NUR 621 WEEK 1-4 Discussions Paper

NUR 621 WEEK 1-4 Discussions Paper

NUR 621 WEEK 1-4 Discussions Paper

NUR 621 WEEK 1-4 DQs

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Topic 1 DQ 1

The healthcare policy that I believe has had the greatest impact on healthcare in the United States is the Affordable Care Act (ACA). The law implemented broad reforms aimed at enhancing the accessibility, quality, and affordability of health care. The ACA has minimized the number of uninsured individuals in the US to historically low levels and helped many people, especially people of color and low-income earners to access healthcare services (Park et al., 2019). According to ASPE (2023), more than 40 million Americans had been covered under the ACA by the beginning of the year 2023, which is the highest total on record. Bustamante et al., (2019) also reported that ACA has made tremendous progress toward addressing long-standing challenges that the US healthcare system is facing such as affordability, access, and quality of care. After the passage of ACA into law, the rate of uninsured has significantly declined due to the law’s reforms.


The ACA has facilitated access to health coverage by Americans throughout their lives and also provided various tools to bring the increasing cost of care under control (Gao et al., 2022). The law is consistently transforming the healthcare payment systems. Notably, before the adoption of ACA, the US healthcare system relied on “fee-for-service” payment systems, which repeatedly penalized care providers and healthcare organizations who sought to deliver efficient healthcare and also failed to incentivize providers and organizations for improved quality of care. The law has transformed the healthcare payment system in various important ways. ACA has introduced alternative payment methods such as Accountable Care Organizations and bundled payments (Gao et al., 2022). These payment methods and associated reforms have led to a sustained period of gradual growth in healthcare spending per enrollee and improvements in the quality of healthcare.

 ASPE. (2023). Health coverage under the Affordable Care Act: Current Enrollment Trends and State estimates. ASPE.

Bustamante, A. V., Chen, J., McKenna, R. M., & Ortega, A. N. (2019). Health care access and utilization among US immigrants before and after the Affordable Care Act. Journal of Immigrant and minority health, 21, 211-218.

Duggan, M., Gupta, A., & Jackson, E. (2022). The impact of the Affordable Care Act: evidence from California’s hospital sector. American Economic Journal: Economic Policy, 14(1), 111-151.

 Gao, P., Lee, C., & Murphy, D. (2022). Good for your fiscal health? The effect of the affordable care act on Healthcare borrowing costs. Journal of Financial Economics, 145(2), 464-488.

Park, S., Stimpson, J. P., Pintor, J. K., Roby, D. H., McKenna, R. M., Chen, J., & Ortega, A. N. (2019). The effects of the Affordable Care Act on health care access and utilization among Asian American subgroups. Medical Care, 57(11), 861-868.


Topic 1 DQ 2     

Healthcare regulation characterizes a set of rules and procedures that assist healthcare providers to provide their full services to consumers, especially during the outbreak of a disease and its endemic stage to enable them to control and prevent the disease from becoming a pandemic or epidemic (Yang et al., 2021). Health regulation plays a vital role in the healthcare system of protecting the public from various health risks and provision of different programs to promote public health and welfare (Pyone et al., 2020). Moreover, healthcare regulations are crucial in ensuring adherence to and provision of safe healthcare to all individuals who access the healthcare system. In turn, healthcare regulatory agencies are expected to monitor practitioners and healthcare organizations, deliver information regarding changes in the industry, foster safety, ensure quality services, and promote legal compliance. Federal, state, and local regulatory agencies have the responsibility of creating rules and regulations for the healthcare industry, and their supervision is obligatory.

 Health care regulation is associated with various costs known as compliance costs. These costs are the expenses that an organization incurs to comply with industry regulations. The compliance costs include payroll for the department of regulatory compliance, systems needed for the regulatory process, finances and time spent on regulatory reporting, and conduct costs, which entail payments and fees made by an organization for breaching the current regulations (Barber et al., 2019). Compliance costs often increase with the increase in the regulations in the industry. As such, healthcare organizations risk incurring rising compliance costs when dealing with different regulations. Healthcare regulations often affect healthcare consumers by protecting them against health risks. The public is also affected by ensuring public interests and welfare are served by health initiatives. Providers are also impacted by ensuring safe working conditions for practitioners.


Barber, S. L., Lorenzoni, L., & Ong, P. (2019). Price setting and price regulation in health care: lessons for advancing Universal Health Coverage (No. WHO/WKC-OECD/K18014). World Health Organization.

Pyone, T., Aung, T. T., Endericks, T., Myint, N. W., Inamdar, L., Collins, S., … & Wilson, A. (2020). Health system governance in strengthening International Health Regulations (IHR) compliance in Myanmar. BMJ global health, 5(11), e003566.

