Term Paper Budget Final
Term Paper Budget Final
Term Paper Budget Final
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A Term Paper
Presented to
Graduate School
In Partial Fulfillment
by
Doha, Qatar
This term paper is made possible through the help and support from everyone,
including: parents, family, friends, head nurses and charge nurses of Rumailah
First and foremost, to God, who give me life and wisdom in doing this paper.
Second, I would like to thank My Hubby Philip for the moral and financial support
To my RJ, Yuri and Myles who are my inspirations to those days and nights while I’m
I would like to thank Ms. Sherlin Alexander, HN MU2 for her most support and
encouragement and Mr. Christian Puruganan, Staff Nurse MU2 for reading my paper
and offered invaluable detailed advices on grammar, organization, and the theme of
the paper.
Finally, I sincerely thank to my Mom Tita Untalasco, who taking care my kids while
To my dad “Domeng” (deceased), who inspire me and keep challenge me his words
To my two siblings Teddy and Dante, who always they’re pampering me to study and
earn,
The product of this Term paper would not be possible without all of them.
types and budgets within the healthcare organization: operating, capital expenditure,
and cash. The operating budget is the main budget the nurse manager/leader
and supply costs. Collaboration with the nursing staff on the unit as well as other
parties involved with the budget process helps create a powerful tool in controlling
the day-to-day operations of the unit and providing quality care to the
patients. Preparation is the key to a successful budget and to the success of the
organization.
Contents PAGE
Acknowledgement 1
Abstract 2
Table of Contents 3
Introduction 4
Research Question 5
Hypothesis 5
Definition of Terms 6
15
Operating Budgets for a Nursing Unit
18
Capital Budgeting for a Nursing Unit
Conclusion 18
References 20
Budgeting is a delegate task of Nurse Managers. They have the accountability and
responsibility to the nursing budget. Without a budget, each department may operate
objectives. This lack of coordination results in inefficiency and increasing cost. The
operating budget becomes the master plan of action for the entire organization,
reflecting the coordinated efforts of all levels of management. This helps the
organization to operate smoothly and efficiently so that goals and objectives are met.
The enlightened nurse manager knows that whoever controls the budget is in control
of the department. 1
Budgeting is inextricably linked with patient care as its affects the degree of clinical
quality of services.
units of Rumailah Hospital, Doha Qatar” discusses about the role of nurse managers
in financial management and budgeting in the unit. This explores the perception and
Nurse managers oversee all fiscal aspects of their unit. Nurse managers ensure that
expenses stay within the unit’s budget. Expenses may include staffing costs ,
Doyle,G ; Williamson,P
2
ensure the delivery of high quality of patient care, improved patient safety, increasing
productivity of staff nurses and job satisfaction as the resources and financial aspect
Research Question
Since this study sought to explore significant relationships between nurse manager
knowledge and budgeting from the selected units of Rumailah Hospital, this study
budgeting.
Hypothesis
budgeting.
The purpose of this study is to explore and understand the relationship between the
Nurse managers knowledge in budgeting. In particular, nurse managers use budgets
to monitor personnel and supply costs. It is important that nurse managers are
familiar with the different types of budgets, specifically the operating budget, because
it is the nurse manager who is closest to the patient and knows exactly what is
I would have liked to evaluate the relationship between nurse manager’s knowledge
and budgeting. The result of such study could assist nursing administrators in order
education about budgeting. Primary data collection on Head Nurses, Charge Nurses
and Shift-In Charges working in Rumailah Hospital such as Stroke Unit, Female
Rehabilitation Unit (FGRU), Male Unit 1, Male 2, FGRU, and Stroke Unit thru
interview.
Definition of Terms
Budget - a plan, roadmap, or a tool used by managers to ensure that quality and
Annual Budget - a written plan for the organization and the department plan that
balances or schedules expenses to income. Budgets are created annually prior to the
Danna, Denise DNS, RN, NEA-BC, FACHE
3
equipment used on a rehab unit or manuals used for restorative nursing programs.
Expenses - the cost of providing services to patients. They are frequently called
overhead. It includes wages and salaries, fringe benefits, supplies, food service,
Fiscal Year: The 12 month period between settlements of financial accounts. Many
organizations use the calendar year (Jan-Dec); but others use July 1 to June 30; and
others use October 1-September 30th. It is important for you to know your
Fixed Costs – are expenses that occur regardless of census or resident acuity. Costs
that are basically fixed may related to utility charges; insurance fees, building
Indirect Costs – are expenses not associated with a specific program or service such
personnel, and supplies, typically over a one-year period. It is also referred as master
Operating Expenses – are expenses that relate directly to the provision of care and
services such as: salaries, benefits, supplies, food, medications, therapists, etc.
McConnell, Charles R.
4
McConnell, Charles R.
5
generally the items that the DON has responsibility to monitor and contain7”.
