termpaper budget final

8/9/2019 Termpaper Budget Final

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Budgeting Knowledge of Nurse Managers in selected units of

Rumailah Hospital, Doha, Qatar

A Term Paper

Presented to

MANG 501 : Nursing Administration

Graduate School

Master of Arts in Nursing

Philippine Womens University

In Partial Fulfillment

Of the Requirements for the Degree

Master of Arts in Nursing

by

Ruby Untalasco- Gealan, BSN, RN

Doha, Qatar

First Semester, 2013


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Student Name : Ruby Untalasco Gealan "

ACKNOWLEDGEMENT

This term paper is made possible through the help and support from everyone,

including: parents, family, friends, head nurses and charge nurses of Rumailah

Hospital and in essence, all sentient beings.

Especially, please allow me to dedicate my acknowledgment of gratitude toward

First and foremost, to God, who give me life and wisdom in doing this paper.

Second, I would like to thank My Hubby Philip for the moral and financial support

despite of our financial constraint, unending understanding and encouraging me to

pursuit my Master degree and always there to cheer me up.

To my RJ, Yuri and Myles who are my inspirations to those days and nights while Im

doing this paper away from them.

I would like to thank Ms. Sherlin Alexander, HN MU2 for her most support and

encouragement and Mr. Christian Puruganan, Staff Nurse MU2 for reading my paper

and offered invaluable detailed advices on grammar, organization, and the theme of

the paper.

Finally, I sincerely thank to my Mom Tita Untalasco, who taking care my kids while

working here at Qatar and studying

To my dad Domeng (deceased), who inspire me and keep challenge me his words

all my life all through the years

To my two siblings Teddy and Dante, who always theyre pampering me to study and

earn,

And to my friends, who provide the advice and moral support.

The product of this Term paper would not be possible without all of them.


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ABSTRACT

The nurse manager/leader is responsible in knowing and understanding the different

types and budgets within the healthcare organization: operating, capital expenditure,

and cash. The operating budget is the main budget the nurse manager/leader

maintains an active role in for the healthcare organization by controlling personnel

and supply costs. Collaboration with the nursing staff on the unit as well as other

parties involved with the budget process helps create a powerful tool in controlling

the day-to-day operations of the unit and providing quality care to the

patients. Preparation is the key to a successful budget and to the success of the

organization.


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TABLE OF CONTENTS

Contents PAGE

Acknowledgement 1

Abstract 2

Table of Contents 3

Introduction 4

Statement of the Problem 5

Research Question 5

Hypothesis 5

Significant of the Research 5

Scope and Limitation 6

Definition of Terms 6

Nurse Manager Knowledge in Budgeting 9

Operating Budgets for a Nursing Unit15

Capital Budgeting for a Nursing Unit18

Conclusion 18

References 20


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Introduction

Budgeting is a delegate task of Nurse Managers. They have the accountability and

responsibility to the nursing budget. Without a budget, each department may operate

without regard to what any other department is doing or to the organizations

objectives. This lack of coordination results in inefficiency and increasing cost. The

operating budget becomes the master plan of action for the entire organization,

reflecting the coordinated efforts of all levels of management. This helps the

organization to operate smoothly and efficiently so that goals and objectives are met.

The enlightened nurse manager knows that whoever controls the budget is in control

of the department. 1

Budgeting is inextricably linked with patient care as its affects the degree of clinical

care provided and the manner in which it is provided.2Therefore, it is a prime

responsibility of nurse mangers to ensure they have resources to provide a high

quality of services.

In this research paper entitled Budgeting Knowledge of Nurse managers in selected

units of Rumailah Hospital, Doha Qatar discusses about the role of nurse managers

in financial management and budgeting in the unit. This explores the perception and

knowledge of nurse managers in selected units of Rumailah Hospital regarding

budgeting, as accountable for the consumption of resources.

Statement of the Problem

Nurse managers oversee all fiscal aspects of their unit. Nurse managers ensure that

expenses stay within the units budget. Expenses may include staffing costs ,

operating costs, physical plant costs, equipment and supplies.

1Harley, Patricia, RNC, MSN

2Doyle,G ; Williamson,P


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Therefore, exploring and studying the perception and knowledge of Nurse managers

regarding budgeting in selected units of Rumailah Hospital, Doha Qatar is a good

predictor to assess the knowledge of Nurse manager regarding budgeting and to

ensure the delivery of high quality of patient care, improved patient safety, increasing

productivity of staff nurses and job satisfaction as the resources and financial aspect

of unit are utilized effectively and efficiently.

