Budgeting Knowledge of Nurse Managers in selected units of

Rumailah Hospital, Doha, Qatar

A Term Paper
Presented to

MANG 501 : Nursing Administration

Graduate School
Master of Arts in Nursing
Philippine Womens University

In Partial Fulfillment
Of the Requirements for the Degree
Master of Arts in Nursing

by

Ruby Untalasco- Gealan, BSN, RN

Doha, Qatar
First Semester, 2013

ACKNOWLEDGEMENT
This term paper is made possible through the help and support from everyone,
including: parents, family, friends, head nurses and charge nurses of Rumailah
Hospital and in essence, all sentient beings.
Especially, please allow me to dedicate my acknowledgment of gratitude toward
First and foremost, to God, who give me life and wisdom in doing this paper.
Second, I would like to thank My Hubby Philip for the moral and financial support
despite of our financial constraint, unending understanding and encouraging me to
pursuit my Master degree and always there to cheer me up.
To my RJ, Yuri and Myles who are my inspirations to those days and nights while Im
doing this paper away from them.
I would like to thank Ms. Sherlin Alexander, HN MU2 for her most support and
encouragement and Mr. Christian Puruganan, Staff Nurse MU2 for reading my paper
and offered invaluable detailed advices on grammar, organization, and the theme of
the paper.
Finally, I sincerely thank to my Mom Tita Untalasco, who taking care my kids while
working here at Qatar and studying
To my dad Domeng (deceased), who inspire me and keep challenge me his words
all my life all through the years
To my two siblings Teddy and Dante, who always theyre pampering me to study and
earn,
And to my friends, who provide the advice and moral support.
The product of this Term paper would not be possible without all of them.

Student Name :
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Ruby Untalasco Gealan

20122924
Nursing Administration
Professor Jerry V. Manlapaz
TERMPAPER

ABSTRACT
The nurse manager/leader is responsible in knowing and understanding the different
types and budgets within the healthcare organization: operating, capital expenditure,
and cash. The operating budget is the main budget the nurse manager/leader
maintains an active role in for the healthcare organization by controlling personnel
and supply costs. Collaboration with the nursing staff on the unit as well as other
parties involved with the budget process helps create a powerful tool in controlling
the day-to-day operations of the unit and providing quality care to the
patients. Preparation is the key to a successful budget and to the success of the
organization.

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Ruby Untalasco Gealan

20122924
Nursing Administration
Professor Jerry V. Manlapaz
TERMPAPER

TABLE OF CONTENTS
Contents

PAGE

Acknowledgement

Abstract

Table of Contents

Introduction

Statement of the Problem

Research Question

Hypothesis

Significant of the Research

Scope and Limitation

Definition of Terms

Nurse Manager Knowledge in Budgeting

Operating Budgets for a Nursing Unit

Capital Budgeting for a Nursing Unit

15
18

Conclusion

18

References

20

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Ruby Untalasco Gealan

20122924
Nursing Administration
Professor Jerry V. Manlapaz
TERMPAPER

Introduction
Budgeting is a delegate task of Nurse Managers. They have the accountability and
responsibility to the nursing budget. Without a budget, each department may operate
without regard to what any other department is doing or to the organizations
objectives. This lack of coordination results in inefficiency and increasing cost. The
operating budget becomes the master plan of action for the entire organization,
reflecting the coordinated efforts of all levels of management. This helps the
organization to operate smoothly and efficiently so that goals and objectives are met.
The enlightened nurse manager knows that whoever controls the budget is in control
of the department. 1
Budgeting is inextricably linked with patient care as its affects the degree of clinical
care provided and the manner in which it is provided.2 Therefore, it is a prime
responsibility of nurse mangers to ensure they have resources to provide a high
quality of services.
In this research paper entitled Budgeting Knowledge of Nurse managers in selected
units of Rumailah Hospital, Doha Qatar discusses about the role of nurse managers
in financial management and budgeting in the unit. This explores the perception and
knowledge of nurse managers in selected units of Rumailah Hospital regarding
budgeting, as accountable for the consumption of resources.
Statement of the Problem
Nurse managers oversee all fiscal aspects of their unit. Nurse managers ensure that
expenses stay within the units budget. Expenses may include staffing costs ,
operating costs, physical plant costs, equipment and supplies.

