Set 2 Questions
Variances Reporting
Nurse leaders must have a thorough understanding of variance reporting because these reports provide information about the differences between an actual budget and a forecasted budget (Finkler, Jones & Krover, 2013). A nurse leader can use data gathered from these reports to better understand budgetary deficiencies, hence allowing him or her to develop more accurate budget forecasts in the future. Variance reports can also help a nurse leader identify the causes of variances. By recognizing the causes early on, nurse leaders can put appropriate actions in place to prevent further exacerbating existing variances. Nurse leaders can also use variance reports as a tool with which to gauge work center productivity.
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An activity report can provide operational statistics such as occupancy rate, average daily census, and average length of stay (Finkler, Jones & Krover, 2013). Though these numbers are important and have a great influence on the operational budget, a nurse leader needs more information in order to justify staffing. Nurse leaders can obtain additional information from workload reports. Patient classification system measure workload by assigning each patient a classification level based on his or her unique care needs and then determine the number of care hours required per patient per day. Many organizations express this in hours per patient day (HPPD) or relative value units (RVU) (Finkler et al., 2013). Workload reports are useful because they can identify changes in patient mix that can increase or decrease the need for nursing personnel. Bi-weekly fulltime equivalent (FTE) reports are also useful because they convey to nurse leaders exactly how many man-hours were used by each FTE (Liberty University, 2015). Furthermore, the report provides a breakdown of productive time; contract hours, paid time off (PTO), and overtime. It also accounts for nonproductive time such as time spent on education, training, and orientation (Liberty University, …show more content…
This system provides annual statics on Medicare payment amounts for institutional providers. A nurse leader can use HCRIS to find other similar institutions with whom to compare reimbursement rates and use this information to make necessary adjustments (“Healthcare Cost Report”, 2016). Lastly, nurse leaders can also use cost-to-charge ratios, volume-based measures, per diem rates, and balanced scorecards to gain better insight of unit reimbursement (Liberty University,
With the passage of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) has initiated reimbursement based off of patient satisfaction scores (Murphy, 2014). In fact, “CMS plans to base 30% of hospitals ' scores under the value-based purchasing initiative on patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems survey, or HCAHPS, which measures patient satisfaction” (Daly, 2011, p. 30). Consequently, a hospital’s HCAHPS score could influence 1% of a Medicare’s hospital reimbursement, which could cost between $500,000 and $850,000, depending on the organization (Murphy, 2014).
The real world business situation I presented in the task 1 of this paper is as follows: I addressed a concern that a hospital would have by collecting and analyzing a set of data, specifically that of the hospital staff and the patient safety interaction. This situation which is relevant to a Hospital business that I will continue to answer in this paper by collecting and analyzing a set of data is: Is there a relationship to the number of hours a Registered Nurse (RN) works and patient safety? RNs are the main caregivers to the patient. They continually monitor, provide medication, take vitals, and assess the overall health of each patient in their care. With such a demanding job and many job duties, a deeper look at how they perform under not only stress but fatigue will allow us to see what type of care they are able to provide to their patients. The data we collect will allow us to answer if patients are safe with an RN working prolonged hours.
The reason for the controversy of the Hospital Consumer Assessment of Healthcare Providers & Systems, referred to as HCAHPS (pronounced “H-caps”), is the tie that the Center for Medicare and Medicaid Services (CMS) placed between the scores of the assessment and healthcare reimbursement (Westbrook, Babakus, & Grant, 2014). There are two sides to consider when addressing HCAHPS/Press Ganey surveys as they directly affect hospital reimbursement. Patient satisfaction, quality of care, and how they portray their hospital stay contributes to the reimbursement that hospital receives. The nurse-patient relationship plays a large role in influencing the quality of care than patients feel that they are receiving.
Working in long-term care can be overwhelming. Imagine you are a new graduate nurse putting your new found knowledge and skills to practice for the first time. Your orientation lasted three days which is standard for nurse home orientation compared to hospital orientation that last approximately six to eight weeks for new grads. The shift has just begun and already you have a new admit, new found pressure ulcer to assess, a possible medication reaction, several new orders to take off and eight patients to document on for varying reasons. Feelings of frustration and confusion take over as you are the only nurse on the unit along with a Certified Medication Technician (CMT) and three Certified Nursing Assistants (CNAs) taking care of 47 patients. Ideal nurse-to-patient ratio continues to be a national issue in both the hospital and long-term care setting (LTC). In the LTC setting there is no official nurse-to-patient ratio; there is a suggested staff-to-patient ratio. This issue not only affects the new licensed nurses but the seasoned nurse as well. Recently, there has been controversial debates as to whether heavy workloads are detrimental to patients. The federal, state, and local government regulates many aspects of healthcare. However, it is the physicians, nurses and other healthcare professional that provide care directly to patients. Consequently, does insufficient staffing, heavy workloads, and unsupportive work environment directly contribute to poor patient satisfaction, nurse burnout, high turnover and job dissatisfaction?
