Week 4 Examples Collapse Top of Form Total views: 17 (Your views: 1) EXAMPLE 1 Managing Resources Designed as an overflow unit, 8th NT was staffed with float pool registered nurses and nurse technicians, and was opened Monday through Thursday by clinical nursing supervisors based on patient volumes and the need for additional beds.  Because this unit was not considered a “permanent” floor, the budget for this first year will take the zero-based approach. Sullivan (2013) defines the zero-based budget as one that creates a basis for comparison for upcoming years, and its advantage is that every expense is justifiable. The actual unit had already been used as a staging unit while two inpatient units (8th Oncology and 7th Medical) in the South Tower were renovated.  Therefore, major electronic components, the nurse call system and the tube system, were in place when the decision was made to open the unit as a permanent 15 bed inpatient med-surg floor, so no renovation or retrofitting was necessary. Equipment and Supplies: 15 new Hill Room beds and mattresses were ordered for this unit at the cost of $185,652.  .  Additional equipment (i.e. suction set ups, O2 flow meters, IV poles) was ordered and cost is estimated at $45,000. Because the unit has housed patients on a PRN basis, it has been fully stocked with patient care supplies including items such as IV start kits, jelco’s, dressing change supplies, IV tubing, fluids etc. The supply costs YTD for this unit have been $17, 614. Personnel: This unit is currently staffed with float pool staff (RN’s and NT II).  As float staff, they are paid an accelerated rate of pay. Fiscal year to date since the opening of the unit on January 14, 2014, the unit has spent $98,600.00 in total salaries. YTD Patient days for this unit have been 278. In mid April, the decision was made to open the unit with a full complement of staff and transition the unit from an overflow unit to a fully staffed medical-surgical Unit. Lexington Medical Center is licensed for 414 beds.  With the opening of the 8th North Tower, the facility will be utilizing 413 beds. There are 30 rooms available on 8th NT, and the assumption is that as the county grows and DHEC re-evaluates the needs, the hospital will eventually be given the certificate of need to fill those additional rooms that for now will continue to serve as classrooms for competencies, CPR, ACLS classes etc.  The following is an outline for the approved FTE budget for this unit. (* entry level wage information is used for the staff and the midpoint salary range for the Nurse Manager.  These figures do not include any differentials – shift, weekend, certification, degree, etc.) Role FTE Estimated Budget Nurse Manager 1.0 88,088.00 Clinical Coordinators 2.7 113,55.52 Care Manager 1.0 42,057.60 Clinical Mentor 1.0 42,057.60 Registered Nurses 6.5 260,395.20 NT II 3.6 65,819.50 Clearly, the projected budget for opening the floor permanently is far more costly than the.

1. Week 4 Examples
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Total views: 17 (Your views: 1)
EXAMPLE 1
Managing Resources
Designed as an overflow unit, 8th NT was staffed with float
pool registered nurses and nurse technicians, and was opened
Monday through Thursday by clinical nursing supervisors based
on patient volumes and the need for additional beds. Because
this unit was not considered a “permanent” floor, the budget for
this first year will take the zero-based approach. Sullivan
(2013) defines the zero-based budget as one that creates a basis
for comparison for upcoming years, and its advantage is that
every expense is justifiable. The actual unit had already been
used as a staging unit while two inpatient units (8th Oncology
and 7th Medical) in the South Tower were renovated.
Therefore, major electronic components, the nurse call system
and the tube system, were in place when the decision was made
to open the unit as a permanent 15 bed inpatient med-surg floor,
so no renovation or retrofitting was necessary.
Equipment and Supplies:
15 new Hill Room beds and mattresses were ordered for this
unit at the cost of $185,652. . Additional equipment (i.e.
suction set ups, O2 flow meters, IV poles) was ordered and cost
is estimated at $45,000. Because the unit has housed patients on
a PRN basis, it has been fully stocked with patient care supplies
including items such as IV start kits, jelco’s, dressing change
supplies, IV tubing, fluids etc. The supply costs YTD for this
unit have been $17, 614.
Personnel:

