Reflective Journal Due Mar. 4th

Surprisingly I enjoyed learning about budgets this week. I naturally enjoy finding ways to save money and avoid debt. Looking over the budget, I was surprised that the majority of money paid out was to nurses and with some adjusting of nurse and CNA hours, over $20k could be saved. The following table is what I used to show temporary staffing hour changes. My intent was not to lay anyone off, but to notify the employees that we had a slow month and may have to cut back hours temporarily until we get our feet back on the ground. I would ask any there are any nurses and CNAs that would volunteer for a decrease in hours.  And then I would rotate who gets called off so there'd be a balance of who's hours get cut back. This would also give nurses a chance to look for a new job if they want to, without losing their current job. Many of the nurses in this case study were seasoned nurses making high wages. If some of these seasoned nurses quit, then new nurses could be hired when business picks up and they could start at a lesser wage, saving the hospital money.

MONTHLY COST

(Average is 3 pts/day) (sugg = suggestion)

	Ave. Wage/Hr	Current units/shift	Sugg1 units/shift	Sugg2 units/shift	Current Cost	Sugg1 Cost	Sugg2 Cost
Nurses	$31.78	2.7	1.5	2	$61,391	$34,322	$45,763
CNAs	$11.06	0.6	1	0	$5,001	$7,963	$0
				Totals:	$66,392	$42,285	$45,763
				Savings:		$24,107	$20,629

I was going to add more into my budget savings, but with just changing staffing alone, it would help
the budget immensely.

I found some other savings ideas that were interesting as well:

The first idea is properly sorting hazardous from non-hazardous waste. Molly Gamble (2011), says that 70%
of hospital waste comes from operating rooms and labor-delivery suites, according to John Hopkins. Our focus
is med/surg budgets, but this can also apply to these floors. Other waste can be sorted correctly, such as
making sure medicine, vials, and other equipment are disposed of into correct bins. Companies that dispose
of hazardous waste charge according to weight. What not to put into blue and white bins that I’ve seen are
empty or partially full NS bags with its tubing. NS bags can be drained in a sink and directly discarded into a
garbage can. Here’s an image of what gets discarded where:

Another idea for saving money would be to cut food waste in half by weighing it. Molly Gamble (2011) shares
how six Iowa Health System Hospitals adopted a program to reduce the amount of unused food thrown away.
They partnered with a food waste tracking company and installed ValuWaste tracking systems. Before kitchen
staff threw food away, they weighed it's submitted reasons for disposal. Staff tracked it and made adjustments
to production practices. The Iowa Methodist Medical Center and Iowa Lutheran Hospital cut their food costs in
half. I’m not sure if food is part of med/surg budgets, but I do know that we often have too much extra food
delivered to our floor and the food goes bad.

And the last idea deals with supplies. Sometimes we are overstocked in our supplies and supplies can expire
before we get a change to utilize them. If we can be better at scanning our supplies in the supply room, it will
give us an accurate count of how much we use on average. We can order less at a time so they don’t expire.
There’s sometimes a balance, however, because if we order in bulk sometimes the price per unit is less
expensive. Another idea is to discontinue buying disposable pillows and only use reusable pillows. Generic
brands can be purchased for supplies and for medications as well. Reward and recognition of employees for
ideas for savings can be helpful. This may encourage employees to brainstorm new ideas for savings.

During our team discussion, some team members had great ideas such as cutting out paid conferences and travel time to conferences until the company's finances improved. There were a lot of little changes that could be made, but none seemed to significantly improve the budget. There were definitely over staffing issues that needed to be changed so I stand by that decision.

Where I work, we had a few months where several of us kept getting put on call due to low patient volume. Some nurses quit and some got second prn nursing jobs to make up for the hours they weren't working at the hospital. I also have a prn nursing job at a clinic that has definitely helped fill in my lack of hours at the hospital. The low patient volume only lasted for a few months and now the hospital is seeking help from nurses to work additional hours. In a business such as a hospital, income for the hospital isn't consistent and flexibility and budget adjustments will need to be made. I feel like it would be a stressful job managing a hospital budget.

In my own nursing practice, I will try to do the little things to help save money, such as disposing of biohazard waste correctly and being thrifty with supplies. I also think it's important to have a prn back up job, which I have. 0