MANAGING RESOURCES:a price increase is to take the estimated total ending expense for the year and multiply it by the inflationary factor.
a price increase is to take the estimated total ending expense for the year and multiply it by the inflationary factor.
To determine projected price increases:
Multiply current total line item expense $12,758 by inflation factor plus 1.0 * 1.05
$13,396
Increases in expenses, such as maintenance agreements and rental fees, should also be incorporated as part of the budget request. The introduction of new technology and changes in programs and regulatory requirements may require additional resources for supplies as well as increased salaries.
The Capital Budget The capital budget is an important component of the plan to meet the organization’s long-term goals. This budget identifies physical renovations, new construction, and new or replacement equipment planned within a specified time period. Organizations define capital items based on certain conditions or criteria. Usually, capital items must have an expected performance of one year or more and exceed a certain dollar value, such as $500 or $1,000.
The capital budget is limited to a specified amount, and decisions need to be made how best to allocate available funds. Priority is given to those items needed most. Not all items that fall under capital budget will necessarily get funding in a given year.
Today, few nurse managers are asked to prepare a capital budget because most organiza- tions are buying through consortiums or negotiated agreements with one supplier. Many health care organizations have departments that coordinate bringing in selected vendors and items and limit choices to that equipment. The nurse manager would then be responsible for reporting what needs exist, helping select and determine the amount of equipment needed. The capital pool is expensed out across all units that use the equipment.
The impact of the new equipment on the unit’s expenses, such as the number of staff needed to run the equipment, use of supplies, and maintenance costs, needs to be considered as part of the operating budget, however. Likewise, the need for additional nursing and nonnursing per- sonnel to operate the new equipment, additional workload, and training of personnel should be quantified for the next year’s budget.
Timetable for the Budgeting Process Depending on the size and complexity of the organization, the budgeting process takes between three and six months. The process begins with the first-level manager. The individual at this level of management may or may not have formalized budget responsibilities, but he or she is key to identifying needed resources for the upcoming budget period.
The manager seeks information from staff about areas of needed improvement or change and reviews unit productivity and the need for updated technology or supplies. The manager uses this information to prepare the first draft of the budget proposal.
Depending on the levels of organizational management, this proposal ascends through the managerial hierarchy. Each subsequent manager evaluates the budget proposal, making adjust- ments as needed. By the time the budget is approved by executive management, significant changes to the original proposal usually have been made.
The final step in the process is approval by a governing board, such as a board of direc- tors or designated shareholders. Typically, the budget process timetable is structured so that the budget is approved a few months before the beginning of the new fiscal year.
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Clearly articulating budgetary needs is essential for the manager to be successful in bud- get negotiations. Senior management must prioritize budget requests for the entire organiza- tion, and they base those decisions on strong supporting documentation. Nurse managers should not expect to receive all of their budget requests, but they need to be prepared to defend their priorities.
Monitoring Budgetary Performance During the Year The difference between the amount that was budgeted for a specific revenue or cost and the actual revenue or cost that resulted during the course of activities is known as the variance. Variance might occur in the actual cost of delivering patient care for a certain expense line item in a speci- fied period of time. Nurse managers are commonly asked to justify the reason for variances and present an action plan to reduce or eliminate these variances.
Managers receive reports summarizing the expenses for the department (see Table 14-1). In the past, monthly reports on paper were sent to managers, but technology makes such a system obsolete today. Reports can be compiled and communicated rapidly, allowing managers to ad- just quicker.
The reports show expense line items with the budgeted amount, actual expenditure, variance from budget, and the percentage from the budgeted amount that such variance represents. These reports often also show the comparison between actual year-to-date results and the year-to-date budget.
To assess variance:
● Identify items that are over or under budgeted amounts ● Find out why the variance occurred (e.g., a one-time event or an ongoing occurrence) ● Keep notes on what you have learned in preparation for next year’s budget ● Examine the payroll and note overtime or use of agency personnel ● Validate the use of overtime or additional personnel and keep a note for your files
Keeping notes throughout the year will help prevent the annual budget process from becom- ing an overwhelming challenge. Trying to reconstruct what happened and why during the past 12 months is unlikely to present a complete and accurate picture of events and makes creating a future budget more difficult.