1
Harley, Patricia, RNC, MSN
2

Doyle,G ; Williamson,P

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20122924
Nursing Administration
Professor Jerry V. Manlapaz
TERMPAPER

Therefore, exploring and studying the perception and knowledge of Nurse managers
regarding budgeting in selected units of Rumailah Hospital, Doha Qatar is a good
predictor to assess the knowledge of Nurse manager regarding budgeting and to
ensure the delivery of high quality of patient care, improved patient safety, increasing
productivity of staff nurses and job satisfaction as the resources and financial aspect
of unit are utilized effectively and efficiently.
Research Question
Since this study sought to explore significant relationships between nurse manager
knowledge and budgeting from the selected units of Rumailah Hospital, this study
proposed the research question:
a. Is there a significant relationship between nurse manager knowledge and
budgeting.

Hypothesis
The hypothesis will be tested in this study:
a. There will be significant relationship between nurse manager knowledge and
budgeting.
Significant of the Research
The purpose of this study is to explore and understand the relationship between the
Nurse managers knowledge in budgeting. In particular, nurse managers use budgets
to monitor personnel and supply costs. It is important that nurse managers are
familiar with the different types of budgets, specifically the operating budget, because
it is the nurse manager who is closest to the patient and knows exactly what is

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Ruby Untalasco Gealan

20122924
Nursing Administration
Professor Jerry V. Manlapaz
TERMPAPER

needed to provide care and services3. The long-term goal of this study is to provide
information to nursing administration in order to make necessary changes to increase
knowledge of nurse managers about budgeting thru continuing education and
thereby improve quality of patient care and improved staff satisfaction.
Scope and Limitation
I would have liked to evaluate the relationship between nurse managers knowledge
and budgeting. The result of such study could assist nursing administrators in order
to make necessary changes to increase the knowledge of nurse managers thru
education about budgeting. Primary data collection on Head Nurses, Charge Nurses
and Shift-In Charges working in Rumailah Hospital such as Stroke Unit, Female
Rehabilitation Unit (FGRU), Male Unit 1, Male 2, FGRU, and Stroke Unit thru
interview.
Definition of Terms
Budget - a plan, roadmap, or a tool used by managers to ensure that quality and
cost-effective services are provided to patients. A detailed, operational management
plan or schedule that communicates the organizations financial expectations.
Annual Budget - a written plan for the organization and the department plan that
balances or schedules expenses to income. Budgets are created annually prior to the
beginning of the entity's fiscal year start date.
Capital expenditure budget - is established to fund the purchase of major equipment
or projects like expansion, improvement or replacement of the physical plant and
equipment. Purchases of major equipment or facility renovations that are expected to

Danna, Denise DNS, RN, NEA-BC, FACHE

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20122924
Nursing Administration
Professor Jerry V. Manlapaz
TERMPAPER

have at least a "five year life". Many entities require a minimum expense of $500 to
declare an item as a capital expenditure4.
Direct costs: expenses related to a specific service or program such as exercise
equipment used on a rehab unit or manuals used for restorative nursing programs.
Expenses - the cost of providing services to patients. They are frequently called
overhead. It includes wages and salaries, fringe benefits, supplies, food service,
utilities, and office and medical supplies.
Fiscal Year: The 12 month period between settlements of financial accounts. Many
organizations use the calendar year (Jan-Dec); but others use July 1 to June 30; and
others use October 1-September 30th. It is important for you to know your
organization's fiscal year5.
Fixed Costs are expenses that occur regardless of census or resident acuity. Costs
that are basically fixed may related to utility charges; insurance fees, building
depreciation costs, taxes and some contract services/maintenance agreements etc.
Indirect Costs are expenses not associated with a specific program or service such
as building depreciation, facility dues or memberships6.
Operating budget - a plan to monitor anticipated day-to-day activities, resources,
personnel, and supplies, typically over a one-year period. It is also referred as master
budget. It is estimated expenses and revenues for a specific time frame.
Operating Expenses are expenses that relate directly to the provision of care and
services such as: salaries, benefits, supplies, food, medications, therapists, etc.

4
McConnell, Charles R.
5

McConnell, Charles R.

