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Nursing Workforce Planning: a System Not a Process

Following is a guest blog from our board member Tim Porter-O'Grady. I particularly like his discussion regarding the importance of evaluating the supply chain of nurses in one's local geography, and deploying strategies to develop and augment the supply by investing in available employees. Effective workforce planning requires both micro- and macroeconomic approaches as Tim aptly discusses below. We'd love to hear your comments!

Workforce planning and management requires more than simply responding to current issues and levels of concern related to how many resources and what kind are necessary for rendering good patient care. In fact, workforce planning activities should be a major construct of ongoing nursing leadership responsibilities in both the short and long term. While this is not a revolutionary notion, many of the mechanisms used to plan workforce strategy are often missing from the conceptual and content foundations of the role and practices of nurse leaders.

Of course, workforce planning should be systematic. Included in its activities should be the following discrete yet integrated activities related to effective workforce utility:
• patient population and care characteristics
• population demands and clinical needs
• clinical demands and intensity measures
• skill level demands and staff competency needs
• nursing age distribution and clinical competency levels
• nursing education and developmental opportunities for and responding to care demands and related competency
• performance expectations, quality measures, and evidence of clinical value
• support service availability, clinical technology and tools, resource allocation, and financial factors affecting budgeting

These major arenas of workforce planning require that nurse leaders have a systematic approach to fully managing the resource capacity of the organization in relationship to matching patient needs with appropriate levels of clinical service response. Of course, response to these various arenas of workload and service planning should reflect understanding of the state-of-the-art, available research, and full comprehension and management of the resource configurations available to support workload planning within a particular organizational milieu. Effectiveness in any one of these areas does not assure well managed resource planning activities unless the integration with all of the elements associated with effective use of knowledge workers is equitably addressed.

Often, recognized standards and data which reflect them are not consistently used as a basis for establishing a rationale for good workforce planning activities. Contemporary understanding with regard to educational levels and clinical experience suggest that there is a direct relationship between the two that influences competence, capacity, and clinical outcomes. However, the continuing production of the most limited prepared practitioner in huge numbers has done nothing to improve or accelerate value, clinical outcome, quality measures, or patient safety. One might even suggest that low levels or challenges in each of these areas can be directly related to the percentage of nurses prepared at the most foundational levels of nursing education. This is not to suggest that such nursing education is not appropriate for access or entrée into the profession. It does suggest however that if that remains the foundational level of education of the practitioner, there is a direct limitation of impact on advancing clinical outcomes, service quality, value, and patient safety.

A good workforce planning model should include the recognition of these realities and incorporation of them in the selection of strategies related to particular workforce planning activities. For example, if a hospital or health service is in an area where limited access to baccalaureate and above nursing preparation is unavailable, much more attention needs to be paid to continuing education and development as well as competency and outcome assessments driven from the employing institution to compensate for what isn't available in the educational arena. This differentiates from the academic medical center which may have ready access to higher levels of BSN education and continuing education than does the more isolated or rural counterpart not having access to such resources. Both are influenced by their prevailing reality and their workforce planning priorities should reflect this differentiation.

Every nurse manager and executive should have a specific model that addresses each of the above workforce planning elements in her or his own institution. Seeing workforce planning as a system rather than a response ensures that each of the elements affecting nurse utilization, competence, and clinical impact are carefully considered, linked and integrated in a way which presents a whole-systems picture of continuing workforce force needs as they influence and inform management priorities and clinical values and measures. In fact, the ability to demonstrate both challenge and value with regard to workforce resources and positive patient outcomes can't be sustained without this more systematic and effective approach.

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