Define Budgeting It is the allocation of scarce resources on the basis of forecasted needs for proposed activities over specified

period of time. Purposes of Budgeting Ensure the most effective use of scarce financial and non-financial resources. Coordinate efforts among organizational departments. Establish a frame of reference for managerial decisions. Provide a criterion for evaluating managerial performance Identify budget planning steps 1.Formulation stage Develop objectives and management plans Gather all financial, historical, and statistical data and distribute to cost-center managers. Analyze data. 2. Review and Enactment Stage Prepare unit budgets Present unit budget for approval Revise and combine into organizational budget Present to budget council Revise and present to governing board Revise and distribute to cost-centers manager. 3. Execution Stage Direct and evaluate expenses and receipts. Revise budget if indicated Terms related to Budgeting Cost-is money expended for all resources used, including personnel, supplies and equipment. FACTORS AFFECTING COSTS Length of patient stay Salaries Prices of materials Case mix Seasonal factors Costs factor Seasonal factors Efficiencies Market share Third party payers Age and size of the company Types and amount of services provided Agency missions Relationships of healthcare providers Terms related to Budgeting Fiscal year (FY)-budgetary or financial year Year to date (YTD)-the accumulated units of service at the particular point in the fiscal year Terms related to Budgeting Expenses-costs of providing services to patients frequently called overhead expenses.

Expense Budgeting-process of forecasting, and monitoring the man power, materials, and supplies and monetary needs of an organization in such a way that the operation of the various components of the organization can be controlled. Types of Expenses/Costs Fixed- not related to volume Constant as volume decreases or increases over a period of time. Examples Depreciation of equipment and buildings Salaries, benefits, utilities, interests on loans, or bonds or taxes Variables-relate to volume and census Meals, supplies, linen Direct and Direct Costs Direct Cost-cost related to providing services or product Indirect Cost-cost incurred in supporting the provision of the product or service Budget-a plan or schedule adjusting expenses during a certain period to the estimated or fixed income for the period. Webster An operational management plan, stated in terms of income and expenses, covering all phases of activity for a future division of time. Revenue- income from sales of products and services. Budgeting Approaches Zero-Base Budgeting Program Budgeting Flexible Budgeting Fixed Budgeting Types of Budget Personnel services or manpower budget Wages, salaries and compensation pay to permanent employees Fees pay to temporary or casual workers Capital outlay or expenditure budget budget requires long range planning purchases of land, equipment, building or expansion of existing building or plant Operating budget includes purchase of minor equipment, repairs, supplies or overhead expenses Directing is defined as As one of the functions of the nurse manager, Douglas defines it as issuance of assignments, orders, and instructions that permit the worker to understand what is expected of him or her, and the guidance of overseeing of the worker so that he or she can contribute effectively and efficiently to the attainment of organizational objectives. Purpose of Directing You direct to get work done through others To achieve goals of the organization And in nursing, directing is giving directions to others to attain quality client care LEADERSHIP Power is defined as: The capacity to ensure the outcomes one wishes and to prevent those outcomes one does not wish. Bases of Power 1. Reward Power

Based upon a number of incentives that the leader can provide for group members and upon the degree to which group members value those incentives Cont 2. Punishment or Coercive Power based on the negative things that the leader might do to individual group members or as a whole 3. Information Power based on who knows what in an organization and the degree to which access to information can be controlled Cont 4. Legitimate Power stems from the group members perception that the nurse manager has a legitimate right to make request this power is based on the authority delegated to the nurse manager by virtue of her job and position within the management hierarchy Cont 5. Expert Power based on particular knowledge and skills not possessed by staff 6. Referrent Power based on admiration and respect for an individual as a person (leaders personal qualities) Interpersonal Relations It refers to the manner in which people respond to and identify with each other in a situation of everyday living and it is the secret of successful leadership The dynamics of how people interact and why they react to each other as they do Spirit of cooperation prevails among group members Cont.. The foundations of interpersonal relationship is respect, trust, and consideration for other people. Characteristics that will enhance IP Self- Awareness Self-Acceptance Acceptance of others and sensitivity to others needs Respect for the job DELEGATION defined as: -sharing of responsibility and authority with subordinates and holding them accountable for their performance -process that facilitates complex organizations to accomplish work through the coordinated and differentiated efforts of others. Cont -a tool that the nurse manager uses to build morale among the staff. -it involves giving assignments to subordinates and motivating them to perform their job efficiently and effectively. it is a means of promoting internalized motivation and job enrichment, Giving employee a sense of being their own boss through the opportunity to exercise control over their work. Purposes of Delegation Saves time and can help develop others

Maximizes the use of talents of staff associate Uses latent abilities in personnel that contribute to their growth and development Aspects of Delegation Responsibility denotes obligation Authority is the power to make final decisions and give commands Accountability refers to liability Guidelines for Effective Delegation Give a clear description of what it is you want the employee to do. Share with the employee the outcome you expect and by when. Cont Discuss the degree of responsibilities and authority that the employee will have. Ask the employee to summarize the main points of the task that has been delegated Areas to Consider for Delegation Routine Tasks Tasks for which you dont have time Problem Solving Change in Your Own Job emphasis Capability Building Areas Not To Be Delegated The power to discipline Responsibility for maintaining morale Overall control The hot potato Barriers to Delegation I can do it better my self Lack of ability to direct Absence of controls that warn of impending difficulties Aversion to taking risk MOTIVATION Defined as: aimed to arouse, excite, or influence another person to behave in some role or perform some action the person should not ordinarily do. inner drive, impulse or intention that causes one to act or believe in a certain way or to seek particular goal Theories of Motivation Level 1 - Survival Needs Survival needs (in Maslows Hierarchy) include very basic physiological needs for oxygen, food, water and nurturing of some kind (for children) or sex to continue the species (for adults). So long as physiological needs are unsatisfied, they exist as a driving or motivating force in a persons life. Level 2 - Safety Needs Safety needs (in Maslows Hierarchy) include shelter, stability, protection, freedom from fear and anxiety, structure, order and law Level 3 - Social Needs Social needs (in Maslows Hierarchy) include the need for belonging, peer group involvement and love. People at this level are striving for acceptance by their peer group and seeking respect as an individual in comparison to others (beating the competition, winning the war, trouncing an enemy, achieving success, gaining status, collecting toys, being beautiful, etc).

