Describe How Income Flows Into The Organisation Where You Work Nursing Essay

Describe How Income Flows Into The Organisation Where You Work Nursing Essay Cash inflow, as defined by Brideau (2004) is the measurement of the movement of cash into the organization, usually generated from operating, investing and financing activities. The components of cash flow must be visible on a planner so that it will be easily understood exactly what occur. Without cautious monitoring of the cash flow, the organization may not have the profit realization as they scheduled it (Donaldson Gerard, 2005). Hence, by having the knowledge of how income flows into ones organization is vital. So, corrective actions can be done to prevent incidents that may run the organization into economic failure. The current clinical setting where I work in is conveniently located at the annex block of Mount Elizabeth hospital. The unit consists of 24 beds, involving a team of 32 healthcare workers, ranging from doctors, nurses, pharmacists and laboratory technicians. Our center is mainly specialized in haematological disorders such as anaemia, leukaemia, thalasemmia and so on. Majority of our patients are those who required blood transfusion, Bone Marrow Aspiration (BMA) and chemotherapy. Primarily, the core income will be coming from the consultation fees generated by our team of haematologists. Beside consultation fees, procedural fees commonly involved are BMA, intra-thecal chemotherapy and insertion of Central Venous Catheter (CVC). On the nursing part, services provided for patients normally include blood taking, blood transfusion, performing dressing to CVC site and giving injections to post chemotherapy patients to boost their immunity. Furthermore, our clinic is involved in the blood donation drive and counselling is mandatory for both the donors and recipients. All the above mentioned services delivered would drive income into our department. Currently, the nurses have the authority to recommend some of the topical skin moisturiser for patients undergoing chemotherapy, who will usually encounter dry skin conditions. Hence, this will further increase the income flow into the department. A built in laboratory and a pharmacy are also available in our clinic, which provide blood test services and dispensing of medicines respectively. External funding and donations from other organisations also constitute part of the income flow into our department. In general, our revenue is generated through a variety of means, along with billable patient services, investments and donations to the organization. Specific unit-based revenue is generated through billing for services such as invasive diagnostic or therapeutic procedures, physical therapy and so on. Revenues are also arising through the provision of multiple services overtime, such as hourly rates for chemotherapy administration or blood transfusion. Hence, nurses need to be informed and partner with the management team to generate revenue and control expenses in relation to patient care (McCue et al, 2003). Ultimately, these are the ranges of services available in the clinic that will be involved in the generating of income flow. 2. Critically evaluate the steps you would take when reviewing the skill mix in your own clinical setting. Discuss how you might balance the financial implications of your actions? The challenge in healthcare is to ensure that quality of care and the calibre of the staffs are not comprised in this ever-changing, cost-controlled environment. Many healthcare organizations are looking into skill mix (SM) as a potential solution to healthcare service delivery problem. As stated by Adam et al (2003), SK is the percentage of registered nurses (RNs) to other direct care staffs such as enrolled nurses (ENs) and SM plays a critical role in improving organization effectiveness and the quality of care. So what is the specific role of the RNs and ENs based on my current clinical setting? These questions need to be answered prior to the reviewing of the skill mix in the clinical setting. Serrano Slunecka (2006) stated that, the RNs are responsible for patient assessment, diagnosis, care planning and evaluation, whereas, the ENs are trained to perform bed-side duties such as bathing, feeding, toileting and ambulating patients. In my current setting, our main issue is inadequate staffing due to inappropriate SM. As evidenced by Gillies (2003), insufficient staff is the most common contributing factor causing negligent of patients, thus, leading to poor quality of care. Hence, significant steps must be taken to efficiently establish a staffing pattern, a plan that articulates how many and what kind of staffs are required per shift to staff a unit of department (McCue et al, 2003). We must first examine the following factors and take into consideration that a novice nurse takes longer to accomplish the same task than an experienced one. The acuity of patients, the capabilities of the staffs, the complexity of the nursing task, the amount of supervision a RN will be able to provide and the number of available staffs assigned to accomplish the unit workload are the key points when reviewing SM in a clinical setting (Adam et al, 2003). For illustration, in an intensive care unit, the RNs skill mix will be much higher than in a nursing home where the skills of RNs are required to much lesser degree. Lastly, Hall et al (2004) stated that cost is associated with the nature of SM. In developing a staffing pattern that leads to a budget, it is important to benchmark