2. This unit is currently staffed with float pool staff (RN’s and NT
II). As float staff, they are paid an accelerated rate of pay.
Fiscal year to date since the opening of the unit on January 14,
2014, the unit has spent $98,600.00 in total salaries. YTD
Patient days for this unit have been 278.
In mid April, the decision was made to open the unit with a full
complement of staff and transition the unit from an overflow
unit to a fully staffed medical-surgical Unit. Lexington Medical
Center is licensed for 414 beds. With the opening of the
8th North Tower, the facility will be utilizing 413 beds. There
are 30 rooms available on 8th NT, and the assumption is that as
the county grows and DHEC re-evaluates the needs, the hospital
will eventually be given the certificate of need to fill those
additional rooms that for now will continue to serve as
classrooms for competencies, CPR, ACLS classes etc.
The following is an outline for the approved FTE budget for
this unit. (* entry level wage information is used for the staff
and the midpoint salary range for the Nurse Manager. These
figures do not include any differentials – shift, weekend,
certification, degree, etc.)
Role
FTE
Estimated Budget
Nurse Manager
1.0
88,088.00
Clinical Coordinators
2.7
113,55.52
Care Manager
1.0
42,057.60

3. Clinical Mentor
1.0
42,057.60
Registered Nurses
6.5
260,395.20
NT II
3.6
65,819.50
Clearly, the projected budget for opening the floor permanently
is far more costly than the PRN budget. However, having the
additional 15 beds for use at all times falls directly in line with
the mission of the facility to provide healthcare services to meet
the needs of our community, and the vision which is the
delivery of accessible and affordable care that improves the
health of the community (Lexington Medical Center Nursing
Strategic Plan, 2007).
Projected Staffing Plan
This staffing plan is based on the following assumption of an
average daily census which was generated based on the YTD
average daily census for the PRN overflow unit:
Day
Census
Annual Patient Days
Sunday
6

4. Monday
12
Tuesday
12
Wednesday
12
Thursday
12
Friday
11
Saturday
6
Total
71
71X52 = 3692
Budgeted Hours/Patient Day (Paid)
8.8X3692=32489.6/2080=15.62 [16]
Worked Hours/Patient Day (Worked)
8.3x3642=3064.36/2080=14.73
FTE Budget:
Nurse Manager: 1.0
Clinical Coordinators: 2.7
Care Manager: 1.0
Clinical Mentor: 1.0
RN: 6.5
NT II: 3.6

5. Total Requested FTE’s:16.00
References
Lexington Medical Center Nursing Strategic Plan (2007).
Retrieved April 23, 2014, from www.lexmed.com
Sullivan, E. J. (2013). Effective leadership and management in
nursing (8th ed.). Upper Saddle River: Pearson
EXAMPLE 2
Budgeting for a change project can be a daunting task. Many
times changes must be implemented after yearly budgets are
already completed and unexpected costs such as a major
practice change can significantly impact budget variances.
Change however, is a necessary part of health care therefore
nurse managers need to be prepared to be creative with costs
and provide explanation when budgetary variances exist. A
nurse manager with a good understanding of budgets may find
innovative ways to fund practice changes without causing
extreme budget variances.
One important element for managers to consider during the
budget year is utilizing all monies available in the budget. If
monies are left over from the previous year often these funds
may be considered not necessary and cut from future budgets
reducing the manager’s available monies (Sullivan, 2013). This
concept is how we will attempt to offset some of the costs we
will incur with the mother-baby change project. We have a
distinct advantage in that the nursing unit that will be utilized
for mother-baby is already operating as the postpartum unit so
only minor physical and technological modifications are
anticipated. Nurse and patient care technician training are
anticipated to be the majority of costs and time related to the
mother-baby change project. Another advantage we may have is
that currently the postpartum unit and nursery are separate cost
centers with separate budgets; with some coordination and

6. collaboration some project costs may be able to be divided
between the cost centers to avoid large variances (Sullivan,
2013).
Reallocation of funds from the reusable surgical supplies
budget, since we are not anticipating any major purchases with
these funds this fiscal year, may be one source of funding to
offset other equipment purchases needed for the mother-baby
unit. Redistribution instead of purchasing of supplies and
computer application licenses will allow us to further neutralize
costs during implementation. Sharing costs across cost centers
can help utilize budget funds as well as avoid large variances
for one cost center. Using reallocation, redistribution, and
sharing cost centers we can hopefully significantly reduce or
level costs incurred by this change project.
When planning this change there will be a concerted effort to
minimize costs as limited budgetary funds existed for use.
Examples of costs neutrality will be the redistribution of patient
supplies, surgical supplies, and computer application licenses.
To defer supply costs we examined current supply levels in the
traditional nursery and plan for reduction of these levels since
fewer infants will receive care here and will shift the difference
to the mother-baby unit supply levels. In addition, we will use
the same plan with computer application licensing, since
additional licenses cannot be purchased for this project due to
cost, licenses will be shifted from the traditional nursery to the
new mother-baby unit where the volume of care providers and
computer use will increase significantly. Surgical supplies will
be handled in the same manner; few circumcisions will now be
performed in the traditional nursery so the majority of surgical
supplies will be relocated to the new mother-baby unit’s
procedure room. An example of cost sharing may be each unit
ordering one scale rather than one unit incurring costs for two.
Out sister unit, labor and delivery has offered to utilize some of
their budget dollars and will also order an additional scale.
Training care provider staff to include RN’s, LPN’s, and PCT’s
will be the largest expense for this project and will likely create