Alexander, Sherlin, HN MU2

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20122924
Nursing Administration
Professor Jerry V. Manlapaz
TERMPAPER

These are the items that are often referred to as the "controllable costs" and are
generally the items that the DON has responsibility to monitor and contain7.
Personnel budget is the salary/manpower budget for a particular unit or cost center.
Besides salaries it includes compensation for vacation, sick leave, holidays, overtime
and merit increases.
Program Budget- is estimated revenue and expenses for a specific program such as
the Medicare program or adult day care program.
Revenue - the income of a government from taxation, excise duties, customs, or
other sources, appropriated to the payment of the public expenses. For a nursing
unit, the revenues will be projected from patient days, average daily census, or
procedures. The amount of money derived from resident care and non- operational
pursuits that can be utilized for departmental expenses.
Revenue Budgeting the process in which a hospital determines revenues required
to cover anticipated expenses and establish prices sufficient to generate revenue.
Variable Costs - Expenses that fluctuate in relation to census or output, such as
supplies, wages of direct care staff, and laundry services.
Zero- Based Budgeting - Reconstructing the budget each year rather than building on
the same budget from previous year. A budgeting process that requires managers to
start from zero budget levels every year.
Nurse managers are referred to Head Nurses, Charge Nurses .

7
Alexander, Shirlen, HN MU2
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Professor Jerry V. Manlapaz
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Nurse Manager Knowledge in Budgeting

Qatar is one of the fastest growing economies in the Middle East. Rumailah Hospital
is under Hamad Medical Corporation, a non-generating fund government hospital
that provides free medical health services to both expatriates and locals. However,
studying about nurse managers knowledge about budgeting served as a challenged
to be cost-effective and aware on unit finances. Nursing department budget can
account for as much as half of hospital total expenses, there will be significant
pressure upon this department to increase efficiency and effectiveness. For nursing
to respond to the pressures and the uncertainty of the economic climate, nurse
managers at all levels must become proficient in the budgeting process. Declining
reimbursement and financial incentives connected to quality and patient satisfaction
outcomes are making finance a language requirement for every future nurse
manager. If nurse leaders want to continue to have a seat at the strategic table and
remain influential advocates in future healthcare decisions, they must become fluent
in the language of finance.8
As quoted by Ms. Jasmin Cherian, DON RH I will ensure that my staff have the
necessary tools to provide care and support to our clients on a daily basis.9
Years ago staff nurses were promoted to management positions based on clinical
skills and technical competencies. As a result, front-line managers were not
adequately skilled to address the array of interpersonal issues and complex, everchanging priorities.10 Nursing is the largest professional group in the hospitaland

8

Muller, Rick PhD; Karsten, Margo PhD, MSN, RN

Cherian, Jasmin, RN , DON RH

10

RWJF

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20122924
Nursing Administration
Professor Jerry V. Manlapaz
TERMPAPER

usually the most expensive. As a staff nurse, I can play an important role in helping
reduce costs by monitoring the consumption of supplies and utilization of man power
according to Eloy Buergo, Shift in Charge, MU211. Nurses can help make a difference
in their unit budgets by not overstaffing their unit when they are in charge, avoiding
excessive use of unscheduled leave that could require overtime, and monitoring the
use of supplies12. Most nurses do not enter the clinical field with a great desire to be
responsible for financial outcomes and/or to monitor revenues and expenses .
Unfortunately, the dynamics of the health care world require that all nurses, and
especially those in administrative or managerial positions, be well versed in basic
accounting principles especially Head Nurses and Charge Nurses who acts as head
nurses during the absence of Head Nurse of units. As quoted by Allan Batac, CN 13.
Nursing managers are uniquely positioned to contribute to this portion of the costreduction effort, yet without a comprehensive understanding of budgeting, they often
hardwire old mistakes into future cost predictions and decisions.
A study was done in Cape South African reflecting the perception of South African
Nurse manager regarding budgeting. The perceptions of nurse managers regarding
cost containment issues in selected public hospitals in the Port Elizabeth metropole
of the Eastern Cape were investigated. Results indicated that nurse managers
required better preparation for their cost control responsibilities. Although the majority
of the nurse managers realized that staffing issues affected cost containment efforts,
they were reportedly unable to prevent nurses from leaving their points of duty
without due authorization, curb the rate of absenteeism or reduce the number of

