Preparing and Managing a Capital Budget Essay.
Note: Complete the assessments in this course in the order in which they are presented.Preparing and Managing a Capital Budget Essay.
You are the unit manager of a 50-bed, step-down unit, and it is time for you to prepare your annual capital budget. You have seen a significant turnover in your nursing staff in the past three years; a review of exit interviews and patient surveys indicates low nurse satisfaction, poor morale, and complaints of an antiquated and depressing work environment. You have researched the impact of a positive working environment on staff productivity and morale and decided to request a renovation of the nurses\’ lounge as the main purchase in your capital budget. You will present your request as a quality improvement investment.Preparing and Managing a Capital Budget Essay.
Note: Remember that you can submit all of, or a portion of, your draft to Smarthinking for feedback, before you submit the final version for this assessment. However, be mindful of the turnaround time of 24–48 hours for receiving feedback, if you plan on using this free service.Preparing and Managing a Capital Budget Essay.
Note: The requirements outlined below correspond to the grading criteria in the assessment scoring guide. Be sure that your budget addresses each point, at a minimum. You may also want to read the Guiding Questions: Preparing and Managing a Capital Budget [DOCX], linked in the Resources under the Suggested Resources heading, to better understand how each criterion will be assessed.Preparing and Managing a Capital Budget Essay.
Prepare a capital budget for a facility renovation. Assemble your budget figures in a table, using a format of your choice. You may use either Microsoft Word or Excel to create your budget table.Preparing and Managing a Capital Budget Essay.
Note: You may use the budget in the Vila Health: Preparing a Capital Budget multimedia exercise from the Resources as an example of how you might format your table. You may also use a budget format used in your organization or a format you find in any of the course resources or on the Internet.
If you used Microsoft Excel to create your budget table, submit the Excel file along with your budget narrative. You may also add the Excel file to your Word document as an embedded object.
Format your budget using APA style.
Nurse Manager-Prepared Operating Budget for a 35- Bed Hospital Unit: Controlling Expenses and Maximizing Revenues While Assuring Patient Safety
MSN-FP6216 Advanced Finance and Operations Management
Preparing and Managing an Operating Budget
Nurse Manager-Prepared Operating Budget for a 35- Bed Hospital Unit: Controlling Expenses and Maximizing Revenues While Assuring Patient Safety
A budget is an organization’s financial plan based on previous financial performance and future projections. The nurse manager is an important person in the process of budgeting for any nursing unit as they are the person responsible for the management of the nursing staff as well as the resources of the unit. Every unit of an organization is supposed to operate profitably and sustainably as the funds allocated to the nursing unit is that unit’s budget. This means that revenues must always surpass expenses at any given time. In the budget, predictions must be made for the following period’s patient volume, revenues, and expenses.Preparing and Managing a Capital Budget Essay. These parameters are themselves based on growth projections and a prior period’s actual performance. The components of the budget include revenue which is calculated from patient days and drawn from all payer sources such as insurance, private pay, Medicare, and Medicaid (Brown et al., n.d.). Also included are the expenses which are incurred from supplies, procurement and use of equipment (as well as their maintenance), and staff salaries and other benefits. In a good budget, the costs or expenses (personnel remuneration, overheads, and items) are supposed to remain constant or reduce as revenues rise. To do this, the nurse manager has to keenly manage staffing and nurse to patient ratios. Managing the nursing staff therefore means that a balance must be struck between staff productive time and non-productive time. The productive time of the nursing staff is the time period that they actually worked and are paid for.Preparing and Managing a Capital Budget Essay. Non-productive on the other hand is the time period that is paid for by the organization even though the staff are not working. This is time such as sick time, scheduled holidays, official training time organized by the organization, and paid time off (Gealan, 2013; Brown et al., n.d.). The nurse manager in making the budget should therefore ensure an appropriate mix of nurses that is in congruence with the actual patient care hours to ensure maintenance of quality and effective nursing care (Gealan, 2013; Brown et al., n.d.). In every nursing unit, properly titrating the personnel costs to the patient days every month means the nurse manager can avoid having non-essential staff on duty when the patient days are not high. This paper is about the preparation of such a budget as described above by the nurse manager of a 35-bed nursing unit in a hospital with 20 permanent nurses working full-time equivalent (FTE) shifts.Preparing and Managing a Capital Budget Essay.
