Budget overruns in the last few years have made it necessary to examine all medical center costs. Part of the cost reductions included reductions in force. All support departments were affected, including nursing. Although these actions were successful in bringing costs more in line, workloads within the medical centers did not change. Processes and procedures were not examined nor changed to accommodate lower support staff numbers. What resulted was a large, and growing, workload for the remaining staff. Staff had to make decisions on a daily basis regarding priorities. Work was left undone that seemed to have no immediate detrimental effect on patient care. Long-term fallout from this neglected work was not considered.

The resolution to this problem includes reviewing present processes and procedures for effectiveness and necessity and eliminating unnecessary work processes or modifiying work processes that are essential. Automation where possible would also be helpful, however this would require a commitment of hard-to-find financial resources.. A second look at the support staff personnel may also reveal that added staff is necessary and that cost containment will need to look elsewhere for reductions.