NR 711 Week 8 Capital Funding Recommendation Example

Funding Recommendation for the FY2029 Nursing Capital Pool: Five Requests Funded, Two Refused, One Conditional

Student Name

College of Nursing, Chamberlain University

NR 711: Fiscal Analysis and Project Management

Instructor Name

Month Day, Year

Funding Recommendation for the FY2029 Nursing Capital Pool: Five Requests Funded, Two Refused, One Conditional

The Decision

The FY2029 nursing capital pool holds $240,000. Seven requests totaling $377,000 were submitted. I recommend funding five of them for $236,800, one of which is conditional on an audit due 30 September 2028, and refusing two. The remaining $3,200 is held unallocated until the condition is settled.

Table 1

FY2029 Nursing Capital Requests, Ranked, With the Funding Line

Note. Note. Pool $240,000; funded $236,800; unallocated $3,200. Requests total $377,000.

The Criteria, Applied to Every Request in the Same Order

Four criteria were fixed before any request was read, and every request below is judged on all four in this order. First, a dated obligation: whether there is a date after which not buying creates a risk the hospital would carry. Second, harm on the requester's own data: what the request addresses, measured in the requesting unit rather than borrowed from the literature. Third, three-year cost: capital plus three years of recurring cost, less any return the requester has measured. Fourth, readiness: whether the request can be in use within FY2029. Fixing the criteria first, and making the reasons public, is what lets a refused requester accept the outcome as fair even when disappointed (Daniels, 2000).

The Funded Requests

Bladder scanners, rank 1. The manufacturer ends support in March 2029. This request was deferred last cycle precisely because it could wait one year; it cannot wait two. Three-year cost $34,800. Ready on delivery.

Telemetry transmitters, rank 2. Support for the current transmitters ends 30 June 2029, the last day of the fiscal year, so they must be replaced within this cycle. Three-year cost $82,800. The date decides it, as the infusion pumps were decided two cycles ago.

Postpartum hemorrhage carts and quantitative blood loss scales, rank 3. There is no date, but the harm is severe and the unit's data are specific: in FY2028 labor and delivery recorded 23 hemorrhages, and in 9 of them blood loss was estimated by eye rather than measured. The three-year cost of $24,600 is the lowest in the pool, with nothing recurring.

Ceiling lifts on 6 West, rank 4. 6 West reported three lifting injuries last year, with workers' compensation costs of about $47,000. Three-year cost $73,600. If the lifts prevented the same three injuries every year, the avoided claims over three years would come to about $141,000; even at half that rate the lifts roughly pay for themselves, and the injuries fall on staff the hospital cannot easily replace.

The Conditional Request

Video monitoring on 5 West, rank 5, funded on one condition. 4 West's program has shown that cameras can replace sitter hours, but only for patients who need observation for confusion or fall risk, and only when the unit's own sitter orders contain enough of those patients. 5 West has not yet audited its sitter orders. The $46,800 is approved on the condition that 5 West's three-month audit, due 30 September 2028, shows at least 40% of sitter hours ordered for camera-eligible patients. If it does, the purchase order is released on 1 October. If it does not, the full amount returns to the pool that day. The condition is attached to an event with a date, not to a judgment someone makes later.

The Line, and the Refusals

The line falls after rank 5, with $3,200 left. Neither remaining request fits.

Vascular access ultrasound, rank 6, is refused this cycle and is next in line. The vascular access team shares a device with the ICU and reports waiting for it, but the request did not say how often or for how long. To rank higher, the team should log, for three months, every insertion delayed by waiting for the device and the length of each delay. If the 5 West condition fails on 30 September, this request is funded from the released $46,800, which leaves $11,500 unallocated.

High-fidelity simulation mannequin, rank 7, is refused. The current mannequin was booked for 41 hours last year, and the request did not show who would use a second one or for how many hours. Its three-year cost, $114,500, is the highest in the pool. To come back, the education department should bring a schedule of at least 200 booked hours with named courses, and price a lease against the purchase. Telling the department only that its request was strong but unaffordable would leave it nothing to change, which is the opposite of what a refusal is for (Mitton & Donaldson, 2004).

Checking That the Totals Fit

Funded capital: $29,400, $72,000, $24,600, $64,000 and $46,800 add to $236,800, which is $3,200 under the $240,000 pool. The recurring costs the funded requests bring, $18,200 a year in total, fall on the operating budgets of the units that asked for them and have been confirmed with each unit's director. If the condition fails and the ultrasound replaces the cameras, funded capital becomes $228,500 and recurring falls to $10,800 a year.

Limits of This Recommendation

Funding everything was never the aim. Requests that reach a pool as a set always outrun it, and a recommendation that approved all seven would have answered a question the committee did not ask (Penner, 2017). It also does not rank by how strongly each request was argued. The mannequin request was the best written of the seven and ranks last, because the criteria are about need and readiness, not prose. Nor does it reopen last cycle's decisions. 4 West's cameras, the bariatric lifts and the emergency department safe room were funded a year ago and are not ranked again here; their recurring costs are already in the FY2029 operating budgets. A committee member who wants to revisit one of them can bring it as a new request next cycle, judged on the same four criteria as everything above.

References

Daniels, N. (2000). Accountability for reasonableness. BMJ, 321(7272), 1300-1301. https://doi.org/10.1136/bmj.321.7272.1300

Mitton, C., & Donaldson, C. (2004). Health care priority setting: Principles, practice and challenges. Cost Effectiveness and Resource Allocation, 2, Article 3. https://doi.org/10.1186/1478-7547-2-3

Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders (3rd ed.). Springer Publishing.