against other organization with similar patients population. It is important to note that RNs hours of care are more costly than those of lesser skilled workers, hence, it is important to evaluate the patient care required and who can perform necessary functions (Hall et al, 2004). Allocating ENs appropriately and freeing RNs from uncalled for duties can assist in cost control. As evidenced by Rothberg et al (2005), it is cheaper to have ENs to perform supportive care than to have RNs to perform them. Therefore, SM is accountable for the distribution and consumption of resources. It is essential that nurses need to be informed and collaborate with the management team so that appropriates decisions can be made regarding cost-effective practices (McCue et al, 2003). The key is to have the right number and skill level of caregiver available to ensure safe, effective and appropriate care. 3. Develop a system which would enable you to audit your staffing expenditure on a monthly basis. Give a detailed critical discussion of your rationale underpinning your system. Table 1: Budgeting and spending of an individual staff Spending: Pay/wages Shift allowance Meal allowance Medical entitlement Total Spend/budget Spend/Budget Spend/Budget Spend/Budget Spend/Budget Spend/Budget Staff Nurse (1 year experience) $1500/$1500 $100/$100 $15/$22 $130/$350 $1745/$1972 Staff Nurse II (2 year experience) Senior Staff Nurse (5 year experience) $1700/$1700 $2300/$2300 $150/$150 $180/$180 $28/$28 $20/$30 $200/$600 $1320/$1200 $2078/$2478 $3820/$3710 Enrolled Nurse (1 year experience) Enrolled Nurse II (2 year experience) $1200/$1200 $ 1450/$1450 $75/$75 $125/$125 $15/$15 $28/$23 $110/$250 $250/$300 $1400/$1540 $1878/$1898 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Staff A $2970 $2800 $2900 $2700 $2890 $2700 $2900 $3000 $2700 $2830 $2790 $6800 Staff B $2900 $2910 $2900 $2780 $2810 $2700 $2800 $2780 $2730 $2700 $2890 $6500 Staff C $2550 $2500 $2520 $2300 $2600 $2650 $2400 $2600 $2420 $2520 $2490 $6000 Staff D $2570 $2500 $2400 $2450 $2500 $2420 $2400 $2450 $2430 $2530 $2340 $6100 Table 2 (12 month wages) Late for work Medical leave Patient compliments Staff A 0 1 0 Staff B 1 1 0 Staff C 15 0 1 Staff D 6 2 1 Table 3 (monthly audit for staff) Staffing expenditure (SE) generally accounts for the expenses associated with labours. According to Brambleby (2005), healthcare services are very labour intensive and it is estimated that salary and benefits accounts for 50% to 60% of an organization cost. As defined by Payne Keep (2004), staffing expenditure is determined by identifying the expenses of every staffs in the organization. SE is commonly broken down into monthly basic salary, staff benefits, allowances and lastly, annual increment and bonus. Besides the above listed, it is compulsory for every organization in Singapore to contribute 13% of total gross income to Central Provident Fund. In an organization, the first most common expense is the basic salary of every individual staff. However, the amount of salary a particular staff will be eligible to depend on their individual experience. Medical fees entitlement, staff allowances and benefits would include meal allowances and shift allowances, which would fluctuate every month within an individual pending on numbers of working years. Whereas, annual bonus and increment will depends on individual performance. Looking at Table 1, it keeps a record on the spending and budgeting of an individual staff based on their wages, meal allowance, shift allowance, medical fees and the total wages draw by the individual staff in the month of January. As for Table 2, in this table showed the collection data of the total wages each individual staff draw from January to December over a period of 12 month. Zooming in at the month of December in Table 2, all the staffs are drawing a higher wages as compare to all the other month. This is the amount of the annual bonus given to the individual staff. According to Kanji (2004), staff performance can be benchmarked by the number of utilized medical leave, the number of compliments from patients and the punctuality of the employees. By keeping a record of staff performance, it will reduce instance of bogus sickness, hence increase work productivity and increased job satisfaction of staffs (Murray Frenk, 2004). The system ensures that expenses are kept within the budgeted amount, revenue generated is consistent with projected productivity and standards and necessary corrective actions are carried out. You are required to give a detailed discussion how you would audit non-staff expenditure on a monthly basis in your clinical setting. What reasonable cost effective strategy would you implement in order to maintain best practice? _______________________________________________________ Jan Feb Mar Out Balance Out Balance Out Balance Gauze 100 150 90 180 130 100 Glove 20 40 20 50 35 20 Syringes 300 200 320 200 350 150 Needles 190 200 210 220 250 200 Dressing set 50 100 30 120 70 100 Alcohol swab 30 30 32 20 35 15 Figure 1 Jan Feb March Budget Spent Budget Spent Budget Spent New equipment $5000 $3000 $5000 $5500 $5000 $2000 Equipment Maintainers $1000 $800 $1000 $500 $1000 $500 Laundry $500 $300 $500 $600 $500 $550 Utility Bills $5000 $4500 $5000 $3500 $5000 $5000 Stationary $1000 $900 $1000 $500 $1000 $700 Figure 2 As stated by Payne Keep (2004), non-staff expenditure can be subdivided into direct expenses and indirect expenses. Direct expenses are associated with the patients, such as medical and surgical supplies and