Research Question

Since this study sought to explore significant relationships between nurse manager

knowledge and budgeting from the selected units of Rumailah Hospital, this study

proposed the research question:

a. Is there a significant relationship between nurse manager knowledge and

budgeting.

Hypothesis

The hypothesis will be tested in this study:

a. There will be significant relationship between nurse manager knowledge and

budgeting.

Significant of the Research

The purpose of this study is to explore and understand the relationship between the

Nurse managers knowledge in budgeting.In particular, nurse managers use budgets

to monitor personnel and supply costs. It is important that nurse managers are

familiar with the different types of budgets, specifically the operating budget, because

it is the nurse manager who is closest to the patient and knows exactly what is


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Student Name : Ruby Untalasco Gealan'

needed to provide care and services3(The long-term goal of this study is to provide

information to nursing administration in order to make necessary changes to increase

knowledge of nurse managers about budgeting thru continuing education and

thereby improve quality of patient care and improved staff satisfaction.

Scope and Limitation

I would have liked to evaluate the relationship between nurse managers knowledge

and budgeting. The result of such study could assist nursing administrators in order

to make necessary changes to increase the knowledge of nurse managers thru

education about budgeting. Primary data collection on Head Nurses, Charge Nurses

and Shift-In Charges working in Rumailah Hospital such as Stroke Unit, Female

Rehabilitation Unit (FGRU), Male Unit 1, Male 2, FGRU, and Stroke Unit thru

interview.

Definition of Terms

Budget - a plan, roadmap, or a tool used by managers to ensure that quality and

cost-effective services are provided to patients. A detailed, operational management

plan or schedule that communicates the organizations financial expectations.

Annual Budget - a written plan for the organization and the department plan that

balances or schedules expenses to income. Budgets are created annually prior to the

beginning of the entity's fiscal year start date.

Capital expenditure budget - is established to fund the purchase of major equipment

or projects like expansion, improvement or replacement of the physical plant and

equipment. Purchases of major equipment or facility renovations that are expected to

3Danna, Denise DNS, RN, NEA-BC, FACHE


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have at least a "five year life". Many entities require a minimum expense of $500 to

declare an item as a capital expenditure4.

Direct costs: expenses related to a specific service or program such as exercise

equipment used on a rehab unit or manuals used for restorative nursing programs.

Expenses- the cost of providing services to patients. They are frequently called

overhead. It includes wages and salaries, fringe benefits, supplies, food service,

utilities, and office and medical supplies.

Fiscal Year: The 12 month period between settlements of financial accounts. Many

organizations use the calendar year (Jan-Dec); but others use July 1 to June 30; and

others use October 1-September 30th. It is important for you to know your

organization's fiscal year5.

Fixed Costs are expenses that occur regardless of census or resident acuity. Costs

that are basically fixed may related to utility charges; insurance fees, building

depreciation costs, taxes and some contract services/maintenance agreements etc.

Indirect Costs are expenses not associated with a specific program or service such

as building depreciation, facility dues or memberships6.

Operating budget - a plan to monitor anticipated day-to-day activities, resources,

personnel, and supplies, typically over a one-year period. It is also referred as master

budget. It is estimated expenses and revenues for a specific time frame.

Operating Expenses are expenses that relate directly to the provision of care and

services such as: salaries, benefits, supplies, food, medications, therapists, etc.

4McConnell, Charles R.

5McConnell, Charles R.

6Alexander, Sherlin, HN MU2


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These are the items that are often referred to as the "controllable costs" and are

generally the items that the DON has responsibility to monitor and contain7.

Personnel budget is the salary/manpower budget for a particular unit or cost center.

Besides salaries it includes compensation for vacation, sick leave, holidays, overtime

and merit increases.

Program Budget- is estimated revenue and expenses for a specific program such as

the Medicare program or adult day care program.

Revenue - theincomeofagovernmentfrom taxation, excise duties, customs,or

othersources,appropriatedto the payment of the public expenses.For a nursing

unit, the revenues will be projected from patient days, average daily census, or

procedures. The amount of money derived from resident care and non- operational

pursuits that can be utilized for departmental expenses.

Revenue Budgeting the process in which a hospital determines revenues required

to cover anticipated expenses and establish prices sufficient to generate revenue.

