Running head: ZERO BASED BUDGET

Zero Based Budget

Jessica Organt
Bon Secours Memorial College of Nursing
Business of Health Care in Complex Systems
NUR 4240
Professor Catherine Mikelaites
June 11, 2015

I Pledge
Zero Based Budget
When considering a project that would benefit not only the nurses on the unit I work, but
also the patients, many items initially came to mind. I believe everyones first instinct would be
to consider any new technology and equipment that may make the work a little easier. The unit
being discussed is unit 4C, a very busy Medical-Surgical/Telemetry/Oncology unit at
Richmonds VA (Veterans Affairs) Medical Center. Recently, this unit purchased new beds that
would assist with turning, new lifts and tracks for each patient room, new computer programs to
assist in documentation, medication administration, and combining all aspects of the patients

care such as exams and test results, as well as consults. So what could this unit possibly need
now?
Because this unit is the only unit in the facility that administers intravenous (IV)
chemotherapy, I thought one way to improve patient care, patient safety, and employee
satisfaction would be to require that all nurses working on the unit obtain and maintain their
Oncology Nursing Society (ONS) Chemotherapy Certification. Currently on this ward there are
thirty beds, with six beds designated to chemotherapy patients. There are twenty-seven registered
nurses (RNs) on the floor, with only twelve of the nurses holding their chemotherapy
certification. Because there are so few nurses who can administer chemotherapy, often nurses
must come in on days off, or are mandated to stay over to cover chemotherapy on the floor.
This VA facility currently only acknowledges ONS certification for chemotherapy
administration, so this is the only option available for research. Certification and training hours
are required to allow any nurse to administer chemotherapy and only qualified and trained nurses
and physicians may administer chemotherapy (Neuss et al., 2013) For initial certification, the
class and exam cost is $279.00. The certification is required to be renewed every two years, with
a renewal fee of $139.00 (Oncology Nursing Society, 2015). Many of the challenges faced in this
project were not from researching the certification itself, but taking into account all costs
involved in this project. To get a better idea of overall cost, I met with a former member of the
budget council, as well as the unit manager to help uncover all costs that may be involved. I had
taken into account the cost of the certification and recertification, however I did not initially take
into consideration the cost of the nurse attending a two-day online course. This requires the
facility to pay for the nurse to have the time to take the class and the exam at the end. I had also
not considered the cost of nurse satisfaction. When nurses feel the workload is uneven and

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unfair, many nurses look for employment elsewhere. When this happens, a new nurse must be
brought in, and according to the budget council at the VA, can cost the facility up to $60,000.
This cost includes pay for the new nurse during orientation while they are not taking patients, as
well as the senior nurse who is designated to orient the new nurse. The process is very time
consuming and costly to any facility.
When preparing the presentation, I wanted to make sure I had three alternatives that were
all realistic for the facility, so that the audience would have more than one option to consider
when they finished with the power point. I wanted to make sure that the focus was not only on
monetary gains, but also on patient safety and patient care concerns. The first alternative, which
was essentially doing nothing different than what is being done now, is not recommended
because of the extra cost for having to hire new employees due to dissatisfied nurses. This
alternative stated that the nurses who had their certification would continue to be the ones caring
for chemotherapy patients, and this means that often nurses are required to do mandatory
overtime or come in on days off to cover chemotherapy. This increases the likelihood of
medication errors and patient safety issues because quite often the nurse is working over and
tired, and more mistakes can happen.
The second alternative, encouraging more nurses to go for their ONS certification by
implementing a $1,000 incentive reward, as is offered for many of the other certifications at the
VA, is still not ideal. Because nurses are still not required to obtain their certification in this
scenario, there may still be many nurses who choose not to go for their certification, and an
uneven workload may still exist, causing many nurses to still be frustrated with their work
environment and possibly leave. This means increased spending for new nurses, costs for the

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exams and certifications for those who choose to go for their certification, as well as the initial
incentive award. This alternative was too expensive, and did not guarantee a pay out in the end.
The last alternative, requiring all nurses to obtain and maintain their certification, is the
recommended alternative. In this scenario, all nurses must be chemo certified, making the
workload even for all nurses on the floor. This will lead to higher nurse satisfaction, and less
turn-overs, ultimately saving the facility thousands of dollars each year. The facility will still be
paying for the class and exam upon completion, but the incentive award has been removed in this
scenario. In this alternative, all members of the team have the same expectations, and no one will
feel there is unfair treatment. Also, because the work is evenly spread, patient safety will
improve, and reduce the chances of any medication errors. With more time to be with each
patient, the nurse can watch closely for any side effects that could be fatal, such as some cardiac
arrhythmias. This scenario is the ideal solution, and one that would be recommended to the
director and shared governance committee.
Overall, I enjoyed this project because it truly gave me an insight to all aspects of what a
budget committee may be concerned with. Up until this point, I had not had any experience with
budget whatsoever, nor ever taken it into account when coming up with ideas. In completing this
project, I had to look for the less obvious areas of spending involved with each scenario. As
mentioned previously, at first I had only looked at the cost of the class and exam itself, but there
are more areas that need to be investigated, such as cost involved with the staff and possible loss
of staff. This project helped me to realize that although an idea may seem cost-effective and to
save money in my head, when outlined on paper, there are often other less-obvious areas
involved that may be costing great amounts of money. This project has also helped me to look at
areas of improvement on my unit, and ways that leadership can work with employees to work

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together and come up with an effective plan. As shared governance is still new at my facility, it
has allowed me to bring this issue to their attention, to hopefully gain some speed in bringing
about change. It has allowed me to see that change does not just happen, that it comes with time
after much research, time and evaluation of all alternatives and outcomes. I know that next time I
have an idea for improvement on my unit or facility-wide, I will think more about all aspects of
the budget that are involved.
Budgets and plans need to investigate all aspects of the idea, as well as all the possible
benefits and downsides to every plan. There should always be more than one option, explaining
why one may be more beneficial than the next. Most importantly, the plan needs to clearly show
its importance of being implemented, and who all will benefit in the long run.

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6
References

Neuss, M. N., Polovich, M., McNiff, K., Esper, P., Gilmore, T. R., LeFebvre, K. B., ... Jacobson,
J. O. (2013). 2013 Updated american society of clinical oncology/oncology nursing
society chemotherapy administration safety standards including standards for the safe
administration and management of oral chemotherapy. Oncology Nursing Forum, 40(3),
225-233. Retrieved from https://www.ons.org/sites/default/files/2013chemostandards.pdf
Oncology Nursing Society. 2015. ONS/ONCC chemotherapy biotherapy certificate course.
Retrieved from: https://www.ons.org/content/onsoncc-chemotherapy-biotherapycertificate-course