Yang, B. K., Johantgen, M. E., Trinkoff, A. M., Idzik, S. R., Wince, J., & Tomlinson, C. (2021). State nurse practitioner practice regulations and US health care delivery outcomes: a systematic review. Medical Care Research and Review, 78(3), 183-196.

Topic 2 DQ 1

Capital purchases connote money used by a setting to make a massive investment in long-term fixed assets (Raghupathi & Raghupathi, 2020). This can include buying equipment and furniture for the unit. The budgeting process for capital expenditures is crucial and the nurse leader needs to factor in some information before approving capital purchase. The first information to consider is the payback period, which represents the duration needed for the cash flows produced by the investment to pay back the cost of the initial investment (Srithongrung et al., 2021). For instance, suppose an investment of $400 will produce a yearly cash flow of $100 annually for six years, the number of years needed to recover the investment is four years. The Payback Period analysis is essential in availing the understanding of the liquidity of the investment.

 The second information that should be considered is Profitability Index (PI). PI is calculated by dividing the current value of the cash inflow and the capital investment by the current value of the cash outflow of the capital investment. If the PI is greater than one, the capital investment is adopted. If the PI is lower than one, the capital investment is rejected (Wang, 2022).  The other information is technological changes. Nurse leaders need to conduct a thorough review of the cost of new products and the productive efficiencies before making a capital purchase. The other information is competitive strategy. Where a business rival is acquiring new equipment to boost capacity, enhance efficiency, and reduce costs, a nurse leader may have to follow by opting for capital purchases for similar equipment (Greer et al., 2020). The information about the cash flow of the organization should also be considered by a nurse leader to help in identifying the appropriate time to make capital purchases.


Greer, S. L., Klasa, K., & Van Ginneken, E. (2020). Power and purchasing: why strategic purchasing fails. The Milbank Quarterly, 98(3), 975-1020.

Raghupathi, V., & Raghupathi, W. (2020). Healthcare expenditure and economic performance: insights from the United States data. Frontiers in public health, 8, 156.

Srithongrung, A., Yusuf, J. E. W., & Kriz, K. A. (2021). A systematic public capital management and budgeting process. In Research Anthology on Preparing School Administrators to Lead Quality Education Programs (pp. 598-619). IGI Global. DOI: 10.4018/978-1-7998-3438-0.ch027

Wang, Y. (2022). Evaluating digital health care startups: Forecasts and market insights. In 2022 2nd International Conference on Enterprise Management and Economic Development (ICEMED 2022) (pp. 1298-1304). Atlantis Press. DOI 10.2991/aebmr.k.220603.210

Topic 2 DQ 2

The MSN degree in Nursing Leadership is essential in preparing students for advanced leadership roles in nursing by creating independent proficiency in the critical analysis and evidence-based assessment of intricate issues associated with healthcare organizations and systems (Morse & Warshawsky, 2021). The emphasis of this program is on professionalism in leading collaborative interprofessional teams, innovation in the incorporation of healthcare services, and evidence-based management practices to realize quality outcomes for beginners and budding nurse leaders. The question I have about this program is whether it can mold me to play a critical role in the transformation of the constantly changing healthcare environment across various settings and specialties. The other question is about how the program will build on my existing nursing knowledge, abilities, and skills to improve my nursing career in leadership.

 What I am looking forward to the most in this program is the development of my leadership skills. I expect to be trained to think and act strategically, take part in policy development and decisions, and lead the organization through change and upgrading (González‐García et al., 2021). This program is expected to prepare students not only for the typical healthcare administrative and management roles but also for rising leadership roles in safety, coordination, quality, magnet, and provider practice management. The concepts offered by this program are used in real-world situations, which is critical in developing skills to lead change in complex healthcare organizations.

 I opted for the MSN Leadership program to gain the leadership and management skills needed to be an astute healthcare leader. These skills are effective in responding to organizational, clinical, and fiscal challenges that are rampant in the US’s evolving healthcare industry (Joseph et al., 2022). The current healthcare system needs people who not only have strong clinical experience and communication skills but are also highly knowledgeable in strategic leadership, organizational behavior, fiscal and human resource management, and applied quality improvement.


González‐García, A., Pinto‐Carral, A., Pérez‐González, S., & Marqués‐Sánchez, P. (2021). Nurse managers’ competencies: A scoping review. Journal of nursing management, 29(6), 1410-1419.