Variable Costs - Expenses that fluctuate in relation to census or output, such as

supplies, wages of direct care staff, and laundry services.

Zero- Based Budgeting - Reconstructing the budget each year rather than building on

the same budget from previous year. A budgeting process that requires managers to

start from zero budget levels every year.

Nurse managers are referred to Head Nurses, Charge Nurses .

7Alexander, Shirlen, HN MU2


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Nurse Manager Knowledge in Budgeting

Qatar is one of the fastest growing economies in the Middle East. Rumailah Hospital

is under Hamad Medical Corporation, a non-generating fund government hospital

that provides free medical health services to both expatriates and locals. However,

studying about nurse managers knowledge about budgeting served as a challenged

to be cost-effective and aware on unit finances. Nursing department budget can

account for as much as half of hospital total expenses, there will be significant

pressure upon this department to increase efficiency and effectiveness. For nursing

to respond to the pressures and the uncertainty of the economic climate, nurse

managers at all levels must become proficient in the budgeting process. Declining

reimbursement and financial incentives connected to quality and patient satisfaction

outcomes are making finance a language requirement for every future nurse

manager. If nurse leaders want to continue to have a seat at the strategic table and

remain influential advocates in future healthcare decisions, they must become fluent

in the language of finance.8

As quoted by Ms. Jasmin Cherian, DON RH I will ensure that my staff have the

necessary tools to provide care and support to our clients on a daily basis.9

Years ago staff nurses were promoted to management positions based on clinical

skills and technical competencies. As a result, front-line managers were not

adequately skilled to address the array of interpersonal issues and complex, ever-

changing priorities.10Nursing is the largest professional group in the hospitaland

8Muller, Rick PhD; Karsten, Margo PhD, MSN, RN

9Cherian, Jasmin, RN , DON RH

10RWJF


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usually the most expensive. As a staff nurse, I can play an important role in helping

reduce costs by monitoring the consumption of supplies and utilization of man power

according to Eloy Buergo, Shift in Charge, MU211. Nurses can help make a difference

in their unit budgets by not overstaffing their unit when they are in charge, avoiding

excessive use of unscheduled leave that could require overtime, and monitoring the

use of supplies12. Most nurses do not enter the clinical field with a great desire to be

responsible for financial outcomes and/or to monitor revenues and expenses .

Unfortunately, the dynamics of the health care world require that all nurses, and

especially those in administrative or managerial positions, be well versed in basic

accounting principles especially Head Nurses and Charge Nurses who acts as head

nurses during the absence of Head Nurse of units. As quoted by Allan Batac, CN 13.

Nursing managers are uniquely positioned to contribute to this portion of the cost-

reduction effort, yet without a comprehensive understanding of budgeting, they often

hardwire old mistakes into future cost predictions and decisions.

A study was done in Cape South African reflecting the perception of South African

Nurse manager regarding budgeting. The perceptions of nurse managers regarding

cost containment issues in selected public hospitals in the Port Elizabeth metropole

of the Eastern Cape were investigated. Results indicated that nurse managers

required better preparation for their cost control responsibilities. Although the majority

of the nurse managers realized that staffing issues affected cost containment efforts,

they were reportedly unable to prevent nurses from leaving their points of duty

without due authorization, curb the rate of absenteeism or reduce the number of

11Buergo, Eloy, BSN, RN Staff Nurse/Shift-in- Charge

12Sherman, Rose & Bishop, Mary

13Batac, Allan, Charge Nurse, MU2


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resignations. Nurse Managers suggested that cost containment efforts would benefit

from effective security checks to curb losses of stock and equipment, including

wheel-chairs, and that more public telephones should be installed in hospitals.

Rationalization of staff and specialized services among the four major hospitals could

further enhance cost containment efforts14. Budgets and budgeting can be defined in

a variety of ways depending on the individual or organization. However, to budget is

generally to determine how much cash is available to an individual/organization. A

budget will provide you with a costing for both income and expenditure 15.

A budget is a financial plan that outlines the resources an entity foresees using for a

particular time period. The master budget encompasses all the departmental

budgets. Based on the organization's strategic goals and vision, the master budget is

the actual statement of projected revenues and expenditures for the entire hospital.

