Fiscal Planning
Not intuitive, practical experience is key
Requires vision and creativity
Requires knowledge of social, political, and economic forces
Should include subordinates in the planning process
What types of questions are illegal to ask in an interview?
Any question about an applicant's marital status, number or age of children, information about childcare arrangements, questions about pregnancy, or questions about race are prohibited. Review the table in the text for additional information
Why is staffing important?
Staffing can make or break the relationship between finance and nursing
Staffing can blow a budget
Staffing affects the cost of care
Staffing affects the quality of care
Staffing matters to nursing
Staffing must be appropriate to meet the needs of the client
What are the 6 domains of quality as defined by the Institute of Medicine (IOM)?
Effectiveness, Efficiency, Equity, Patient Centeredness, Safety, Timeliness
How are hospitals reimbursed?
Private insurance
Medicare
Medicaid
Self-pay
Discuss the principle of cost-effectiveness
Shortages occur when the economy is in an upswing and decrease when the economy recedes.
Discuss how the nurse should use an acuity tool for assigning clients to nurses
Objectively classifies client acuity
Does not always accurately predict the acuity of a client
The RN should review the care needs of each client
Does not take into consideration continuity of care
What are the distinguishing characteristics of standards?
Standards are predetermined
Standards are established by an authority
Standards should be communicated to those affected by them
Insurance program managed by the federal government
Paid for by a trust fund established by those who pay into it
Must be eligible
What are ways to reduce expenditure in the operating budget?
Reducing obsolete inventory
Saving unused supplies
Monitoring for waste/pilferage
What factors contribute to the nursing shortage?
Not enough faculty
Insufficient number of clinical sites
Insufficient classroom space
Not enough clinical preceptors
Nursing faculty is retiring at a faster rate than it can be replaced
What are some considerations when 12-hour shifts are implemented?
RNs will receive more overtime pay
RNs have increased satisfaction
RNs have increased judgment errors
RNs have increased risk for burnout
RNs have an increased susceptibility to obesity, cardiovascular disease, HTN, diabetes, and mood disorders
What are the characteristics of clinical practice guidelines?
CPGs reduce healthcare costs
CPGs give providers instructions on how to provide treatment
CPGs are based on evidence
CPGs are based on diagnoses
What makes one eligible for Medicare?
Must have paid into it
Must be 65 years of age or older OR must have a qualifying condition
Discuss the principles of incremental budgeting
Simplest method
Multiply the current year expenses by the inflation rate or CPI to project the budget for the upcoming year
Inefficient
Historically used by hospitals
What are benefits of turnover?
Some turnover is normal and desirable
Turnover gives the organization with fresh ideas
Groupthink is reduced
What are potential issues when agency RNs are utilized?
Increased cost
Unfamiliar with unit and policies
Decreased continuity of care
What are the tenants of total quality management?
Always room for improvement
Proactive problem solving
Employees are trusted to be responsible, knowledgeable, and accountable
Customer-centered environment
What is Medicaid?
State assistance program for medical expenses
Discuss the principles of zero-based budgeting
Listing all current and proposed objectives or activities in the department
Alternative plans for carrying out these activities
Costs for each alternative
Advantages and disadvantages of continuing or discontinuing an activity
How can the nurse manager reduce bias in the interviewing process?
Use a team approach
Conduct multiple interviews
What are considerations with having flex-time as a scheduling option?
Variable start times to allow for work-life balance
Can affect the continuity of care
May require adjustments in scheduling if there are holes in the schedule
Give 6 examples of a sentinel event
Hyperbilirubinemia >30 mg/dL
Foreign body retention after surgery
Client suicide within 3 days of a hospital or ED discharge
Death
Rape, assault, or homicide
Hemolytic transfusion reaction
Fire during client care
What makes one qualify for Medicaid?
Low-income
Any age is eligible
Benefits vary from state-to-state