The Operating Budget of the Nursing Unit
Table 1: Operating Budget of the 35-bed unit for the year 2020
|Item||Actual Unit’s Budget Previous Year (2019)||Projected Budget Year 2020|
|Revenue||USD 55,370,000||USD 56,700,000|
|Staff productive time||USD 2,200||USD 2,184|
|Staff non-productive time||USD 541||USD 548|
|Total staff expenses||USD 2741||USD 2,732|
|Supplies||USD 252||USD 268|
|Overheads||USD 105||USD 105|
|Total non-staff expenses||USD 357||USD 373|
|Total expenses||USD 3,098||USD 3,105|
The above table represents the projected budget for the unit for the year 2020. This estimate is compared to the previous year’s budget (for the year 2019) to make it easier to see the areas that are expected to improve in terms of spending and inflow of revenue. Looking at the budget, the expense on staff productive time is expected to go down in the following year because of an intended reduction in the number of overtime work that the current nurses are doing. This will not be because of having less nurses per shift, but because of better deployment of skill mix of nurses in every shift.Preparing and Managing a Capital Budget Essay. Staff non-productive pay will marginally increase because there are nurses who are scheduled to proceed for their annual vacation while several training opportunities have also been arranged to upskill the nurses in the unit. In total, however, the overall expense on nursing staff and certified nurse assistants is expected to go down out of this prudent management of the human resource from USD 2,741 to USD 2,732. Because the unit is expected to handle more patient days in the following year, it follows that the expense on equipment, supplies, and overheads will also rise. From the estimated budget, this will rise from the previous year’s figure of USD 357 to USD 373. The good news is that since the patient days are expected to rise from the previous year’s 5,537 to 5,670, the revenue is also expected to correspondingly rise from the previous year’s actual amount of USD 55,370,000 to an estimated amount of USD 56,700,000. The total expenses will marginally rise from USD 3,098 to USD 3,105.Preparing and Managing a Capital Budget Essay.
In preparing this budget, the knowledge gaps and unknowns include factors such as the occurrence of pandemics that cannot be predictable. If this happens in the year of the projected budget (2020), the dynamics in terms of patient days and expenses on equipment and supplies will definitely change. The other unknown is whether there will be staff turnover or not. When nurses leave the employment of the hospital, there will have to be reorganization of the staffing arrangement and deployment of skills to ensure quality patient care is maintained. Missing information is represented by factors such as what the cost of maintenance of the novel technologies and machines will be in the next year. This is information that therefore has to be estimated from an informed standpoint. Preparing and Managing a Capital Budget Essay.This means that the nurse manager has to consult the maintenance and engineering department of the hospital to get near accurate information that she then uses to estimate this component of the expense. The areas of uncertainty where further information could improve the budget are represented by especially the influence that the level of satisfaction of the patients will have on the projected patient numbers. This is demonstrated by the rating of the hospital and how it is ranked by the Joint Commission in terms of its offering quality healthcare services. It is a known fact that patients who are satisfied by the services of the hospital are likely to come back to the hospital for care. However, what cannot be predicted is the exact magnitude of this effect, as well as the percentage of extra new patients that the good word-of-mouth is bound to bring in the next period of the budget. If this information was known, the budgeting process would be more refined and close to perfect in terms of setting aside required resources t handle those patient numbers. These resources are human as well as material.Preparing and Managing a Capital Budget Essay.
