Staff nurse financial management committees--the nurse manager's guide to effective financial performance

As Cohen states (1991, p. 25), "The future role that nursing will play in the health care delivery system is one of many major issues faced by contemporary nursing...Nursing must be able to determine realistically the cost of and evaluate the effectiveness of nursing care provided to its patients." A unit-based financial management committee is one very effective way of teaching the skills needed for the professional nurse to advance the practice in financial management. This will help nursing gain the professional status that they have always worked for. But beyond these very lofty ideals, a staff nurse managed financial management committee can make the nurse manager's life much easier. Staff nurses need to understand and accept the importance of managing the financial as well as the quality side of patient care. When this happens, the budget becomes theirs. Nurses develop a sense of ownership of the budget and learn how to effectively manage the unit's finances. Much staff nurse brain power is not used. Systems must be developed to access nurses' effective ideas for financial management--first in a financial management committee and then on the unit. Not only will this develop the professional status that nurses need and deserve, but it will also impact the cost of health care. In a society where the cost of an appendectomy requires Dayton Hudson to sell 39,000 Ninja Turtle action figures, Atlantic Richfield to sell 192,000 gallons of gas a day, Anheuser-Busch to sell 11,627 6-packs of 12 oz.(ABSTRACT TRUNCATED AT 250 WORDS)     

Educational innovation: nursing's leadership challenge

Hospitals are increasingly looking for the best graduates, but as this competitive environment increases, little focus is on collaboration and innovation in changing the education system so there will be more "best nurses." In universities today we find numerous barriers to investment in innovation and risk, which hampers the ability to address national workforce needs and compete in a global marketplace. Academic institutions need to become more creative, and begin to look at nursing as a partnership between those who essentially purchase our product and those who develop the product. Nursing leadership needs to collaborate quickly with integration and innovation in developing, improving, and maintaining the skill set of the nursing workforce and assuring competent practitioners from our educational system going forward. We need to share our valuable resources and move out of our silos and begin to look at the big picture, and we need to reach inside and find that creative child that works within us.     

Nursing is the room rate

Shrinking dollars increase the need for health care stakeholders to clearly understand nursing's worth. For nursing to assure an adequate investment in nurses, it needs to articulate its value drivers. Nursing revenue offers a data source that reflects stakeholder choices and patient needs. The daily nursing billing supports hospital payment and provides cost data, important for hospital financial decision making. This revenue is a tangible asset reflecting nursing value and can be used to justify an investment in the profession. Nursing leadership can use this daily nursing charge data to monitor and measure the impact of efficiencies related to patient care.     

Public perceptions of nursing careers: the influence of the media and nursing shortages

The high public regard for nurses has not necessarily translated into an adequate supply of individuals who are willing to be nurses. The expected future demand for nurse labor challenges us to look more closely at the public's perceptions of nursing and nursing careers, and consider how they are shaped by personal experience, media messages, and socio-demographic factors. As part of ongoing efforts to examine factors shaping the future of the nursing workforce, a national survey of Americans was conducted to probe attitudes toward the nursing profession and their experiences with nurses. The data in this national survey of the public about nursing demonstrate that the nursing profession is highly respected and that the vast majority of the general public would recommend nursing careers to qualified students. If the profession is so well thought of and so highly recommended, why are there persistent concerns that not enough people are becoming RNs to avoid or at least slow down the development of future shortages? A prolonged and persistent effort is needed to educate people about nursing careers, to stimulate the expanded production of nursing faculty, and to bring creative approaches to financing nursing education and workforce improvements to convert the large number of seriously interested candidates into the nursing profession.     

Building a nursing research fellowship in a community hospital

Often, registered nurses feel that they are using "evidence" to guide practice, but in reality the sources of evidence are not based on research. The nursing leadership team at Northwest Community Hospital was committed to integrating evidence-based practice and nursing research into the clinical setting for RNs at all levels of the organization. The scope of the fellowship program enabled direct care RNs to receive protected release time for a 12-month period to develop a research proposal, implement the study, and disseminate the findings. The Nursing Research Fellowship Program was successful from the perspective of the Magnet appraisers who recognized the program as a Magnet exemplar, the chief executive officer, the CNE, members of the nursing leadership team, professional colleagues, the fellows and partners, and registered nurses at all levels in the organization. Nursing research is now part of the professional nursing culture.     

The 'Parent Shift' program: incentives for nurses, rewards for nursing teams

To create new opportunities for nurses to reenter the workforce, a RN p.r.n. program must meet the needs of nurses who wish to make dual commitments to home and work. The Parent Shift program provides an innovative model of attracting and retaining nurses in a hospital workforce. Many nurses who joined the program were away from the field of nursing for many years and were drawn to the program because of the promise of flexible shifts and minimal requirements for participation. In this study, flexible shifts not only encouraged program entry, they were also a powerful motivator for continued program participation over time. Parent Shift nurse presence was perceived by nurse managers to decrease stressors and improve time efficiency of full-shift staff.     

