| Course | NUR-7020 Nursing Administration Executive Managerial Process |
|---|---|
| Module | Module 2 |
| Paper type | Administration paper: staffing, outcomes and turnover |
| Length | About 1,026 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Nursing Administration |
| Updated | October 2026 |
Free sample paper for NUR 7020 Module 2
One Shift in Four Below Target: A Staffing and Retention Case for a Linden Surgical Unit
Student Name
M.S. in Nursing, Nursing Administration, Thomas Edison State University
NUR-7020: Nursing Administration: Executive Managerial Process
Mentor Name
Month Day, Year
One Shift in Four Below Target: A Staffing and Retention Case for a Linden Surgical Unit
The Unit's Pattern
The hospital and the unit in this paper are invented. The surgical unit at a community hospital in Linden has 32 beds and cares mainly for patients after colorectal, vascular and general surgery. Its staffing plan calls for six registered nurses on day shift and five at night, with patient care technicians on both. Over the past twelve months, 24 percent of shifts ran at least eight hours of registered nurse time below that plan, usually because a nurse called out, a position was vacant or the unit absorbed a late admission without help. Eleven registered nurses left the unit during the year, a turnover rate of 22 percent, and the positions took an average of four months to fill.
The director of nursing asked the manager, an experienced nurse completing her MSN in nursing administration, to explain the pattern and propose a solution the finance committee would fund. The hospital's first instinct was to cover gaps with overtime, which was already high, and to ask nurses to take more patients when short.
Staffing and Mortality
Needleman et al. (2011) studied 197,961 admissions and 176,696 nurse shifts at an academic medical center. Unlike many earlier staffing studies, which compared hospitals with different average staffing, this study tracked each patient's exposure to individual shifts that ran below target. A patient's hazard of death rose about 2 percent for every shift that ran eight or more registered nurse hours short of plan, and about 4 percent for every shift crowded with admissions, discharges and transfers. Risk accumulated, so someone who lived through several short or chaotic shifts was in more danger than someone who met none.
That design matters for this unit. The study did not compare good hospitals with bad ones. It showed that within a hospital with generally good staffing, the shifts that fell short carried risk. The Linden unit's patients were exposed to below-target shifts on about one day in four.
The Wider Evidence
Kane et al. (2007) pooled observational studies of registered nurse staffing and patient outcomes. More registered nurse staffing was associated with lower hospital mortality, as well as fewer cases of failure to rescue, hospital-acquired pneumonia and other complications. An additional registered nurse full-time equivalent per patient day was associated with lower odds of death in intensive care, surgical and medical patients, with the largest reduction among surgical patients. The authors cautioned that the studies were observational and that the associations might not be causal, but the consistency across many studies strengthens them.
| Evidence | Finding | Meaning for the unit |
|---|---|---|
| Needleman et al. (2011) | Each shift 8+ RN hours short raised mortality hazard about 2 percent | Short shifts are a patient risk, not only a staff burden |
| Kane et al. (2007) | More RN staffing linked with lower mortality, largest for surgical patients | The unit's patient group is the one most affected |
| Jones (2008) | Every RN who leaves costs the hospital a large sum | Turnover is a budget problem as well as a staffing one |
The Cost of Turnover
Jones (2008) updated her earlier estimate of what it costs a hospital when a registered nurse leaves, counting vacancy costs such as overtime and agency coverage, hiring, orientation and training, the lower productivity of new nurses and the loss of productivity before a nurse departs. Adjusted for inflation, the cost of each registered nurse turnover was estimated at roughly $82,000 to $88,000. The largest components were vacancy coverage and the time new nurses take to reach full productivity.
Using the lower figure, eleven departures cost the hospital about $900,000 last year. The manager notes that local figures may differ from a national estimate and that the hospital's finance office should calculate its own number, but the scale is useful for the committee.
Why Short Shifts and Turnover Feed Each Other
On this unit, the two problems are linked. Nurses leave in part because short shifts make the work unsafe and exhausting. Each departure creates a vacancy that is covered by overtime or left short, which produces more short shifts. Breaking the cycle requires both reliable coverage and reasons for nurses to stay.
The Proposal
The manager proposes three changes. First, a shared float pool of six registered nurses for the hospital's three surgical units, cross-trained and scheduled to cover call-outs and vacancies before overtime is offered. Second, a retention plan for the unit: self-scheduling within rules set by the unit council, a protected preceptor program for new graduates, mentoring for nurses in their first two years and a stay interview with every nurse each year to learn what would keep them. Third, an admission and discharge coordinator role on day shift, filled by a registered nurse, to spread patient turnover and support nurses during heavy transfer periods, since Needleman's study found high-turnover shifts carried their own risk.
The cost of the float pool and the coordinator role is estimated at about $820,000 a year for the three units. If turnover on the three units falls by a third and overtime falls by a quarter, the savings would approach that figure, before counting any benefit to patients.
Measures
The unit will report each month the share of shifts at least eight hours below target, high-turnover shifts, overtime and agency hours, registered nurse turnover and vacancy days. It will also track failure to rescue, falls with injury and patient experience scores each quarter.
Limits
The mortality studies were observational, and the academic center in Needleman's study may differ from a community hospital. A float pool depends on cross-trained nurses who are willing to move between units. Turnover cost estimates are national and dated, and the hospital's own costs may be higher or lower.
