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Building new programs in women's health: a fiscal perspective.


Many staff nurses have not been exposed to budgeting principles in their basic educational nursing programs. Historically, nurses were taught clinical nursing and not fiscal management (Parsons, 2008). Nurses readily express their lack of skills in fiscal planning. This article is meant to introduce the concepts of budgeting and project management with application to developing childbirth education or nurse in-service education with a hospital budget.

In the nursing profession budgeting is generally the responsibility of nursing management. Budget development is frequently taught to new nurse managers when they are promoted (Catalano, 2012), but staff nurses and nurses employed in the hospital's education department may lack the skill set to develop a budget for patient education programs. Women of child-bearing age are generally healthy cohorts who seek out information to care for themselves and their newborn. A myriad of programs are needed to educate these consumers. The reader is also encouraged to think about applying for grant money to start health education classes and private funding courses. The purpose of this article will be on budget planning and development and information will be shared for two major programs; breast feeding and childbirth education.

Basic Budget Information

A budget is a financial plan. In nursing, a plan is developed after determining the needs of the population needing services. Once a budget plan is formalized (placed in writing) by the planning team and quantified (costs outlined in dollar terms) the project manager can begin work on a given program (Swayne, Duncan, & Ginter, 2008; Finkler, Kovner, & Jones, 2007). Project planning on a maternal-child care unit focuses on operational matters important to providing comprehensive care, which includes patient education, within the hospital organization (Finkleman, 2012).

The project manager needs a roadmap to guide steps in the planning process to determine the activity that needs to be completed, determine the responsible person, and set a deadline date for completion. The budget plan for education programs will be determined by delivery trends within the organization; therefore, each hospital will have its own timetable for offering educational classes (Finkler, Kovner, & Jones, 2007). The reader is referred to Table 1 to view a sample budget timetable for developing a budget for a breastfeeding class.

Costs Associated with In-Service Education Classes

When developing this program, the planner will need to be aware of basic fiscal terms. Frequently hospital nurses are told that the class must at least break even financially before it can be offered. A budgetary break-even point occurs when a minimum volume is needed (participants enrolled for a class) for a program to be self-sufficient (Finkler, Kovner, & Jones, 2007). A profit occurs if revenues exceed expenses. Conversely, a loss would occur if expenses were greater than the revenue obtained. Therefore, the childbirth educator serving in the project manager role must be familiar with basic supply costs in the operating budget associated with teaching. Consider the costs of printing flyers to advertise the program, the marketing plan fee, and speaker fees for a topic expert. There will also be consumable supplies needed for the class such as posters, handouts, breast pump, and/or mannequins/models, and costs of renting space may need to be determined.

Putting the Budget Plan into Action

Now that the educator/project manager is aware of how the budget timetable aids in making the class a reality s/he can begin to initiate the education class. It is important that the project manager know their specialty field well in planning the program. Here is an example of a breast feeding in-service class planned for staff nurses in the hospital; the program will be marketed to other nurses practicing in the region.

Breastfeeding Class

Multiple benefits are associated with breastfeeding including a decreased incidence of otitis media and diseases of the gastrointestinal and respiratory systems for infants and certain cancers for breastfeeding mothers (Kervin, Kemp, & Pulver, 2010). Breastfeeding support and education for expecting and new mothers is an essential role of the registered nurse. Community breastfeeding classes provide an optimal learning environment for educating expectant parents on the benefits and how to get started with breastfeeding after delivery. Kervin, Kemp, and Pulver found that offering women breastfeeding education classes during pregnancy influenced the intentions of breastfeeding more than other education (2010). In a study by Weiss et al. (2006), women had higher breastfeeding self-efficacy scores after attending a prenatal breastfeeding workshop compared to those who did not participate in a breastfeeding workshop. Nurses educated about breastfeeding from the same childbirth educators who are educating the parents can only increase consistency of information. Hospitals may be required to ensure nurses have yearly education on breastfeeding.