Level 4 - Esteem Needs Esteem needs (in Maslows Hierarchy) include the desire for self-respect, self-esteem and the esteem of others. People at this level are striving to be involved with others in a group experience rather than as stand out as an individual Level 5 - Self-Actualization Needs Self-Actualization needs (in Maslows Hierarchy) consist of the need for self-realization, continuous self-development and the process of becoming all that a person is capable of becoming. Maslow says that in order to achieve self-actualization, a person must first satisfy all the other needs Herbergs Theory of Job Satisfaction Hygiene Factors or needs associated with working conditions such as pay, quality of supervision, job security and agency policy. Motivation Factors or needs associated with the work itself-challenges, added responsibility, opportunities for growth and opportunities for advancement Cont Lack of hygiene factors causes job dissatisfaction and absence of motivation factors causes lack of job satisfaction Motivating Staff Mange change properly Assign undesirable jobs on a rotation basis Job redesign Provide productive climate and high morale Job redesign Job Rotation monotonous, boring and without challenge Job Enlargement overspecialization Job enrichment new skill development Communication Communication-process of transferring of information and understanding from one person to another. Ideation-----Encoding------Transmission----Receiving------Decoding-----Response or Feedback Communication System Chain System Y system Wheel system Circular structure All channel system Lines of Communication Downward Upward Lateral Diagonal Blocks to Communication Poor listening habits Psychological blocks Environmental distractions

Semantic Barriers Principles of Effective Communication Information giving is not communication Responsibility for clarity resides with the sender Simple and exact language should be used The sender must have credibility Acknowledgement of others is essential Direct channels of communication is best STAFFING PREPARED BY: LENILA A. DE VERA, RN,MPH. Upon completion of this chapter, the student should be able to: Define staffing Discuss the staffing process Discuss the importance of orientation Explain the guidelines in scheduling of nursing staff Describe the various categories of patients according to level of care needed. Given a situation, identify which system of assigning nursing personnel is appropriate. Given a situation, compute for the staff needed. Def. of Staffing It is the process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care and to meet the patients demand for care. Staffing Process Selection of Personnel 1.) Recruitment-process of enlisting personnel for employment Methods of Recruitment Advertising Word of mouth Employees recommendation 2.) Screening Screen out applicants who do not fit the image of the agency. Try to fit the job to a promising applicant. Usually, try to fit the applicant to the job 3.) Interview Staffing Process 4.) Orientation 5.) Staff Development System of Assignment 1. Case method- each patient is assigned to a nurse for total patient care including medications and treatment. 2. Functional Method-nurses are assigned to perform specific tasks based on the employee's education and experience. 3.) Team method- Professional, technical, and ancillary nursing personnel are group together as a team to give total care to selected group of patients. System of Assignment

4.) Primary Method-Primary nurse is given the full responsibility of planning, implementing and evaluating the nursing care of four or five patients. 5.) Modular Method- The nurse is assisted by non-nursing members of the health team such as nurse aides and assistants to give nursing care to 8-12 patients. It is a combination of primary and team nursing Scheduling Objectives of scheduling: Provide adequate patient care while avoiding overstaffing. Achieve a desirable distribution of off days Treat individual members of the staff fairly Let the personnel know well in advance what their schedule are. Guidelines in the Preparation of Schedule Let it represent a balance between the needs of the employee and the employer(patient care).When conflicts arise, patient care should have priority. Distribute fairly the good and the bad days off among all employees. Make all employees adhere to the established rotation. Advance posting of schedules so as to allow employees plan their personal lives. Guidelines in the Preparation of Schedule Do not make time schedule a mystery nor use them as a tool to control or discipline. Come up with mechanism for emergency changes to accommodate both employee and employer. Make schedule conform with all labor laws, hospital and department policies. Provide correct number and mix personnel, allowing continuity, which is essential to quality care. Be consistent in scheduling to enable work groups develop teamwork, which contributes to quality care. Modes of Scheduling Centralized Scheduling based on master staffing pattern. Carried out by one person who plans and coordinates the schedule of

Awaiting surgery Category II Moderately ill and recovering from serious illness and or operation Requires nursing supervision or assistance relating to ambulating and care of their own hygiene Category III Needs close attention through out the shift Complete patient care Require frequent and complex medications or treatments. CATEGORY IV Acutely ill patients who need a high level of nurse dependency including those requiring intensive therapy and or intensive nursing care. Unstable condition, needs frequent evaluation with adjustment of therapy

nurses. Decentralized Scheduling Allows the nurse manager to staff her own Self-Scheduling Staff nurses in the unit collectively decide and schedule.

unit. implement the monthly work

Patient Classification System Category I: Minimal Care Category II: Moderate Care Category III: Maximum Care Category IV: Intensive Care Category 1 Convalescing patients No longer require intensive, moderate or maximum care Patients who require diagnostic studies, minimal therapy, less frequent observations, and daily care for minors conditions