The Centers for Medicare and Medicaid Services (CMS) have recently begun requiring hospitals to report to the public how they are doing on patient care. Brown, Donaldson and Storer Brown (2008) introduce and explain how facilities can use quartile dashboards to transform large amounts of data into easy to read and understandable tool to be used for reporting as well as to determine areas in need of improvement. By looking at a sample dashboard for an inpatient rehab unit a greater understanding of dashboards and their benefits can be seen. The sample dashboard includes four general areas, including nurse sensitive service line/unit specific indicators, general indicators, patient satisfaction survey indicators and NDNQI data. The overall performance was found to improve over time. There were areas with greater improvement such as length of stay, than others including RN care hours and pressure ulcers. The areas of pressure ulcers and falls did worse the final quarter and can be grouped under the general heading of patient centered nursing care. The area of patient satisfaction saw a steady improvement over the first three quarters only to report the worst numbers the final quarter. A facility then takes the data gathered and uses it to form nursing plan...
As defined by the American of Nurses Association (ANA, 2002), “Nursing-Sensitive Indicators are those indicators that capture care or its outcomes most affected by nursing care.” The ANA uses the National Database of Nursing Quality Indicators (NDNQI) to statistically test the relationships between nursing interventions, staffing levels, and positive patient outcomes (Nursing Quality - NDNQI, 2016). These indicators utilize unit specific data enabling action planning and intervention according to the unit if improvement is needed (Nursing Quality – NDNQI, 2016). The purpose of this paper is to show how Good Samaritan Medical Center’s 5th floor, pavilion 2, Medical Surgical/Oncology unit uses nurse sensitive indicators such as pain management,
Nurses are the largest and the most trusted professional group in the health care system. They are highly educated and skilled in their areas of practice. However, today’s nurses are experiencing an ever increasing workload, which negatively impacts their ability to deliver safe patient care (Berry & Curry, 2012). This paper explores four published journals that report on survey results on nursing workload and their direct correlation with patient care outcomes. The purpose of this paper is to address the ongoing nursing workload issues and explore the reasons behind it.
Medicare uses the Medicare Physician Fee Schedule to pay physicians and the Outpatient Prospective Payment System to pay hospitals and other outpatient facilities. Recently, the Centers for Medicaid and Medicare Services (CMS) made changes to physician and outpatient payments. The five levels clinic visit codes or five outpatient codes were replaced with a single code. “The Chronic Care Management Fee will go into effect in January 2014 and will be the new form of physician compensation. Bundle Payment is a way for paying for high volume, high cost hospital procedures. Global payment enables providers to reduce unnecessary care and bring down spending under control but creates incentives for providers to restrain the supply of services.
People are living longer and healthier lives now more than ever before. Much of this can be attributed to the advances in modern medicine over the past few decades. However, in healthcare, there is now a growing population of patients that are becoming sicker and more complex to care for. With the new generation of sick patients present in the hospitals, today’s nurses are stressed and fatigued more than ever before. Much of the stress and fatigue can be attributed to the nurse to patient ratio and the associated workload.
Frith, K. H., Anderson, E. F., Tseng, F., & Fong, E. A. (2012). Nurse staffing is an important
It is important for nurses to be well organized and if leaders are strong in organization, the team will be as well. “Nurse leaders at every level and position must develop organizational and management skills, whether they are managing human, fiscal, policy, time, material or other resources” (Canadian Nurse Association, 2008, p. 9). “Exerting good management skills is part of being a good leader – and leadership skills are necessary for good management” (Canadian Nurses Association, 2008, p. 9). When nurses are able to organize their time, they are able to assess their patients thoroughly. Following these assessments, nurses are able to organize and prioritize which patient is in most need of assistance or immediate attention. If a leader is not well organized themselves, patient care may be affected. Practical Nurses like any other nurses need to have strong organizational skills, especially, if a practical nurse is working on a demanding, fast paced unit. Patient’s health and well-being depends on their ability to manage information and multi-task. It is easy to become overwhelmed and make mistakes if a practical nurse lacks in good organizational skills. Being well organized is even more important when working short staffed. In this instance the practical nurse would have to be able to organize her patients in priority order and be able to divide her time accordingly to provide safe and competent
Nurse to patient ratios are extremely paramount in assisting with overall patient mortality and wellness of our nurses. It is an issues which unfortunately affected by legislation of our government (which is affect specifically on a monetary basis). My research via Academic Search Complete allowed me to identify topics that assist my PICOT question, and enables me to further analyze and research to find out what issues directly affect is matter. Proper nurse to patient ratio, operational costs, government regulation, nurse work life and health, patient wellness, and nursing procedures and duration of those procedures are all affected by this topic and we must ensure that all are properly balanced.
Hospitals recognized the need for the case management model in the mid 1980’s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007). In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals ...
Thousands of nurses throughout the nation are exhausted and overwhelmed due to their heavy workload. The administrators do not staff the units properly; therefore, they give each nurse more patients to care for to compensate for the lack of staff. There are several reasons to why
The leaders will follow staff nurses during report offering advice and providing guidance. (Ferris, 2013) Strong leadership and communication skills are essential in order to create an atmosphere of trust. Those qualities will also initiate change in the attitudes and behaviours of staff in a complex environment. (Evans, 2012) Binders will also be placed at each nursing station to allow the nurses to write down any concerns or feedback management may need to know about the process. Then, weekly management will review the feedback left in the binder and address with the nurses during staff