Variance Analysis In the daily course of events, it is unlikely that projected budget items will be completely on target in all situations. One of the manager’s most important jobs is to manage the financial re- sources for the department and to be able to respond to variances in a timely fashion.
When expenses occur that differ from the budgeted amounts, organizations usually have an established level at which a variance needs to be investigated and explained or justified by the manager of the department. This level may be a certain dollar amount, such as $500, or it may be a percentage, such as a five percent or ten percent increase above the budget.
In determining causes for variance, the nurse manager must review the activity level of the unit for the same period. There may have been increases in census or patient acuity that gener- ated additional expense in salary and supplies.
Also, in many situations, variances might not be independent of one another. Variances may result from expenses that follow a seasonal pattern and occur only at determined times in the year (renewal of a maintenance agreement is one example). Expenses may also follow a ten- dency or trend either to increase or to decrease during the year. Even if the situation is outside the manager’s usual responsibility or control, the manager needs to understand and be able to identify the cause or reason for the variance.
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To determine when a variance is favorable or unfavorable, it is important to relate the vari- ance to its impact on the organization in terms of revenues and expenses. If more earnings came in than expected, the variance is favorable; if less, the variance is negative. Likewise, if less was spent than expected, the variance is favorable; if more was spent, the variance is negative.
For instance, the nurse manager might receive the following expense report:
Budgeted Expenditures
Actual Expenditures
Variance (in $)
Percent (in %)
$34,560 $36,958 (2,398) (6.9)
This expense variance is considered unfavorable because the actual expense was greater than the budget. In this example, more money was spent on medical/surgical supplies than was projected in the budget.
If the variance percentage of the actual budget amount is not presented in the reports, it can be calculated as follows:
$2,398
$34,560 = 0.069
Divide the dollar variance by the budget amount, then multiply by 100:
0.069 * 100 = 6.9% over budget
Salary Variances With salary expenditures, variances may occur in volume, efficiency, or rate. Typically these factors are related and have an impact on each other. Volume variances result when there is a difference in the budgeted and actual workload requirements, as would occur with increases in patient days. An increase in the actual number of patient days will increase the salary expense, resulting in an unfavorable volume variance. Although the variance is unfavorable, concomi- tant increases in revenues for the organization should be apparent. Thus, the impact to the organization should be welcomed, even though it generated higher salary costs at the nursing unit level.
Efficiency variance, also called quantity or use variance, reflects the difference between budgeted and actual nursing care hours provided. Patient acuity, nursing skill, unit manage- ment, technology, and productivity all affect the number of patient care hours actually pro- vided versus the original number planned or required. At the same time, if the census had been higher than expected, it would be understandable if more hours of nursing care were provided and paid. A favorable efficiency, or fewer nursing care hours paid, could suggest that patient acuity was lower than projected, that staff was more efficient, or that higher- skilled employees were used. An unfavorable efficiency may be due to greater patient acuity than allowed for in the budget, overstaffing of the unit, or the use of less experienced or less efficient employees.
Rate variances, also known as price or spending variance, reflect the difference in budgeted and actual hourly rates paid. A favorable rate variance may reflect the use of new employees who were paid lower salaries. Unfavorable rate variance may reflect unanticipated salary increases or increased use of personnel paid at higher wages, such as agency personnel.
Nonsalary Expenditure Variances A nonsalary expenditure variance may be due to changes in patient volume, patient mix, supply quantities, or prices paid. New, additional, or more expensive supplies used at the nursing unit because of technology changes or new regulations could also influence expenditure totals.
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Position Control Another monitoring tool used by nurse managers is the position control. The position control is used to compare actual numbers of employees to the number of budgeted FTEs for the nursing unit. The position control is a list of approved, budgeted FTE positions for the nursing cost cen- ter. The positions are displayed by category or job classification, such as nurse manager, RNs, LPNs, and so on. The nurse manager updates the position control with employee names and FTE factors for each individual with respect to personnel changes, new hires, and resignations that take place during the year.