The organization may hire a board certified lactation consultant to teach the class or may support one of their nurses to become certified as a lactation consultant. The International Board of Lactation Consultant Examiners (IBLCE) has three pathways for individuals to qualify for examination (IBLCE, 2011). However, there are specific requirements to meet eligibility. The cost to sit for the exam ranges from 460.00 to 640.00 U.S. dollars. This cost is contingent on when the nurse registers for the exam and registration deadlines; i.e. early registrants pay a lower fee. Costs associated with becoming a certified lactation consultant vary.

Breastfeeding classes directed at mothers in the community may need a budget proposal to become available. Best practices have shown that breastfeeding classes should be taught over a 1 1/2 to 2 hour duration by a Board Certified Lactation Consultant for expectant mothers. They can be offered monthly or weekly depending on the community need. The class will include the following topics: benefits of breastfeeding and getting started, positioning, latching, milk production and storage, pumping, preventing and treating problems, tips for success and going back to work. The reader is referred to Box 1 to review the outline of the breast feeding class. The classes taught to nurses replicates what is being taught to mothers.
Box 1. Outline of a Breast Feeding Class for Mothers

I.   Benefits of breastfeeding
     a. DVD on Benefits of Breastfeeding
II.  Positioning and latching
III. Milk production and storage
IV.  Pumping
V.   Going back to work
VI.  Tips for success
VII. Preventing and treating problems

A variety of teaching tools are essential for educating expectant mothers on breastfeeding basics and these teaching aids help the visual learner absorb and retain information. Supplies for an in-service education for nurses could be shared with classes for expectant mothers.

Refining the Breast Feeding In-Service Budget

The costs for the Certified Lactation Consultant and the consumable supplies outlined in Table 1 totaled approximately $800.00. If marketing the program cost $1,000 and the salaries for the education director and the education department staff cost approximately $700.00, the total program would cost the hospital $2,500.00. If the charge to the participant for attending the in-service was $50.00 there would have to be 50 nurses in attending the classes for a budgetary break-even point to occur. The calculation is as follows: 50 participants x $50.00 = $2,500.00

Therefore, a strategy that the project manager could use to justify the budget to upper administration could be citing that several new parents in the region have requested the in-service on the topic of breast feeding and an audience of 100 nurses is projected. The project manager would justify the in-service expense by citing that the program would generate a $2,500 profit to the organization.

Childbirth Education

The International Childbirth Education Association (ICEA) is another prominent organization that provides practice guidelines, patient teaching materials, and certification courses for nurse educators. The ICEA values differing professional viewpoints for maternal-infant care. Their website prominently describes the organization's philosophy as follows: "The International Childbirth Education Association (ICEA) is a professional organization that supports educators and health care professionals who believe in freedom to make decisions based on knowledge of alternatives in family-centered maternity and newborn care" (para. 1).

Expectant parents who choose ICEA techniques for the childbirth experience find their approaches consistent with their own values of being informed consumers of healthcare (London, Ladewig, Ball, Bindler, & Cowen, 2011). Several non-pharmacologic approaches are practiced by ICEA nurse educators. These include but are not limited to Kegal exercises that strengthen muscle tone prior to birth and facilitates quicker muscle repair following birth (Ladewig, London, & Davidson, 2010). Other interventions include pelvic tilt exercises to prevent or minimize muscle strain in the back and promote abdominal muscle strength. Breathing techniques are encouraged to promote relaxation during delivery and to promote adequate oxygen levels for the mother and fetus during the birth process.

Information about the role and costs associated with being a Lamaze[R] Certified Childbirth Educator (LCCE) might also be helpful. Childbirth education can be a key factor in the successful delivery of healthy babies. Because the positive outcomes of childbirth education classes are well known, antenatal education has evolved to be a standard offering of health promotion classes in many healthcare facilities (Berman, 2006). Sercekus and Mete (2010) reported that studies indicate that women who receive childbirth education are less likely to smoke and drink alcohol than women who do not receive childbirth education. Women who receive childbirth education also report more interest in their health such as exercising and improved nutrition.