7. an unavoidable variance in the salary budgets for this year. This
project however will be easily explained by the nurse managers
and service line director. Orientation is an entitlement for all
nurses and as such should be carefully planned (McConnell,
2004). Additionally the American Nurses Associations Guide to
the Code of Ethics for Nurses Provision 4 clearly indicates that
nurses must be minimally competent to provide care and must
be provided or obtain the necessary education to meet this
ethical standard. With this in mind the Family Centered Care
committee that has been formed to develop the details of the
change process has suggested the following plan for training
and orientation of current staff. Staff training will consist of 4
didactic classes (8 hours each in length) and 9 shifts (12 hours)
of patient care orientation for RN’s and LPN’s, and 1 didactic
class (8 hours) and 6 shifts (12 hours) of patient care
orientation for PCT’s. In addition to this multiple skills fairs
will be held for competency verification for all staff that is drop
in and should not last longer than 2-3 hours per staff member.
While nursing leadership has demonstrated support of the
change project they have declined use of agency or travelers to
facilitate the education of staff therefore the units will have to
accommodate this education and orientation without additional
nursing man power. Per Diem staff will be utilized as possible
but insufficient numbers of per diem staff exist to adequately
meet all staffing needs during this transition. Conducting this
education plan will be challenging without additional staff to
provide coverage during the education classes, skills fairs, and
orientation which may result in reduced staffing numbers on the
unit or impede training progress. Target date for completion has
been set at 6 months.
A sample budget estimate is as follows:
Non-Salary Budgetary Items
• Patient Care Supplies
$0 (offset)
• Computer Terminals (10)

8. • Printers (1)
$3,000.00
$200.00
• Ophthalmoscopes (23)
$4,140.00
• Scales (3)
$15,000.00
• Computer Application Licenses
$0 (offset)
• Surgical Equipment
$0 (offset)
• Minor construction (chart racks)
$1200.00
Total Non-Salary estimates:
$24,340.00
Salaries
• Nurse Training (64 RN’s, 4 LPN’s)
$286,000.00
• PCT Training (19 PCT’s)
$ 14,250.00
• Committee Meeting Salary Expense
$1,000.00 weekly (2hr. weekly meeting x 8)
Total Salary estimates:
$308, 250.00
It is clear from this estimate that the largest impact to the
budget will be salary dollars. To implement a project of this
magnitude however costs must be incurred. This change project
however is absolutely in line with the overall vision and goals
of the service line and organization. Perhaps the biggest
challenge that the nurse managers will face will be maintaining

9. staff to ensure quality patient care while ensuring staff
completes education and orientation. Past projects in our
organization have demonstrated that staff will resist change
simply by avoiding education or training; many nurses think if
they avoid education they will not be forced to make changes.
Staying on track and completing this plan will be a monumental
task for the nurse managers and staff involved. If the nurse
managers can embraces a change model such as Roger’s theory
of innovation they could utilize the innovators or early adopters
within the nursing ranks to help facilitate the transition and
moderate the resistance (Schmidt & Brown, 2012).
References
McConnell, C. R. (2004). Managing employee performance. The
Health Care Manager, 23(3), 273-283. Retrieved from
www.aspenpublishers.com
Schmidt, N. A., & Brown, J. M. (Eds.). (2012). Evidence-based
practice for nurses: Appraisal and application of research (2nd
ed.). Sudbury, MA: Jones & Bartlett Learning.
Sullivan, E. J. (2013). Effective leadership and management in
nursing (8th ed.). Upper Saddle River, NJ: Pearson.
EXAMPLE 3
The majority of change projects implemented at a
healthcare facility require a budget in order for the change to
take place. Budgets provide a basis for managing and
evaluating financial performance by detailing how resources
will be acquired and used during a specific period of time. The
budgeting process helps to ensure that the needed resources are
available for the change to take place (Sullivan, 2013).
Court Manor’s mission is to provide quality care to the
residents. In order to do this, the facility realizes that change is
important, and it embraces new technology. The management at
Court Manor has the vision to see that implementation of new
technology is vital to the growth of the organization and the
continued effort of giving quality care to its residents. My
change project requires a limited budget due to the fact that it

