Week 6 Assignment: Project Planning and Preparation

Week 6 Assignment: Project Planning and Preparation

Week 6 Assignment: Project Planning and Preparation

Purpose

Project planning will be an important aspect of your role as a DNP-prepared nurse. The purpose of this assignment is to explore the project management process further as you prepare for your DNP project. This assignment extends the Week 2 and Week 4 assignments and any previous work you completed on your selected practice problem or for your DNP project planning.

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Instructions

Follow these guidelines when completing each component of this assignment. Contact your course faculty if you have questions.
Revise your week 4 Evidence Synthesis paper as instructed from your faculty feedback and track changes in your assignment.

Please note more information is required for this assignment below and some sections are different.

Use the most current version of Microsoft Word that is the format for all Chamberlain University College of Nursing found in student resources. The Document is labeled DNP and will end in “docx.”

All Chamberlain University policies related to plagiarism must be observed.

Review the rubric for the grading criteria.

The assignment includes the following components:

Introduction

Start your introduction with a powerful statement or two to stimulate interest.

Present the purpose of your proposed project. Begin your formal purpose statement by stating, “The purpose of the proposed (DNP) project is to…”

Provide a preview of what the paper will include with a strong thesis sentence outlining the paper’s content.

Assessment

Describe the practice problem at the national level. Support with data.

Describe the practice problem at the practicum site. Support with data if available.

Identify and describe the sources of data from the practicum site. For example, Incident reports, readmission rates, infection rates, etc.

Planning—Evidence Synthesis

Use the synthesis from the Week 4 assignment—be sure to accept track changes and update your Week 4 paper based on feedback provided by course faculty before adding to this paper.

Identify the evidence-based practice (EBP) intervention to address the practice problem.

Identify and discuss the main themes that emerge from the sources. (Cited)

Contrast main points in the evidence sources. (Cited)

Present an objective overarching synthesis of research evidence supporting the evidence-based intervention. (Cited)

Implementation

Briefly describe the DNP project evidence-based intervention.

Explain the rationale for why this intervention was chosen.

Identify the survey or data collection instrument, if using one, and why it was selected.

If not using a survey/ instrument/ tool, how will you be collecting data? For example, chart audits.

Describe your project implementation plan and include milestones.

Evaluation

Propose measurable outcomes for the project.

Describe how the outcomes will be evaluated.

Conclusion

Effectively summarize your project plans in one to two comprehensive paragraphs that clearly describe your project plans:

Briefly summarize the Practice Problem.

Summarize how you will implement the project.

Summarize how you will evaluate the project.

APA Standards and References

Uses appropriate Level I headers.

Creates the reference page in correct APA format.

In-text citations are required in every section if information is used from published work

Each reference has a matching citation and citations are in current APA style.

Writing Requirements (APA format)

Length: 5-7 pages (not including title page or references page)

1-inch margins

Double-spaced pages

12-point Times New Roman font or 11-point Arial

Headings & subheadings

In-text citations

Title page

References page

Standard English usage and mechanics

Program Competencies

This assignment enables the student to meet the following program competencies:

Integrates scientific underpinnings into everyday clinical practice. (POs 3, 5)

Uses analytic methods to translate critically appraised research and other evidence into clinical scholarship for innovative practice improvements. (POs 3, 5)
Appraises current information systems and technologies to improve healthcare. (POs 6, 7)

Analyzes healthcare policies to advocate for equitable healthcare and social justice to all populations and those at risk due to social determinants of health.

Leads others in professional identity, advanced clinical judgment, systems thinking, resilience, and accountability in selecting, implementing, and evaluating clinical care.

