Budgeting and Principles
The preparation of a nurse manager to effectively manage a department includes the education to manage hospital resources (Finkelman, 2016). This includes budgeting. Though nurse managers are held accountable for maintaining a department budget, they are not prepared to plan and maintain a budget (Beach, 2013). A key element of budgeting for a department is that it compels the manager to plan (Finkelman, 2016). It is important of not only the nurse manager to consider and act on strategies toward conserving financial resources, but also the nursing staff should understand and consider these strategies (Seifert, 2012).
Application of Budget to Preceptor Experience
Both preceptors for nursing and risk management were well aware of their budget constraints. Nursing management is accountable to the chief executive officer and risk management is accountable to the risk management corporate office for their budgets. The budget for the nurse manager considers staffing, equipment, and office supplies. Datz, Hallberg, Harris, Harrison, and Samples (2012) state that workforce planning is related to predicting staffing needs. The nurse manager uses a specific matrix that determines the amount of nursing staff needed by the number of patients. The acuity level of the patient is not considered. The nurse manager reviews past census levels. It was found that during the winter months, the patient census was higher. The staffing needs are then planned accordingly based on past patient census. The summer months also had a higher patient census because of the high tourist population that found they could not tolerate the high elevation of 7000 feet in Santa Fe, New Mexico. Reviewing past patient census and the number of nursing staff assigned assists the nurse manager to plan for the future. On a monthly basis, the nurse manager meets with his staff to explain the current status of meeting budget requirements as well as planning for the annual budget. The nurse manager feels that if the staff is aware of the budget requirements and how it affects the purchase of updated equipment, they will be more cognizant of how staffing and the haphazard use of supplies affects the unit. Vacation and sick time is also discussed at meetings to explain how this also affects the budget.
The hospital provides the nurse manager with a template for a weekly, monthly and annual report. The budget is kept within the expenditure parameters as required by hospital administration. When there is a high patient census, this usually contributes to a cost saving, highly productive activity. Fortunately, financing nursing continuing education is procured from an education budget that is separate from the nursing unit budget. Datz et al. (2012, explain the positive outcomes of Banner Health systems resulting from financial planning. One area is the predicting the need of nursing staff. The authors state that by becoming more accurate with this prediction, the cost can be closely determined. This is the budget practice used by the nurse manager that I followed. I am still questioning not considering patient acuity for staffing and workload.
Control of Variances
I asked the nurse manage how he could control variances that were related to census changes. He stated that with the current system of a set staffing matrix, he could not control staffing needs as it related to the patient census. He did state that when the patient census is low, this provides better working conditions. He can apply this slight loss in productive hours to when he needs more nursing during a high and acuity patient census. Even though acuity is not considered in the staffing matrix, he will consider acuity during a patient census phase. The financial impact of utilizing more nurses will even out in the final reporting of the budget. If the budget is borderline, he will come in to do patient care or the charge nurse role.
Human Resource Needs and the Budget
Markey and Tingle (2012) state how a hospital changed hiring practices to obtain the best registered nurse candidate. It was felt that by hiring a competent candidate, this would support the nursing efforts of the hospital. The new hiring practice included interviewing techniques that would reveal clinical practice decisions, the recognition of equipment and a skills demonstration. The authors state that using this different process of interviewing new nurse employees enabled the nurse recruiter to recognize the best nurse applicant for specific nursing unit.
The current system used by my nurse manager preceptor is for human resources to first screen a nurse applicant to confirm experience and nursing licensure within the state. The nurse manager will then interview the nurse to ask basic questions as to why the nurse would like to work at the hospital and their goals. If the nurse is felt to be a good candidate, the nurse will then meet with the charges nurses of the unit. Basic questions are asked of the nurse to share goals, problem-solving style, strengths, and weaknesses. The nurse manager makes the final decision to hire or not to hire the nurse applicant. If a nurse is hired that does not meet the basic requirements of the hospital, this could lead to the nurse terminating employment and leaving the hospital short of staff. Orientation and functioning with less than optimal nursing staff is costly, and for the patient, not safe.
Nurse Manager and Best Practices
Observing each nurse during patient rounding provides the nurse manager the opportunity to evaluate for best clinical practice. An expectation of patient rounding is to explain the plan of care and the purpose of the plan of care to the patient. After observing the nurse with the patient, the nurse manager may need to take this opportunity to educate the nurse on nursing best practices. As the nurse manager observes during future patient rounding, he can determine if the nurse has learned and applied best practice skills in the plan of care. Other opportunities to educate the staff of nursing best practice are through discussions during a staff meeting and informal conversations with each staff nurse. The nurse manager can control best practices through evaluation and educational follow up.
Future of Reimbursement Patterns
As Datz et al. (2012)) state, an aging workforce, aging population, need for effective electronic medical records and budget play an integral part in the survival of any healthcare system. The authors outline the strategic plan of the Banner Healthcare system through a plan, do, study and act cycle (PDSA). Finkelman (2016) states that the PDSA cycle is used to evaluate a change and determine if it will be effective or not.
Due to fragmentation, approach to problems, rising costs, poor outcomes and differences in payment and access to healthcare, healthcare patterns for reimbursement are seriously under examination (Salmond, Echevarria, 2017). Cutting-edge technology, increasing prescription drugs and healthcare costs have motivated healthcare systems to re-examine their approach to patient care (Salmond, Echevarria, 2017). In addition to these factors influencing rising costs, the aging patient population also brings an increase in chronic disease management (Salmond, Echevarria, 2017). The authors emphasize that nursing has an important role to play in the management of patient care and reimbursement. They state that new skill sets for wellness will be required and that nurses will need to function at the full scope of nursing practice. I feel that nurses are in the position to improve quality and patient safety outcomes. This in itself can reduce cost and improve patient satisfaction.
All of the elements contributing to rising healthcare costs will need to be seriously considered by hospital administrators and healthcare providers to judiciously oversee how patient care dollars are used while maintaining patient quality and safety care.
Thank you,
Maria Olds
References
Beach, P.R. (2013). Knowledge central. Oncology Nursing Forum, 40(6), 611-612. doi: 10.1188/13.ONF.611-612
Datz, D., Hallberg, C., Harris, K., Harrison, L., & Samples, P. (2012). Strategic workforce planning for a multihospital, integrated delivery system. Nursing Administration Quarterly, 36(4), 362-371. doi: 10.1097/NAQ.0b013e31826692d1
Markey, L., & Tingle, C. (2012). Screening RNs: A change in hiring practice. Nursing Management, 43(2), 13-15. doi: 10:1097/01.NUMA.0000410917.67960.a3
Finkelman, A.W. (2016). Leadership and management for nurses (3rd ed.). Upper Saddle River, NJ: Pearson.
Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopaedic Nursing, 36(1). 12-25. doi: 10.1097/NOR.0000000000000308
Seifert, P. (2012). The business of nurses is business. Association of periOperative Registered Nurses Journal, 95(2), 181-183. doi: 10.1016/j.aorn.2011.11.013