Designing of the Budget
The designing of the budget follows the fact that the operating budget is reflective of the day to day activities of the nursing unit. Because of this, it must reflect the staffing of the unit in terms of the amounts of money expected to be aid to staff for the time that they have worked. It is also expected, on the same front, to reflect the amount of time that the staff will be paid without actually working.Preparing and Managing a Capital Budget Essay. Also, if the permanent full-time equivalent or FTE staff are not there in sufficient numbers and also cannot be able to cover all the shifts, there may be need to contract short-term staff such as locums. This will be expense that must be factored in the budget as well. Designing the budget requires that expenses are kept to a minimum and revenues are maximized. This is achieved by properly making use of full-time equivalents or FTEs month by month. A full time equivalent or FTE nurse is employed permanently by the hospital. This particular unit has 20 FTE staff nurses. The reason why an FTE nurse is cost-effective is because she works for 8 hours a day and 5 days a week. This results in a total of 2,080 hours of personnel time a year (Brown et al., n.d.). When used properly, locum and contract employees may also be used to reduce costs as they will only work when needed. The locum and contract employee cost is usually based on and calculated from the FTE model or cost.Preparing and Managing a Capital Budget Essay. In designing this budget also, there was need to increase efficiency of use of overheads such as electricity and surgical supplies like syringes and catheters. This was assured by placing nurses with the correct skill mix in shifts. These are qualified and experienced nurses who are responsible and will guide the other staff to be prudent in their use of organizational resources to preventing wastage. The use of technology is also added to the skills of the nurses in designing the budget to ensure that expenses are kept low and revenues are increased. All this is done as the quality of healthcare offered is maintained. That means healthcare that is safe, efficient, effective, timely, patient-centred, and equitable (Kirbi, 2015; Waxman, 2015; Russell, 2014). The design of the budget took into account the staffing levels, equipment and supplies, and the revenues generated.Preparing and Managing a Capital Budget Essay.
Staffing levels will change as per the quantity of patient beds accessible, patients being thought about (expected) and their medical problems. An emergency unit ordinarily has a higher staff-to-patient proportion than a normal unit and will be comparatively costly to manage. A working financial plan typically records the numbers of the healthcare workforce in every worker classification or category. For instance, registered nurses, enrolled nurses, certified nurse assistants, and other non-medical staff as well as a breakdown of their compensation and advantage in costs for each position are considered. Expenses related with new workers was also factored in.Preparing and Managing a Capital Budget Essay.
Supplies and Equipment
In the above nursing budget, anything that is considered to be used in a medical sense, for administrative purposes, for maintaining patient hygiene, for infection control measures, or any other supplies used in the unit was included as supplies or equipment. This is a cost or expense. In this particular budget, these have been included under the two categories that are ‘supplies’ and ‘overheads’. It is under these two titles that all of those supplies and other expenses such as maintenance have been included.Preparing and Managing a Capital Budget Essay.
Revenue in this budget is the amount of money that comes into the organization and can be directly attributed to this unit in this case. The designing of this budget recognized that revenue will vary depending on the type of patient (patient acuity) as well as the services that are provided to that patient. All payers are sources of revenue and include private insurance, personal out-of-pocket pay, Medicare, and Medicaid. Some of these payers will negotiate with the hospital and pay different rates from those that the other payers will for the same services. Because this information may be uncertain, general averages have been used in the designing and making of this operating budget.Preparing and Managing a Capital Budget Essay.
In designing this budget, it is acknowledged that some conflicting data exists and may be difficult to explain. A good example is that it would be expected that with the increase in patient days, the amount of money spent on the productive time of nursing staff would also increase. This conclusion is drawn from the fact that higher numbers or higher patient days translate to an increased workload that requires more nurses to be on duty or a requirement for closer observation due to increased patient acuity. However, in this budget, it can be seen that the reverse is the case and this represents conflicting information. The only explanation for this as given is that a prudent deployment and delegation of nurses based on skill mix will be employed by the nurse manager.Preparing and Managing a Capital Budget Essay.
Proposed Strategic Plan and Criteria for Future Evaluation
In consideration of the above budget, the strategic plan for this particular unit would be as follows:
The proposed criteria for future evaluation of outcomes that may be used to assess accomplishment of the components of this strategic plan are from a quality improvement standpoint. This is to say the factors that will form these criteria will be such as a reduction in the readmission rate for the unit, zero or reduced rates of hospital-acquired infections (HAI) such as catheter-associated urinary tract infections (CAUTI) and central line-associated blood stream infection or CLABSI, and a positive rating by the Joint Commission.Preparing and Managing a Capital Budget Essay.
The approach to ongoing budget management for this unit will be to:
The assumptions on which this approach is based are that there will be no drastic staff turnovers during the period of the budget, and that there will be no staff who will be incapacitated by sickness.Preparing and Managing a Capital Budget Essay.
