Premiums Some organizations offer premiums for certifications or clinical ladder steps. In this situation, a fixed dollar amount may be added to the base hourly rate of eligible personnel; for example, an
CHAPTER 14 • BUDGETING AND MANAGING FISCAL RESOURCES 191
additional $1.00 per hour paid for professional certifications. This would result in the hourly rate of the employee being adjusted from a base of $18.00 to $19.00. In this case, if the employee is full time and works 2,080 hours a year (40 hours a week multiplied by 52 weeks a year), the annual new salary would be $39,520, or $19.00 multiplied by 2,080.
Salary Increases Merit increases and cost-of-living raises also need to be factored into budget projections. These increases are usually calculated on base pay. For example, if a three percent cost-of-living raise is projected and the base salary for an RN is $40,000, then the new base becomes $41,200.
Additional Considerations Other important factors to consider when developing the salary budget are changes in technology, clinical supports, delivery systems, clinical programs or procedures, and regulatory requirements. Changes in patient care technology or the introduction of new equipment may influence the num- ber, skill, or time that unit personnel may spend in becoming trained to use the new equipment and, later, operating and maintaining it. If significant, the projected number of additional labor hours for the new budgetary period should be incorporated into the request.
The Joint Commission, the organization that accredits health care organizations, evaluates an institution to determine whether it is adhering to the level of staffing required to maintain a safe patient care environment (Joint Commission, 2011). For example, the institution may have established a standard for critical care units and some other specialty units that a minimum of two staff members are required at all times, regardless of patient number or acuity. Additionally, some states have mandated staffing levels.
Departments such as environmental services, dietary, escort, or laboratory may provide the nursing unit with support in performing certain tasks, such as transporting patients or speci- mens. Any change in the level of support they provide should be reviewed, and the effect of such change on the unit’s staffing levels should be quantified for the next year’s budget request. Changes in staffing can place new demands on the unit. Therefore, orientation and additional workload needs should also be considered.
In addition, changes might be made to the way the organization charges costs. For ex- ample, some direct or indirect costs formerly charged under other divisions might now be allocated to the various units. You might find your unit charged its fair share of the heating or security budget. Major changes, of course, are planned ahead of time but some changes occur during the budget year, and the unit might be expected to absorb those additional costs within its original budget.