Personnel budget is the salary/manpower budget for a particular unit or cost center.
Besides salaries it includes compensation for vacation, sick leave, holidays, overtime
Program Budget- is estimated revenue and expenses for a specific program such as
other sources, appropriated to the payment of the public expenses. For a nursing
unit, the revenues will be projected from patient days, average daily census, or
procedures. The amount of money derived from resident care and non- operational
Zero- Based Budgeting - Reconstructing the budget each year rather than building on
the same budget from previous year. A budgeting process that requires managers to
Alexander, Shirlen, HN MU2
7
Qatar is one of the fastest growing economies in the Middle East. Rumailah Hospital
that provides free medical health services to both expatriates and locals. However,
account for as much as half of hospital total expenses, there will be significant
pressure upon this department to increase efficiency and effectiveness. For nursing
to respond to the pressures and the uncertainty of the economic climate, nurse
managers at all levels must become proficient in the budgeting process. Declining
outcomes are making finance a language requirement for every future nurse
manager. If nurse leaders want to continue to have a seat at the strategic table and
remain influential advocate’s in future healthcare decisions, they must become fluent
As quoted by Ms. Jasmin Cherian, DON RH “I will ensure that my staff have the
necessary tools to provide care and support to our clients on a daily basis.”9
Years ago staff nurses were promoted to management positions based on clinical
adequately skilled to address the array of interpersonal issues and complex, ever-
8
Muller, Rick PhD; Karsten, Margo PhD, MSN, RN
RWJF
10
reduce costs by monitoring the consumption of supplies and utilization of man power”
according to Eloy Buergo, Shift in Charge, MU211. Nurses can help make a difference
in their unit budgets by not overstaffing their unit when they are in charge, avoiding
excessive use of unscheduled leave that could require overtime, and monitoring the
use of supplies12. “Most nurses do not enter the clinical field with a great desire to be
Unfortunately, the dynamics of the health care world require that all nurses, and
accounting principles especially Head Nurses and Charge Nurses who acts as head
nurses during the absence of Head Nurse of units.” As quoted by Allan Batac, CN 13.
Nursing managers are uniquely positioned to contribute to this portion of the cost-
A study was done in Cape South African reflecting the perception of South African
cost containment issues in selected public hospitals in the Port Elizabeth metropole
of the Eastern Cape were investigated. Results indicated that nurse managers
required better preparation for their cost control responsibilities. Although the majority
of the nurse managers realized that staffing issues affected cost containment efforts,
they were reportedly unable to prevent nurses from leaving their points of duty
without due authorization, curb the rate of absenteeism or reduce the number of
Buergo, Eloy, BSN, RN Staff Nurse/Shift-in- Charge
11
from effective security checks to curb losses of stock and equipment, including
Rationalization of staff and specialized services among the four major hospitals could
further enhance cost containment efforts14. Budgets and budgeting can be defined in
budget will provide you with a costing for both income and expenditure15.
A budget is a financial plan that outlines the resources an entity foresees using for a
particular time period. The master budget encompasses all the departmental
budgets. Based on the organization's strategic goals and vision, the master budget is
the actual statement of projected revenues and expenditures for the entire hospital.
assessment that looks at trends in healthcare and in the hospital as well as its
competition. Once such assessments are made, the hospital's goals and objectives
are evaluated to determine whether any changes must be made. If changes must be
made, the unit's goals are set based on the prior year's performance, trends in the
service (UOS), and revenue for the unit—are put together and distributed to
Ntlabezo ET, Ehlers UV, Booyens US.
14
NHS
15
basic business skills is essential. “No longer are nurse managers expected to be
clinical experts but, instead, must be equipped and skillful in "running their business."
thing that probably comes to mind is the budget or the finances, but business skills
include so much more. Business skills frequently include human resources, strategic
planning, and systems thinking, to name a few.” 18 There are three categories identify
several of the business skills that are essential for nurse managers as mentioned by
the head nurses of Rumailah Hospital that have been interviewed these are financial
Building Budget
16
American Nurses Association (ANA) and the Institute of Medicine (IOM). The 2010
IOM report suggests that RNs have a responsibility to become active participants in
utilization” suggests that all RNs need to identify consumer care needs, the potential
for harm, the complexity of the task, and the desired outcome when evaluating
resource allocations. The first step to accomplish this goal is for nurses to understand
plan to educate yourself and your direct reports and be able to develop a basic unit
and recognize the different line items and categories that are included in the budget.
organization. Learn how to monitor and analyze budget variances and be able to
Muller, Rick PhD; Karsten, Margo PhD, MSN, RN
19
“When nurses become more engaged with finance and more involved in
management, they bring about a significant difference to the quality of patient care”
This is the common response of Head Nurses from the selected unit of Rumailah
Hospital regarding the financial management in preparing unit budget. They consider
to include assess factors related to workload, staffing, and labor costs before
negotiating between the nurse manager and Director of Nursing (DON), as well as
any other departments, occur. Once the DON approves the budget, it will be present
it to the administration and the Finance Officer from Finance Department. The
Finance Officer will likely have questions the manager needs to address. Following
the meeting with administration and the Finance Department, nurse manager must
represent or appeal the budget, this is the time to do so. The budget is then
The Nurse Managers are the responsible for managing the activities of the unit;
therefore, nurse managers must know what they have control over. Typically, Nurse
Managers control most of the activities on the unit that contribute to the budget. Such
activities include staffing, skill mix, education, staff meetings, and orientation length.