Developing a budget is an ongoing process. Here is a cycle that adapted from

Building Budget (Fig1). The budget cycle typically involves an environmental

assessment that looks at trends in healthcare and in the hospital as well as its

competition. Once such assessments are made, the hospital's goals and objectives

are evaluated to determine whether any changes must be made. If changes must be

made, the unit's goals are set based on the prior year's performance, trends in the

marketplace, and assumptions about the future. The organization's operational

objectives are developed and approved by the administrative department. It is at this

point that the formal budget packagesincluding instructions, projected units of

service (UOS), and revenue for the unitare put together and distributed to

14Ntlabezo ET, Ehlers UV, Booyens US.

15NHS


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department managers. Expect to receive such a package approximately four to six

months before the budget is due.16

!"#$%& ( )$*#&+ ,-./&

For a nurse manager to be successful in today's healthcare environment, mastery of

basic business skills is essential. No longer are nurse managers expected to be

clinical experts but, instead, must be equipped and skillful in "running their business."

17. Running their business means be knowledgeable in business skills. The first

thing that probably comes to mind is the budget or the finances, but business skills

include so much more. Business skills frequently include human resources, strategic

planning, and systems thinking, to name a few. 18There are three categories identify

several of the business skills that are essential for nurse managers as mentioned by

the head nurses of Rumailah Hospital that have been interviewed these are financial

management, Human resources, and strategic management. Nurse managers

16 Building Budget

17 Gavino, Francia ,BSN RN , Head Nurse FGRU

18Ben Gaied, Habib, HN , Head Nurse Stroke Unit


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interested in connecting caring and quality patient-care delivery with efficient and

effective financial strategies. The ability to be conversant in the language of finance

is beginning to emerge in the clinical arena. Financial knowledge is a concern of the

American Nurses Association (ANA) and the Institute of Medicine (IOM). The 2010

IOM report suggests that RNs have a responsibility to become active participants in

shaping healthcare and managing resources. The ANA's standard of resource

utilization suggests that all RNs need to identify consumer care needs, the potential

for harm, the complexity of the task, and the desired outcome when evaluating

resource allocations. The first step to accomplish this goal is for nurses to understand

the financial priorities behind healthcare business decisions.19

Become knowledgeable with basic financial terminology and definitions. Develop a

plan to educate yourself and your direct reports and be able to develop a basic unit

budget. As a Head Nurse, it is important to be able to develop a basic unit budget

and recognize the different line items and categories that are included in the budget.

Ms. Gilda Capiceno, HN MU1.

Become proficient in reading and understanding organizational budget reports. Ms.

Shirlen Alexander, HN MU2

Establish strong working relationships with the finance personnel at your

organization. Learn how to monitor and analyze budget variances and be able to

develop strategies to address the variances. According to Ms. Sosama Abraham,

CN /Acting Head Nurse MU2

19Muller, Rick PhD; Karsten, Margo PhD, MSN, RN


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Participate in the selection of programs that influence nursing such as productivity

programs, inventory management, and documentation systems. Zouhair Ben

Hassine, Acting HN MU2

When nurses become more engaged with finance and more involved in

management, they bring about a significant difference to the quality of patient care

Allan Batac, Charge Nurse MU2

This is the common response of Head Nurses from the selected unit of Rumailah

Hospital regarding the financial management in preparing unit budget. They consider

to include assess factors related to workload, staffing, and labor costs before

negotiating between the nurse manager and Director of Nursing (DON), as well as

any other departments, occur. Once the DON approves the budget, it will be present

it to the administration and the Finance Officer from Finance Department. The

Finance Officer will likely have questions the manager needs to address. Following

the meeting with administration and the Finance Department, nurse manager must

make the necessary adjustments to the unit budget. If there is an opportunity to

represent or appeal the budget, this is the time to do so. The budget is then

approved, stamped, sealed, and ready to be implemented. At the year's end, it is

time to evaluate the annual budget.

The Nurse Managers are the responsible for managing the activities of the unit;

therefore, nurse managers must know what they have control over. Typically, Nurse

Managers control most of the activities on the unit that contribute to the budget. Such

activities include staffing, skill mix, education, staff meetings, and orientation length.