Budgeting is an important function of the nurse manager. Preparing an operational budget for the unit is one of the important skills required of the nurse manager in this respect. The operational budget comprises of items that represent the day-to-day operations of the unit. Typically, these are factors of expenses as well as revenues that can be directly attributed to the unit and calculated from the patient days. Expenses are due to personnel and non-personnel reasons. Using nursing staff working under the FTE model goes a long way in maximizing on efficiency and frugal personnel expenditure.Preparing and Managing a Capital Budget Essay.
A Capital Budget for a 50-Bed Step-Down Unit in a Hospital Prepared by the Unit’s Nurse Manager
Healthcare quality in today’s healthcare system is the most important single factor that determines every other aspect of the sector. For instance, since the enactment of the Patient Protection and Affordable Care Act of 2010, reimbursement for health services rendered has been done based on quality rather than volume. This is the so-called pay-for-performance policy (Holmström, 2017). Only healthcare services that meet the quality criteria get the highest rates of reimbursement. These quality criteria have been enumerated by the Institute of Medicine (IOM) as safety, timeliness, efficiency, effectiveness, equitability, and patient-centeredness (Beattie et al., 2013).Preparing and Managing a Capital Budget Essay. To ensure that hospitals and other healthcare organizations adhere to standards of quality prescribed, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) monitors quality parameters of these institutions (such as readmission rates, patient falls, nursing and medical errors, and so on) ad produces an annual report on the same. In a nursing unit such as this one with 50 intermediate care or high-dependency beds, the quality of care provided will be directly proportional to the efficiency of the nursing workforce. As such, factors such as a high turnover rate will negatively impact the quality of care delivered in the unit.Preparing and Managing a Capital Budget Essay. To prevent this, staff retention must be made a priority and be considered as a quality improvement (QI) initiative. Studies have shown that some of the measures that are effective in achieving this are the practicing of transformational leadership and the provision of all the necessary tools and equipment required by the nurses to perform their functions. This increases the morale of the nurses and boosts job satisfaction. A transformational nurse leader creates a welcoming workplace environment in which nurses feel free to voice their opinions and suggestions without fear. She also encourages them to report any mistakes and errors without fear of victimization, thereby creating psychological safety at the workplace (Cheng et al., 2016). The result is usually greater job satisfaction, high morale, high staff retention rates (low turnover), less burnout, improved patient safety, and a general increase in the quality of healthcare and nursing care offered. This 50-bed high dependency unit has experienced a high staff turnover rate in the last 3 years, with the main reasons being cited as poor job satisfaction, low staff morale, obsolete equipment, and a non-conducive work environment. In this paper, the nurse manager responsible for the unit proposes a capital budget aimed at addressing this staff turnover problem through capital expenditure. The whole project is a quality improvement initiative.Preparing and Managing a Capital Budget Essay.
A capital budget is concerned with the acquisition of long-term (fixed) assets (Gealan, 2013). Capital budgets are normally prepared separately from recurrent or operational budgets by the unit’s nurse manager. The items (capital assets) in a capital budget are typically expensive and last longer than one year in their productive life. Usually, the nurse manager must provide the rationale for requesting such capital assets that are cost-intensive (Brown et al., n.d.). In this case, the rationale for the proposed capital acquisition is to:Preparing and Managing a Capital Budget Essay.
Being a step-down unit within the hospital, this is a unit that has patients with high acuity levels near those requiring critical care in the intensive care unit or ICU (Armony et al., 2016; Prin & Wunsch, 2014). As such, a high quality of nursing care is needed to facilitate exceptionally good patient outcomes. To increase the quality of care, the nurse manager seeks to motivate the nursing staff, boost their morale, and improve their job satisfaction by proposing capital acquisition or expenditure as follows:Preparing and Managing a Capital Budget Essay.
The assumptions on which the above plan is based include that there will be negligible inflation between the time of making the budget and the time of implementation after approval, nurses will be able to use the novel technologies (clinical systems) incorporated into the hospital’s existing EHR system without the need for upskilling (which is another cost), and that funding will be available for the quality improvement project since it is quite capital-intensive.Preparing and Managing a Capital Budget Essay.
