Nursing budget experiences and challenges

Nurse Management

Experiences of the Nursing Budget: An Overview

The experiences of a budgeting manager are varied particular in a health care environment. Community Hospital of the Monterey Peninsula has expanded and grown since its inception, and along the ways changed their budgetary practices to accommodate the growing staff and needs of the citizens it serves. Within the scope of a hospital setting such as that of CHOMOA, nurse managers have many responsibilities with regard to budgetary affairs, including ensuring that quality service is maintained within the scope of the budgetary allocations for the year. Nursing managers work in tandem with executives to ensure that the budget is maintained in a sensible and practical manner.

This paper will examine budgetary experiences particular to Community Hospital of the Monterey Peninsula, and will include insight from an interview with the Director of the ICU as well as historical and analytical information about hospital budgeting.

History/Mission of Hospital

Founded in 1934, Community Hospital of the Monterey Peninsula serves the healthcare needs of people living in Monterey. The hospital actually 'unofficially' started as early as 1929, when a woman by the name of Grace Deere Velie Harris helped create a clinic that specialized in treating people with metabolic disorders. Since that time the hospital has grown exponentially, providing a variety of services to patients in the Monterey Peninsula and the surrounding community. Grace Deere Velie Harris' clinic, which was referred to as "Carmel" clinic, later converted into a 30 bed hospital to care for general health complaints, entitled "Peninsula Community Hospital." This is where Monterey hospital got its true start.

Tom Tonkin became the administrator of the hospital in 1955. It wasn't until 1961 that the hospital adopted its official name, becoming "Community Hospital of the Monterey Peninsula."

By 1962 Community Hospital of the Monterey Peninsula had 100 beds and was operating out of a 210,000 square foot facility. It was the first community hospital to be able to offer private rooms to patients. Most of the funds for supporting the hospital are acquired through private community donations.

Since that time the hospital has been growing and expanding continually. In 1982 for example the Eskaton Monterey Hospital joined forces with and became part of the hospital. An outpatient surgery center was also opened in 1988, and a few short years later the rehabilitation services department expanded. Patients can now expect state of the art diagnosis and treatment for all manner of conditions including cancer. In 2004 plans were set to add 120 patient rooms and centralize critical care departments at the Forest Pavillion.

The mission of Community Hospital of the Monterey Peninsula has always remained the same. The people working there are dedicated to meeting the needs of the people living in the Monterey Peninsula and the surrounding communities. The vision of the hospital is to be the healthcare organization in the region "most concerned for those we serve, most chosen for the quality and value of our service, and most respected for the integrity, competency and commitment of employees, medical staff and volunteers" (Chompa, 2005).

Experiences of Nursing Budget

The person interviewed for their experiences of the nursing budget was the Director in the ICU unit for 3 years at another hospital before coming to work with CHOMP. They have now been at CHOMP for 25 years, and have been handling departmental budgets for the duration of that time.

The types of budget the director is most familiar with include departmental budgets within hospitals. This coincides with the experience of a majority of budgeting executives who typically manage budgets by examining the needs of various departments throughout the year (Ward, 1994). The budgeting process at CHOMP is varied and requires that nursing managers and department heads keep a close eye on the daily activities of staff. It is described as a structured process that begins with planning meetings in August with the financial services department. The department director and the Vice President sign off on the budget in December, and then all budgets are reviewed by the President's Advisory Committee which includes the CEO and the Vice Presidents.

Department directors also have to sign off on their budget in November or December. Budgeting decisions are made by each nursing department. The budget is generally two to three million dollars, including wage and non-wage budgets. The budget is flexible. Nurses need to stay between 95-105% for productivity with an aim of 100%. The budget is averaged so on days when full time employees exceed the hours budgeted based on patient numbers they can be averaged for days when the budget was within the budget standards.

The nursing manager's role in determining budgets is fixed. The nurse manager is responsible for staying within his or her budget. The staffing budget is set at 18.92 hours per patient day. Other unites generally have between eight and eleven hours budgeted. The total budget for the year for staff hours is approximately 2,080.

The nurse manager role could be developed in a number of ways with regard to budget determination. Budgeting is a vital component of any management process, and for nurses to be successful participating in budgeting affairs they must first better understand what exactly a budget is and the role that budgeting plays essential to their ability to carry out the strategic goals and relevant to management's responsibilities (Ward Jr., 1994). To that extent nurses should be more involved in the planning and organizational stages with regard to the budget.