Course Outcomes

Examine the role of the DNP-prepared nurse in leading financial planning and management across healthcare settings. (PCs 5, 8; POs 2, 4, 9)

Develop strategies to lead project planning, implementation, management, and evaluation to promote high value healthcare. (PCs 1, 3, 4; POs 3, 5, 7)

Due Date

By 11:59 p.m. MT on Sunday

Late Assignment Policy applies

Rubric

Week 6 Assignment Grading Rubric

Week 6 Assignment Grading Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeIntroduction

Requirements:

1. Start your introduction with a powerful statement or two to stimulate interest.

2. Present the purpose of your proposed project. Begin your formal purpose statement by stating, “The purpose of the proposed (DNP) project is to…”

3. Provide a preview of what the paper will include with a strong thesis sentence.
30 pts

Includes all requirements and provides an in-depth introduction.

27 pts

Includes all requirements and provides a sufficient introduction.

24 pts

Includes 2 requirements and/or provides a partial introduction.

0 pts

Provides an undeveloped introduction.
30 pts
This criterion is linked to a Learning OutcomeAssessment of the Practice Problem

Requirements:

1. Describe the practice problem at the national level; support with data.

2. Describe the practice problem at the practicum site; support with data if available.

3. Identify and describe the sources of data from the practicum site. For example, Incident reports, readmission rates, etc.

40 pts

Includes all data requirements and provides an in-depth discussion in the assessment of the practice problem.

36 pts

Includes at least 2 requirements and/or provides a sufficient discussion in the assessment of the practice problem.

32 pts

Includes at least 1 requirements and/or provides a partial discussion in the assessment of the practice problem.

0 pts

Provides an undeveloped discussion in the assessment of the practice problem.
40 pts
This criterion is linked to a Learning OutcomePlanning- Evidence Synthesis

Requirements:

1. Use the synthesis from the Week 4 assignment—be sure to accept track changes and update your Week 4 paper based on feedback provided by course faculty before adding to this paper.

2. Identify the evidence-based practice (EBP) intervention to address the practice problem.

3. Identify and discuss the main points/salient themes that emerge from the sources (Cited)

4. Contrast main points in the evidence sources (Cited)

5. Present an objective overarching synthesis of research evidence supporting the evidence-based intervention. (Cited)

45 pts

Includes all requirements and provides an in-depth evidence synthesis supporting the evidence-based intervention. All requested revisions from the previous evidence synthesis assignment were completed.

41 pts

Includes at least 4 requirements and/or provides a sufficient evidence synthesis supporting the evidence-based intervention.

36 pts

Includes at least 3 requirements and/or provides a partial evidence synthesis supporting the evidence-based intervention.

0 pts

Provides an undeveloped evidence synthesis supporting the evidence-based Intervention.

45 pts

This criterion is linked to a Learning OutcomeImplementation

Requirements:

1. Briefly describe the DNP project evidence-based intervention.

2. Explain the rationale for why this intervention was chosen.

3. Identify the survey or data collection instrument, if using one, and why it was selected. (If not using a survey/ instrument/ tool, how will you be collecting data?)

4. Describe your project implementation plan and include milestones.

45 pts

Includes all requirements and provides an in-depth implementation plan with milestones.

41 pts

Includes at least 3 requirements and/or provides a sufficient implementation plan.

36 pts

Includes at least 2 requirements and/or provides a partial implementation plan.

0 pts

Provides an undeveloped implementation plan.
45 pts
This criterion is linked to a Learning OutcomeEvaluation

Requirements:

1. Propose measurable outcomes for the project.

2. Describe how the outcomes will be evaluated.

40 pts

Includes all requirements and provides an in-depth evaluation.

36 pts

Includes all requirements and provides a sufficient evaluation.

32 pts

Includes at least 1 requirement and/or provides a partial evaluation.

0 pts

Provides an undeveloped evaluation.

40 pts

This criterion is linked to a Learning OutcomeConclusion

Requirements:

1. Effectively summarize your project plans in one to two comprehensive paragraphs that clearly describe your project plans:

–Summarize how you will implement the project.

–Summarize how you will evaluate the project.
30 pts

Includes all requirements and provides an in-depth summary in the conclusion.

27 pts

Includes at least 2 requirements and/or provides a sufficient summary in the conclusion.

24 pts

Includes at least 1 requirement and/or provides a partial summary in the conclusion.

