NURSING BUDGETING

Nursing Budgeting

Nursing Budgeting

Introduction

My Clinical experience was at St. Francis Hospital located in Columbus, Georgia. My advanced clinical preceptor allowed me to experience two clinical settings cardiac/ telemetry unit and an orthopedic unit.

1. Observe the method of staffing on your unit. Determine the method of care delivery and analyze why this delivery is used.

Block staffing and mix staffing was utilized on both units. Staffing was available on all shifts and staffers were available to support the overflow patients. Although, the staff nurse make their on schedule with the exception of a mandatory weekend on a 6 week schedule. The overtime is optional, special request and vacations are subject to approval of the nurse manager. The method of care delivery is beneficial when the unit has access to other employees during the peak times; doctors' rounds, meals times, post operative cases and change of shift. There is no true solution when there is a nursing shortage, low acuity and limited reimbursements for nursing services.

2. Determine the personnel mix on each shift. List the number o f RNs, LPNs, CNAs, Respiratory Techs etc. Is this mix adequate for the acuity of the patients? Also, describe the shifts. Is there any flexibility in shift hours? Sharing?

The staff included 5 RN's, 0. LPN, 1.Certified nursing assistant. 1. Respiratory Technician, 1. Occupational therapist and 2. Physical therapist.

The mix was not adequate for the patient acuity. There is flexibility in making the schedule and they have incorporated a staffer. The staffer comes in around noon to receive post-operatives patient.

The nurses were complaining about being pulled to another unit, while leaving their unit under staffed. The unit we left had 10 patients and 1 certified nursing assistant (CNA).The unit that we were pulled to appear to be overstaffed, four nurses and sixteen patients. The unit also had a staffer to come in at noon to receive the new post-operative patients. The unit utilizes Residency Nurses, nurses that are new graduates or have less than one year experience. Their training includes extensive clinical training, mandatory monthly classes and a patient acuity of four. The utilization of the pulling or staffer nurse appeared to be beneficial for their unit but the objective is to retain the nurse in residency program. It appears that the method of leadership by the charge nurse is authoritarian and democratic style.

3. Does the nurse manager analyze the work load and make staffing decisions accordingly? Give specific examples. Do staff members feel staffing is adequate and do these members have any input into staffing decisions?

No, the appropriate staff is not available they utilized a pull list to determine who will be pulled. The House Supervisor determines the number of nurses based on patient acuity on each unit. If the patient is low nursing service will cancel nurse within a 2 hour window of their shift. The nurses are usually not cross trained to other unit's basic nursing skill and assessment should utilize in caring for ...