Chapter 20

Group 1

Managing Costs and Budgets

Do this exercise with a group. Develop charts or other graphic ways to illustrate the following activities.

Scenario: Expansion!

You have been informed that because of your statistical justification efforts, administration has recognized the need for more monitored beds. This means that your department will expand from its current 11 beds to 20 monitored beds. As a nurse manager, you are initially very pleased about this expansion, but then you feel dismayed because you will have a lot of work to do and only a little time in which to accomplish it. You also have an additional 12 FTEs to add to your current 20.5 FTEs. The current staffing mix is as follows:

RN FTEs = 12 (10 full time and 4 part time)

LPN (LVN) FTEs = 3.5 (2 full time and 3 part time)

Nursing assistant FTEs = 1.5 (6 work every other weekend and 1 works the Friday along with her weekend)

Nursing aide FTEs = 1.0 (full time, works only Monday to Friday)

Unit clerk FTEs = 2.5 (2 full time, work 9 to 5:30 during the week and every other weekend; 1 part-time, works 6 PM to 10 PM Monday through Friday)

The additional 12 FTEs include all support personnel (unit clerks, nursing assistants, and aides, as well as RNs and LPNs [LVNs]).

Establish the following:

1. List three goals for the new expanded unit. Include patient outcomes such as discharge criteria, acuity level, and patient teaching.

2. Make a list that differentiates the allocation of FTEs of caregivers and support personnel. Some of the support personnel may also be listed as caregivers, such as nursing assistants or unit clerks who are cross-trained as nursing aides. Consider the following when doing the allocation:

As the manager lists the allocations of FTEs of caregivers and support personnel, he or she will quantify the quality of nursing care by matching patients needs to numbers and types of nursing personnel, using time as the unit of measure.

a. Nine additional patients require care.

For example, the staffing ratio for a telemetry unit may be a 4:1 (patient-to-RN) ratio. This would mean increasing your staffing to include one additional RN per shift with a patient census of 20 patients.

b. At times, no unit clerk is available, and the daytime clerks have to work overtime to cover the period from 5:30 PM to 6:00 PM.