Manage Resources for Practicum Change Project

Week 4 Examples

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EXAMPLE 1

Managing Resources

Designed as an overflow unit, 8th NT was staffed with float pool registered nurses and nurse technicians, and was opened Monday through Thursday by clinical nursing supervisors based on patient volumes and the need for additional beds.  Because this unit was not considered a “permanent” floor, the budget for this first year will take the zero-based approach. Sullivan (2013) defines the zero-based budget as one that creates a basis for comparison for upcoming years, and its advantage is that every expense is justifiable. The actual unit had already been used as a staging unit while two inpatient units (8th Oncology and 7th Medical) in the South Tower were renovated.  Therefore, major electronic components, the nurse call system and the tube system, were in place when the decision was made to open the unit as a permanent 15 bed inpatient med-surg floor, so no renovation or retrofitting was necessary.

                       

Equipment and Supplies:

15 new Hill Room beds and mattresses were ordered for this unit at the cost of $185,652.  .  Additional equipment (i.e. suction set ups, O2 flow meters, IV poles) was ordered and cost is estimated at $45,000. Because the unit has housed patients on a PRN basis, it has been fully stocked with patient care supplies including items such as IV start kits, jelco’s, dressing change supplies, IV tubing, fluids etc. The supply costs YTD for this unit have been $17, 614.

 

Personnel:

This unit is currently staffed with float pool staff (RN’s and NT II).  As float staff, they are paid an accelerated rate of pay. Fiscal year to date since the opening of the unit on January 14, 2014, the unit has spent $98,600.00 in total salaries. YTD Patient days for this unit have been 278.

In mid April, the decision was made to open the unit with a full complement of staff and transition the unit from an overflow unit to a fully staffed medical-surgical Unit. Lexington Medical Center is licensed for 414 beds.  With the opening of the 8th North Tower, the facility will be utilizing 413 beds. There are 30 rooms available on 8th NT, and the assumption is that as the county grows and DHEC re-evaluates the needs, the hospital will eventually be given the certificate of need to fill those additional rooms that for now will continue to serve as classrooms for competencies, CPR, ACLS classes etc.

 The following is an outline for the approved FTE budget for this unit. (* entry level wage information is used for the staff and the midpoint salary range for the Nurse Manager.  These figures do not include any differentials – shift, weekend, certification, degree, etc.)

                

Role	FTE	Estimated Budget
Nurse Manager	1.0	88,088.00
Clinical Coordinators	2.7	113,55.52
Care Manager	1.0	42,057.60
Clinical Mentor	1.0	42,057.60
Registered Nurses	6.5	260,395.20
NT II	3.6	65,819.50

 

Clearly, the projected budget for opening the floor permanently is far more costly than the PRN budget. However, having the additional 15 beds for use at all times falls directly in line with the mission of the facility to provide healthcare services to meet the needs of our community, and the vision which is the delivery of accessible and affordable care that improves the health of the community (Lexington Medical Center Nursing Strategic Plan, 2007).

 

 

Projected Staffing Plan

This staffing plan is based on the following assumption of an average daily census which was generated based on the YTD average daily census for the PRN overflow unit:

Day	Census	Annual Patient Days
Sunday	6
Monday	12
Tuesday	12
Wednesday	12
Thursday	12
Friday	11
Saturday	6
Total	71	71X52 = 3692

 

Budgeted Hours/Patient Day (Paid)

8.8X3692=32489.6/2080=15.62    [16]

Worked Hours/Patient Day (Worked)

8.3x3642=3064.36/2080=14.73

FTE Budget:

Nurse Manager:                       1.0                                          

Clinical Coordinators:             2.7

Care Manager:                         1.0

Clinical Mentor:                      1.0

RN:                                         6.5

NT II:                                      3.6

 

Total Requested FTE’s:        16.00

 

 

 

References

Lexington Medical Center Nursing Strategic Plan (2007). Retrieved April 23, 2014, from  www.lexmed.com

Sullivan, E. J. (2013). Effective leadership and management in nursing (8th ed.). Upper Saddle River: Pearson

EXAMPLE 2

Budgeting for a change project can be a daunting task. Many times changes must be implemented after yearly budgets are already completed and unexpected costs such as a major practice change can significantly impact budget variances. Change however, is a necessary part of health care therefore nurse managers need to be prepared to be creative with costs and provide explanation when budgetary variances exist. A nurse manager with a good understanding of budgets may find innovative ways to fund practice changes without causing extreme budget variances.

