Post your response and respond to at least three (3) other students responses. Use one scholarly source for each response.  100 words. APA 7 format

RESPONSE TO DISCUSSION POST 1:
In every unit in the hospital, cost management is necessary. In the unit described where they are consistently spending over budget, changes need to be made to reduce costs. This is a more complex issue than just cutting supplies or staff because reducing staff and supplies leads to a decrease in the delivery of patient care and decreases patient satisfaction.

One strategy to contain costs to not exceed the budget for the unit would be to minimize the overtime from the nursing staff and providing adequate training (Kaw et al., 2019). Reducing overtime instead of laying off nursing staff has many benefits. Reducing the nursing staff would potentially lead to high nurse turnover rates as nurses would become overworked and stressed due to higher patient-nurse ratios. Many nurses who work a lot of overtime end up getting burnt out resulting in them leaving their job. Reducing turnover rates in itself decreases the cost to the unit. This is because having to constantly hire new nurses and training them is expensive and also time-consuming. Another way of reducing turnover rates is by providing adequate training to nurses (Kaw et al., 2019). It is noted that around 40% of nurses that do not receive adequate training end up leaving within their first year of employment, further contributing to turnover rates and higher costs (Kaw et al., 2019).

Another strategy to keep this unit within budget is to evaluate if the unit is possibly underdiagnosing malnutrition (Stratton et al., 2018). Not diagnosing malnutrition leads to a high rate of readmission. Readmissions that could be prevented costs hospitals billions of dollars each year. Diagnosing malnutrition could lead to the reduction of adverse effects. This is done by using nutritional supplements to correct and prevent some of the adverse effects leading to increase patient outcomes and the reduction in hospital stays and readmissions (Stratton et al., 2018).

RESPONSE TO POST #2
The manager of a unit that is consistently going over their allowed budget needs to take a step back and determine what the main problem areas are before implementing any changes (Yoder-Wise, 2018). For example, if overtime is consistently a problem, the way the scheduling is being done should be reexamined. Overtime can be a significant part of a budget (Ingels & Maenhout, 2018). The way a unit is staffed should depend not only on the nurse-to-patient ratio, but on the amount of care each patient needs (Stafseth et al., 2018). If the patients on the unit are all high needs patients, the manager might want to consider calling in extra unlicensed assistive personnel (UAP) for the shift or even an extra nurse. This would depend on the level of assistance the nurses and patients might need that shift (Stafseth et al., 2018). If the patients are not high needs, the manager could stay with nurse-to-patient ratios and possibly get help from a UAP if more patients are admitted to the unit. This could reduce overtime hours by properly staffing the unit with enough nurses or UAP to ensure patient safety and quality care. Another area the manager should look at is hospital-acquired infections and how that is impacting the budget. Hospital-acquired infections can cost a hospital a lot of money and are, most of the time, preventable (Jayasree & Afzal, 2019). If the unit has a high rate of infections, education should be provided to reinforce proper handwashing technique, proper sterile technique, and possibly a second nurse or charge nurse should be required to be present for procedures such as catheterizations (Jayasree & Afzal, 2019).

RESPONSE TO POST TO #3
Medical tasks require a variety of materials and delivering critical care is expensive (Wilcox et al., 2019). The Wilcox et al. study found that there were about only 5% of cost-effective savings in participating studies they reviewed. This was a result of the lack of homogeneity of interventions nurses used along with the complexities of care required such as mechanical ventilation. A second study also found that specific interventions like extracorporeal cardiopulmonary resuscitation could potentially be more cost-effective than alternative interventions for certain emergencies such as cardiac arrest (Dennis et al, 2019). This indicates that evidence-based research can identify interventions that can be more cost-effective for units, reducing the need for expensive interventions that are ineffective for patients. As a result, a unit may have various factors that contribute to their exorbitant expenses which may be hard to track.

Hospital units go through a lot of supplies and materials each month. As a PT/OT aide, one of my responsibilities was to ensure that supplies were stocked and ordered for the unit at all times. In doing so, I was asked to stay within budget and notify managers if we were approaching the upper limits of our budget. Similarly, at the ICU I work in, there are strategies in place to ensure that we keep track of usage which helps determine our budget monthly and yearly as a unit. Two suggestions to maintain a budget are the following: tracking usage of supplies and encouraging management to educate staff on proper procedures so that they arent using items in excess as a result of avoidable errors. For example, the clean supply room has a Pyxis for materials that may cost more or be valuable so that staff is not wasting excess materials. Similarly, for the open supplies, we punch in how many items we take or return in order to notify the correct department for when the unit may require more. Lastly, we are trained on skills so that we are comfortable using materials and able to perform duties with as little error as possible. This can be beneficial as we are not wasting items or medications as a result of errors and negligence.