Nurses are educated to be good stewards of supplies, resources, items entrusted to us by our organizations. However, we have little to no education of how stewardship and cost go hand in hand.  According to Penner 2014 nurses are well aware of direct costs associated with patient care. These types of costs or charges are visible, such as direct patient care staff and medical supplies needed to provide the care.  For my DNP project a STEMI protocol will be created according to the American Heart Association and American College of Cardiology guidelines for door to balloon. This protocol will include policy initiation, updating of ED chest pain order set, creation of an audit tool that tracks cares completed, speed and staff participating in care. The direct costs identified with this project thus far is patient care staff (mid-level provider and registered nurse staffing Emergency Dept.), medical supplies (medications, oxygen, cardiac monitoring, and IV supplies, etc.), and EMTALA paperwork (EMS, Flight team, Receiving Facility). According to Penner 2014 indirect costs account for support staff and administrative costs. Laboratory, Radiology, and Respiratory Services are essential in quick and accurate diagnosis and contribute to UOS. Environmental Services (EVS) cost, supply chain cost, and n agreed upon budgeted administration fee.

After talking with my chief financial officer Amanda V. the initial cost of project development will be incorporated into the Emergency Department budget in which I currently manage. Research and table top meetings will contribute to much of the budget. Unless, I can get staff to volunteer time I will need to transfer their hours to the ED cost center to eat the cost of their time. EMS, ED providers, respiratory, lab, radiology and ED staff, and sister facility with STEMI protocol currently in place will be included within table top sessions. All supplies needed for implementation will be purchased from staples under our corporate account per CFO.

Sustainment of this project will fall under the Emergency Department. Being the manager will ensure an audit tool is completed for every patient that presents to unit with complaint of chest pain, heaviness in chest, SOB with cardiac history to ensure every patient is receiving up to date evidence-based quality health care. Each month the audit tool will be reviewed. ED providers and staff will be held accountable for care received and or neglected to receive.

References

Mukherjee, D. (2017).  2017 ESC guidelines for the management of STEMI. College of   Cardiology. Retrieved from

https://www.acc.org/latest-in-cardiology/ten-points-to-     remember/2017/09/08/09/32/2017-esc-guidelines-for-the-

management-of-stemi

Penner, S. J. (2014). Economics and financial management for nurses and nurse leaders (2nd ed.). New York, NY: Springer

 

Wordcloud. (2018). 123RF.

As a manager/staff nurse of a rural Emergency Department I find myself between a rock and a hard place frequently. As a nurse my first obligation is to my patient. My patients receive the level of care they expect, and I stand by their decisions because sometimes we are their only advocate within the healthcare team. As a manger my focus is on admissions, income, revenue, patient satisfaction and so forth. This is where cost-effectiveness analysis (CEA) comes into play. According to the World Health Organization 2018 CEA focuses on finding an intervention the provides the outcome expected for the least amount of monies. Whereas Penner 2013 places more of a focus on comparing and contrasting two or more alternative programs and/or interventions to determine cost verse benefit outcome.

Penner 2013 believe by calculating cost per unit of effectiveness (CE) cost can be minimized by choosing the cheapest intervention for the desired achievement or outcome.To determine the CE value, one would take the cost and divide by the effectiveness (Penner,2013). The question at hand is cost decreased by comparing and contrasting two or more alternatives that all produce the desired outcome. A good example would be to compare three different methods to achieving  infection free laparoscopic Cholecystectomies and the costs associated with each. Once cheapest method determined the sound financial choice would be to go with that option. It is a win-win. The patient is provided with optimal patient care, while the organizational cost is minimized for care being provided.

References

Penner, S. J. (2013). Economics and financial management for nurses and nurse leaders, 2^nd ed. New York, NY: Springer Publishing Company, LLC.

World Health Organization. (2018). Cost-effectiveness analysis for health interventions. Health and Environment Linkages Initiative. Retrieved from http://www.who.int/heli/economics/costeffanalysis/en/

According to Penner 2013 a mission statement is meant to communicate the overall purpose of an organization. While the vision effectively communicates what the organization would like to accomplish (Penner, 2013). According to Centura Health 2018 it has stood by the mission statement handed down from their sponsors Adventist Health System and Catholic Health Initiatives from day one. Their mission statement states, “We extend the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities”. Followed by their new vision statement, which was updated in August of 2018 stated as follows, “Every community, every neighborhood, every life – whole and healthy” (Centura Health, 2018).

My personal values closely align with the mission statement and vision of Centura. I went into nursing to provide holistic care for all. My own vision is to provide quality healthcare for every patient every time. I hope to make a positive difference in the life of every patient I come in contact with.  I moved to rural Kansas with my own mission in mind. I wanted to provide a healing ministry to the underinsured, underserved, and immigrant populations in southwest rural Kansas. Centura and I both have a faith-based foundation, however we choose to serve all, no matter the faith, conviction, or denomination one may or may not have.

Sorry, for the late post. We just bought a house and are in the middle of the transition.

References

Centura Health. 2018. Mission and Values. Centura Health. Retrieved from https://www.centura.org/about-centura/mission-and-

values

Penner, S. J. (2013). Economics and financial management for nurses and nurse leaders. New York: Springer Publishing Company.