N487 Leadership in Nursing: Fiscal Planning and
Responsibility
ANAs position on healthcare reform - ANS -supportive of reform and ACA
\Cost containment is whose responsibility - ANS -every health-care professional
\Define a personnel budget - ANS -(most expensive) Accounts for the majority of health-care organization's expense this
is why understaffing or overstaffing is looked at so often throughout the day
\Define fixed, variable, controllable, and non-controllable expenses - ANS -Fixed Expenses-do not vary with volume
Variable Expenses- vary weekly, hourly
Controllable- can be controlled by the manager
Non-controllable - cannot be controlled by the manager
\Explain a bundled payment system - ANS -similar to prospective payment system, but gives a lump amount for a patient's
care out to 90 days
Hospitals can acquire a lot of money if they don't spend the entire lump sum
\Explain a prospective payment system - ANS -hospitals paid for a specific amount of days based upon the care/surgery
required
makes hospitals focus care and discharge
\Explain flexible budget - ANS -Works well for difficult to predict census areas (ER)
Continually changes throughout the year based on census, calculated at time budget for staff, supplies.
, Justifies staff needs based on "now" vs historical data
\Explain incremental budgeting - ANS -Simplest method for budgeting
Multiply current year expenses by inflation (1.3 - 1.5%)
Pro: more money each year
Con: gets less reimbursement from the gov
\Explain patient acuity staffing model - ANS -Take into consideration patient acuity. Still somewhat based off of the
"average patient" to nurse ratio.
Uses a points system (more points, more acuity)
example: PCU assigns 8 points to a nurse, based on the score of a patient, the nurse could have 8 level one patients, or 2
level 4 patients
\Explain Performance Budget - ANS -Emphasis placed on outcomes to justify continued funding. If outcomes aren't met,
you will have to re-justify your budget and come up with another plan.
Goal focused
Pro: makes manager focus on outcomes
Con: fiscal impacts can effect care
\Explain productivity - ANS -In staffing models, you are using the appropriate number of staff
\Explain the nurse/patient (ratio) staffing model - ANS -Example:
1 nurse to 4 patients in emergency rooms
1 to 2 in ICUs
...
\Explain the standard staffing model - ANS -Nursing Care Hours (NCH) per patient-day (PPD)
Average given "budget" to an inpatient manager is 6 NCH/PPD
Responsibility
ANAs position on healthcare reform - ANS -supportive of reform and ACA
\Cost containment is whose responsibility - ANS -every health-care professional
\Define a personnel budget - ANS -(most expensive) Accounts for the majority of health-care organization's expense this
is why understaffing or overstaffing is looked at so often throughout the day
\Define fixed, variable, controllable, and non-controllable expenses - ANS -Fixed Expenses-do not vary with volume
Variable Expenses- vary weekly, hourly
Controllable- can be controlled by the manager
Non-controllable - cannot be controlled by the manager
\Explain a bundled payment system - ANS -similar to prospective payment system, but gives a lump amount for a patient's
care out to 90 days
Hospitals can acquire a lot of money if they don't spend the entire lump sum
\Explain a prospective payment system - ANS -hospitals paid for a specific amount of days based upon the care/surgery
required
makes hospitals focus care and discharge
\Explain flexible budget - ANS -Works well for difficult to predict census areas (ER)
Continually changes throughout the year based on census, calculated at time budget for staff, supplies.
, Justifies staff needs based on "now" vs historical data
\Explain incremental budgeting - ANS -Simplest method for budgeting
Multiply current year expenses by inflation (1.3 - 1.5%)
Pro: more money each year
Con: gets less reimbursement from the gov
\Explain patient acuity staffing model - ANS -Take into consideration patient acuity. Still somewhat based off of the
"average patient" to nurse ratio.
Uses a points system (more points, more acuity)
example: PCU assigns 8 points to a nurse, based on the score of a patient, the nurse could have 8 level one patients, or 2
level 4 patients
\Explain Performance Budget - ANS -Emphasis placed on outcomes to justify continued funding. If outcomes aren't met,
you will have to re-justify your budget and come up with another plan.
Goal focused
Pro: makes manager focus on outcomes
Con: fiscal impacts can effect care
\Explain productivity - ANS -In staffing models, you are using the appropriate number of staff
\Explain the nurse/patient (ratio) staffing model - ANS -Example:
1 nurse to 4 patients in emergency rooms
1 to 2 in ICUs
...
\Explain the standard staffing model - ANS -Nursing Care Hours (NCH) per patient-day (PPD)
Average given "budget" to an inpatient manager is 6 NCH/PPD