The effect of workforce issues on patient safety

The workforce of any health care organization is vital to its continued survival, but a highly competent and committed workforce is vital to its success. The evidence is clear: employees influence not only the financial performance of the organization, but also the safety and quality of the clinical care provided to patients. Health care organizations must understand these important linkages and have in place corporate strategies to manage workforce issues with a systems focus that ensures excellent leadership and operational processes, a healthy culture, and optimum patient outcomes. New levels of knowledge, resources, and implementation are needed to move health care in the United States to the next level of quality performance. Staff satisfaction and retention should be at the heart of the clinical improvement strategies. Such an approach will allow organizations to cope and thrive in an environment of workforce shortages and increasing consumer demand for quality. To quote Robert Waller, MD, of the Mayo Clinic, "The goal is the best care for every patient, every day. Our patients deserve nothing less.     

A transparency and accountability framework for high-value inpatient nursing care

Transparency and accountability are terms that typically refer to activities aimed at measuring and holding providers responsible for their performance through such vehicles as public disclosure of comparative results. Today, transparency and accountability policies are widely accepted strategies to drive quality improvement and stimulate consumer choice. Yet nursing, the single largest health care profession, has not yet been engaged in these policy directions nor considered in their design or implementation. The framework reported here offers nurses and their professional organizations a model for which to advocate for policy change. Hospital and health system executives who have the freedom to establish institutional policies might implement this framework to achieve higher value. This framework provides both the context and components of a system that, if implemented, would measure, report, and reward hospital nursing's contributions to high value.     

Taking action to close the nursing-finance gap: learning from success

Nurse leaders control the largest part of a hospital labor budget, in some cases the largest part of the overall budget. The effectiveness of overseeing this responsibility can mean the difference between an organization's financial stability and financial turmoil. The nursing department at Northwestern Memorial Hospital took ownership of its financial performance. Over the past 2 years, their financial performance saved $4.9 million in productivity while reducing nurses turnover costs by $7.6 million. Valuable lessons from their experience are offered for improving health care's financial and operational outlook.     

Bank competition, financial reform, and institutions: The importance of being developed

In this paper, I estimate the degree of market power at the bank-level for 84 banking systems worldwide. Subsequently, I analyze the sources of bank competition, placing emphasis on the impact of financial reform and the quality of institutions. I find that financial liberalization policies reduce the market power of banks in developed countries with advanced institutions. In contrast, banking competition does not improve at the same pace in countries with weaker institutions and a lower level of institutional development. The results hold across a wide array of identification tests and estimation methods. The main policy implication to be drawn is that a certain level of institutional development is a precondition for the success of reforms aimed at enhancing the competition and efficiency of banking markets.     

A critical competency: determining and communicating the number of nurses you must hire

Nurse leaders must understand and articulate critical concepts of budgeting and staffing to provide credible leadership to our nursing organizations. Determining the ideal number of nurses to hire on any given unit is as much an art as it is a science. Understanding the relationship between hiring requirements and the budget can lead your nursing organization to achieve important results for your hospital.     

Financial shocks,financial stability,and optimal Taylor rules

We assess the performance of optimal Taylor-type interest rate rules, with and without reaction to financial variables, in stabilizing an economy following financial shocks. The analysis is conducted in a DSGE model with loan and bond markets, each featuring financial frictions. This allows for a wide set of financial shocks and transmission mechanisms and can be calibrated to match the bond-to-bank finance ratio featured in the US financial system. Overall, we find that monetary policy that reacts to credit growth, a form of the so-called “leaning against the wind”, improves the ability of the central bank to achieve its mandate in the wake of financial shocks. The specific policy implications depend partly on the origin and the persistence of the financial shock, but overall not on the assignment of a mandate for financial stability in the central bank’s objective function.     

Navajo nation public health nurses inspire thoughts on health care reform

The wisdom and experience of pubic health nurses serving on a Navajo Reservation, who work far from the typical hospital setting, may well hold some of the keys to how we can successfully plan for and navigate the future of our shifting health care system. As more of the nursing workforce moves outside the walls of the hospital, competencies in autonomy, clinical judgment, decision making, and communication will increase in importance. long with safety and quality implications, this may also influence changes in nursing education, job requirements, hiring, and measuring performance. In addition, there may be implications around how new nurses are oriented and how they get the experience needed to function in more independent roles. Within their routine days, the conditions they work in, the situations they face, and the many ways public health nurses find to meet the needs of the people they serve, is a wealth of knowledge that may well translate into solutions for some of the challenges our nation's health care system is facing.     