Studies have also indicated that women find information related to relaxation techniques beneficial (Bingham, 2010). Lamaze practices are based on recommendations by the World Health Organization (WHO) and supported by extensive research. The six healthy birth practices utilized in the Lamaze method support a woman's "natural and inherent ability" (Bingham, 2010, p. 10). Lamaze educators work to increase safety and make sure that every woman has a natural, safe and healthy birth experience.

The Lamaze[R] curriculum employs a contemporary view of childbirth seen as normal, natural and healthy. The Lamaze[R] method "empowers" women and their partners to make knowledgeable decisions. Women enroll in the Lamaze[R] program around 20-22 weeks gestation and begin class at the beginning of the seventh month of pregnancy. The average length of the program is six weeks. In Box 2 is an outline of a common childbirth education class.
Box 2. Outline of the Childbirth Education Class

* Normal labor, birth and early postpartum

* Positioning for labor and birth

* Relaxation and massage techniques to ease pain

* Labor support

* Communication skills

* Information about medical procedures

* Breastfeeding

* Healthy lifestyle

Costs and Criteria for Childbirth Education Certified Options

There are four organizations that offer courses for childbirth education certification; Great Starts Birth and Family Education, Lamaze International, International Childbirth Education Association (ICEA) and the Childbirth and Postpartum Professional Association (CAPPA). Information about these offerings can be viewed at Table 2 (next page).


The best person to educate new mothers and the general public about women's health issues are the registered nurses and trained childbirth educators who provide direct, hands-on care and patient education daily. Information shared within this article will help the nurse project manager organize the teaching plan, develop a budget, construct a budget timetable and gather the appropriate personnel to facilitate offering the in-service program. Learning basic budget concepts will aid the childbirth educator in offering several programs needed by patient and their families or health care professionals in the specialty field of women's health. Once funding is obtained and the education is being provided, the reader will do what they do best, prepare families for birth.

Basic Budget Terms

The education program planner will become more comfortable in planning new programs when basic budget terms are understood. Here are some definitions and examples.

* Fixed Cost--costs that are static (do not change) in total as volume changes.

--Example--Salary of the Education Director when an in-service class is being taught on breast feeding

* Variable Cost--costs that vary in direct relation to volume.

--Example--Handouts for an in-service class. The greater number of participants (volume) the greater number of handouts (volume) must be made.

* Variance--a deviation from the norm.

--Example--15 obstetrics nurses were budgeted to attend the pre-natal in-service education class and only 10 enrolled in the class. There was a deviation of five nurses.

* Budget Justification--explanation given in defending a proposed program budget. This may also occur to explain a variance that occurred after a program has been offered.

--Example--An extra in-service needs to be offered on pre-natal care due to the increased number of deliveries for the current month.


Berman, R. O. (2006). Perceived learning needs of minority expectant women and barriers to prenatal education. The Journal of Perinatal Education, 15(2), 36-42.

Bingham, D. (2010). Lamaze certified childbirth educators: Drawing strength from our past to build the future. The Journal of Perinatal Education, 19(3), 8-10.

Catalano, J. T. (2012). Nursing now! Today's issues, tomorrow's trends. Philadelphia, PA: F.A. Davis Company.

Childbirth Graphics. (2011). Retrieved on November 18, 2011, from www.

Durham, J. (2011). Transitions to parenthood: Childbirth education on the web. Retrieved November 18, 2011, from http://transitiontoparenthood. com/ttp/

Finkelman, A. (2012). Leadership and management for nurses core competencies for quality care (2nd ed.). Boston, MA: Pearson.