Justification for the Need for Capital Acquisition
In the past three years, the unit has experienced a high rate of staff turnover which has been established to have been due to low morale and poor job satisfaction among nurses. Also, the other reasons were established to be the view by the departing nurses that the equipment in the unit is obsolete, and that the workplace environment is depressing and uninspiring. This affected the quality of care that the nurses could deliver, resulting in unpleasant patient outcomes and errors caused by equipment malfunction. Preparing and Managing a Capital Budget Essay.To solve these, renovation and equipping (with television and furniture) of the nurses’ lounge is proposed to correct the “depressing work environment,” purchase of new smart infusion pumps is also proposed to do away with the antiquated analogue pumps in the unit, and purchase and improvement of the electronic clinical systems is proposed to facilitate and ease the work of the nurses (boosting their morale and increasing their job satisfaction). The pros of these improvements include improved patient safety and staff retention, while the cons include a huge capital outlay as well as a rise in maintenance costs in the operational (recurrent) budget.Preparing and Managing a Capital Budget Essay.
The Capital Budget and Process for Calculating Costs
The following is the capital budget prepared by the nurse manager of the unit, showing all the capital assets proposed for acquisition to improve care quality. The total capital expenditure will amount to USD 618,600.Preparing and Managing a Capital Budget Essay.
|Table 1: Capital budget for the 50-bed step-down unit for the year 2020|
|1||Smart infusion pumps (25 pieces)||Better I.V. therapy||50,000|
|2||Pyxisᵀᴹ MedStationᵀᴹ||Less errors||88,600|
|3||EHR system upgrade||More efficiency||300,000|
|4||Renovation (nurses’ lounge)||Staff motivation||180,000|
|TOTAL CAPITAL EXPENDITURE||618,600|
From the budget, the smart infusion pumps will improve the administration and efficiency of I.V therapy, the ADC will improve the administration of medications and greatly lower then incidence of nursing medication errors, and the renovation of the nurses’ lounge will boost their morale and create a welcoming work environment that is appreciative of their efforts. Lastly, the EHR upgrade is aimed at increasing the efficiency of the nurses and making their work easier through electronic sign-out and hand-off tools, bar code medication administration (BCMA), electronic medication administration record (eMAR), and patient data management systems (PDMS).Preparing and Managing a Capital Budget Essay.
In this budgetary plan, the knowledge gaps and areas of uncertainty include the possibility that the initial vendor of the EHR system may not be able to incorporate the suggested clinical systems and make them interface, the nurses may require upskilling (an expense on the organization) for them to effectively use the proposed electronic clinical systems, and inflation may make the estimated costs in te budget balloon at the time of implementation.Preparing and Managing a Capital Budget Essay.
The process for calculating the above costs involved a comparison of current costs of the capital assets, as well as interviews with experts in construction to find out the approximate cost of the project. No attempt was made at adjusting for inflation since the period between approval and implementation is not expected to be more than three months. The only data that is questionable is the cost of the EHR upgrade as well as the renovation. This is because the figures are just estimations that may be more or may fall short of the actual costs.Preparing and Managing a Capital Budget Essay.
Plan for Budget Management and Impact on the Organization’s Financial Health
The plan for budget management is to stay within the estimated budget limits and improvise where the estimates are insufficient, to go for the lowest bidders who can provide the capital assets, and to possibly save and return the remaining finances to the organization’s coffers. The assumption for this is that even after improvisation in the event of insufficiency of funds; the required quality of capital assets will still be realized. This capital expenditure will affect the financial health of the organization in a big way since capital assets are cost-intensive. Preparing and Managing a Capital Budget Essay.However, the impact will be minimised by the fact that capital expenditure in the whole organization is factored in the five-year strategic plan of the hospital. The only areas of uncertainty or knowledge gaps are whether the Board of Directors will reduce some of the proposed assets to cut costs, and whether the capital budgets of the other units in the hospital will so high as to necessitate reduction of all the budgets.Preparing and Managing a Capital Budget Essay.
Capital budgeting is an important function of the nurse manager, just like with the operational or recurrent budget. There must be justification for any proposed capital expenditure, since capital assets are quite cost-intensive.Preparing and Managing a Capital Budget Essay.