NR 719 Week 4 Budget Justification Example

Budget Justification for Spreading Kilogram-Only Pediatric Weighing to Two More Emergency Departments: $12,276 in Year One, $5,156 a Year After

Student Name

College of Nursing, Chamberlain University

NR 719: Topics in Advanced Practice Leadership II

Instructor Name

Month Day, Year

Budget Justification for Spreading Kilogram-Only Pediatric Weighing to Two More Emergency Departments: $12,276 in Year One, $5,156 a Year After

The Total, Stated First

Spreading kilogram-only weighing to the system's 40-bed suburban emergency department and its 14-bed rural critical access emergency department will cost $12,276 in the first year: $7,120 in one-time costs and $5,156 in recurring costs. From the second year, the recurring cost of $5,156 a year continues. The record field change costs nothing further, because it was built once in the emergency department record all three departments share. No savings are claimed against these costs, for reasons given at the end.

Lines Grouped as Finance Groups Them

Table 1

Costs of Spreading Kilogram-Only Weighing to Two Emergency Departments

Note. Note. Rates are each site's loaded hourly rate for a staff registered nurse. Zero lines show which department absorbs the work.

Every line carries a number, its basis and, where it is zero, the department that absorbs it. The equipment prices are from the system's purchasing catalog for June 2027. Personnel is shown as hours and fractions of a post at each site's rate, not by name, so the figures survive a change in who holds each role.

Why Each Line Is the Size It Is

The scale lines follow an inventory taken in June. The suburban department has three standing scales: one current model that locks through a menu and two older models that cannot be locked and are replaced. Its chair scale cannot be locked. The rural department's standing scale locks, but its chair and infant scales cannot. The start-up hours, 20 per site, cover a short readiness assessment, setting the scales, briefing the charge nurses and the first audit; they come from the original department's experience, where the same tasks took about 18 hours. The rural coordinator line is new because the rural department has no pediatric emergency care coordinator, even though the national pediatric readiness recommendations call for one in every department that sees children (Remick et al., 2018); two hours a week covers a monthly audit of 30 records and orientation of new staff. The suburban department already funds a 0.2 coordinator post, and its holder has agreed that the kilogram duties fit inside it.

Recurring Apart From One-Time

The one-time costs, $7,120, buy equipment and set-up and do not recur. The recurring costs, $5,156, are what the system commits to every year the practice continues, and they are almost entirely the rural coordinator's two hours a week. That is the figure that changes next year's base budget, and it is the one the reader should weigh most carefully. Keeping the two apart matters because a request presented only as a one-year total can win approval and then lose its recurring funding in the second budget cycle (Waxman, 2018).

The Source of Funds, Named

The scale replacements, $4,900 together, come from each department's minor equipment budget: $3,110 at the suburban site and $1,790 at the rural site. The start-up hours, $2,100, come from the system nursing quality budget, which funds cross-site improvement work. The rural coordinator's recurring $5,096 comes from the rural department's nursing operating budget, which its director has agreed to request in the next budget cycle. Printing comes from each department's supplies line.

What Moves if Volume Changes

Almost nothing in this budget scales with pediatric visits. The audit size is fixed at 30 records per site per month, so coordinator time does not grow with volume. Printing scales with new staff, not with children. If pediatric volume rose 20% at both sites, the recurring cost would change by less than $20. If the rural department's volume fell sharply, the coordinator hours would still be needed for orientation, so the recurring cost would not fall much either. The budget is therefore stable against volume and sensitive mainly to hourly rates, which rise about 3% a year. At that rate the recurring line would be about $5,310 in the second year and $5,470 in the third, still dominated by the rural coordinator's hours.

Alternatives, Priced

Three cheaper or different options were considered. Reversing the January field change across the shared record would cost nothing in equipment, but it would restore the pound option in all three departments, including the original one, where the measured rate has held above 90%; it would undo a working change to avoid finishing it. Posting laminated conversion charts at each triage desk in the two receiving departments would cost about $30, but it keeps hand conversion as the routine, and hand conversion is the step the suburban audit found wrong 4 times in 31. Replacing every pediatric scale at both sites with the newest model, rather than only those that cannot lock, would cost about $7,500 in equipment instead of $4,900 and buy nothing the cheaper plan does not. The recommended budget is the least expensive option that actually removes the conversion step.

Why No Savings Are Claimed

It would be easy to offset these costs with avoided harm, but the numbers do not support it. The original department filed three weight-related safety reports in the year before the change, all intercepted before harm, and none since; that count cannot be turned into dollars honestly. Any reduction in length of stay or adverse drug events would also be claimed by the system's medication safety program, which already books those savings, so counting them here would count them twice. The case for this spending rests on removing a known error step from two departments, not on a return (Finkler et al., 2013).

References

Finkler, S. A., Jones, C. B., & Kovner, C. T. (2013). Financial management for nurse managers and executives (4th ed.). Elsevier Saunders.

Remick, K., Gausche-Hill, M., Joseph, M. M., Brown, K., Snow, S. K., Wright, J. L., American Academy of Pediatrics Committee on Pediatric Emergency Medicine and Section on Surgery, American College of Emergency Physicians Pediatric Emergency Medicine Committee, & Emergency Nurses Association Pediatric Committee. (2018). Pediatric readiness in the emergency department. Pediatrics, 142(5), Article e20182459. https://doi.org/10.1542/peds.2018-2459

Waxman, K. T. (2018). Financial and business management for the doctor of nursing practice (2nd ed.). Springer Publishing.