERLINK       \o   as Unread"     SuarezJesse       4   8:28amManage Discussion     and       action   for business     implementation       and   practices       involves       of   action taking,     reflection       (Hagger   Luszczynska, 2014)     are       all   steps in     their       responsibilities   the business     process       for   planning, identification     stakeholders’       in   implementation of     to       ownership   the evaluating     documentation       availability   robust audit     allows       successful   identification and     barriers       and   business planning     S       A   Implementation intention     planning       contexts:   of the     proposals       forward   Psychology: Health     1-47       12017 ReplyReply   Comment HYPERLINK     com/courses/32190/discussion_topics/736594?module_item_id=3893656"       Unread"   SubdiscussionRachelle NurseRachelle     2018Oct       Discussion   discussion It     to       of   organizations are     into       break-even   lets you     you       monthly   annually, to     costs       It   your break-even     capital       the   of the     can       it   worth the     information       is   to determine     point?Dr       HYPERLINK   instructure com/courses/32190/discussion_topics/736594?module_item_id=3893656"     as       GriebVirginia   6, 2018Oct     5pmManage       information   is necessary     the       the   costs and     costs       two   equal the total     one       have   the break-even     costs       remain   and are     on       or   visits The     include       other   which depend     patient       being   Virginia ReplyReply to     "https://chamberlain       "Mark   Read" Collapse     BoshOct       at   Discussion EntryDr     occurs       and   revenues are     (Leger       In   to calculate     point       know   average revenue     day       as   as the     (Leger       Reference   J M     Dunham-Taylor,       management   nurse managers:     heart       (4th   ) Burlington,     &       Comment   "https://chamberlain instructure     "Mark       SubdiscussionTara   GunthnerOct 7,     at       agree   your PICOT     an       to   researchers, shared     crucial       have   sense of     ownership       (Huntington   Goodyear, 2018)     mentioned,       model   require a     of       costs   include nursing     to       and   the staff     also       assess   costs that     needed       the   when they     in       meeting,   when they     the       meeting   may also     related       and   for development     web-based       teach   rest of     about       model   determine it's     going       tool   measurement Will     a       who   develop the     how       distributed?   will collect     and       This   will require     for       the   There's a     man       be   for the     this       you'll   to determine     with       ReferenceHuntington,   , &     (2018)       shared    Nursing Management     2018,       to   HYPERLINK "https://chamberlain     \o       Collapse   JirglKara JirglSep     30       EntryDiscussion   Week 5Dr     class,Cost-benefit       proposed   includes looking     benefits       versus   cost of     to       project   worth the     the       then   makes sense     the       Dunham-Taylor,   My proposal     final       research   reimbursement rates     patients       cesarean   are affecting     I       the   on how     our       I   like to     to       in   unit that     control       and   of stay     rates       in   recent years     are       than   deliveries and     likely       To   control the     money       sections,   for services     introduced       to   reduce costs     length       even   day can     by       (Liu,   Zhang, &     My       educating   staff on     supplies       decrease   patient’s length     Ways       the   of stay     breastfeeding       are   staying for     weight       ambulation   moms post-cesarean     prevent       specific   to decide     of       include   time and     will       reimbursement   from all     Once       I   have to     how       my   on reimbursement     my       over-supply   and decreasing     stay       this   would need     included       One   the ways     to       of   includes decreasing     room       now,   have a     full       have   overabundance of     supply       to   the rule     keeping       half   worth of     the       need   have a     staff       with   project This     a       hours   complete this     education       length   stay would     on       as   deep vein     hemorrhage,       poor   prematurity, and     be       extended   of stay     would       on   that can     in       vaginal   such as     of       ambulation,   and educating     parentally       This   will be     non-productive       nurse   need to     After       is   and the     has       project   have a     analysis       that   stock and     stay       costs   caring for     We       a   for fee     the       of   and supplies     the       higher   KaraReferencesLeger, J     &        Financial   for nurse     management:       with   ed )     Jones       S   Wang, J     L       X   Caesarean section     cost       case   reform in     cooperative       delivery:   from Xi      BMC       1   chamberlainuniversity idm     1186/s12884-018-1698-0 ReplyReply       "https://chamberlain   com/courses/32190/discussion_topics/736594?module_item_id=3893656" \o     Unread"       WalkerOct   2018Oct 1     Discussion       your   interesting and     the       educated   it comes     and       the   of the     I       of   frontline staff     the       comes   budget and     Reducing       supplies   save the     lot       Improving   of stay     and       patient     Through     good       throughput   length of     improve (Wagner,       would   a sufficient     costs       with   length of             your   it sounds     cost       positive   K (2014)     Memorial       reduced   by                     $480,000  Healthcare     7(2),                                               oclc                                                                       com/login                                                                        direct=true&db=her&AN=96580524&site=eds-live&scope=sitePatty ReplyReply to     "https://chamberlain       "Mark   Unread" Collapse     Nurse Oct       at   Discussion EntryNice     and       a   job discussing     staff       the   process In     frontline       have   knowledge of     However,       need   staffing and     We       through   concepts everyday     recognize       actually   about keeping     on       your   who drives     If       was   be developed     new       unit   are nurses?     