One important element for managers to consider during the budget year is utilizing all monies available in the budget. If monies are left over from the previous year often these funds may be considered not necessary and cut from future budgets reducing the manager’s available monies (Sullivan, 2013). This concept is how we will attempt to offset some of the costs we will incur with the mother-baby change project. We have a distinct advantage in that the nursing unit that will be utilized for mother-baby is already operating as the postpartum unit so only minor physical and technological modifications are anticipated. Nurse and patient care technician training are anticipated to be the majority of costs and time related to the mother-baby change project. Another advantage we may have is that currently the postpartum unit and nursery are separate cost centers with separate budgets; with some coordination and collaboration some project costs may be able to be divided between the cost centers to avoid large variances (Sullivan, 2013).

Reallocation of funds from the reusable surgical supplies budget, since we are not anticipating any major purchases with these funds this fiscal year, may be one source of funding to offset other equipment purchases needed for the mother-baby unit. Redistribution instead of purchasing of supplies and computer application licenses will allow us to further neutralize costs during implementation. Sharing costs across cost centers can help utilize budget funds as well as avoid large variances for one cost center. Using reallocation, redistribution, and sharing cost centers we can hopefully significantly reduce or level costs incurred by this change project.

When planning this change there will be a concerted effort to minimize costs as limited budgetary funds existed for use. Examples of costs neutrality will be the redistribution of patient supplies, surgical supplies, and computer application licenses. To defer supply costs we examined current supply levels in the traditional nursery and plan for reduction of these levels since fewer infants will receive care here and will shift the difference to the mother-baby unit supply levels. In addition, we will use the same plan with computer application licensing, since additional licenses cannot be purchased for this project due to cost, licenses will be shifted from the traditional nursery to the new mother-baby unit where the volume of care providers and computer use will increase significantly. Surgical supplies will be handled in the same manner; few circumcisions will now be performed in the traditional nursery so the majority of surgical supplies will be relocated to the new mother-baby unit’s procedure room. An example of cost sharing may be each unit ordering one scale rather than one unit incurring costs for two. Out sister unit, labor and delivery has offered to utilize some of their budget dollars and will also order an additional scale.

Training care provider staff to include RN’s, LPN’s, and PCT’s will be the largest expense for this project and will likely create an unavoidable variance in the salary budgets for this year. This project however will be easily explained by the nurse managers and service line director. Orientation is an entitlement for all nurses and as such should be carefully planned (McConnell, 2004). Additionally the American Nurses Associations Guide to the Code of Ethics for Nurses Provision 4 clearly indicates that nurses must be minimally competent to provide care and must be provided or obtain the necessary education to meet this ethical standard. With this in mind the Family Centered Care committee that has been formed to develop the details of the change process has suggested the following plan for training and orientation of current staff. Staff training will consist of 4 didactic classes (8 hours each in length) and 9 shifts (12 hours) of patient care orientation for RN’s and LPN’s, and 1 didactic class (8 hours) and 6 shifts (12 hours) of patient care orientation for PCT’s. In addition to this multiple skills fairs will be held for competency verification for all staff that is drop in and should not last longer than 2-3 hours per staff member. While nursing leadership has demonstrated support of the change project they have declined use of agency or travelers to facilitate the education of staff therefore the units will have to accommodate this education and orientation without additional nursing man power. Per Diem staff will be utilized as possible but insufficient numbers of per diem staff exist to adequately meet all staffing needs during this transition. Conducting this education plan will be challenging without additional staff to provide coverage during the education classes, skills fairs, and orientation which may result in reduced staffing numbers on the unit or impede training progress. Target date for completion has been set at 6 months.

A sample budget estimate is as follows:

Non-Salary Budgetary Items
•         Patient Care Supplies	$0 (offset)
•         Computer Terminals (10) •         Printers (1)	$3,000.00 $200.00
•         Ophthalmoscopes (23)	$4,140.00
•         Scales (3)	$15,000.00
•         Computer Application Licenses	$0 (offset)
•         Surgical Equipment	$0 (offset)
•         Minor construction (chart racks)	$1200.00
Total Non-Salary estimates:	$24,340.00
Salaries
•         Nurse Training (64 RN’s, 4 LPN’s)	$286,000.00
•         PCT Training (19 PCT’s)	$ 14,250.00
•         Committee Meeting Salary Expense	$1,000.00 weekly (2hr. weekly meeting x 8)
Total Salary estimates:	$308, 250.00

 

