NUR 7120 Module 5 Material Resources Paper: Supply Costs, a PPE Shortage and a Value Analysis Plan Example

When the Shelves Ran Empty: Nurses and the Management of Material Resources

Student Name

M.S. in Nursing, Nursing Administration, Thomas Edison State University

NUR-7120: Nursing Administration: Resource Acquisition and Management

Mentor Name

Month Day, Year

When the Shelves Ran Empty: Nurses and the Management of Material Resources

The Problem

In the spring of 2020, our hospital limited each nurse to one N95 respirator per shift, then per several shifts, stored in paper bags between uses. Gowns ran short for two weeks, and a shipment of masks bought from a new supplier failed fit testing. Staff were frightened and angry, and many felt decisions were made without them. Three years later, our supply budget has risen sharply, and nurses still have no regular voice in which products the hospital buys.

Supplies as a Major Expense

Abdulsalam and Schneller (2017) argue that supply expenses are among the largest costs hospitals face, second only to labor in many organizations, yet they receive far less attention from researchers and leaders. Supply decisions involve clinicians' preferences, purchasing contracts, group purchasing organizations and distributors, and they affect quality and safety as well as cost. The authors call for more research and for treating supply management as a strategic function that involves clinicians, not only a purchasing task.

A National Shortage

Ranney et al. (2020) described the shortages of ventilators and personal protective equipment facing US hospitals early in the COVID-19 pandemic. Demand surged worldwide just as manufacturing, concentrated in a few countries, was disrupted, and the national stockpile held only a small fraction of what a severe pandemic required. The authors called for federal coordination of production and distribution, use of emergency production powers and clear guidance on conserving supplies, such as extended use and reuse of respirators, while warning that such measures put health workers at risk if used too long.

Buying in a Crisis

Livingston et al. (2020) described what happened when they tried to help health systems obtain protective equipment during the shortage. They encountered brokers with no products, counterfeit respirators, demands for large payments in advance and prices many times higher than normal. They advised buyers to work with established suppliers when possible, to verify products and certifications before payment and to test equipment on arrival, lessons that matched our hospital's failed mask shipment.

What Went Wrong Locally

In a debrief with the supply chain director, we identified four gaps. The hospital held about two weeks of respirators, based on normal use. Conservation rules changed weekly and reached staff unevenly. No nurse sat on the committee deciding which products to buy or substitute. And emergency purchases from unfamiliar vendors were not tested before distribution.

The Proposal

I proposed four changes. First, a standing seat for a staff nurse and a nurse manager on the hospital's value analysis committee, which reviews new products and substitutions, so that nurses weigh in on usability, safety and fit as well as price. Second, a rotating reserve of respirators, gowns and gloves sized to 90 days of surge use, with stock rotated into daily use before expiration to avoid waste. Third, a written conservation protocol, agreed with infection prevention in advance, with clear triggers for each step and a single communication channel to staff. Fourth, a vendor verification checklist for emergency purchases, including certification checks and fit testing of samples before distribution.

Cost and Value

A 90-day reserve requires space and an upfront purchase of about $410,000 for our hospital, partly offset by rotating stock into regular use. The value lies in avoiding emergency prices many times higher than normal, protecting staff and maintaining care during a surge. Nurse input on product selection may also reduce waste from products that staff avoid using.

Engaging Staff

Staff nurses on the value analysis committee will report back at unit meetings, and the conservation protocol will be practiced in a drill each year, so that staff know what to expect before the next shortage.

Everyday Waste

Shortages are rare, but waste happens every day. Nurses on our unit described supplies opened and discarded when isolation rooms were cleaned, duplicate kits stocked in every room and items ordered by habit that no one used. A two-week audit with the supply chain team found about $3,200 a month in unused supplies discarded from isolation rooms alone. Adjusting par levels and stocking isolation rooms with smaller packs will reduce that loss and help pay for the reserve.

Fair Distribution

During the shortage, some units received respirators before others with similar exposure. The conservation protocol now sets distribution by exposure risk rather than by which manager asked first, with the infection prevention team making the final call.

Sustainability

The value analysis committee will also consider reusable gowns and other durable products where infection prevention agrees they are safe, since reusable stock is less exposed to global shortages and reduces waste. A trial of reusable isolation gowns on two units will compare cost, laundering capacity and staff acceptance over three months.

Communication During a Shortage

The debrief showed that conflicting messages hurt trust as much as the shortage itself. During any future shortage, one daily update from the incident command team, posted on each unit and sent by text, will state current supply levels and the conservation step in effect.

Measuring Results

We will track days of reserve on hand, product substitutions reviewed with nurse input, staff confidence in supply decisions measured by survey and emergency purchase prices compared with contract prices.

Limits

The pandemic shortage was extreme and may not represent future events. Reserves require storage and management costs. The hospital and figures are invented.

Conclusion

Abdulsalam and Schneller showed that supplies are a major expense that deserves clinical input, Ranney and colleagues described the national shortages that left hospitals rationing protective equipment and Livingston and colleagues showed the dangers of buying in a panic. A nurse seat on the value analysis committee, a rotating reserve, an agreed conservation protocol and vendor verification prepare the hospital to protect its staff next time.

References

Abdulsalam, Y., & Schneller, E. (2017). Hospital supply expenses: An important ingredient in health services research. Medical Care Research and Review, 76(2), 240-252. https://doi.org/10.1177/1077558717719928

Livingston, E., Desai, A., & Berkwits, M. (2020). Sourcing personal protective equipment during the COVID-19 pandemic. JAMA, 323(19), 1912-1914. https://doi.org/10.1001/jama.2020.5317

Ranney, M. L., Griffeth, V., & Jha, A. K. (2020). Critical supply shortages: The need for ventilators and personal protective equipment during the Covid-19 pandemic. New England Journal of Medicine, 382(18), Article e41. https://doi.org/10.1056/NEJMp2006141