At the end of each month, Nurse Managers must justify to DONs any discrepancies

in the numbers you budgeted. Internal accounting reports are usually given to


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managers. Such reports show the difference between the expected performance

planned in the budget and the actual results. The responsibilities of Nurse Managers

are controllable expenses such as staffing and supplies and uncontrollable expenses

such as patients' acuity levels and unit activity levels and Types of benefits.20

The unit level budgets are expenses are monitored via productivity or hours per

patient per day (HPPD). This, in turn, is based on acuity levels, census, staffing

levels, and length of stay. The nursing staff directly affects the units expenses. The

misuse of sick time, excessive overtime, lateness, and waste greatly influence

expense.21

Operating Budgets for a Nursing Unit

According to the Head Nurses, there are five factors, which affect an operating

budget these are the environment, objectives, policies, and assumptions, long-range

budget, program budgets and budgets from other units. Operating budget

summarizes revenue and expenses over a year.

There are 3 main sections: Personnel budget, Supply and equipment budget and

Revenue or income from reimbursement.

Personnel Budget the biggest expense in the nursing departmentand the

hospitalis staff salaries. In fact, salaries often account for up to 75% of department

and hospital budgets. The personnel budget determines how much staff is needed to

operate the unit 24 hours a day, 365 days a year.22

The personnel budget projects

the salary costs that will be paid and charged to the cost center. It accounts for

20Building a Budget

#"Budgeting and Resource Allocation

22Building a Budget


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replacement of staff for benefit time, overtime, shift differentials, orientation, on-call

hours, bonuses and premiums, and salary increases23. The personnel budget

includes actual worked time (Productive time), and time the organization pays the

employee for not-working time (Non-productive time). Nonproductive time includes

the cost of benefits, new employee orientation, employee turnover, sick and holiday

time, and education time24.

One of the central responsibilities of the nurse manager on a clinical unit is to provide

the appropriate number and mix of nursing staff (nursing care hours [NCH]) to match

actual or projected patient care needs (patient care hours) that will result in safe,

effective, quality care for the patients on the unit. While the nurse manager may plan,

organize, staff, direct, and controldoing a multitude of things simultaneously all day

longthe purpose of a great deal of this activity is to ensure that this responsibility

will be carried out. Appropriate staffing has become even more critical as the focus

on quality care at a reasonable cost has become paramount. To develop a master-

staffing pattern, a nurse manager must determine how many hours of nursing care

are required, based upon available patient classification system information. Once

the hours of required nursing care are determined, the number of full-time

equivalents (FTEs) can be calculated. One full-time equivalent is equal to 40 hours

per week, 80 hours per two-week pay period, or 2,080 hours per year. There are

several methods to determine required FTEs once a desirable staffing pattern has

been established25.

23Budgeting and Resource Allocation

24Nursing Division Budgeting

25Alexander, Sherlin, HN MU2


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Supply and Equipment expenses are the expenses include such daily expenses as

the cost of electricity, repairs and maintenance, and medical/surgical supplies (as

syringes, catheters, tube feedings...etc)26. Hospital supplies and equipments are

dealt with under material management. Supplies are those items that are used up or

consumed; hence the term consumable is used for supplies. The supplies in hospital

include drugs, surgical goods (disposables, glass wares), chemicals, antiseptics,

food materials, stationeries, the linen supply etc. The term equipment is used for

more permanent type of article and may be classified as fixed and movables. Fixed

equipment is not a structure of the building, but it is attached to the walls or floors

(egg; steriliser,) Movable equipment includes furniture, instruments etc27. The nurse

manager willassess supplies to look at competitive options for products. Look at

stock levels which currently available, rather than topping up with each supply order,

discuss with other members of staff to determine what is needed and the amount

which is required. This will ensure that stocks are not wasted and misused 28.

Revenue or income from reimbursement, Nurse Manager may not be required to

calculate revenue for r unit budget, especially if it are in an inpatient setting. Nurse

Manager should, however, understand the association of revenue with nursing care,

but the finance department controls the charges (i.e., room charges) made to the

patients on the unit. For nurse managers who run a unit with multiple levels of care

(i.e., medical-surgical and telemetry), the patient room charge is based on the level of

care the patient receives on your unit. The level of care is typically based on staffing

26Ben Gaied, Habib, HN MU2

27Gavino, Francia, HN FGRU

28Thomas, Leela, CN MU2


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effectiveness. For nursing to respond to the pressures and the uncertainty of the

economic climate, nurse managers at all levels must become proficient in the

budgeting process. The knowledge of Nurse Managers about budgeting and financial

aspect of an organization is important. There is a significant relationship between the

knowledge of nurse manager and budgeting.


