NURS 625 Week 8 Reflection: Strategic Planning in Action Example

Reflection on Strategic Planning in Action: Watching a Nursing Division Turn a Discharge Problem Into a Plan

Introduction

My practicum this term has been with the director of medical-surgical nursing at a 160-bed independent hospital in a small Southern city. In the fourth week, she invited me to the nursing division's mid-year planning session, where the managers of five inpatient units met with the chief nursing officer, the director of case management and two staff nurses from the shared governance council to decide what the division would focus on for the next eighteen months. I expected a discussion of staffing. Instead, most of the afternoon was spent on a problem that seemed small at first: patients who were ready to leave were not leaving until late afternoon. This paper reflects on how that session turned a frustration into a strategic objective, what I learned from watching it, and how the experience compares with the strategic plan my group completed in this course.

The Planning Activity I Observed

The session began with data. The director had prepared a one-page summary showing that only 14% of medical-surgical discharges left before noon, that the median discharge time was 3:40 p.m., and that on most weekdays the emergency department held four to six admitted patients waiting for beds between noon and 5 p.m. The chief nursing officer asked each manager to describe what happened on their unit on the morning of a typical discharge. Their accounts differed. One blamed late physician rounds, another pharmacy delays for discharge prescriptions, and another transportation. The case management director pointed out that many discharge orders were written early but not acted on.

The turning point came when one of the staff nurses described her own mornings. Discharge teaching, medication reconciliation and arranging rides all fell to the bedside nurse, she said, during the same hours as morning medications and new admissions, so discharge work waited until after lunch. The room went quiet, and the conversation changed from whose department was slow to how the work was designed. By the end of the afternoon, the group had written a draft objective: increase discharges before noon from 14% to 35% within twelve months, with a discharge nurse role piloted on two units, next-day discharge planning at afternoon huddles and a bedside prescription delivery program with pharmacy.

What I Learned

Planning Begins With a Shared Definition of the Problem

Harris (2018) places assessment of the internal environment before goals and strategies, and I had read that as a step of collecting data. The session showed me that assessment is also a social process. The data told everyone that discharges were late; it did not tell them why, and each manager arrived with a different explanation rooted in a different department. Until the group agreed on what the problem was, any objective would have been a compromise between five theories. The director's choice to ask for descriptions of real mornings, rather than opinions about causes, was what made agreement possible. I will use that approach in my own planning: ask people what happens before asking them why.

Frontline Nurses Change the Plan

The staff nurse's account reframed the entire discussion, and I am not sure the managers would have reached it alone. Research suggests that how nurses experience their organization's planning matters to them as well as to the plan. Saleh et al. (2026) surveyed 379 nurses at a university hospital in Egypt and found that their perception of strategic planning was positively associated with both resilience and coping strategies and partly mediated the relationship between the two. The study was cross-sectional and set in a very different health system, so it cannot show that involving nurses in planning builds their coping. Still, it suggests that nurses who understand and trust their organization's plans may handle stress better, which gives leaders a reason to involve them beyond the quality of their ideas. The most useful person in the planning session was the one with the least authority in the room.

Workforce Questions Belong Inside Operational Plans

The draft objective was operational, but its central strategy, a discharge nurse role, was a workforce decision. Someone would need to fund the position, write the role, recruit for it and decide which units received it first. I noticed that no one from human resources was present, and the chief nursing officer said she would "take it to HR later." Apenteng et al. (2026) analyzed American Hospital Association survey and Medicare cost report data from 2,749 US hospitals and found that system affiliation and larger size were associated with building more workforce planning and development activities into strategic planning, while critical access hospitals, for-profit ownership and location in the South were associated with less. My practicum hospital is independent, mid-sized and Southern, which fits the pattern of hospitals that tend to plan operations and workforce separately. In hindsight, I would have suggested inviting human resources to the second session so that the role could be planned alongside the objective rather than after it.

Comparing the Practicum With Our Group Project

Our group strategic plan aimed to keep registered nurses aged 55 and older in a composite health system. Writing it, we followed Harris's sequence closely: assessment, SWOT, goal, objectives, strategies, budget, timeline and evaluation. The plan was orderly, but looking back, it was written entirely by four MSN students working from data and literature. We never heard directly from a late-career nurse. The practicum session showed me what we missed. If our plan were real, I would want two or three nurses in their sixties to read the objectives before anyone presented them, because they would almost certainly find a flaw in the shift options or the legacy roles that the literature could not show us.

The practicum also showed me how much of strategic planning happens after the session ends. Two weeks later, the director told me the discharge objective had been accepted by the executive team but the discharge nurse position had been delayed to the next budget cycle. The objective survived; one of its strategies did not, at least for now. Our group plan assumed approval of a full budget at once, and I now think a stronger plan would have ranked its strategies so that leaders could fund them in stages.

Implications for My Future Practice

I hope to move into a nurse manager role within two years, and this experience has given me three commitments. I will begin any planning effort by asking people to describe the work as it happens. I will invite at least one frontline nurse into every planning conversation that affects their work, and I will make sure the workforce implications of an operational plan are discussed with human resources from the start. Proverbs teaches that plans fail for lack of counsel but succeed with many advisers (English Standard Version Bible, 2001/2016, Proverbs 15:22), and the session I observed proved it: the counsel that saved the plan came from the person least likely to be asked.

References

Apenteng, B. A., Opoku, S. T., Anokye-Mensah, S., Puobebe, C., Boakye, K. G., Kimsey, L., Peden, A. H., & Owens, C. F. (2026). Rural-urban differences in the incorporation of workforce planning and development in the strategic planning process of US hospitals. The Journal of Rural Health, 42(2), Article e70168. https://doi.org/10.1111/jrh.70168

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Harris, J. M. (2018). Healthcare strategic planning (4th ed.). Health Administration Press.

Saleh, W. A., El-Sayed, M. M., Elshazly, E. M. A., Othman, A. A., Mohamed El-Sayed, B. K., Alqarawi, N., & AbdElaal Mohamed Ali, A. (2026). Strategic planning perception as a mediator between psychological resilience and coping strategies among nursing staff: Implications for workforce resilience. Journal of Nursing Management, 2026(1), Article e5563937. https://doi.org/10.1155/jonm/5563937