C6 | AORN Connectionsdoi: 10.1016/S0001-2092(11)00160-8

© AORN, Inc, 2011

Financially able

Gone are the days where nurse managers focus only on patient advocacy and the clini-cal aspects of their jobs. Increasingly, nurse

managers are involved with the business of health care as well. This includes understanding financial terminology and concepts, managing and balanc-ing budgets and negotiating contracts.

Job Growth“There has been a gradual movement over the

last 30 years to provide nurses with more financial responsibility and control,” says Steven A. Fin-kler, PhD, CPA, professor emeritus of public and health administration, accounting and financial management at the Robert F. Wagner Graduate School of Public Service, New York, N.Y. “Finance officers have come to realize they just can’t do it all by themselves—they have to give up some con-trol to have better outcomes. . .The judgment and experience of nurse managers is critical in making appropriate decisions that will have the desired effect in departments where nurses work.”

Part of these financial responsibilities includes understanding different measures of cost, know-ing how to use sophisticated forecasting tech-niques to create more accurate budgets and being able to determine when it is more economical to lease equipment rather than buy it, Finkler says. “In essence, [nurse managers] need to know enough about financial techniques to make the most effective decisions,” he adds.

Learning the RopesBeth Gasson, MSN, RN, CNOR, Professional/

Practice Issues Chair for the Leadership Specialty Assembly, recommends nurse managers consider taking budgeting or finance classes, and to look at masters programs in business or nursing masters that include business courses.

Gasson suggests nurse managers reach out to other nurse leaders in the same community.

“We’re all dealing with the same thing,” she says. “Instead of recreating the wheel, see what’s work-ing best at other places and see if it’ll work at your facility.”

Dr Finkler will be presenting the “Financial management certificate course for nurse managers and executives” on March 18 at AORN Congress in Philadelphia. The course will provide partici-pants with a better understanding of financial and business skills needed in today’s health care environment, and teach nurses to communicate with financial managers.

Learning the language of finance doesn’t mean becoming a financial manager, Finkler explains. “The goal is not to replace the financial manager,” he adds. “Rather, it is to gain sufficient knowledge of finance to be able to communicate and work with the financial manager.”

Team WorkFor nurse managers, knowing how to commu-

nicate with financially minded individuals and establishing a rapport with their financial coun-terparts goes a long way. Nurses can help finance managers understand clinical issues, and the finance manager can in turn help nurses under-stand finance issues.

“By putting together the intuition of the nurse manager, which is the result of years of experi-ence and specific clinical knowledge, with the techniques of finance, we get financial information which allows us to make the most effective deci-sions,” Finkler says.

Effective decisions aren’t always popular deci-sions, however, and sometimes hard choices can affect team morale. “My facility is struggling with that at the moment, and it does tend to lower the morale of your staff,” Gasson says about recent changes to retirement matching and merit raise policies. “However, I think the biggest thing as a manager or director that you can do is to be frank

By Kimberly J. RetzlaffEditor, AORN Journal

NuRse maNaGeRs aRe FiNdiNG ThemseLves moRe oFTeN RespoNsibLe FoR FiNaNciaL Tasks as paRT oF TheiR eveRyday RoLes

March 2011 Vol 93 No 3 • AORN Connections | C7

and honest with your employees. Have a two-way communication.”

The Road Ahead “Health care providers should always bear in

mind that the costs of the health care system are headed down an unsustainable path,” Finkler warns. He points to data from the Congressional Budget Office (Figure 1), which show that in 1960, $.04 of every dollar earned in the United States went to health care. Today, that figure is up to $.17 and is expected to grow to $.50 around 2082.

Nurse managers also should be paying special attention to value-based purchasing and account-able care organizations (ACOs), Finkler says.

The Hospital Value-Based Purchasing Program will apply to payments for discharges that occur on or after Oct. 1, 2012. Proposed measures will reward hospitals for meeting or exceeding specific performance measures.

Establishing ACOs is intended to encourage co-operation among providers to reduce unnecessary costs and improve care for Medicare beneficiaries. This program is intended to be established by Jan. 1, 2012.

“At the perioperative level, nurse managers will without doubt be involved in promoting evidence-based medicine and creating reports on quality and cost to help their hospital’s ACO suc-ceed,” Finkler says.

“If your hospital doesn’t become part of an ACO, don’t think you are off the hook,” he adds. “If the hospital across town is in an ACO that is trying to increase market share, you had better be anticipat-ing what response you need to make, and how your perioperative areas are going to adjust to volume decreases that you may have.”

Figure 1. Projected Spending on Health Care as a Percentage of Gross Domestic Product (Percent)

Source: Congressional Budget Office.Note: Amounts for Medicare are net of beneficiaries’ premiums. Amounts for Medicaid are federal spending only.