In the wake of the 2012 US presidential election, hospitals are taking action to mitigate the anticipated financial impact of the 2010 Affordable Care Act. “Over the next 10 years, the federal government will cut reimbursements to hospitals by over $150 billion.” 1 Gralia J Moody's sees affordable care act pressuring hospitals. Reuters Business & Financial News. http://www.reuters.com/article/2012/06/28/us-usa-healthcare-moodys-idUSBRE85R1KD20120628Date: June 28, 2012 Google Scholar According to Moody's Investor Service, the newly expanded Medicaid program for the care of formerly uninsured patients will not balance the scale. 1 Gralia J Moody's sees affordable care act pressuring hospitals. Reuters Business & Financial News. http://www.reuters.com/article/2012/06/28/us-usa-healthcare-moodys-idUSBRE85R1KD20120628Date: June 28, 2012 Google Scholar Financial leaders are merging their expertise with clinical nurse leaders to design new infrastructures for nurse staffing to meet increasingly complex needs of patients via a fiscally sustainable model. Embedded in this activity is a call to action for a new worldview underlying the theories and methodologies of nurse staffing. Stability in nurse staffing supports a practice environment that enables registered nurses (RNs) to maintain a sense of autonomy, to perform productively, and to think more critically. 2 Duffield C Diers D O'Brien-Pallas L et al. Nurse staffing, nursing workload, the work environment and patient outcomes. Appl Nurs Res. 2011; 24: 244-255 Abstract Full Text Full Text PDF PubMed Scopus (302) Google Scholar , 3 Tuttas C Robbing Peter to pay Paul: breaking the RN “recruitment cycle.”. J Nurs Care Qual. 2002; 16: 39-45 Crossref PubMed Scopus (3) Google Scholar Old staffing strategies (“the way we have always done it”) will not suffice in the new milieu of healthcare delivery. With declining reimbursement on the horizon, some hospitals have already initiated preparation. In November 2012, a North Carolina academic medical center announced the elimination of 950 full-time jobs, including full-time nursing positions. 4 Garloch K Wake Forest Baptist Medical Center announces eliminations of 950 positions, 7 percent of staff. Charlotte Observer. http://www.charlotteobserver.com/2012/11/15/3665739/wake-forest-baptist-medical-center.htmlDate: November 15, 2012 Google Scholar An article in News & Record quoted North Carolina State economics professor Michael Walden: “I think this is a bellwether announcement likely to be repeated across the state and nation.” 5 Associated Press Update: Wake Forest Baptist Medical Center to cut 950 jobs. News & Record. http://www.charlotteobserver.com/2012/11/15/3665739/wake-forest-baptist-medical-center.htmlDate: November 14, 2012 Google Scholar In the wake of the 2012 US presidential election, hospitals are taking action to mitigate the anticipated financial impact of the 2010 Affordable Care Act. “Over the next 10 years, the federal government will cut reimbursements to hospitals by over $150 billion.” 1 Gralia J Moody's sees affordable care act pressuring hospitals. Reuters Business & Financial News. http://www.reuters.com/article/2012/06/28/us-usa-healthcare-moodys-idUSBRE85R1KD20120628Date: June 28, 2012 Google Scholar According to Moody's Investor Service, the newly expanded Medicaid program for the care of formerly uninsured patients will not balance the scale. 1 Gralia J Moody's sees affordable care act pressuring hospitals. Reuters Business & Financial News. http://www.reuters.com/article/2012/06/28/us-usa-healthcare-moodys-idUSBRE85R1KD20120628Date: June 28, 2012 Google Scholar Financial leaders are merging their expertise with clinical nurse leaders to design new infrastructures for nurse staffing to meet increasingly complex needs of patients via a fiscally sustainable model. Embedded in this activity is a call to action for a new worldview underlying the theories and methodologies of nurse staffing. Stability in nurse staffing supports a practice environment that enables registered nurses (RNs) to maintain a sense of autonomy, to perform productively, and to think more critically. 2 Duffield C Diers D O'Brien-Pallas L et al. Nurse staffing, nursing workload, the work environment and patient outcomes. Appl Nurs Res. 2011; 24: 244-255 Abstract Full Text Full Text PDF PubMed Scopus (302) Google Scholar , 3 Tuttas C Robbing Peter to pay Paul: breaking the RN “recruitment cycle.”. J Nurs Care Qual. 2002; 16: 39-45 Crossref PubMed Scopus (3) Google Scholar Old staffing strategies (“the way we have always done it”) will not suffice in the new milieu of healthcare delivery. With declining reimbursement on the horizon, some hospitals have already initiated preparation. In November 2012, a North Carolina academic medical center announced the elimination of 950 full-time jobs, including full-time nursing positions. 4 Garloch K Wake Forest Baptist Medical Center announces eliminations of 950 positions, 7 percent of staff. Charlotte Observer. http://www.charlotteobserver.com/2012/11/15/3665739/wake-forest-baptist-medical-center.htmlDate: November 15, 2012 Google Scholar An article in News & Record quoted North Carolina State economics professor Michael Walden: “I think this is a bellwether announcement likely to be repeated across the state and nation.” 5 Associated Press Update: Wake Forest Baptist Medical Center to cut 950 jobs. News & Record. http://www.charlotteobserver.com/2012/11/15/3665739/wake-forest-baptist-medical-center.htmlDate: November 14, 2012 Google Scholar