11

Buergo, Eloy, BSN, RN Staff Nurse/Shift-in- Charge

12

Sherman, Rose & Bishop, Mary

13

Batac, Allan, Charge Nurse, MU2

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resignations. Nurse Managers suggested that cost containment efforts would benefit
from effective security checks to curb losses of stock and equipment, including
wheel-chairs, and that more public telephones should be installed in hospitals.
Rationalization of staff and specialized services among the four major hospitals could
further enhance cost containment efforts14. Budgets and budgeting can be defined in
a variety of ways depending on the individual or organization. However, to budget is
generally to determine how much cash is available to an individual/organization. A
budget will provide you with a costing for both income and expenditure15.
A budget is a financial plan that outlines the resources an entity foresees using for a
particular time period. The master budget encompasses all the departmental
budgets. Based on the organization's strategic goals and vision, the master budget is
the actual statement of projected revenues and expenditures for the entire hospital.
Developing a budget is an ongoing process. Here is a cycle that adapted from
Building Budget (Fig1). The budget cycle typically involves an environmental
assessment that looks at trends in healthcare and in the hospital as well as its
competition. Once such assessments are made, the hospital's goals and objectives
are evaluated to determine whether any changes must be made. If changes must be
made, the unit's goals are set based on the prior year's performance, trends in the
marketplace, and assumptions about the future. The organization's operational
objectives are developed and approved by the administrative department. It is at this
point that the formal budget packagesincluding instructions, projected units of
service (UOS), and revenue for the unitare put together and distributed to

14

Ntlabezo ET, Ehlers UV, Booyens US.

15

NHS

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Nursing Administration
Professor Jerry V. Manlapaz
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11

department managers. Expect to receive such a package approximately four to six

months before the budget is due.16

Figure 1 Budget Cycle

For a nurse manager to be successful in today's healthcare environment, mastery of

basic business skills is essential. No longer are nurse managers expected to be
clinical experts but, instead, must be equipped and skillful in "running their business."
17 . Running their business means be knowledgeable in business skills. The first
thing that probably comes to mind is the budget or the finances, but business skills
include so much more. Business skills frequently include human resources, strategic
planning, and systems thinking, to name a few. 18 There are three categories identify
several of the business skills that are essential for nurse managers as mentioned by
the head nurses of Rumailah Hospital that have been interviewed these are financial
management, Human resources, and strategic management. Nurse managers

16
Building Budget
17

Gavino, Francia ,BSN RN , Head Nurse FGRU

18

Ben Gaied, Habib, HN , Head Nurse Stroke Unit

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interested in connecting caring and quality patient-care delivery with efficient and
effective financial strategies. The ability to be conversant in the language of finance
is beginning to emerge in the clinical arena. Financial knowledge is a concern of the
American Nurses Association (ANA) and the Institute of Medicine (IOM). The 2010
IOM report suggests that RNs have a responsibility to become active participants in
shaping healthcare and managing resources. The ANA's standard of resource
utilization suggests that all RNs need to identify consumer care needs, the potential
for harm, the complexity of the task, and the desired outcome when evaluating
resource allocations. The first step to accomplish this goal is for nurses to understand
the financial priorities behind healthcare business decisions.19
Become knowledgeable with basic financial terminology and definitions. Develop a
plan to educate yourself and your direct reports and be able to develop a basic unit
budget. As a Head Nurse, it is important to be able to develop a basic unit budget
and recognize the different line items and categories that are included in the budget.
Ms. Gilda Capiceno, HN MU1.
Become proficient in reading and understanding organizational budget reports. Ms.
Shirlen Alexander, HN MU2
Establish strong working relationships with the finance personnel at your
organization. Learn how to monitor and analyze budget variances and be able to
develop strategies to address the variances. According to Ms. Sosama Abraham,
CN /Acting Head Nurse MU2

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Muller, Rick PhD; Karsten, Margo PhD, MSN, RN

