Nursing Management - Reference textbook: Sullivan, E.J. (2012). Effective leadership and management in nursing. (8th Ed.). Upper Saddle River, NJ: Prentice-Hall. ISBN-10: 0132814544 | ISBN-13: 978-0132814546

Chapters: 14, 15,16

Overview - Budget and Finance

Financial issues in healthcare often seem remote to the nurse and the nurse must have an understanding of financial matters of the health care delivery system, including the viability of the workplace, and the opportunities to optimize healthcare for the welfare of their patient. Key behaviors needed by nurse managers and those who care for groups of patients is ability to: understand the budgeting process; recognize general types of budgets; distinguish between direct and indirect costs; be familiar with the steps of a typical budgetary process and cost out nursing services. Different types of budgets include: operating budget, performance budget, capital budget, expense budget, zero-based budget, product line budget, cash budget. Operational plans, cost center, expense, revenue and profit are other key concept that will be addressed in the readings.

A budget is a formal plan for managing financial resources. The budget document indicates the expected income and expected expenses of an organization, department, or individual. It provides a method of tracking cost and, therefore, a way to examine where saving s could be made. The total organizational budget is usually separated into two distinct sections: the operating budget and the capital budget.

Budget planning procedures vary from organization to organization. However, some parts of the process are common to all organizations. These include steps to gather information before budget preparation such as making an environmental assessment, stating mission and goals, making assumptions about the future setting operational objectives, obtaining the budget guidelines, preparing budget manuals and budget projections packages (last year's budgets, sets of forms all used in estimating future expenses).
Environmental assessment for budget purposes includes the environments that are both internal and external to the organization. As part of the internal assessment, the budget planners will identify the strengths and weaknesses of the organization. The external environment takes into account the changing needs of the population, shifts in third-party payment patterns, reimbursement, service contracts and loss or gain of physicians/programs and mergers.

With the economic climate of health care in turmoil, greater attention is being given to reduce cost while maintaining or improving the quality of care. The nursing budget can account for as much as half an organization's total expenses nurse managers at all levels are facing significant pressure to become proficient in the budgeting process, to allocate resources, and control and monitor expenses.
Staffing, Scheduling

When asked "what professional issues keep you up at night?" nurse managers will often report staffing issues as the cause. The science of allocating the right human resources for the right work at the right time, taking care of the right population of patients is combined with the art of effective communication to create a healthy and healing environment for both patients and their caregivers. Staffing plans are based on a projected year and need to be closely aligned with the budgeting process. Staffing of personnel in healthcare facilities is regulated and directed by federal and state laws, professional accrediting organizations and professional standards. Forecasting and calculating full time equivalent (FTE). Forecasting takes into account both productive and non-productive time. A number of variables are involved in calculating FTEs. Some of these include shift rotation, weekend needs, length of shifts. The Power Point slides for this unit will outline calculation of FTEs. Also, state laws such as the Nurse Practice Act guide the responsibility of the nurse in regards to floating to another unit or not. These laws may vary from state to state. The nurse needs to know the organization's policy and its congruency with state and federal laws. Scheduling process in an organization may be centralized or staff may do self-scheduling. This may vary from unit to unit based on philosophy and organizational guidelines. There is also computer software for scheduling. Managers in healthcare as in other organizations need to evaluate productivity. Each unit has different numbers for calculating productivity. How is nurse productivity evaluated on your S482 clinical unit? Leadership has a great deal of influence on productivity. Environments that have a culture of civility, team work and respect for the worker are a few examples of factors that contribute to productivity.

Assignment questions: Post answers in Forums Module VI. See calendar for due date.

1. Discuss steps in developing the unit or department budget. Who all is involved?

2. How is the cost of nursing care incorporated into a budget?

3. How does a nursing unit determine how many nurses are needed for a 12 month period?

4. Differentiate among various types of budgets: fixed, variable, capital budgets.

5. Describe how to calculate hours necessary to equate to one FTE.