D580 Task 2 Capstone Executive Summary Example

Memorandum

To: Senior Leadership Team, Tri-County Health

From: Capstone Project Lead, Office of the Chief Nursing Officer

Date: September 29, 2026

Re: Executive summary: system-wide internal float pool

Recommendation

Approve a pool of 80 staff nurses who belong to no single unit, hired by the system and scheduled from one office for all three hospitals, with the goal of reducing contract nursing hours on our general medical, telemetry and step-down floors by 60% within 24 months. The illustrative first-year investment is $2.9 million, the expected gross annual saving at full operation is about $7.8 million and the project reaches payback within its first 18 months.

What Approval Commits Us To

Approval today releases the first-year budget, authorizes human resources to post the float pool positions within 30 days and gives the central staffing office authority to assign pool nurses across all three hospitals. It also commits nursing leadership to two rules: contract nurses are booked only after the pool and voluntary overtime are exhausted, and any new contract agreement longer than 13 weeks requires sign-off from the chief nursing officer. Without those rules, contract labor would keep filling gaps by habit and the pool would add cost instead of replacing it.

The Problem

Contract nursing cost the system $41.6 million last fiscal year, more than four times the level of five years ago, and is the largest single reason our operating margin fell to 0.4%. We still use about 96 travel nurses on an average day. Each contract hour costs us about $50 more than an hour worked by an employed nurse, and the constant churn of short-term staff unsettles unit routines and frustrates our own nurses, whose turnover reached 19% last year. The causes are 142 vacancies, census swings of up to 20% a week and the absence of any internal pool: each hospital covers gaps alone, so one site hires contract nurses while another sends staff home.

The Solution

The internal float pool would be staffed by experienced nurses who are cross-trained on two unit types, paid a 15% premium for flexibility and allowed to choose shifts four weeks ahead. A central staffing office would place pool nurses where census forecasts show the greatest need each week, across all three hospitals. Contract nurses would be booked only after the pool and voluntary overtime are exhausted. The pool also serves recruitment and retention, since a flexible, well-paid float role appeals to experienced nurses who might otherwise leave for travel work.

Why It Will Work

Three findings support the design. When one academic center priced its supplemental staffing, a little of it saved money while a lot of it did not (Xue et al., 2015), and we are now firmly in the second group. Agency staffing did not raise death rates in a national hospital study (Aiken et al., 2013), so the gains here come from lower cost and better continuity rather than from correcting a safety failure. And a recent study found that dedicated float pool nurses went with fewer pressure injuries and central line infections (Stephens et al., 2026), a sign that a trained pool can support quality rather than dilute it. Peer health systems of our size have adopted internal pools for the same reasons.

Financial Summary

The figures below are illustrative estimates from the capstone proposal. They assume the pool reaches 80 nurses by month 12 and replaces 60% of in-scope contract hours by month 24.

Stakeholders

Our chief nursing officer sponsors the project, with the finance chief jointly answerable for the savings. Nurse managers gain reliable coverage in exchange for some control over staffing, and a manager advisory group will shape floating rules. Staff nurses gain colleagues who stay and a new career option. The shared governance council will approve competency and floating policies, and human resources will lead recruitment and pay design.

Risks

Recruiting 80 experienced nurses is the main risk; we will recruit first from our own staff and from nurses who left for travel work, and we can operate with a smaller pool while hiring continues. Manager resistance will be addressed through the advisory group and monthly reports showing each unit's coverage. Nurses' concern about working at unfamiliar sites will be reduced by grouping assignments by week and reimbursing mileage. If quality measures worsen on in-scope units, the staffing office will pause cross-site assignments for affected nurses while competencies are reviewed.

Expected Outcomes

Leaders should expect to see four results: contract nursing hours on in-scope units down 60% by month 24; contract spending below $22 million by the end of the second fiscal year; float pool turnover below 15%; and no increase in pressure injuries or falls with injury on in-scope units. The implementation plan that follows sets out the recruitment, training, scheduling, communication and evaluation steps, and progress will be reported to this team monthly.

References

Aiken, L. H., Shang, J., Xue, Y., & Sloane, D. M. (2013). Hospital use of agency-employed supplemental nurses and patient mortality and failure to rescue. Health Services Research, 48(3), 931-948. https://doi.org/10.1111/1475-6773.12018

Stephens, C. P., Norton, J., Walker, D., & Verklan, M. T. (2026). Float nurses' association with nurse-sensitive indicators: A cross-sectional study. Journal of Nursing Care Quality, 41(4), 336-342. https://doi.org/10.1097/NCQ.0000000000000948

Xue, Y., Chappel, A. R., Freund, D. A., Aiken, L. H., & Noyes, K. (2015). Cost outcomes of supplemental nurse staffing in a large medical center. Journal of Nursing Care Quality, 30(2), 130-137. https://doi.org/10.1097/NCQ.0000000000000100