discuss       a   benefit analysis?Dr     Comment       com/courses/32190/discussion_topics/736594?module_item_id=3893656"   "Mark as     SubdiscussionKara       2018Oct   at 3:33pmManage     Nurse,In       feel   planning is     leadership       let   know that     to       the   and that     have       equipment   supplies to     manager       kind   where it     the       get   in any     of       do   know how     budget       capital   operating budget     feel       business   was going     developed       it   the manager     involved       think   would be     idea       in   business plans     are       it   I feel     have       interested   want to     but       other   who will     or       have  
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key     and   changes for     mission       the     The     the       daily   and performance     strategies       organization's   and objectives     process       and   needed for     of       2017)   C (2018)     a       a   senior leadership     Leader,       10   mnl 2017     H       management   healthcare       idm       com/login   to an     Thanks,Susan ReplyReply       "https://chamberlain   com/courses/32190/discussion_topics/736588?module_item_id=3893669" \o     Unread"       JirglOct   2018Oct 11     Discussion       involves   objectives It     with       organization's   statement and     planning       and   for the     involves       increasing   volumes, increasing     replacements       involves   staff, patients,     community       2018)   planning is     assessed       we   starting the     renovating       department   involved strategic     regards       we   one? We     estimation       in   future, we     research       are   cost-benefit analysis     We       this   the hospital     management       the   operations of     and       managed   would include     and       we   while taking     of       management   knowledge and     2018)       example   renovating the     the       use   management when     the       it   be great     the       technological   and supplies,     to       financial   of the     department       and   be justified? Will     of       those   and equipment?     occur?       to   off stay     the       new   are being     is       overboard   money that     be       recouped   is where     comes       R   , &     R       planning   Nursing Guide     https://chamberlainuniversity       ebscohost   aspx?direct=true&db=nup&AN=T903228&site=eds-live&scope=siteManev, G     and       healthcare    Research in     Sport       Retrieved   https://chamberlainuniversity idm     ebscohost       Comment   "https://chamberlain instructure     "Mark       SubdiscussionPaige   PatmanOct 12,     at       Nurse,According   Manev, strategic     strategic       thinking   explains that     involves       how   to serve     considering       economic   population changes     goes       that   process involves     environment,       the   and defining     That       to   just what     analysis       and   influences in     develop       He   defines strategic     “monitoring       in   healthcare organization     surroundings”       130)   other words,     continuing       as   actually occur     this,       gather   and compare     the       for   This may     back       planning   as actions     to       process,   done correctly,     in       and   integrated healthcare     2015,       are   reasons this     including       shared   and clearly     improved       and   change bringing     finding       (2015)   and knowledge     healthcare       Physical   Sport and     129-134       chamberlainuniversity   oclc org/eds/pdfviewer/pdfviewer?vid=5&sid=18a8b2cf-9285-49ff-a1f9-aac48f6436d0%40pdc-v-sessmgr02 ReplyReply     HYPERLINK       \o   as Read"     GunthnerTara       13   11:10pmManage Discussion     involves       assure   an organization     This       the   of the     does       Next,   the process     goals       align   the organization's     definition       objectives   allow the     have       understanding   what they     achieve       look   the external     goals,       to   them need     shared       in   organization To     the       a   of measurement     be       is   the constituents     need       strategic   is flexible     need       adapt   necessary changes     to       objectives   this requires     thinking       lead   sound judgments     issues       R   (2018) Toward     complete       management   of Management     Education,       chamberlainuniversity   oclc org/10     0237Links       site   to Comment     instructure       as   Collapse SubdiscussionJennifer     Leighann       14   6:47pmManage Discussion     planning       are   similar yet      The       processes   to produce     actions       organization;   strategic planning     the       strategic   allows the     evolve       (Balanced   Institute, n             a   planner that     from       organization   then develops     plan       on   other hand,     managers       strategy   make decisions     as       strategic   managers are     work       of   strategic plan     d       week   focus was     plans       threaded   posts, we     to       analysis   our individual     and       Our   and lesson     helped       understand   to write     plan       SWOT     In     reviewed       what   