0 pts

Provides an undeveloped summary in the conclusion.
30 pts
This criterion is linked to a Learning OutcomeAPA Style and Standards

Requirements:

1. Uses appropriate Level I headers.

2. Create a reference page(s) with all references in current APA format.

3. Each reference has a matching citation and citations are in current APA style.

4. Paper length is 5-7 pages excluding title, reference pages, and appendix.

10 pts

Includes all requirements of APA style and standards.

9 pts

Includes 3 requirements of APA style and standards.

8 pts

Includes 2 requirements of APA style and standards

0 pts

Includes 1 requirement of APA style and standards.
10 pts
This criterion is linked to a Learning OutcomeClarity of Writing

Requirements:

1. Standard English grammar and sentence structure

2. No spelling or typographical errors

3. Organized presentation of ideas
10 pts

Includes all requirements of clarity of writing.

9 pts

Includes 2 requirements of clarity of writing.

8 pts

Includes 1 requirement of clarity of writing.

0 pts

Includes fewer than all requirements and/or demonstrates poor clarity of writing.
10 pts

Total Points: 250

Week 6 Lesson 1

Budget: Creating

Introduction

Budget planning for a nursing unit or ambulatory care clinic requires meeting the financial goals and objectives of the organization while ensuring patients receive high-quality care. The budgeting process is dynamic and requires ongoing monitoring and evaluation.

Budgeting Process Image Description

Collect relevant data

Plan services

Plan activities

Implement the plan

Monitor the budget

Take corrective action when necessary (Rundio, 2022)

Note. Adapted from The Nurse Manager’s Guide to Budgeting and Finance (3rd ed., p. 74), by A. Rundio, 2022. Sigma Theta Tau International. Copyright 2022 by Sigma Theta Tau International Honor Society of Nursing.

Operating Budget

An essential aspect of managing a nursing unit or ambulatory care clinic is creating an operating budget. The critical components of an operating budget are expenses and revenue. Operating budgets help nurse leaders administer the daily operations and track income and expenses. The budget aims to identify the expected workload volume (such as procedures, patient days, visits, births, operations, etc.) or units of service (UOS), human resource allocations (hours and FTEs), and define the direct and total hours worked per unit of service (Waxman & Knighten, 2023).

The operating budget is a one-year plan that is the best estimate of nursing revenues and nursing expenses. Healthcare facilities must make sufficient revenue to cover operating costs and generate a profit to put back into the business to improve the facility and services. For nursing units, the primary source of revenue is payment for nursing care services as part of the Room and Board or Room Care Charge. Revenue may be generated from Medicare and Medicaid, insurance companies, self-pay, or charity care.

Expenses are the cost of providing services to patients. Click through the following tabs to learn about different types of costs.

Expand AllPanels Collapse AllPanels

Direct Costs

Direct costs include any expense that can be directly attributed to a specific service. Direct costs include items under the direct control of the nurse leader and Include personnel wages and salaries, employee benefits, supplies, and medical supplies.

Indirect Costs

Indirect costs are expenses allocated for services necessary for the unit’s operation but are not under the leader’s direct control. Examples include utilities, maintenance, space, and administrative support that are commonly shared. Indirect cost allocation is commonly based on a formula.

Fixed Costs

Fixed costs are costs that do not change in total as volume changes. For a nursing unit, an example would be the minimum number of nurses needed to open the unit.

Variable costs

Variable costs are costs that vary in direct proportion with volume. For example, adding more nurses and support personnel as patient volume and acuity increase.

Learn More: Variable Costs

The budget is based on predicted volumes. An expense budget is based on the budgeted volume. The expense budget may be flexed to correspond to actual volume. The amount of money by which the budget would be flexed depends on the percentage of variable costs that apply to the unit.

Personnel Budget

The personnel budget is a key component of the operating budget. Staffing expenses generally are the largest portion of the nursing operating budget. Nurse leaders control this budget and need to clearly understand the financial concepts required to manage the personnel budget.

