DNRS 6211 Week 11 Reflection Paper Example

Asking Where the Number Came From: A Reflection on Reading a Unit Budget

Student Name

College of Nursing, Walden University

DNRS 6211: Finance and Economics in Healthcare Delivery

Instructor Name

Month Day, Year

Asking Where the Number Came From: A Reflection on Reading a Unit Budget

What I Believed Before

When this course began, I believed that a unit budget arrived from above as a fixed instruction and that a nurse manager's job was to live inside it. I had managed my rehabilitation unit for 3 years that way. Each spring the finance office sent a spreadsheet with a total, a target of hours per patient day, and a supply figure, and each month I received a variance report telling me how far I had strayed. I treated the targets the way I treat a medication order from a physician I trust: I followed them, and when I could not, I explained why. It did not occur to me to ask where the numbers had come from, because I assumed someone with better information had already asked. I am not proud of that belief, but I held it firmly and I think many managers hold it too.

Looking back, the belief was comfortable because it put the numbers outside my responsibility. If the budget was wrong, someone else had made it wrong, and my part was only to report the gap. That comfort cost my unit something I only noticed later: when my staff asked why we were always over on hours, I had no answer except that finance had set the target, and they heard that as a manager who could not speak for them.

When It Broke

The belief broke during the budget worksheet in week 3, which required an assumption and a named source beside every line. Most lines were easy. Wage rates came from the human resources table, supplies from last year's cost report, and census from two years of unit data. Then I reached the line that drives most of the budget, a staffing target of 6.8 hours of nursing care for each patient day, and realized I could not fill in the source column. I knew the number. I had enforced it for 3 years. I did not know what it was based on. The exercise made visible something I had never looked for: the most important number in my budget was the one I understood least. Penner (2017) describes staffing standards as assumptions that should be revisited as patient needs change, and I had been treating mine as a fact.

The Evidence That Something Changed

The week after the exercise, I asked the finance analyst assigned to nursing where the 6.8 target came from. After some searching, she found that it had been set from an external benchmark 5 years ago, before our unit began admitting patients with spinal cord injury and before our share of patients needing continuous safety attendants rose. No one had revisited it, because no one had asked. That conversation matters more to me than the answer. For the first time, I brought a question about a number to the person who produced it, instead of bringing an explanation of why I had missed it. When the March labor variance came in the following month, I was able to separate the part caused by census, the part caused by premium pay, and the part caused by intensity, and to say which part the 6.8 assumption itself might be wrong about (Dunham-Taylor & Pinczuk, 2015). The analyst and I have agreed to review the target with actual acuity data before the next budget cycle.

What I Will Do Differently

My changed practice is simple enough that a colleague could watch for it: whenever a number arrives that I am expected to manage to, whether a budget line, a productivity target, or a benchmark on a dashboard, I will ask for the assumption behind it and the record it came from before I accept it. I will write the answer in the margin of the budget, as the worksheet taught me to. If no one can tell me, I will say so in writing, as a risk, rather than enforce the number silently. This is not a plan to argue with every target. Most assumptions will turn out to be sound, and knowing that is useful too, because a manager who can explain why a target is right is in a stronger position than one who can only say it was assigned (Reiter & Song, 2021).

What Remains Unclear

I am still unsure how far a unit manager's questions can reach. The hours target turned out to be revisable, but I do not yet know whether the benefit rate, the allocation of overhead, or the hospital's assumption about payer mix are open to the same conversation, or whether they belong to decisions made well above my level. I expect to find out by asking.

References

Dunham-Taylor, J., & Pinczuk, J. Z. (2015). Financial management for nurse managers: Merging the heart with the dollar (3rd ed.). Jones & Bartlett Learning.

Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders (3rd ed.). Springer Publishing Company.

Reiter, K. L., & Song, P. H. (2021). Gapenski's healthcare finance: An introduction to accounting and financial management (7th ed.). Health Administration Press.