Finkler, S. A., Kovner, C. T., & Jones, C. B. (2007). Financial management for nurse managers and executives (3rd ed.). St. Louis, MO: Saunders Elsevier.

International Board of Lactation Consultant Examiners (IBLCLE). Retrieved November 18, 2011, from

International Childbirth Education Association (2011). ICEA philosophy statement. Retrieved on December 6, 2011, from

Kervin, B. E., Kemp, L. & Pulver, L. J. (2010). Types and timing of breastfeeding support and its impact on mothers' behaviours. Journal of Paediatrics and Child Health, 46, 85-91.

Ladewig, P. W., London, M.L. & Davidson, M.R. (2010). Contemporary maternal-newborn nursing care. (7th Ed.). Upper Saddle River, NJ: Pearson.

Lamaze International. (2011). Childbirth educator training (Data file). Retrieved from:

London, M.L., Ladewig, P.W., Ball, J.W., Bindler, R.C. & Cowen, K.J. (2011). Maternal and Child nursing care (3rd Ed.). Upper Saddle River, NJ: Pearson.

Parsons, L. C. (2008). Management and leadership in nursing. Brockton, MA: Western Schools.

Sercekus, P. & Mete, S. (2010). Effects of antenatal education on maternal prenatal and postpartum adaptation. Journal of Advanced Nursing, 66(5), 99-1010. doi: 10.111/j.1365- 2648.2009.05253.0

Swayne, L. E., Duncan, W. J., & Ginter, P. M. (2008). Strategic management of health care organization. (6th ed.). San Francisco, CA: Jossey Bass Imprint.

Weiss, J. N., Rupp, A., Cragg, B., Bassett, V. & Woodend, A. K. (2006). Randomized controlled trial to determine effects of prenatal breastfeeding workshop on maternal breastfeeding self-efficacy and breastfeeding duration. Journal of Obstetric, Gynecologic, & Neonatal Nursing (JOGNN), 35(5), 616-624.

Lynn Parsons DSN RN NE-BC, Teresa Howell MSN RN CNE and Teresa F. James MSN RN CNE

Lynn C. Parsons has held administrative positions in the acute hospital and academic settings for the past 30 years. She has two advanced degrees in administration and is certified as a nurse executive through the American Nurses Credentialing Center (ANCC).

Teresa Howell has 30 years of experience that includes being a Nurse Manager for Medical-Surgical and Maternal/ Newborn Acute Care Units. She is a bereavement counselor for ELNEC (End of Life Nursing Education Consortium) where she has earned state and national recognition for her work with children and bereavement. Currently she is an Associate Professor of Maternal/Newborn Nursing and a holds NLN certification as a Certified Nurse Educator (CNE).

Teresa James has 24 years of nursing experience including women's care/newborn nursery and nursing education. She was previously certified as a lactation consultant through the I.B.L.C.E. and taught breastfeeding classes in the community setting. She is currently pursuing a Doctoral of Nursing Practice degree at the University of Kentucky.
Table 1.

Activity               Responsibility         Deadline

Appointment of         Chief Nurse            January 1
Budget Committee       Executive

Appointment of         Education Director     January 15
Budget Committee

Initial Budget         Budget Committee       February 1
Projections &          Chair
Communication with
Unit Managers *

Complete Program       Budget Committee       February 15
Budget                 Chair and Budget

Negotiation between    Education Director     March 1
Unit Managers and
Budget Committee

Compilation of         Education Director     March 15
Budget Requests

Development of         Education Director     March 31
Project Budget         in Consultation with
                       Budget Committee

Approval of the        Chief Nursing          April 15
Project Budget         Officer

Implementation of      Budget Committee       May 1
Budget Plan            Chair & Budget

* Unit Managers includes Labor & Delivery, Post Partum and Newborn

Table 2. Childbirth Education Certification Options

ICEA--International Childbirth Education Association

GS--Great Starts Birth & Family Education, Seattle

Lamaze--Lamaze International

CAPPA--Childbirth and Postpartum Professional Association

Name             ICEA              Great Starts      Lamaze

Enrollment       Enrollment:       $75               Study Guide
cost             $100                                $125 for Lamaze