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13

Participate in the selection of programs that influence nursing such as productivity

programs, inventory management, and documentation systems. Zouhair Ben
Hassine, Acting HN MU2
When nurses become more engaged with finance and more involved in
management, they bring about a significant difference to the quality of patient care
Allan Batac, Charge Nurse MU2
This is the common response of Head Nurses from the selected unit of Rumailah
Hospital regarding the financial management in preparing unit budget. They consider
to include assess factors related to workload, staffing, and labor costs before
negotiating between the nurse manager and Director of Nursing (DON), as well as
any other departments, occur. Once the DON approves the budget, it will be present
it to the administration and the Finance Officer from Finance Department. The
Finance Officer will likely have questions the manager needs to address. Following
the meeting with administration and the Finance Department, nurse manager must
make the necessary adjustments to the unit budget. If there is an opportunity to
represent or appeal the budget, this is the time to do so. The budget is then
approved, stamped, sealed, and ready to be implemented. At the year's end, it is
time to evaluate the annual budget.
The Nurse Managers are the responsible for managing the activities of the unit;
therefore, nurse managers must know what they have control over. Typically, Nurse
Managers control most of the activities on the unit that contribute to the budget. Such
activities include staffing, skill mix, education, staff meetings, and orientation length.
At the end of each month, Nurse Managers must justify to DONs any discrepancies
in the numbers you budgeted. Internal accounting reports are usually given to
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20122924
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Professor Jerry V. Manlapaz
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managers. Such reports show the difference between the expected performance
planned in the budget and the actual results. The responsibilities of Nurse Managers
are controllable expenses such as staffing and supplies and uncontrollable expenses
such as patients' acuity levels and unit activity levels and Types of benefits.20
The unit level budgets are expenses are monitored via productivity or hours per
patient per day (HPPD). This, in turn, is based on acuity levels, census, staffing
levels, and length of stay. The nursing staff directly affects the units expenses. The
misuse of sick time, excessive overtime, lateness, and waste greatly influence
expense.21
Operating Budgets for a Nursing Unit
According to the Head Nurses, there are five factors, which affect an operating
budget these are the environment, objectives, policies, and assumptions, long-range
budget, program budgets and budgets from other units. Operating budget
summarizes revenue and expenses over a year.
There are 3 main sections: Personnel budget, Supply and equipment budget and
Revenue or income from reimbursement.
Personnel Budget the biggest expense in the nursing departmentand the
hospitalis staff salaries. In fact, salaries often account for up to 75% of department
and hospital budgets. The personnel budget determines how much staff is needed to
operate the unit 24 hours a day, 365 days a year.22 The personnel budget projects
the salary costs that will be paid and charged to the cost center. It accounts for

20
Building a Budget
21 Budgeting
22

and Resource Allocation

Building a Budget

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20122924
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Professor Jerry V. Manlapaz
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15

replacement of staff for benefit time, overtime, shift differentials, orientation, on-call
hours, bonuses and premiums, and salary increases23. The personnel budget
includes actual worked time (Productive time), and time the organization pays the
employee for not-working time (Non-productive time). Nonproductive time includes
the cost of benefits, new employee orientation, employee turnover, sick and holiday
time, and education time24.
One of the central responsibilities of the nurse manager on a clinical unit is to provide
the appropriate number and mix of nursing staff (nursing care hours [NCH]) to match
actual or projected patient care needs (patient care hours) that will result in safe,
effective, quality care for the patients on the unit. While the nurse manager may plan,
organize, staff, direct, and controldoing a multitude of things simultaneously all day
longthe purpose of a great deal of this activity is to ensure that this responsibility
will be carried out. Appropriate staffing has become even more critical as the focus
on quality care at a reasonable cost has become paramount. To develop a masterstaffing pattern, a nurse manager must determine how many hours of nursing care
are required, based upon available patient classification system information. Once
the hours of required nursing care are determined, the number of full-time
equivalents (FTEs) can be calculated. One full-time equivalent is equal to 40 hours
per week, 80 hours per two-week pay period, or 2,080 hours per year. There are
several methods to determine required FTEs once a desirable staffing pattern has
been established25.

23

Budgeting and Resource Allocation

24

Nursing Division Budgeting

25

Alexander, Sherlin, HN MU2

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20122924
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Professor Jerry V. Manlapaz
TERMPAPER