Personnel Budget for Nursing Units

Description
Amount/Calculation

Total bed capacity – Available beds

80

Projected occupancy
80%

Projected average daily census (ADC)

64

Projected annual patient days

23,360 (64 x 365 days/year)

Average nursing hours per patient day (HPPD)

8 hours per patient day per 24-hour period

Average nursing hours (staffed hours)

186,880 (23,360 x 8)

Average hourly wage

$74.95

Annual salary cost minus benefits

$14,006,656 (186,880 x 74.95)

Benefits at 30% salary costs

$4,201,996 (0.30 x 14,006,656)

Total annual personnel (payroll) costs

$18,208,652 (14,006,656 + 4,201,996)

Average monthly patient days
1,946.6 (23,360 ÷ 12)

Average monthly nursing hours

15,573(186,880 ÷ 12)

Average monthly personnel costs

$1,517,387 (18,208,652 ÷ 12)

Note. Adapted from The Nurse Manager’s Guide to Budgeting and Finance (3rd ed., p. 108). by A. Rundio, 2022, Sigma Theta Tau International. Copyright 2022 by Sigma Theta Tau International Honor Society of Nursing.

Zero-Based Budget

Zero-based budgeting is a budgeting process that does not rely on historical data. Every year, leaders start the budgeting process at zero budget levels rather than starting with the previous period’s budget and adjusting it as needed. Each expense item and revenue item needs to be justified. It can take a lot of time to create and manage a zero-based budget but may be appropriate in some situations.

In zero-based budgeting, the income minus expenses equal zero. With a zero-based budget, the leader has to ensure that the expenses match the income during the month.

Proposed Budget as Part of the Business Plan

A proposed budget is an essential component of a business plan. When developing the budget plan, estimates of revenues and expenses are attained. The revenues can be based on the demand projections from the market analysis and assumptions of the payer mix. The expenses are based on approximations of the types and amounts of resources needed and may include startup costs of the program, such as the purchased equipment, office supplies, salaries, and other miscellaneous items. The proposed budget should include performance and financial indicators and benchmarks.

Review this proposed ED Expansion Pro Forma Balance Sheet in the chart below:

ED Expansion Pro Forma Balance Sheet

Year 1

Year 2

Year 3
Year 4

Year 5

Inpatient visits

138

280

385
512

512

Outpatient visits

2,486
3,832
4,714

5,610

6,518

Total ED visits
2,624
4,112

5,109
6,122

7,030

Gross revenue
13.396,109
23,235,060

30,552,132
37,758,985
40,093,541

Revenue Deduction

9,220,322

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16,203,580

21,520,837
26,670,224
28,320,068

Net patient revenue

4,173,777
7,031,480

9,031,295
11,088,761

11,773,473

Direct Expenses

Salaries and benefits

1,519,102
2,764,699

3,974,730

4,971,729

5,286,882

Professional Fees

28,118
51,081

68,591

88,416

90,924

Supplies

2,243,468

683,286

984,345
1,406,429

1,457,834

Purchased Services

200,800
350,703
454,638
563,481
609,355

Depreciation

1,193,226

1,193,226

1,193,226

1,193,226
1,193,226

Other Expenses

19,141
33,521
46,121
57,513
62,083

Total Direct Expenses

5,203,885

5,076,516
6,721,651
8,280,794
8,700,304

Contribution Margin
(1,030,078)

1,954,964

2,309,644

2,807,967
3,073,169

Note: Adapted from T. Bock, KT. Waxman, C. Abner, and J. Maxworthy in K. T. Waxman (Ed.) Financial and Business Management for the Doctor of Nursing Practice (3rd ed., p. 145), 2023, Springer Publishing Company. Copyright 2023 by Springer Publishing Company, LLC.

Self-Check

Review the following interactive to check your understanding.

Self-Check Interactive Transcript

Flip each card to reveal the answer.

Card 1

Will this clinic be profitable in the first year of operation?

Answer

No. The 2020 financial estimates for the Foot Care Clinic show a loss, not a profit.