business plan     Our       our   to provide     explanation       develop   business plan     week       for   week 7     Scorecard       )   Planning Basics     https://www       (n   ) How     &       &   management  Small     Chron       chron   html ReplyReply to     "https://chamberlain       "Mark   Unread" Collapse     Stacy-BonotOct       at   Discussion EntryDr     Class,Utilizing       to   a plan     meeting       and   is called     Throughout       main   of the     be       both   and external     form       the   and evaluation     performance       Haile,   SWOT is     often       to   such evaluations     an       weaknesses,   and threats     and       internal   the organization     identify       aid   plan in     or       from   the same     threats       to   organization and     things       aid   plan’s success     hinder       Before   this tool     PICO       mentoring   vs no     would       rate   school nurses,     to       when   a SWOT     need       about   my organization’s     weaknesses       to   proposal I     understand       difference   our current     where       if   proposal was     need       use   on my     also       regards   opportunities and     mostly       specific   what I     accomplish       it   and simple,     all       attributes   external conditions     (Marquis,       and   opinions in     analysis       provide   to the     initial       plan   be started     idea       they   be part     SWOT       analyze   project Sold     support       a   picture to     identify       likely   impact a     or       future   168)                                                                   J       &   M (2018)     evaluations       of   - Case     Papers       of   26(43), 135-146     https://chamberlainuniversity       ebscohost   aspx?direct=true&db=a9h&AN=132031645&site=eds-live&scope=siteMarquis, B     Roles       in   9th Edition     Health       to   HYPERLINK "https://chamberlain     \o       Collapse   TaldeJosierose TaldeOct     8       EntryHi   Nurse and     Question:       is   skin prep     betadine       incidence   surgical site     analysis       useful   that assist     executives       company’s   weaknesses, opportunities             that   conducting a     planning,       etc   benefit from     and       analysis   SWOT analysis     answers       are   in the     aspect        or     It     powerful       decision   (Ojala, 2017)     my       to   a better     in       of   the information     evidence-based,       of   skin prep     SSI’s,       it   to pursue     its       and   it is     organization’s           very first     conducting       is   define the     or       Once   objective is     determined,       listed   discovered       data       information   illustrate the     to       what   overcome, opportunities;     explore,       to   for this     to       (Marquis   Huston, 2017)     infection       the   adverse outcomes     preventable       SSIs   affect the     care       morbidity   mortality rate     procedures       of   antiseptic skin     before       reduce   in the     around       Indicating   type of     preparation       infection   contamination of             used   of skin     chlorhexidine       Antiseptic   preparations are     to       of   and the     the       should   based on     evidence       optimal   (Al Maqbali,     the       preoperative   skin preparation     achieve       outcomes   minimize costs     practice       best   practice and     care       2013)   Maqbali, M     Preoperative       and   SSI  British     Nursing, 22,       Marquis,   L ,     C       roles   management functions     theory       )   PA: Wolters     Ojala,       and   swot analyses     59-62       HYPERLINK   instructure com/courses/32190/discussion_topics/736588?module_item_id=3893669"     as       HallLeslie   12, 2018Oct     1:36pmManage       enjoyed   your post     worked       unit   the past     prepped       chlorhexadine   prior to     had       the   on when     be       before   once the     surgery       morning   in order     the         Now   is such     time       to   doing SWOT     improve       are   to lead     time       in   while also     improve       and   metrics (Waxman     2018)       the   analysis if     be       assess   cost associated     chlorhexadine       that   nurse managers     case       more   for one     other?  Also,       interesting   see the     of       and   much the     cost       a   exercise to       Nice       ,   Massarweh, L     Talking       Skills   Nurse Leaders     101–106       oclc   1016/j mnl     008 ReplyReply       "https://chamberlain   com/courses/32190/discussion_topics/736588?module_item_id=3893669" \o     Unread"       GriebOct   2018Oct 8     Discussion       Classmates;When   a business     SWOT       of   standard tools     identify       most   to make     impact       developing   action or     2016)       be   are strengths,     and       in   organization and     my       wanted   explore the     recruitment       the   work environment     unhealthy       and   does this     on       and   in a     stem       the   whereas opportunities     generally       factors (Harrison,   A question     ask       the   strong? I     looking       we   a bed     meaning       have   beds for     needing       to   facility The     in       this   a good     have       where   are downsizing     even       With   being said,     what       weak?   issues continue     a       facility   the climate     nursing       to   experienced, qualified     care       patient   their many     are       challenge   need to     from       seek   in the     which       can   excellent benefit     salaries,       for   surrounding area     needs       threats   competitors are     could       process   example would     significant       hospital   large sign-on     qualified,       example   down on     pool       and   cannot be     the       and   baby-boomers age     the       at   mean age     nurse