drugs. Whereas, indirect expenses are expenses for items such as utilities, comprising of gas, electricity, maintenance and support functions. Referring to Table 1, it displayed the number of consumables being utilized and its balance stock in a month. This stock inventory system is being performed on a monthly basis. On top of that, a First in first out system is being imposed, meaning those with the nearest expiry items should be placed at the outer shelf and to be used first. All these system will help to monitor the amount of usage of the items, preventing the wastage of unnecessary items which resulted from overstock or under-stock. Hence, by saving resources, it will enhance cost-effectiveness. While searching for a supplier, key points to look for will be an item of good quality and with the lowest cost. By exploring new products with vendor representatives and networks with colleagues, discussing the quality and cost differences of supplies with other staffs and management, who had tried both new and modified products, cost wastage can be reduced. Usually, bulk ordering will take place for frequently used consumables, thus, saving cost. Budget monitoring is generally carried out on a monthly basis, to ensure that revenue generated is consistent with projected productivity and standards. Staffs are encouraged to discuss the implementation or reinforcement of strategies that can positively affect the budget. For example, they should learn to plan for supplies needed for every patient encounter and consciously eliminate unnecessary items. Typically, budgets are monitored monthly because if deficiencies arise throughout the year, financial improvement plans can be instituted early. Corrective action is often initiated to prevent long-term effects in a particular area, such as wastage or loss of supply items. Therefore, by acquiring a working knowledge of how a department monitors financial and quality indicators, and participate in the development of actions is vital (McCue, 2003). It helps to increase patients satisfaction or to create the best patient experience. All these strategies act as a tool to foster collaboration with an organization because individuals must work together to achieve cost-effectiveness by utilizing consumables appropriately. You are required to describe in detail essential information which would enable you to successfully manage your staff and non-staff budget. From your information, what do you consider to be key issues in terms of successful management? An effective management encompassed the ability to develop a budgeting plan that would provide the necessary for staffs and effective nursing care. Only through effective planning can a balanced relationship between quality services and cost of services begin to be achieved. As Donaldson Gerard (2005) had stated, budgeting is an ongoing activity in which revenues and expenses care managed to maintain responsibility and health. A basic management plan through which all expenditures and revenues from all sources maybe projected and controlled is critical, so that excellent and cost-effective healthcare services can be delivered. Certain elements are necessary to establish an effective budgeting system. Firstly, according to Mitton Donaldson (2004), commitment to strategic planning is a basic requirement, where well-defined and objectives are developed. The budget should be an outcome of discussions at all levels and departments within the company related to priority setting in accordance with the companys goal, acknowledgement of achievements, responses to new demands and looking beyond the time frame of the ensuing year. Secondly, effective organizational structure and chart, presenting with clear and direct lines of authority is essential. As supported by Dixon (2005), it is only when authority is clearly defined, than an individual can be held responsible for the activities of the department. Hence, major objectives of the budget can be more easily accomplished. For example, the manager has the responsibility and accountability for managing the nursing budget; they are required to make all the decision on adjusting the nursing budget to manage the program and cost. This will include adding and removing programs, expanding and controlling the program and modification of revenues and expenses within the nursing department. Lastly, an uniform budget reporting system is required, so as to facilitate program monitoring and aids in strategic planning, ensuring that plan is updated by periodically and allowing the evaluation of the progress of the organization. An important factor is ensuring that the time period within which a service development must be achieved, the projected budget is able to balance against the complexity and defining area of scale of change required and the existing resources envelope (Fine, 2006). Overall, the process of setting and monitoring budgets should be an important part of both the planning and performance management cycle. It should always be remembered that within the resource package are included staff (clinical and non-clinical), equipments and building as well as money. An essential part of management planning process is to assess the ability of current resources to be used in new and different ways to meet changing needs and to increase the productivity of existing resources, while acquiring new resources (Murray Frenk 2000). By having a well-conceived budget in place, it is possible to foresee the results of quality standard of care; best practice in the organization.