Conclusion
A quarter of the unit's shifts ran short, and evidence ties such shifts to higher patient mortality. More staffing is linked with better surgical outcomes in particular, and each nurse who leaves costs the hospital a large sum. A float pool, a coordinator and a retention plan address both sides of a cycle in which short shifts drive turnover and turnover drives short shifts.
References
Jones, C. B. (2008). Revisiting nurse turnover costs: Adjusting for inflation. JONA: The Journal of Nursing Administration, 38(1), 11-18. https://doi.org/10.1097/01.NNA.0000295636.03216.6f
Kane, R. L., Shamliyan, T. A., Mueller, C., Duval, S., & Wilt, T. J. (2007). The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. Medical Care, 45(12), 1195-1204. https://doi.org/10.1097/MLR.0b013e3181468ca3
Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C. L., Stevens, S. R., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. New England Journal of Medicine, 364(11), 1037-1045. https://doi.org/10.1056/NEJMsa1001025
Reading the NUR 7020 Module 2 assignment instructions
Staffing is one of the core managerial processes behind quality nursing outcomes in TESU's catalog description of NUR-7020, and because the course syllabus is held for enrolled students, the second module is planned as a staffing and turnover paper for one unit. Expect to write an administration paper that describes the unit's staffing pattern with its own data, reviews research linking staffing to patient outcomes with attention to study design, estimates the financial cost of turnover from published and local figures, explains how staffing and retention affect each other and proposes changes with costs, expected savings and measures. Some sections ask for a full staffing grid with hours per patient day or a productivity analysis instead. Confirm whether the brief wants a budget table, a specific staffing model such as acuity-based staffing, or a presentation to a finance committee, and gather your unit's numbers before you start writing.
How the NUR 7020 Module 2 example is put together
An invented 32-bed surgical unit in Linden, with a quarter of shifts below target and 22 percent turnover, opens the paper. A study tracking patients' exposure to short shifts shows a mortality risk for each one. A meta-analysis adds that surgical patients benefit most from more nurse staffing, and a three-row table ties each study to the unit. Inflation-adjusted turnover costs put the year's departures near $900,000. The cycle linking short shifts and turnover is explained before the three-part proposal, its cost and its expected savings. Monthly measures, the limits and a closing paragraph come last. Annotations explain matching evidence to the setting and addressing both halves of the cycle rather than one.
NUR 7020 Module 2 rubric: what earns full marks
Staffing papers are graded on how well the unit's pattern is shown with its own data, on accurate reporting of outcome studies and their designs, a turnover cost estimate with its assumptions, an explanation of how staffing and retention interact and a proposal with costs, expected savings and measures. Mentors credit papers that use within-hospital evidence, such as shift-level exposure, rather than only comparisons between hospitals. Distinguishing association from cause shows careful reading. A proposal that a finance committee could evaluate, with numbers it can check, shows administrative skill. Studies should be cited exactly as published, and national cost figures should be labeled as estimates that the hospital's own finance office will need to confirm.
NUR 7020 Module 2 help: mistakes that cost marks
Staffing papers often argue from workload and nurse frustration alone; bring in outcome evidence and the cost of turnover so that leaders see patient and financial stakes. Another frequent problem is proposing more staff without a cost estimate. Show how the plan affects both short shifts and departures. Use the lower end of published cost ranges to keep the case conservative. Pick measures that the unit already collects or can collect easily, and report them monthly. Ask your finance office for local turnover costs if you can. Use the Linden case as a template if it helps; a first draft built on your own unit's figures is free.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More NUR 7020 and M.S. in Nursing, Nursing Administration sample papers
- NUR 7020 Module 1: Manager Competency Paper: Structural Empowerment, the AONL Domains and a New Manager's Development Plan
- NUR 7020 Module 3: Handoff Communication Paper: SBAR, Mnemonic Evidence and a Bedside Report Redesign
- NUR 7020 Module 4: Quality Indicator Paper: NDNQI Falls Data and the Fall TIPS Trial
- NUR 7020 Module 5: Health Care Environment Paper: Workplace Violence and an Emergency Department Prevention Program
- NUR 7020 Module 6: Professionalism Paper: Just Culture After a Barcode Workaround and a Medication Error
- NUR 7120 Module 3: Technology Resources Paper: Bar-Code Medication Administration, Workarounds and Adoption
NUR 7020 Module 2 questions, answered
Where can I find a free NUR 7020 Module 2 sample paper?
The staffing and turnover paper for an invented 32-bed surgical unit in Linden, from its short shifts to the float pool proposal, can be read on this page.
Do understaffed shifts increase patient mortality?
Yes. Needleman's team found that every shift running eight or more RN hours short added about 2 percent to a patient's hazard of death.
Does more RN staffing lower mortality?
Kane's meta-analysis tied higher RN staffing to fewer hospital deaths, and surgical patients showed the biggest drop.
How much does registered nurse turnover cost?
Each departing registered nurse cost a hospital roughly $82,000 to $88,000 in Jones's inflation-adjusted estimate, counting vacancy coverage, hiring, orientation and lost productivity.
How can a unit break the cycle of short staffing and turnover?
Cover gaps reliably, for example with a float pool, and give nurses reasons to stay, such as self-scheduling, preceptor support and stay interviews.