Card 2

What cost savings might be realized by the healthcare organization by implementing the Foot Care Clinic?

Answer

Reduced emergency department utilization and reduced hospitalizations and length of stay related to complications.

Week 6Lesson 2

Budget: Ongoing Monitoring and Evaluation

Introduction

The budget process is ongoing and dynamic. It provides feedback on actual revenue and expenses. Once the budget has been created, it is necessary to ensure that the unit adheres to it so that expenses stay within projected budgetary limits. Monitoring the budget closely and continuously is the best way to prevent surprises in the evaluation process at the end of the budget cycle.

Variance Analysis

Variance refers to the difference between what has been projected for the budget and the actual results. Variance analysis is the aspect of budgeting in which the actual results are compared with the budgeted expectations. A variance is usually considered favorable if it improves net income and unfavorable if it decreases income. The DNP-prepared nurse responsible for the budget must understand and monitor inputs to the budget that may create a variance to the plan. For example, volume/census, acuity, salaries, and forecasted staffing requirements should be monitored for a nursing unit budget. For ambulatory care or outpatient settings, indicators such as the average number of appointments per day, average number of patient encounters per provider per day, average office visit cycle time, average expense per encounter, and net profit or loss are monitored.

Calculating Budget Variance

Expense Budget Variance
Revenue or Volume Budget Variance

Variance = Budget – Actual

Variance = Actual – Budget

Example:

Example:

$2,000 budgeted
$2,000 budgeted

$2500 actually spent

$2,200 actually received as revenue

-$500 variance, unfavorable

$200 variance, favorable

Spent more than budgeted

Earned more than budgeted

Typically, the individual who has oversight of the budget will be expected to review the monthly budget to identify and explain the variance. Corrective action plans are developed to manage these variances.

Example: Unit capacity is 28, budget ADC is 24.9, budget direct RN HPPD is 6.01, budget direct NA HPPD is 3.28, budget total direct HPPD is 9.29, and total worked is 10.25.

Target RN-to-patient ratio is 1:4 Target NA ratio is 1:7.3.

Variable Staffing Plan for 3M-Med/Surg

A
B
C

D

E

F

G

H

I

J

K

L

M

N

O

P

Q

Census Volume

Budget Direct RN HPPD

Target RN Direct Hr./Day (AxB)

Total Direct RN 12-Hr. Shifts/24-Hrs. (C÷12
RNs/Shift (D÷2)

RN-toPt. Ratio (A÷E)
Budget Direct NA HPPD (G)

Target NA Direct Hr./Day (AxG)

Total NA Direct 12-Hr. Shifts/ 24-Hrs. (H÷12)
NAs Shift (I÷2)
NA-to-Pt. Ratio (A÷J)
Budget Total Direct HPPD (C+G)

Budget Indirect HPPD (M)
Target Indirect Hr./Day (AxM)

Total Indirect 8-Hr. Shifts/24-Hrs. (N÷8)

Indirect Staff/Shift (O÷2)
Budget Total Worked HPPD (B+G+M)

28
6.01

168.28

14.02

7.01
4.0
3.28
91.84
7.65
3.83
7.32
9.29
0.96
26.88
3.36
1.68
10.25

27
6.01

162.27
13.52
6.76
4.0
3.28
88.56
7.38
3.69
7.32
9.29
0.96
25.92
3.24

1.62

10.25

26
6.01

156.26

13.02

6.51

4.0

3.28
85.28

7.11
3.55
7.32
9.29
0.96
24.96
3.12
1.56
10.25

25
6.01
150.25
12.52
6.26
4.0
3.28
82
6.83
3.42
7.32
9.29
0.96
24.00
3.00
1.50
10.25

24
6.01
144.24
12.02
6.01
4.0
3.28
78.72
6.56
3.28
7.32
9.29
0.96
23.04
2.88
1.44
10.25

