A SOAR Analysis of the Medical-Surgical Division at Ridgeline Regional Medical Center: First-Year Nurse Turnover, Contract Labor, and the Case for Growing Our Own
Student Name
School of Nursing and Health Sciences, Capella University
NURS-FPX6200: Management and Leadership for Nurse Executives
Instructor Name
Month Day, Year
The Care Setting and Why a Strengths-Based Frame
Ridgeline Regional Medical Center is a 264-bed nonprofit community hospital serving a metropolitan area of roughly 410,000 people. The care setting analyzed here is its medical-surgical division: 4 East, a 36-bed medical unit; 4 West, a 32-bed surgical unit; and 5 East, a 28-bed progressive care unit. The division carries 96 staffed beds, recorded 29,412 patient days and 11,218 discharges in the 12 months ending June 30, and holds 176 budgeted registered nurse full-time equivalents, of which 150 are filled. It is the largest single cost center in the hospital and the first one the chief nursing officer is asked about in every finance meeting.
The analysis was run as two facilitated 90-minute sessions in April with 22 participants: the chief nursing officer, three nurse managers, six charge nurses, four staff nurses from the unit practice councils, a nursing assistant, the division educator, and business partners from finance, human resources, care management, pharmacy, and patient experience. Each participant received the same data pack one week ahead, containing the human resources separation file, the contract labor ledger, 12 months of patient experience results, the division quality scorecard, and the most recent engagement survey. Systematic appraisal of the practice environment is a standard of nursing administration practice rather than an optional exercise (American Nurses Association [ANA], 2016). Nothing was accepted into a quadrant unless a number or a documented observation stood behind it.
SOAR was chosen deliberately over SWOT. A strengths, opportunities, aspirations, and results frame replaces the weaknesses and threats quadrants with an inquiry into what a group already does well and what it intends to become, on the argument that people execute strategy they helped build from capability rather than from deficit (Stavros & Hinrichs, 2019). That argument had local force here. This division had absorbed two consecutive years of external review, each of which returned a list of deficiencies, and neither of which changed a staffing number. The opportunities quadrant below still holds every difficult finding a SWOT would have produced. It states them as work available rather than as failures already recorded.
Strengths and Opportunities
The division's strengths are not slogans. Each is a measure that has held while the staffing picture deteriorated. Patient experience is the clearest of them: communication with nurses scored 82 percent top-box across 1,146 returned surveys in the 12 months ending June 30, above the 80 percent the division set for itself and above every other inpatient area in the hospital. Clinical quality has held alongside it. Progressive care recorded zero central line-associated bloodstream infections across 4,908 central line days over 18 months, and injurious falls ran at 0.61 per 1,000 patient days, 18 events across 29,412 patient days. A division under this much staffing pressure is not supposed to hold those numbers.
The second strength is the bench the division already owns. Sixty-one of the 150 filled nurse positions, 41 percent, hold specialty certification in medical-surgical or progressive care practice, and 14 nurses have completed the hospital's charge nurse development course in the past two years. Unit practice councils on all three units have met monthly for 26 consecutive months and hold the falls and mobility work themselves. This matters strategically rather than sentimentally. A division with certified nurses, a functioning council structure, and its own charge nurse bench already owns most of the infrastructure a formal nurse residency needs, which is the difference between building a program and buying one.
The opportunities are equally measured, and they concentrate in the first year of employment. Registered nurse turnover for the division was 24.1 percent, 38 separations against an average of 158 filled positions. Inside that figure sits the finding the sessions kept returning to: 22 of the 70 nurses hired during the same window left within 12 months, a first-year turnover rate of 31.4 percent. Exit interviews from those 22 name the same three items in different words, which are an orientation that ended before independent practice began, a preceptor assigned by availability rather than by preparation, and no scheduled manager contact after week six. None of the three is a compensation problem, and burnout rather than pay is what predicts both organizational and position turnover in hospital nurses (Kelly et al., 2021).
The financial consequence sits on one line. The division used 18.2 contract nurse full-time equivalents at an average billed rate of $104 per hour, spending $3.94 million against a budgeted $1.2 million, while 26 of its own 176 budgeted positions stood vacant at 14.8 percent vacancy. The dollars are being spent either way; they are simply being spent at a premium and on nurses who leave at the end of a 13-week contract. National reporting has placed hospital staff nurse turnover near this division's rate for three consecutive years, so the pattern is ordinary rather than local (NSI Nursing Solutions, 2024). A throughput opportunity sits beside it: 22 percent of 11,218 discharges left before noon against a 35 percent target.