King Lear :: English Literature Essays

King Lear King Lear is a play written by William Shakespeare that focuses on the relationships of many characters, some good, some evil. This is a great tragedy that is full of injustice at the beginning and the restoring of justice towards the end. The good are misjudged as evil and the evil are accepted as good. It is not until the end of the play that the righteous people are recognized as such. There is great treachery and deceit involved in the hierarchy of English rule. The great mistake in this play was made by Lear when he decided to divide up his kingdom to his three daughters. In order to determine which share each should get, he had each of his daughters give testimonies of love for him. Cordelia, the youngest, refused to go overboard with her statement. When asked for her testimony, she simply replied, "Unhappy that I am, I cannot heave my heart into my mouth. I love your Majesty according to my bond, no more no less."(I,i, ln 91-93) Lear becomes enraged and casts ! her off saying, "Here I disclaim all my paternal care, propinquity and property of blood, and as a stranger to my heart and me hold this from thee for ever."(I,i, ln 113-116). Some think that Cordelia was prideful, or even a fool in her response, but I believe she was simply being honest and true. Another mistake that was made in the course of the play was by the Earl of Gloucester. After being tricked by his bastard son, Edmund, into believing that his other son, Edgar, was plotting to kill him, he put all his faith in Edmund, which would eventually lead to his demise. Besides believing that Cordelia was being true and honest to her father, I think that Lear and the Earl of Gloucester were fools, regarding the banishments of their righteous children. After reading this play, I found it hard to believe that Cordelia was being anything but true in her simple proclamation of love for her father. I can't believe that Shakespeare was trying to portray her as a spoiled, prideful child. I do not believe she was foolish in her decision to restrain from trying to persuade him into giving her a larger portion of his kingdom. I think it was apparent early that Cordelia was struggling with what she was going to say to her father.

Aims Of Guidance And Counselling Essay

The aims of the guidance and counselling service are similar to the purposes of education in general—to assist the student in fulfilling her basic physiological needs, understanding herself and acceptance of others, developing associations with peers, balancing between permissiveness and controls in the educational setting, realizing successful achievement, and providing opportunities to gain independence. The purposes of guidance and counselling provide emphasis and strength to the educational program. Some specific aims of the school guidance and counselling program include the following (Gibson, 2009): To Provide for the Realization of Student Potentialities To all students, the school offers a wide choice of courses and co-curricular activities. A significant function of education is to help students identify and develop their potentialities. The counsellor’s role is to assist students to distribute their energies into the many learning opportunities available to them. Every student needs help in planning his major course of study and pattern of co-curricular activities. To Help Children with Developing Problems Even those students who have chosen an appropriate educational program for themselves may have problems that require help. A teacher may need to spend from one-fifth to one-third of his time with a few pupils who require a great deal of help, which deprives the rest of the class from the teacher’s full attention to their needs. The counsellor, by helping these youngsters to resolve their difficulties, frees the classroom teacher to use his time more efficiently. To Contribute to the Development of the School’s Curriculum Counsellors, in working with individual students, know their personal problems and aspirations, their talents and abilities, as well as the social pressures confronting them. Counsellors, therefore, can provide data that serve as a basis for curriculum development, and they can help curriculum developers shape courses of study that more accurately reflect the needs of students. Too often, counsellors are not included in curriculum development efforts.

Comparing Hap by Thomas Hardy and The Second Coming by Yeats

Comparing Hap by Thomas Hardy and The Second Coming by Yeats Thomas Hardy (1840-1928) was one of the great writers of the Late Victorian era. One of his great works out of the many that he produced was his poem Hap, which he wrote in 1866, but did not publish until 1898 in his collection of poems called Wessex Poems. This poem seems to typify the sense of alienation that he and other writers were experiencing at the time, as they saw their times as marked by accelerating social and technological change and by the burden of a worldwide empire (Longman p. 2165). The poem also reveals Hardys own abiding sense of a universe ruled by a blind or hostile fate, a world whose landscapes are etched with traces of the fleeting stories†¦show more content†¦The game of chance that rules a persons fate is played by Time and Causality, or Crass Causality as stated in the poem (Hardy, Longman p. 2255: ll. 11). These things are not an entity with life of their own, and thus they rule our fates with a blind eye, since they cannot see and react to us as an entity like God could. Thus they just go about their ways with indifference to the inhabitants of the world and their worldly lives. Pain and joy thus come about to men without regularity and intent from an almighty, just as consequences of and unrefined Causality and a gambling Time. The last four lines of Hardys poem state this assumption of his very well by stating --Crass Causality obstructs the sun and rain, / And dicing Time for gladness casts a moan.... / These purblind ( meaning half-blind) Doomsters had as readily strown / Blisses about my pilgrimage as pain. (Hardy, Longman p. 2255: ll. 11-14). As you can see, this poem is a very dark and pessimistic poem about a loss of faith in an individual in God. The man replaces his faith in God with his newfound faith in Chance. He believes he is at the mercy of the elemental forces of nature, who rule over him with a blind eye. Fate is thus totally indifferent to him and his life, and he has a deep sadness out of this newfound understanding. He would much rather believe in a God above ruling over his fate, giving him joy and