23
6.01
138.23
11.52
5.76
4.0
3.28
75.44
6.29
3.14
7.32
9.29

0.96
22.08

2.76
1.38

10.25

22
6.01

132.22

11.02

5.51

4.0
3.28

72.16
6.01
3.01
7.32
9.29
0.96
21.12
2.64
1.32
10.25

21

6.01

126.21

10.52
5.26
4.0

3.28
68.88
5.74
2.87
7.32
9.29

0.96
20.16
2.52
1.26

10.25

20
6.01
120.20
10.02
5.01
4.0
3.28

65.6
5.47
2.73
7.32

9.29

0.96
19.20

2.40
1.20

10.25

19
6.01

114.19
9.52
4.76
4.0
3.28

62.32
5.19

2.60
7.32
9.29
0.96
18.24
2.28
1.14
10.25

18
6.01
108.18
9.02
4.51
4.0

3.28

59.04

4.92
2.46
7.32
9.29
0.96
17.28
2.16

1.08

10.25

17

6.01
102.17
8.51
4.26

4.0

3.28

55.76
4.65
2.32

7.32

9.29
0.96
16.32
2.04

1.02
10.25

Note. Adapted from “Budgeting in Acute Care Settings,” C. Suby, in K. T. Waxman (Ed.) Financial and Business Management for the Doctor of Nursing Practice (3rd ed., p. 145), 2023, Springer Publishing Company. Copyright 2023 by Springer Publishing Company, LLC.

Self-Check

Review the following interactive to check your understanding.

Self-Check Interactive Transcript

Flip the card to reveal the answer.

What is your analysis of the variances in this budget report?

Answer

The differences between budgeted and actual HPPD, productive hours, productive FTE, and productive hourly expense are so small that the units are meeting these budget targets. The RN overtime hours reflect the budgeted 4.0 hours per productive FTE and the 6.5 average overtime hours per productive FTE. Overtime hours are over budget by 62.5% and reflect the same 62.5% budget overrun as the overtime hours.

Evaluation of Productivity

Monitoring the department’s productivity is important to ensure efficiency. Productive nursing hours are the hours that the nurse spends performing nursing activities caring for the patient. Non-productive hours include paid vacation leave, paid holidays, sick leave, bereavement leave, jury duty, orientation time, committee time, and education and training time.

The pressure to reduce costs and increase productivity is as critical as ever. Close attention must be paid to staffing and productivity efforts. Nurse leaders must consider staffing patterns and productivity to control costs without harming service quality or staff satisfaction. Welch and Smith (2020) define productivity as the measurement of output (nursing hours) divided by input (patient volume). Multiple types of comparative benchmark data and national standards should be established to measure and track the department’s productivity.

Care Efficiency and Throughput

Patient throughput allows for the efficient flow of patients through the hospital, ensuring the timely and appropriate level of care. Hospitals must execute innovative strategies that deliver efficient throughput and enhance revenue while still preserving high-quality services. The aim is to optimize patient placement to ensure the right care is provided at the right plac and, at the right time. Hospitals that have prioritized patient throughput have realized improvements in quality patient care, patient satisfaction, and a positive financial impact. Recommendations of the Institute for Healthcare Improvement (Rutherford et al., 2020) for improving care efficiency and hospital-wide patient flow are based on these principles .

Click through the following interactive to learn more about the different approaches.

Improvement Approaches Interactive Transcript

Select an icon to learn more.

System-wide approach

Understanding hospital-wide patient flow requires looking at the whole system of care, not just individual patient care units or subgroups of patients.

Hospital-wide learning system

This system utilizes the science of improvement to inform whether and how changes are affecting flow failures, delays, and bed capacity.

Integration of various approaches

Examples include quality improvement, Lean management, operational engineering, complex systems analysis, and operations research.

Utilization of advanced data analytics

Assess and manage demand and capacity at the hospital-wide level and in all hospital departments and inpatient units.

Focus on reducing and shaping demand

Instead of adding capacity to hospital departments or units to meet patient demand, waits and delays in patient flow throughout a hospital stay can be reduced by shaping or reducing demand.