Case Study: Beth Cannon, RN, is a nurse manager for a 20-bed medical surgical unit in a small, 110-bed community hospital. She was promoted to the position because she has a strong clinical background.
The unit has an Average Daily Census [ACD] of 17 (or 85% occupancy). Beth is budgeted for 30 full time equivalent personnel with 6.0 Hours Per Patient Day [HPPD] (the competitor hospital budgets 6.5 HPPD for Medical Surgical Unit). The unit is staffed for three shifts with a mix of 75% nurses to 25% ancillary personnel.
Beth did not submit any requests for a capital budget last year because there were no anticipated changes for her unit (shift in patient population, combining nursing units). She based her entire budget on historical data from the last two years. She knows that there is an acuity system for staffing; however, she does not really understand how it works or the significance to her unit.
Over the past three months Beth notes that she is over budget. She does not understand what has happened to cause the variances. Anticipating a call from the Director of Nursing and Chief Financial Officer, she turns to you as a seasoned manager to help her understand.
Utilizing a nursing theoretical approach (e.g. Benner’s Model Novice-to-Expert), what is your assessment of Beth’s managerial skill level at this point? Provide your rationale.
What suggestions would you make for Beth regarding budget management?
