Nursing Fiscal Plan of Action Case Study

Excerpt from Case Study :

Nursing Fiscal Plan

The author of report is asked to assess a budget framework and compare what has happened to what is set to happen through the rest of the year and ascertain how best to close out the year. The author is asked to assess budget line item requests for the duration of the year as well as what expenses can and should be deferred until the new fiscal year. The budget projections that were accurate are to be labeled as well as what factors have caused the inaccuracies. As to the latter, it is asked if those inaccuracies were controllable or predictable.

The author is asked to do a bit of research on patient acuity symptoms and to ascertain the best approach for that process vis-a-vis quality patient care. The author is asked what strategies pertaining to motivation, communication, care delivery and so forth need to be implemented in order to retain staff and why it is important for staff to be involved in the improving of customer satisfaction. The type of structure that would best be used for the improvement of customer satisfaction in terms of efficacy is asked for and the author is asked to consider who should be participating in the construction of the same.

Budget Requests

It is quite clear from the budget requests and the other events going on that there is not been a sufficient focus on hiring and retention of people in the name of quality patient care and keeping overtime within the budget. The overtime budget is already exhausted but the personnel budget is roughly two months behind the pace it should be going at. That would be, in and of itself, good news but retention, quality of care and other budget issues are all a concern. The two limb movement machines should be ordered but the conference, which is nearly 66% the cost of one of those machines, is a no-go. The request to hire an addition RN for each shift should absolutely occur as this is no doubt why overtime is so high and overall quality of care is so low because the current nurses are no-doubt stretched to their limit and they need some fresh bodies in the fray to help spread the workload to more manageable levels.

Personal travel expenses, including the conference and anything else, should be brought to a screaming halt. Supplies purchasing should be managed a little tighter but if something is needed, then it's needed. Equipment is at the budget mark already but some money can be drawn from the shortfall in personnel costs because it is unlikely that hiring a few more RN's is going to be anywhere near what is left in the personnel budget for the fiscal year. In short, the glut of money left in the personnel budget should be allocated to the needed machines, new nursing hires and any needed overtime. Doing the RN hires will reduce the amount of overtime, will increase quality of care and will increase the customer service quality of the hospital. Absolutely any non-essential supplies and travel is off limits for at least the rest of the fiscal year.

In terms of what was accurate in terms of budgeting and what was inaccurate, there are a number of observations that can be made. As noted before, the personnel spending is very behind the curve with there being a $50,000 gap between what was budgeted so far this fiscal and what has been spent assuming an even amount per year. Overtime is already exhausted as is equipment, both with three months left in the year. Staff development is under budget for the year but it's going to be over by the end of the fiscal so some of the overflow from personnel can and should be used to cover what is needed. Personal travel has $500 left but no more of that will be used for the rest of the year and can be lumped together with the glut from personnel to covering hiring, customer service improvements, care quality improvements and staff development in general.

As for what factors have contributed to the inaccuracies, there appears to be two major problems. First, the amount of expecting hiring simply has not happened and it has had a clear and negative effect on quality of care, customer service quality, employee retention and overtime expenditures. This was entirely controllable and predictable and staffing levels should have been adjusted as the fiscal wore on. If this had happened, much of the financial and service maladies present now would nto be occurring. The overall spending would probably be higher but that is fine because this could occur and everything would still be within budget.

Patient Acuity Classification Systems

As far as a proper and fitting patient acuity classification system, there were several things found by the author that would be relevant to the hospital discussed above. The proper definition and use of the term "acuity" includes measurement of severity, intensity and the like. Drilling down a bit further, it also includes needs based on traits like physical, psychological, nursing care needs, workload, complexity and case-mix. These classification systems are used in urgency/triage scale applications as well as other uses (Brennan, and Daly).

Another article reviewed by the author of this paper held that "outliers" in ICU can lead to very high physical and monetary costs for ICU unit runners like hospitals and so forth. The study noted that low-acuity ICU patients can be just as problematic in terms of length of stay and cost to the hospital as high-acuity patients if they are not managed properly through a properly run and staff acuity classification system in the hospital. The average cost per day for patients across the board can vary quite widely. For the study done in this article, the cost ranged from $1,436 per day per ICU patient to $1,759 per day. Those same numbers accounted for 69.4% and 45.7% of the total hospital stay cost for the same patients (Korpi et al.)

Another article consulted speaks to the dangers of incorrectly measuring acuity in patients and the related adverse events that can happen to people that are diagnosed wrong or are otherwise discharged from the hospital before they should be. This particular study found that many people had adverse events and roughly half of them could have been prevented through better acuity measurement and better quality of care. Of the 107 patients with certain flagged outcomes that the study was looking for, more than 40 of them had an adverse prevent and more than half of those, as noted above, were preventable through better care quality (Stiell et al.)

Yet another article reviewed how to properly score and measure acuity. The article speaks to the proper and consistent use of tools so that the same patient with the same medical malady or situation is treated in the same precise manner regardless of who is using the tools and when. Consistent with outcomes and how the tools are wielded is very important and is imperative to getting the patients diagnosed and managed correctly. Spending the proper amount of time and, as a related note, to have the proper staffing levels to be able to get patients served as timely and correctly as possible is essential (Radford).

A final scholarly article reviewed for this report focused on the human element of quality of care and quality of service, which is a lesson that the fictional hospital mentioned in this paper needs to learn. The staffing shortages and patient acuity management (or lack thereof) is obviously causing problems. To that end, this last article mentions the importance of interpersonal relations between workers in a hospital as well as the interactions between family and the staff as well as the patients and the staff. Level of urgency is an issue and nurses/doctors need to keep in mind that level of urgency is usually amplified for the family member of a suffering patient and it is part of a nurse's or doctor's job to manage expectations and explain what is going on as soon as is reasonable possible. In the interim, it is important to keep calm and operate in an orderly and logical fashion. Patients and/or family members should not be required to wait more than is reasonable and they should be consistent progress updates as the process goes on (Ekwall, and Gerdtz, and Manias).

Strategies & Satisfaction

As far as what strategies of motivation, communication, care delivery and so forth to retain staff that can be utilized, there are a number of things. First, it should be made clear that staffing levels will be brought as high as they need to be to get the workload and overtime more manageable, whether that be one RN per shift or more than that. Additionally, nurses that clearly perform above and beyond their minimum requirements will be singled out for distinction and/or pay raises to reward them for their excellent service, both…

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