10. does not require implementing electronic charting. It only deals
with eliminating the duplicate paper charts that have been
maintained at Court Manor since the implementation of
electronic charting four years ago. In order to switch entirely
over to electronic charting, extra training using our current
computer software will need to be provided for all staff nurses.
The therapy departments already use all electronic charting and
will not be included in this change project. Currently the
physicians only visit the facility once per month for half a day.
At this time, our facility does not have physician order entry
capability. Therefore, it is more cost effective to continue with
the current procedure of a nurse manager rounding with the
physician and entering the physician’s orders for him or her.
Extra laptops will have to be purchased. The medical records
employee will have extra hours for disassembly of the paper
charts and the cost of disposal for the old records will also need
to be budgeted for. I did not include the cost of electricity or
heating/air conditioning for the facility since these costs are
incurred whether training is occurring or not.
Purchase of 4 laptops (one extra for each nursing station)
4 x $750.00 = $3,000.00
Nursing staff training – estimated at four hours or less per
nurse.
19 total staff nurses x $22.00 (average salary per hour) x 4
hours = $1,672.00
One nurse manager will need to conduct the training sessions
and oversee the entire project. There will be five training
sessions at four hours each for a total of 20 hours. Each
training session will require a half an hour to set up the
conference room and a half an hour to clean up the conference
room after the session for a total of five hours. Another eight
additional hours have been added in for training of the nurse
manager and preparation for the training sessions. (20 + 5 + 8 =
33 hours)

11. 1 x 33 hours x $29.00 per hour = $957.00
Time for one medical records employee to disassemble paper
charts.
70 patient charts to be disassembled x 0.25 hours = 17.5 hours
1 x 17.5 hours x $16.00 per hour = $280.00
3 large shredder containers at $140.00 each for destruction of
paper charts.
3 x $140.00 = $420.00
Description
Total Amount
4 laptops
$3,000.00
Training for 19 staff nurses
$1,672.00
Nurse Manager’s time
$957.00
Medical records employee time
$280.00
3 large shredder containers
$420.00
TOTAL BUDGET FOR CHANGE PROJECT
$6,329.00
The total budget for the change project is $6,329.00.
After checking with the Director of Nursing and the
Administrator of Court Manor, it was determined that there are
monetary resources available to support this project. Both the
Director of Nursing and Administrator agreed that keeping
paper charts in addition to the electronic charting is a
duplication of work by the nursing staff. It was felt that the
facility would benefit by eliminating the paper charts at this
time.

12. Reference
Sullivan, E. J. (2013). Effective leadership and management in
nursing. (8th ed.). Upper Saddle River, NJ: Pearson Prentice
Hall
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4
NURS 4020: Leadership Competencies in Nursing and
Healthcare Practicum
Practicum Change Project
Practicum Objectives
· Differentiate between leadership and management
· Analyze the impact of leadership and management on
implementing change in the health care environment
· Identify a practicum change project that focuses on a quality
and safety issue
· Evaluate a change theory to use as a framework for your
practicum change project
· Describe your setting's mission, vision, and values in relation
to its strategic plan
· Analyze collaborative and communication strategies used by
multidisciplinary teams.
· Select an effective communication strategy for implementing
the practicum change project

13. · Evaluate the impact of the practicum change project on
available organizational resources
· Examine the quality and safety issues associated with the
practicum change project
· Justify evaluation strategies for the practicum change project
· Critique practicum change projects
Discussion Requirements
Post your responses to the Discussion based on the course
requirements. Your initial postings must be 250–350 words (not
including the full references). Keep your responses succinct.
Your written assignments must follow APA guidelines. Be sure
to support your work with specific citations from this week's
Learning Resources. Other scholarly sources may also be
used to support your work. Refer to the APA Publication
Manual to ensure that your in-text citations and reference list
are correct.
Post your response by Day 4 of this week. Respond by Day 7 to
at least two of your colleagues' postings in one or more of the
following ways:
· Ask a probing question.
· Expand on the colleague's posting.
· Offer polite disagreement or critique, supported with
evidence.
In addition to, but not in place of, the above you may:
· Offer and support an opinion.
· Validate an idea with your own experience.
· Make a suggestion or comment which guides or facilitates the
Discussion.
Support your response with references from the professional
nursing literature.

14. Week 1: Practicum Change Project
Team Discussion
Identify a Change Project
This week introduced the concepts of leadership and leadership
theories. In addition, the media presentation and textbook
readings discussed the difference between leadership and
management. As you begin your practicum this week discuss
with your manager possible change projects that focus on a
quality and safety issue that are needed in the agency. Observe
your manager and other leaders at your location. Identify how
management and leadership activities contribute to successful
change initiatives. Informally discuss options with your
manager.
Please address the following:
· What did you see as the difference between leadership
activities and management activities?
· How do management and leadership activities contribute to the
success of change initiatives?
· What change projects are needed in your agency at this time?
· Which of these projects will you select for your practicum
change project?
Week 2: Practicum Change Project
Team Discussion
Apply Change Theory to the Proposed Change
In week one, you formulated some initial ideas about a
Practicum Change Project. You discussed possible change
projects with your manager and identified a project for your
practicum.