At the end of each month, Nurse Managers must justify to DON’s any discrepancies
in the numbers you budgeted. Internal accounting reports are usually given to
14
Student Name : Ruby Untalasco Gealan
Student Number : 20122924
Subject Title : Nursing Administration
Professor: Professor Jerry V. Manlapaz
Module No. : TERMPAPER
managers. Such reports show the difference between the expected performance
planned in the budget and the actual results. The responsibilities of Nurse Managers
are controllable expenses such as staffing and supplies and uncontrollable expenses
such as patients' acuity levels and unit activity levels and Types of benefits.20
The unit level budgets are expenses are monitored via productivity or hours per
patient per day (HPPD). This, in turn, is based on acuity levels, census, staffing
levels, and length of stay. The nursing staff directly affects the unit’s expenses. The
misuse of sick time, excessive overtime, lateness, and waste greatly influence
expense.21
According to the Head Nurses, there are five factors, which affect an operating
budget these are the environment, objectives, policies, and assumptions, long-range
budget, program budgets and budgets from other units. Operating budget
There are 3 main sections: Personnel budget, Supply and equipment budget and
hospital—is staff salaries. In fact, salaries often account for up to 75% of department
and hospital budgets. The personnel budget determines how much staff is needed to
operate the unit 24 hours a day, 365 days a year.22 The personnel budget projects
the salary costs that will be paid and charged to the cost center. It accounts for
Building a Budget
20
Building a Budget
22
hours, bonuses and premiums, and salary increases23. The personnel budget
includes actual worked time (Productive time), and time the organization pays the
the cost of benefits, new employee orientation, employee turnover, sick and holiday
One of the central responsibilities of the nurse manager on a clinical unit is to provide
the appropriate number and mix of nursing staff (nursing care hours [NCH]) to match
actual or projected patient care needs (patient care hours) that will result in safe,
effective, quality care for the patients on the unit. While the nurse manager may plan,
organize, staff, direct, and control—doing a multitude of things simultaneously all day
long—the purpose of a great deal of this activity is to ensure that this responsibility
will be carried out. Appropriate staffing has become even more critical as the focus
staffing pattern, a nurse manager must determine how many hours of nursing care
are required, based upon available patient classification system information. Once
the hours of required nursing care are determined, the number of full-time
per week, 80 hours per two-week pay period, or 2,080 hours per year. There are
several methods to determine required FTEs once a desirable staffing pattern has
been established25.
Budgeting and Resource Allocation
23
the cost of electricity, repairs and maintenance, and medical/surgical supplies (as
dealt with under material management. Supplies are those items that are used up or
consumed; hence the term consumable is used for supplies. The supplies in hospital
food materials, stationeries, the linen supply etc. The term equipment is used for
more permanent type of article and may be classified as fixed and movables. Fixed
equipment is not a structure of the building, but it is attached to the walls or floors
(egg; steriliser,) Movable equipment includes furniture, instruments etc27. The nurse
manager will assess supplies to look at competitive options for products. Look at
stock levels which currently available, rather than ‘topping up’ with each supply order,
discuss with other members of staff to determine what is needed and the amount
which is required. This will ensure that stocks are not wasted and misused28.
calculate revenue for r unit budget, especially if it are in an inpatient setting. Nurse
Manager should, however, understand the association of revenue with nursing care,
but the finance department controls the charges (i.e., room charges) made to the
patients on the unit. For nurse managers who run a unit with multiple levels of care
(i.e., medical-surgical and telemetry), the patient room charge is based on the level of
care the patient receives on your unit. The level of care is typically based on staffing
Ben Gaied, Habib, HN MU2
26
Capital budget is a plan for the acquisition of long-term investments. The key is the
expected life-time of the item purchased extends beyond the year of purchase.
purchasing equipment as call-light system, hospital beds etc30. All proposals for
Nurse Managers are being interviewed about Budget in the unit as part of the
explanations. This area of responsibility can have positive effect on strengthening the
management is better able to make modifications and corrections. Since the nursing
department budget can account for as much as half of hospitals total expenses, there
Building a Budget
29
Gavino, Francia, HN
30
Hartley, Patricia
31
economic climate, nurse managers at all levels must become proficient in the
budgeting process. The knowledge of Nurse Managers about budgeting and financial
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