It is clear from this estimate that the largest impact to the budget will be salary dollars. To implement a project of this magnitude however costs must be incurred. This change project however is absolutely in line with the overall vision and goals of the service line and organization. Perhaps the biggest challenge that the nurse managers will face will be maintaining staff to ensure quality patient care while ensuring staff completes education and orientation. Past projects in our organization have demonstrated that staff will resist change simply by avoiding education or training; many nurses think if they avoid education they will not be forced to make changes. Staying on track and completing this plan will be a monumental task for the nurse managers and staff involved. If the nurse managers can embraces a change model such as Roger’s theory of innovation they could utilize the innovators or early adopters within the nursing ranks to help facilitate the transition and moderate the resistance (Schmidt & Brown, 2012).

 

References

McConnell, C. R. (2004). Managing employee performance. The Health Care Manager, 23(3), 273-283. Retrieved from www.aspenpublishers.com

Schmidt, N. A., & Brown, J. M. (Eds.). (2012). Evidence-based practice for nurses: Appraisal and application of research (2nd ed.). Sudbury, MA: Jones & Bartlett Learning.

Sullivan, E. J. (2013). Effective leadership and management in nursing (8th ed.). Upper Saddle River, NJ: Pearson.

EXAMPLE 3

            The majority of change projects implemented at a healthcare facility require a budget in order for the change to take place.  Budgets provide a basis for managing and evaluating financial performance by detailing how resources will be acquired and used during a specific period of time.  The budgeting process helps to ensure that the needed resources are available for the change to take place (Sullivan, 2013).

            Court Manor’s mission is to provide quality care to the residents.  In order to do this, the facility realizes that change is important, and it embraces new technology.  The management at Court Manor has the vision to see that implementation of new technology is vital to the growth of the organization and the continued effort of giving quality care to its residents. My change project requires a limited budget due to the fact that it does not require implementing electronic charting.  It only deals with eliminating the duplicate paper charts that have been maintained at Court Manor since the implementation of electronic charting four years ago.  In order to switch entirely over to electronic charting, extra training using our current computer software will need to be provided for all staff nurses.  The therapy departments already use all electronic charting and will not be included in this change project.  Currently the physicians only visit the facility once per month for half a day.  At this time, our facility does not have physician order entry capability.  Therefore, it is more cost effective to continue with the current procedure of a nurse manager rounding with the physician and entering the physician’s orders for him or her.  Extra laptops will have to be purchased.  The medical records employee will have extra hours for disassembly of the paper charts and the cost of disposal for the old records will also need to be budgeted for.  I did not include the cost of electricity or heating/air conditioning for the facility since these costs are incurred whether training is occurring or not.

Purchase of 4 laptops (one extra for each nursing station)

4 x $750.00 = $3,000.00

 

Nursing staff training – estimated at four hours or less per nurse.

19 total staff nurses x $22.00 (average salary per hour) x 4 hours = $1,672.00

 

One nurse manager will need to conduct the training sessions and oversee the entire project.  There will be five training sessions at four hours each for a total of 20 hours.  Each training session will require a half an hour to set up the conference room and a half an hour to clean up the conference room after the session for a total of five hours.  Another eight additional hours have been added in for training of the nurse manager and preparation for the training sessions. (20 + 5 + 8 = 33 hours)

1 x 33 hours x $29.00 per hour = $957.00

 

Time for one medical records employee to disassemble paper charts.

70 patient charts to be disassembled x 0.25 hours = 17.5 hours

1 x 17.5 hours x $16.00 per hour = $280.00

 

3 large shredder containers at $140.00 each for destruction of paper charts.

3 x $140.00 = $420.00

 

Description	Total Amount
4 laptops	$3,000.00
Training for 19 staff nurses	$1,672.00
Nurse Manager’s time	$957.00
Medical records employee time	$280.00
3 large shredder containers	$420.00
TOTAL BUDGET FOR CHANGE PROJECT	$6,329.00

 

            The total budget for the change project is $6,329.00.  After checking with the Director of Nursing and the Administrator of Court Manor, it was determined that there are monetary resources available to support this project.  Both the Director of Nursing and Administrator agreed that keeping paper charts in addition to the electronic charting is a duplication of work by the nursing staff.  It was felt that the facility would benefit by eliminating the paper charts at this time.

 

Reference

 

Sullivan, E. J. (2013). Effective leadership and management in nursing. (8th ed.). Upper Saddle River, NJ: Pearson Prentice Hall

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