15. This week has presented information on change, change
management, and how an organization's mission, vision, and
values are reflected in its strategic plan. Using the information
presented in the resources, complete the following two activities
with the guidance of your instructor.
Your instructor has assigned you to apply change theory to the
proposed change. Check for consistency between the proposed
change and the mission/vision/values/strategic plan for the
agency. Read more about change theory in your textbook.
Please address the following:
· Which change theory will you use as a framework for your
change project and why?
· Is there consistency between the proposed change and the
mission, vision, and values of the agency?
· If so, describe.
· If not, how will you address the inconsistencies?
Week 3: Practicum Change Project
Team Discussion
Collaborative and Communication Strategies
You are now in the third week of working on the Practicum
Change Project. So far, you have refined your change project
and chosen a change theory to organize your approach to the
project.
Now, let's begin work on week 3 of the Practicum Change
Project!
This week your instructor has assigned you to seek input on the
possible change from stakeholders, attend a multidisciplinary
team meeting, and interview a leader from another clinical
discipline.
Part I: Observation
Attend a multidisciplinary team meeting. Observe the
communication skills used by the team leader and the group
process. Consider the following questions as you observe the

16. meeting:
· Who served as the team leader? What leadership style did you
observe?
· How well did the team work together?
· Was there group conflict? If so, how was it resolved?
· Were there any outcomes from the group meeting?
· Did you see evidence-based care or decisions during your
observation?
· How was nursing involved in the multidisciplinary group?
Part II: Interview
Interview a leader at least one level above your current or
immediate past position from another clinical discipline
(pharmacy, respiratory, case management, social work,
medicine—not nursing). Ask the following questions:
· How would you describe your leadership style?
· What communication skills do you use?
· What conflicts have you had to manage in the last 3 months?
· What techniques and strategies do you use to work together to
promote multidisciplinary teamwork?
Part III: Discussion
Identify ways in which you collaborated with other
professionals regarding your activities.
· Think about the stakeholders impacted by the change. How
can the change theory you have chosen influence the success of
a change project?
· How can the multidisciplinary team of leaders impact the
change project?
· What is the best way to communicate the change within the
agency?
Week 4: Practicum Change ProjectTeam Discussion
Manage Resourcesfor Practicum Change Project
You are now half-way through the course. Thanks for all of
your hard work on your project thus far!

17. Now, let's begin work on week 4 of the Practicum Change
Project!
This week your instructor has assigned you to evaluate
resources and develop a budget to fund the Practicum Change
Project. Determine if the resources are available for the project
(i.e., salaries, supplies, equipment, technology, and
education)and develop and present the budget in the practicum
discussion area.
Week 5: Practicum Change Project
Team Discussion
Post your responses to the Discussion based on the course
requirements. Your initial postings must be 250–350 words (not
including the full references). Keep your responses succinct.
Your written assignments must follow APA guidelines. Be sure
to support your work with specific citations from this week's
Learning Resources. Other scholarly sources may also be
used to support your work. Refer to the APA Publication
Manual to ensure that your in-text citations and reference list
are correct.
Address Quality and Safety Issues
You have accomplished a lot in the past four weeks. Just two
weeks to go.
Now, let's begin week 5 of the Practicum Change Project!
This week your instructor wants you to identify one quality or
safety issue in your setting that will be addressed by the
Practicum Change Project.
Please address the following:
· What data did you use to identify the quality or safety issue?
· How will the Practicum Change Project address the quality
and safety issue?

18. Week 6: Practicum Change Project
Team Discussion
PowerPoint Presentation
Please submit your PracticumPopulation Project PowerPoint to
the Week 6 Assignment submission link below as well as to
your Group Week 6 Discussion 2 area.
Present Practicum Change Project
Congratulations! You are now in week 6. This is our last week
of the team discussion board.
This week your instructor has assigned you to create and post a
PowerPoint presentation that summarizes your Practicum
Change Project. Post your PowerPoint presentation by Day 4of
this week. (See Rubric in Course Info).
In this Discussion, post the Practicum Change Project you
developed.
In addition and based on your experiences, observations, and
readings, compose a Discussion post that responds to the
following:
· Review all of your team members' presentations in your group
and provide feedback on the proposed change project including
feedback on the proposed evaluation strategies.