Joseph, M. L., Nelson-Brantley, H. V., Caramanica, L., Lyman, B., Frank, B., Hand, M. W., … & Chipps, E. (2022). Building the science to guide nursing administration and leadership decision-making. JONA: The Journal of Nursing Administration, 52(1), 19-26. DOI: 10.1097/NNA.0000000000001098

Morse, V., & Warshawsky, N. E. (2021). Nurse leader competencies: Today and tomorrow. Nursing administration quarterly, 45(1), 65-70.

Topic 3 DQ 1

Nurse leaders usually control the bulk of the labor budget and so, they need to have a strong understanding of budgeting (McFarlan, 2020). A nurse leader should play a pivotal role in ensuring that his or her unit achieves financial goals while realizing patient safety and quality metrics. Regarding the development of the budget, a nurse leader is responsible for establishing budget priorities and ascertaining that the budget portrays the mission and strategic objectives of the organization (Rundio, 2021). A nurse leader should be capable of recognizing areas that require more funding and allocating resources to those areas accordingly. It implies that a nurse leader should suggest sophisticated programs such as quality improvement programs and allocate sufficient funds to such programs during the budgeting process. Other responsibilities of a nurse leader during the development of a budget include analysis of budget spending, allocation of funds to various projects and functions within the unit, optimization of budget based on performance and spending data, assessing and approving team budget requests, and developing and supervising budget planning and processes within the unit.

The most important responsibility of a nurse leader in budget development is establishing budget priorities. Balancing the budget and setting appropriate budget priorities is crucial in ensuring that the basic needs of the unit are met, the organization is protected from credit, and lowering financial stress (Henson, 2023). Establishing budget priorities also enable nurse leaders to focus on cutting cost on unnecessary spending, making changes in the organization based on operational needs, and planning for the future. With proper budget priorities, a nurse leader can evade challenges such as high cost of care, understaffing, and poor resource allocation and utilization.    


Henson, C. R. (2023). Healthcare Financial Management: Applied Concepts and Practical Analyses. Springer Publishing Company.

McFarlan, S. (2020). An experiential educational intervention to improve nurse managers’ knowledge and self-assessed competence with health care financial management. The Journal of Continuing Education in Nursing, 51(4), 181-188.

Rundio, A. (2021). The nurse manager’s guide to budgeting & finance. Sigma Theta Tau.

 Topic 3 DQ 2              

Full-Time Equivalent (FTE) connotes the equivalent of a single full-time employee running for one year. It is computed based on 40 hours a week for 52 weeks (Kurniawan et al., 2022). FTE entails both productive and nonproductive time. A single employee working full-time 40 hours per week for one year characterizes one FTE. Similarly, two members of staff, each working 20 hours a week for one year, are comparable to one FTE. On the other hand, the replacement FTEs connote the number of FTEs needed to replace non-worked hours (Kuriakose et al., 2022).  Determination of FTE and replacement FTEs are essential because they provide an accurate measurement of the number of full-time workers required to complete workloads and also ensure appropriate workforce planning (Kurniawan et al., 2022). Insights into FTE and replacement FTE also enable organizations to informed decisions across various areas such as financial management and human resource management.                Indirect work hours refer to hours spent on tasks that contribute to the organization’s performance but not to the production of goods and services. All labor work hours are classified as indirect work hours, except the work hours used in the practical production of goods and services (Sinambela & Djaelani, 2022). Indirect labor entails employees who are not directly engaged in generating goods or services while the cost of labor entails all labor not directly involved in changing raw materials into finished products or supplying services. Therefore, hours spent on supervision and support such as maintenance, management employees, administrative work, and janitorial can be classified as indirect work hours.




Kuriakose, C., Stringer, M., Ziegler, A., Hsieh, C., Atashroo, M., Hendershott, J., … & Mahoney, M. (2022). Optimizing care teams by leveraging advanced practice providers through strategic workforce planning. JONA: The Journal of Nursing Administration, 52(9), 474-478. DOI: 10.1097/NNA.0000000000001185

Kurniawan, H., Yulianah, Y., & Shaura, R. K. (2022). Workload Analysis Using the Full Time Equivalent (FTE) Method to Optimizing Labor. Enrichment: Journal of Management, 12(4), 3058-3066.

Sinambela, E. A., & Djaelani, M. (2022). Cost Behavior Analysis and Categorization. Journal of Social Science Studies (JOS3), 2(1), 13-16.

 Topic 4 DQ 1

 Budget variances connote the distinctions between the actual and planned income amounts and expenditures over a given duration (Rundio, 2021). They show how effective the business is in adapting to changing conditions, realizing its goals, and managing its resources. There are two major types of budget variances in healthcare including positive and negative variances (Messer, 2020). The positive budget variance happens when the money spent on expenses is less than the amount that was budgeted for. For example, a healthcare organization can negotiate reduced prices with vendors leading to a positive variance. A positive variance can indicate that a healthcare organization is doing exemplary work in controlling its costs. A negative budget variance occurs in situations where the money used for expenditures is more than what was budgeted for. For instance, an organization may use more costly methods of care than what was budgeted for or prices may go up suddenly leading to a negative variance.

