Nursing leadership fiscal planning

Excerpt from book on fiscal planning:

Managers must understand fiscal planning and health-care reimbursement, be aware of their budgetary responsibilities, and be cost-effective in meeting organizational goals. The ability to forecast unit fiscal needs with sensitivity to the organization’s political, economic, social, and legislative climate is a high-level management function. Managers also must be able to articulate unit needs through budgeting to ensure adequate nursing staff, supplies, and equipment. Finally, managers must be skillful in the monitoring aspects of budget control.

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Leadership skills allow the manager to involve all appropriate stakeholders in developing the budget and implementing needed reforms. This has likely never been as important as it currently is, given the current climate of health-care reform with almost countless initiatives and phased-in implementation. Other leadership skills required in fiscal planning include flexibility, creativity, and vision regarding future needs. The skilled leader is able to anticipate budget constraints and act proactively. In contrast, many managers allow budget constraints to dictate alternatives. In an age of inadequate fiscal resources, the leader is creative in identifying alternatives to meet patient needs.

Read and answer scenario below

How Does Policy Influence Your Decision?

You are the evening house supervisor of a small, private, rural hospital. In your role as house supervisor, you are responsible for staffing the upcoming shift and for troubleshooting any and all problems that cannot be handled at the unit level.

Tonight, you receive a call to come to the emergency department (ED) to handle a “patient complaint.” When you arrive, you find a Hispanic woman in her mid-20s arguing vehemently with the ED charge nurse and physician. When you intercede, the patient introduces herself as Teresa Garcia and states, “There is something wrong with my father, and they won’t help him because we only have Medicaid insurance. If we had private insurance, you would be willing to do something.” The charge nurse intercedes by saying, “Teresa’s father began vomiting about 2 hours ago and blacked out approximately 45 minutes ago, following a 14-hour drinking binge.” The ED physician added, “Mr. Garcia’s blood alcohol level is 0.25 [2.5 times the level required to be declared legally intoxicated], and my baseline physical examination would indicate nothing other than he is drunk and needs to sleep it off. Besides, I have seen Mr. Garcia in the ED before, and it’s always for the same thing. He does not need further treatment.”

Teresa persists in her pleas to you that “there is something different this time” and that she believes this hospital should evaluate her father further. She intuitively feels that something terrible will happen to her father if he is not cared for immediately. The ED physician becomes even angrier after this comment and states to you, “I am not going to waste my time and energy on someone who is just drunk, and I refuse to order any more expensive lab tests or x-rays on this patient. I’ve met the legal requirements for care. If you want something else done, you will have to find someone else to order it.” With that, he walks off and returns to the examination room, where other patients are waiting to be seen. The ED nurse turns to look at you and is waiting for further directions.


How will you handle this situation? Would your decision be any easier if there were no limitations in resource allocation? Are your values to act as an agent for the patient or for the agency more strongly developed?

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