Aspirations and Results
Aspirations were recorded as the division stated them and then tested against what the strengths would actually support. The division's aspiration is to become the place in the region where a new nurse is hired into a program rather than onto a schedule, and where an experienced nurse can build a career without leaving the bedside to do it. Three commitments carry that aspiration: every new graduate enters a 12-month residency with a prepared preceptor and protected education time; a clinical ladder gives certified nurses a role and a differential without requiring them to become managers; and the division applies for Pathway to Excellence designation as an external test of whether the work is real rather than as a plaque for the lobby.
An aspiration that does not connect to organizational strategy will not survive its first budget cycle. The Ridgeline board has set two system priorities for the coming two years, workforce stability and margin recovery, and this aspiration serves both out of the same investment. Nurse leader competency in this domain is defined as the ability to state a professional practice aspiration in business terms an executive team can act on, spanning financial management, human resource leadership, and strategic planning (American Organization for Nursing Leadership [AONL], 2023). The residency is therefore taken to the finance committee as a labor substitution plan that happens to be a professional practice model, rather than the reverse, and the contract labor line is the evidence it carries.
Results convert all of it into numbers with dates attached. By June 30 of fiscal year 2027, first-year nurse turnover falls from 31.4 percent to 15 percent or below and total division turnover from 24.1 percent to 16 percent. Vacancy falls from 14.8 percent to 7 percent. Contract nurse full-time equivalents fall from 18.2 to 4 or fewer by the second quarter of that year, with contract spending back inside the $1.2 million budget by the fourth. Specialty certification rises from 61 nurses to 83, which is 55 percent of filled positions. Patient experience rises from 82 percent to 85 percent top-box, with no single quarter below 83.
Two results are guardrails rather than targets, and that is deliberate. Injurious falls stay at or below 0.61 per 1,000 patient days and progressive care holds zero central line-associated bloodstream infections, because a retention plan that quietly costs the division its quality record has failed even if every staffing number improves. Each result carries a named owner: the division director for turnover and vacancy, the finance business partner for contract spending, the education specialist for certification, and the three nurse managers for patient experience. Each is reviewed monthly at the nurse executive council and quarterly at the board quality committee. Workforce pressure of this kind is national (American Hospital Association [AHA], 2024); the owners and dates are what make it accountable here.
References
American Hospital Association. (2024). 2024 environmental scan. American Hospital Association.
American Nurses Association. (2016). Nursing administration: Scope and standards of practice (2nd ed.). American Nurses Association.
American Organization for Nursing Leadership. (2023). AONL nurse leader core competencies. American Organization for Nursing Leadership.
Kelly, L. A., Gee, P. M., & Butler, R. J. (2021). Impact of nurse burnout on organizational and position turnover. Nursing Outlook, 69(1), 96-102.
NSI Nursing Solutions. (2024). 2024 NSI national health care retention and RN staffing report. NSI Nursing Solutions.
Stavros, J. M., & Hinrichs, G. (2019). The thin book of SOAR: Building strengths-based strategy (2nd ed.). Thin Book Publishing.
How this NURS FPX 6200 Assessment 2 example is structured
This NURS FPX 6200 Assessment 2 example is ordered so that each SOAR quadrant arrives with its evidence already on the table. The first body section describes the care setting at the level a nurse executive owns it, beds, budgeted positions, and the data pack the analysis ran on, then says why a strengths-based frame was chosen over SWOT for a division told what is wrong with it for two years. The second section works strengths and opportunities together, because in this division the same night-shift population produces both. The third section records aspirations in the division's own words and then converts them into dated, numbered results with named owners and a review cadence. Ending on results rather than on aspirations is what separates a Distinguished submission in this Capella University Master of Science in Nursing course, Management and Leadership for Nurse Executives, from an inspiring page of intentions.
NURS-FPX6200 Assessment 2 questions, answered
What does NURS FPX 6200 Assessment 2 actually ask you to produce?
A SOAR analysis of a care setting you know: strengths, opportunities, aspirations, and results, each supported by evidence rather than opinion. Most versions ask you to describe the setting, justify why SOAR was used, work all four quadrants, and close with measurable results that could be tracked. The paper above follows that order.
What is the difference between SOAR and SWOT, and does it matter for grading?
It matters. SWOT records weaknesses and threats; SOAR replaces them with aspirations and results, so the analysis ends in commitments rather than in a problem list. Graders look for a stated reason you chose the model. Note that SOAR does not hide bad news; difficult findings move into opportunities, still carrying their numbers.
Do I need real data from my employer to write the SOAR analysis?
No, and using confidential internal data creates problems of its own. Build a composite setting, state its size, volumes, and measures plainly, and keep every number consistent across the four quadrants. What earns credit is that each quadrant carries a denominator and a window and that the results section can be tested against the opportunities section.
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