Supply and Equipment expenses are the expenses include such daily expenses as
the cost of electricity, repairs and maintenance, and medical/surgical supplies (as
syringes, catheters, tube feedings...etc)26. Hospital supplies and equipments are
dealt with under material management. Supplies are those items that are used up or
consumed; hence the term consumable is used for supplies. The supplies in hospital
include drugs, surgical goods (disposables, glass wares), chemicals, antiseptics,
food materials, stationeries, the linen supply etc. The term equipment is used for
more permanent type of article and may be classified as fixed and movables. Fixed
equipment is not a structure of the building, but it is attached to the walls or floors
(egg; steriliser,) Movable equipment includes furniture, instruments etc27. The nurse
manager will assess supplies to look at competitive options for products. Look at
stock levels which currently available, rather than topping up with each supply order,
discuss with other members of staff to determine what is needed and the amount
which is required. This will ensure that stocks are not wasted and misused28.
Revenue or income from reimbursement, Nurse Manager may not be required to
calculate revenue for r unit budget, especially if it are in an inpatient setting. Nurse
Manager should, however, understand the association of revenue with nursing care,
but the finance department controls the charges (i.e., room charges) made to the
patients on the unit. For nurse managers who run a unit with multiple levels of care
(i.e., medical-surgical and telemetry), the patient room charge is based on the level of
care the patient receives on your unit. The level of care is typically based on staffing

26
Ben Gaied, Habib, HN MU2
27

Gavino, Francia, HN FGRU

28

Thomas, Leela, CN MU2

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17

requirements or patient acuity levels. If a patient qualifies as high acuity, the hospital
can charge more for his or her care29.
Capital Budgeting for a Nursing Unit
Capital budget is a plan for the acquisition of long-term investments. The key is the
expected life-time of the item purchased extends beyond the year of purchase.
Examples of capital budget include: renovation of a major wing in the hospital,
purchasing equipment as call-light system, hospital beds etc30. All proposals for
capital equipment need to be fully evaluated for amount of use, payment
methodology, safety, replacement, depreciation of service and every conceivable
angle, including the need for space, personnel and renovation31.
Conclusion and Recommendation
Nurse Managers are being interviewed about Budget in the unit as part of the
organization. Expenditures excessively over and under the budget require
explanations. This area of responsibility can have positive effect on strengthening the
managerial role. However, unless it is matched by authority to make decisions about
revenues and expenditures it will become a troublesome burden and liability.
Budgeting is the process of planning future operations and controlling operations. By
measuring these differences between actual and expected budget items,
management is better able to make modifications and corrections. Since the nursing
department budget can account for as much as half of hospitals total expenses, there
will be significant pressure upon this department to increase efficiency and

29
Building a Budget
30

Gavino, Francia, HN

31

Hartley, Patricia

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Professor Jerry V. Manlapaz
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effectiveness. For nursing to respond to the pressures and the uncertainty of the
economic climate, nurse managers at all levels must become proficient in the
budgeting process. The knowledge of Nurse Managers about budgeting and financial
aspect of an organization is important. There is a significant relationship between the
knowledge of nurse manager and budgeting.

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Ruby Untalasco Gealan

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Professor Jerry V. Manlapaz
TERMPAPER

19

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Budgeting and Resource Allocation
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Building a Budget A Practical Guide to Finance and Budgeting: Skills for Nurse
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date accessed 24 August 2013
ET Ntlabezo, D Litt et Phil student, Department of Health Studies, UNISA VJ Ehlers,
Department of Health Studies, UNISA SW Booyens, Department of Health Studies,
Ruby Untalasco Gealan
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UNISA South African nurse managers' perceptions regarding cost containment in

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Ruby Untalasco Gealan

20122924
Nursing Administration
Professor Jerry V. Manlapaz
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21

Bedside How-to Guide: Developing Front-Line Nursing Managers to Lead Innovation

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Abraham, Sosamma, CN MU2 Rumailah Hospital
Abdullah, Habib Ben Gaied, HN Stroke Unit Rumailah Hospital
Alexander, Shirlen, HN MU2 Rumailah Hospital
Batac, Allan, CN MU2 Rumailah Hospital
Buergo, Eloy, Staff Nurse/Shift in Charge MU2 Rumailah Hospital
Capiceno, Gilda, HN MU1 Rumailah Hospital
Cherian, Jasmin, DON Rumailah Hospital
Gavino, Francia, HN FGRU Rumailah Hospital
Hassine, Zouhair, CN MU2 Rumailah Hospital
Thomas Leela, CN MU2 Rumailah Hospital

22 Student Name :
Student Number :
Subject Title :
Professor:
Module No. :

Ruby Untalasco Gealan

20122924
Nursing Administration
Professor Jerry V. Manlapaz
TERMPAPER