Social support in the workplace: nurse leader implications

The state of the science as it relates to the stress-mediating role of social support in the health care work environment is explored. The ability to build a nursing leadership workforce is dependent upon a type of social support mechanism that mediates the inherent stress that comes along with managerial positions. Independent of the inevitable work-related stress associated with the nurse manager role, social support provided to current and aspiring nurse leaders is assumed to assist with coping and thriving in the work environment.     

The nursing informatics workforce: who are they and what do they do?

Nursing informatics has evolved into an integral part of health care delivery and a differentiating factor in the selection, implementation, and evaluation of health IT that supports safe, high-quality, patient-centric care. New nursing informatics workforce data reveal changing dynamics in clinical experience, job responsibilities, applications, barriers to success, information, and compensation and benefits. In addition to the more traditional informatics nurse role, a new position has begun to emerge in the health care C-suite with the introduction of the chief nursing informatics officer (CNIO). The CNIO is the senior informatics nurse guiding the implementation and optimization of HIT systems for an organization. With their fused clinical and informatics background, informatics nurses and CNIOs are uniquely positioned to help with "meaningful use" initiatives which are so important to changing the face of health care in the United States.     

The labour market effects of financial crises

This paper examines how the 2008–2009 financial crisis affected labour markets in Europe, and how this impact depended on employment protection laws. Using a difference‐in‐differences approach, our estimates isolate the effect of the lack of credit on the labour market from that of the general decline in aggregate economic activity. We find large and negative impacts of the credit shock on total employment, particularly on temporary, unskilled and young workers. These impacts were significantly larger in countries with stronger legal protection of permanent workers from dismissal. This suggests that the differential impact of the crisis across countries was not entirely driven by the heterogeneity of the credit shock, but also by labour regulations. Given regulatory inflexibility in adjusting the permanent workforce, firms responded to tightening financial constraints by disproportionately laying off temporary workers (who tend to be younger and less skilled than permanent workers).     

The implications of nurse staffing information: the real value of reporting nursing data

There is a dearth of information about the relationship between the patient care contributions of nursing and its financial contributions to an organization. As consumers and legislators are becoming more aware of the ramifications of nurse staffing issues, and as they endeavor to address them with legislative solutions, the decision on how best to develop optimal staffing strategies may soon be taken away from nursing leaders. To maintain control of this important issue and develop solutions that will help highlight the economic and patient care contributions of nurses, a thorough understanding of the problem, and a new commitment are needed from nursing leaders to take charge of the issue. To relate nursing care to patient outcomes, meaningful data on the nursing care provided is needed in addition to data on the nursing needs of patients. Staffing and performance monitoring tools should be used to effectively plan, implement, and control financial and operating resources as well as measure the economic value of the nursing profession's contribution to the cost and benefits of patient care.     

Trends in the experiences of hospital-employed registered nurses: results from three national surveys

The comparative results of three national surveys provide the only known source of data describing the evolving state of the nursing workforce over time in this country. These national random sample surveys expose the harmful effects of a lingering shortage of nurses and make plain that much work remains to be done to improve the experiences of hospital-employed RNs. At the same time, nurses and others involved in hospital patient care should be encouraged by the improvements that have been made in recent years, despite the presence of a nursing shortage.     

Caste,Kinship, and Life Course: Rethinking Women's Work and Agency in Rural South India

This paper reexamines the linkages between women's work, agency, and well-being based on a household survey and in-depth interviews conducted in rural Tamil Nadu in 2009 and questions the prioritization of workforce participation as a path to gender equality. It emphasizes the need to unpack the nature of work performed by and available to women and its social valuation, as well as women's agency, particularly its implications for decision making around financial and nonfinancial household resources in contexts of socioeconomic change. The effects of work participation on agency are mediated by factors like age and stage in the life cycle, reproductive success, and social location – especially of caste – from which women enter the workforce.     

Directed credit,financial development and financial structure: theory and evidence

The recent initiative of the RBI in reviving the policy of directed credit allocation in a period dominated by the neoliberal philosophy necessitates reconsideration of the role of policy-directed credit allocation process on financial development and financial structure of firms. Introducing certain policy parameters, the paper attempts to model how financial development-financial structure interlinkage is influenced by the liberalization policies of the government. The theoretical construct is empirically verified using both aggregated and disaggregated (firm-level) data comprising a panel of 932 Indian manufacturing firms. Findings reveal that following the liberalization measures in the early 1990s, there has been a structural shift in the debt–equity ratio of firms, with equity market activities assuming prominence over time. As regards financial development, it has been observed that the withdrawal of DFIs specialized in term-lending activities in the early 2000s led to a significant increase in the degree of financing constraints faced by the manufacturing firms. This contradicts the basic premise of financial liberalization. The paper argues that under certain conditions, government intervention in the form of directed credit programmes would not only act as an effective instrument in ushering financial development, but also provide important guidelines in ensuring sustainability of institutions.