Thank you for your comments. This is never easy and believe it or not it is sometimes more difficult for those staff that are left behind in the work place. They feel guilty, sad, and anxious. Guilty that they still have the job, sad at the loss of a colleague and anxious about how the work will be reassigned and if there are more cuts to come etc.

However, one of the key stategies we have used is to make sure the decison to lay off is the last resort and all other options have been tapped. If layoff is needed to reduce labor costs or align resources then it needs to be done in a coordinated manner. Our HR department takes the lead on this and is very skilled at it. It is important that the inidividual affected is one of the first people to be communicated with and then asking them how they would ike it to be communicated to the rest of the work group has been helpful. It is also helpful to have all the options available for them when the information is communicated like, any assitance provided in finding a new job, any potential vacancies within the organization that they could be retrained to do, severance information to include health insurance bridge(COBRA) etc.

We also try to be very proactive in not replacing vacant positions if we know there is a potential that a work force reduction may occur in certain areas. This allows us to offer options to individuals displaced moving the resources where we need them in the organization.

Our hospital has engaged a productivity benchmarking firm to assist in developing appropriate ranges based on department activity. We are very transparent about our productivity measurements with specific area productivity posted for all employees of that area to see. Our senior team has weaved the concept that our patients are asking us to provide health care in a more affordable fashion. Stewardship of resources including human resources is important in that endeavor. We have been blessed that we have not had to use significant staff reductions but have implemented a strong position management process that has allowed us to reach our targets. I believe our workforce has accepted the "new normal" in terms of staffing patterns. This has required good process improvement strategies to help our units retool or rethink how they provide care. This is where you can really engage the front line employee to help develop how the work gets done with the resources now available to them.

As noted by Ms. Bradley, we too try to avoid lay offs and are generally a last resort. I have been involved in two layoff, one as a taff nurse and one as a nursing manager. What the organization loses in talented staff who leave in fear, mistrust of staff, and orientation curve for replacement makes it the least favorable option. Some of the intrinsics are difficult to quantify in dollars but from a human resource perspective the morale and cooperation of the staff remain changed as evidenced by increased complaints, grievances and union involvement. Currently open postions are not filled, employees are shifted around to other departments and cross training of staff is our approach.