Operational Budget for Yearly Nursing Department: Budget Categories and Projected Costs

A local Southern California hospital serving 5.5% of Los Angeles County’s population recently conducted a triennial Community Needs Assessment and some of the significant community health needs identified were: • Obesity/overweight • Diabetes • Cardiovascular disease • Hypertension • Cholesterol Hospital leadership identified an opportunity to better serve the community, particularly patients with chronic illnesses, and prevent medical readmissions. A private foundation was approached about funding a project to improve patient and family decision making about health issues and medical crises. The primary grant deliverable was to increase the number of patients completing advance care planning (over baseline). The ultimate goal was to reduce unnecessary readmissions for persons with chronic illness by leveraging 24-hour community support for them at home. The DNP on the team, who is a nurse practitioner (NP), is having success with the advance care planning conversations he is having with patients about their chronic conditions, goals for overall wellness, and how to manage a declining chronic disease trajectory. The patients and families are responsive and express gratitude that someone is talking with them about quality of life. However, he is worried that he may not be able to meet the grant deliverables. After the multiyear grant was awarded, some unanticipated issues arose during the project execution phase, including turnover of key hospital personnel who were grant team members, delays in onboarding additional NPs, difficulty obtaining patient-level and aggregate data from the hospital’s data systems, conflict over patient care goals between attending physicians and the project medical staff, and lack of willing/able 24-hour response community resources, such as home health agencies that will respond to the patient’s home rather than an on call phone triage service. The first-year grant report is due in a few months, and the DNP is unable to tell if efforts have been successful in reducing readmissions; he is concerned about the resistance of the medical staff and lack of 24-hour response community resources. He cannot do it all! He makes an appointment to discuss this with the grant Project Manager (PM) and hospital Administrator, who is the project’s executive sponsor. Consider the above scenario, as a DNP able to assess organizational priorities, how would you go about prioritizing the hospital goals based on findings from Hospital Compare on CMS.gov. Prepare a brief proposal or organize an infographic using charts, graphs or tables with a brief summary for a proposal to improve a targeted outcome and estimate the costs involved and a hypothetical return on investment. Use data from peer reviewed literature citing Evidence Base Practices. APA 7th Ed Reference sources 6-7 within the last 3 to 5 years only

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