Class            16 ICEA contact   Either the        Attending a
                 hours             Great Starts      Lamaze educator
                 Professional      training (24      seminar. $395--
                 Childbirth        hours of          645
                 Educator          classtime in 4
                 Workshop costs    days for $500),
                 $250--500         or Childbirth
                                   Training at
                                   School (48
                                   hours over 6
                                   days). $859

Exam             Closed book       Closed book. 60   Exam. 150
                 exam. 150         questions         multiple
                 Multiple choice   (multiple         choice. Given
                 questions. 70%    choice, short     at a
                 to pass. $99 at   answer, essay).   computerized-
                 conference,       85% to pass.      testing
                 $200 elsewhere.   $75. Schedule     location (700
                                   and location at   in the U.S.)
                                   your              two times per
                                   convenience.      year. $250

Study Guide      Study modules.    Comprehensive     Study guide--
                                   study guide to    online or
                                   accompany         printed

Readings         Required (8       3 recommended     Several
                 books)            books             recommended

Observations     None required.    Required:         None required.
                                   Observe 14 hour
                                   series with one
                                   Recommended: 3
                                   hours each with
                                   2 other

Student          Evaluated         (Recommended:     Designing a
Teaching         teaching          Co-teach a 14     curriculum.
                 series, 12+       hour series.)     Documentation
                 hours, with an    Required:         of practice
                 ICEA certified    observed and      teaching
                 instructor.       evaluated teach   experience with
                 Some evaluators   of 14 hour        a mentor.
                 do this free;     series.
                 some charge.

Births           Observe 2         Observe 2         Observe births
                 births.           births.

Other            --                --                --

Annual Dues      $75               --                $95

Total Cert. Fees $525-1125         $650 or 1009,     $865-1315
                                   depending on
                                   training choice

Name             CAPPA             CAPPA Distance

Enrollment       Packet: $35       $400 for packet
cost                               and videos

Class            CAPPA approved    Watch video
                 training          workshop
                 workshop (after   series. (fee
                 completing        above)
                 readings and
                 $350--400 2
                 days: 16 hours

Exam             Open book test.   Open book test.
                 85% to pass.      85% to pass.
                 $75 processing    $75

Study Guide      Pre-workshop      Childbirth
                 study guide       educator manual

Readings         Required (5       Required (5
                 books)            books)

Observations     Observe 1 birth   Observe 1 birth
                 series: 10+       series: 10+
                 hours. 1          hours. 1
                 breastfeeding     breastfeeding
                 class, 1          class, 1
                 newborn care.     newborn care.

Student          15 minute topic   Submit video or
Teaching         at workshop;      audiotape of
                 Two student       yourself
                 teaching hours,   teaching at
                 observed by       least 2 hours
                 certified         of a childbirth
                 instructor.       series. Submit
                                   class outline
                                   and handouts.
                                   $75 for eval.

Births           Observe 2         Observe 2
                 births.           births.

Other            --                2 recommendation
Requirements                       letters

Annual Dues      $45               $45

Total Cert. Fees $505-555          $595

Other options: ALACE (Assoc. of Labor Assistants and Childbirth
Educators), Birthing from Within, Birthworks This material was
excerpted from an article by Janelle Durham with permission. ICEA
information was updated before publication.
COPYRIGHT 2012 International Childbirth Education Association
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2012 Gale, Cengage Learning. All rights reserved.

Article Details
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Author:Parsons, Lynn; Howell, Teresa; James, Teresa F.
Publication:International Journal of Childbirth Education
Article Type:Report
Geographic Code:1USA
Date:Jan 1, 2012
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Next Article:Centering pregnancy: changing the system, empowering women and strengthening families.

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