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REFERENCES

Amsale Cherie; Ato Berhane Gebreikidan Nursing Leadership and Management ,

Addis Ababa University , 2005 pg. 134 to 144

http://www.cartercenter.org/resources/pdfs/health/ephti/library/lecture_notes/nursing_

students/LN_nsg_ldrshp_final.pdfdate accessed 12 August 2013

Budgeting and Resource Allocation

http://www52.homepage.villanova.edu/maureen.sullivan/coursematerial/L&M_Notes/

Budgeting_and_Resource_Allocation.htmdate accessed 25 August 2013

Building a Budget A Practical Guide to Finance and Budgeting: Skills for Nurse

Managers

KT Waxman. 2nded. Marblehead, MA: HCPro Inc., 2008. p37-71.

COPYRIGHT 2008 HCPro, Inc.

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&docType=GALE#p26date accessed 26 August 2013

Danna, Denise

DNS, RN, NEA-BC, FACHE ; Learning and mastering the operating

budget , http://www.strategiesfornursemanagers.com/ce_detail/213520.cfm date

accessed 18 August 2013

Doyle, Gerardine and Williamson, Patricia ; Nurse Managers and Devolved

Budgeting: An education gap

http://www.smurfitschool.ie/academicsampresearch/workingpapers/WP_08_05.pdf

date accessed 24 August 2013

ET Ntlabezo, D Litt et Phil student, Department of Health Studies, UNISA VJ Ehlers,

Department of Health Studies, UNISA SW Booyens, Department of Health Studies,


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UNISA South African nurse managers' perceptions regarding cost containment in

public hospitals

http://www.google.com.qa/url?sa=t&rct=j&q=&esrc=s&source=web&cd=34&ved=0C

DcQFjADOB4&url=http%3A%2F%2Fwww.curationis.org.za%2Findex.php%2Fcuratio

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w887HsxExQ&bvm=bv.51156542,d.Ymsdate accessed 22 August 2013

Harley, Patricia, RNC, MSN Budgeting Concepts ,

https://www.ceufast.com/courses/viewcourse.asp?id=92date accessed 14 August

2013

McConnell, Charles R., MBA, CM The Manager and Equipment Decisions: The

Capital Budget December 2011 , Volume 30 Number 4 Pages 361 371

http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=1252846&Journal_ID=51

5678&Issue_ID=1252650date accessed 26 August 2013

Muller, Rick PhD; Karsten, Margo PhD, MSN, RN Do you speak finance? March

2012 - Volume 43 - Issue 3 - p 5054

http://journals.lww.com/nursingmanagement/Fulltext/2012/03000/Do_you_speak_fina

nce_.13.aspx date accessed 25 August 2013

NHS A guide towards staffing budget

http://www.nursingleadership.org.uk/publications/Budget.pdfdate accessed 25

August 2013

Nursing Division Budgeting ,

http://faculty.ksu.edu.sa/Hanan_Alkorashy/Nursing%20management%20489NUR/6._

Nursing_Division_Budgeting.pdfdate accessed 12 August 2013

The Robert Wood Johnson Foundation (RWJF) Transforming Care at the


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Bedside How-to Guide: Developing Front-Line Nursing Managers to Lead Innovation

and Improvement http://media01.commpartners.com/NQF/02_23_12/TCAB_-

_How_to_Guide_Developing_Front_Line_Nursing_Managers.pdfdate accessed 24

August 2013

Sherman, Rose, EdD, RN, NEA-BC,FAAN & Bishop, Mary,

DNP,RN,NEA,BC,FACHE The business of caring: What every nurse should know

about cutting costs http://www.americannursetoday.com/article.aspx?id=9696date

accessed 21 August 2013

Resource Persons

Abraham, Sosamma, CN MU2 Rumailah Hospital

Abdullah, Habib Ben Gaied, HN Stroke Unit Rumailah Hospital

Alexander, Shirlen, HN MU2 Rumailah Hospital

Batac, Allan, CN MU2 Rumailah Hospital

Buergo, Eloy, Staff Nurse/Shift in Charge MU2 Rumailah Hospital

Capiceno, Gilda, HN MU1 Rumailah Hospital

Cherian, Jasmin, DON Rumailah Hospital

Gavino, Francia, HN FGRU Rumailah Hospital

Hassine, Zouhair, CN MU2 Rumailah Hospital

Thomas Leela, CN MU2 Rumailah Hospital

termpaper budget final

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