 There are also other types of budget variances in healthcare (Ross, 2020). Mix variances occur when services provided shifts from what was initially planned. For instance, where numerous outpatient services are carried out than expected, a mix variance occurs. Price variances occur when the money spent on goods and services varies from what was budgeted. For instance, if the cost of medications increases, there would be a price variance. Utilization variances occur where the use of resources such as labor and supplies differ from the original budget. For instance, if numerous surgical procedures are conducted than anticipated, a higher labor cost is created than budgeted, leading to a utilization variance. Finally, volume variance occurs where there is a higher volume of patients attended or procedures conducted than what was budgeted.


 Messer, R. (2020). Budget Management Decisions. In Financial Modeling for Decision Making: Using MS-Excel in Accounting and Finance (pp. 241-257). Emerald Publishing Limited.

 Ross, T. K. (2020). Practical Budgeting for Health Care: A Concise Guide. Jones & Bartlett Learning.

Rundio, A. (2021). The nurse manager’s guide to budgeting & finance. Sigma Theta Tau.

 Topic 4 DQ 2

Various tactics can be implemented to decrease agency usage. The first tactic is to ensure visibility. Leaders should begin by finding the root of the problem. It is important to survey all stakeholders to get visibility of what pay rates or commissions are used in the organization (Wakerman et al., 2019). If they are varied, crucial to harmonize them by setting commission rates to be used across the whole organization. The other tactic is to set standard pay rates. This is the simplest step to take when minimizing agency spending, yet many organizations fail to do it. There is no need of paying different rates for employees doing the same job. It is important to set clear rates and stick to them (Adynski et al., 2022). The other tactic is to use the use temporary workforce only when it is utterly essential. There is no need of calling temporary workers when someone else in the existing team can assist. It is important to instill a culture where the existing workforce can make arrangements to help where possible without necessarily getting someone else from outside (Wakerman et al., 2019).

 Other tactics include the creation of a float pool, enhancing recruitment and retention efforts, employing more full-time nurses, and using cross-training (Ronnie, 2020). Analysis of how this unplanned overage will impact the overall staffing budget is crucial. Agency nurses are usually costly compared with full-time nurses. Therefore, overage is likely to increase the overall staffing budget in the unit. Moreover, if the overage is consistent, the Nurse Leader will likely increase the volume of full-time nurses to contain the utilization of the agency nurses.


Adynski, G. I., Sherwood, G., Ikharo, E., Tran, A., & Jones, C. B. (2022). Outpatient nurse staffing relationship with organizational, nurse and patient outcomes: A scoping review. International Journal of Nursing Studies Advances, 4, 100064.

Ronnie, L. (2020). Us and them: experiences of agency nurses in intensive care units. Intensive and Critical Care Nursing, 56, 102764.

Wakerman, J., Humphreys, J., Russell, D., Guthridge, S., Bourke, L., Dunbar, T., … & Jones, M. P. (2019). Remote health workforce turnover and retention: what are the policy and practice priorities? Human resources for health, 17(1), 1-8.


Topic 1 DQ 1

Assessment Description

What health policy do you believe has had the greatest impact on health care in the United States? Explain your rationale.

Topic 1 DQ 2

Assessment DescriptionDescribe health care regulation in your own words. What costs are related? Who is affected?

Topic 2 DQ 1

Assessment Description

Discuss the information you would need as a nurse leader before you could approve a capital purchase.

Topic 2 DQ 2

Assessment Description

Watch the “Welcome to MSN-Leadership in Healthcare Systems,” video in the Student Success Center. What questions do you have about your program? What are you looking forward to the most? Why did you choose MSN-Leadership?

Topic 3 DQ 1

Assessment Description

Discuss the responsibilities that a nurse leader has when it comes to development of the budget. What do you feel is the most important of these responsibilities? Explain your rationale.

Topic 3 DQ 2

Assessment Description

Describe the difference between budgeted FTEs, replacement FTEs, and indirect work hours.

Topic 4 DQ 1

Assessment Description

Describe the different types of budget variances and provide examples of each.

Topic 4 DQ 2

Assessment Description

You meet with your supervisor who lets you know that you are over budget for agency nurses used on your unit. What are some tactics you could implement to decrease agency usage? Analyze how this unplanned overage will impact your overall staffing budget.

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