“Nursing costs are way too high. Something must be done. Staffing is out of control, ” said the hospital’s Executive Director to me, the brand new budget manager.

Less than 24 hours later, the Director of Nursing told me, “My staffing is fine. I’m not over spending. I’m tired of being constantly asked to cut staffing.”

The Executive Director gave clear orders to me to follow up with the Director of Nursing and get this issue resolved. Looking at budget to actual line items, nursing salary expenses were over budget.

“Before you talk to me about staffing costs over budget, would you be willing to listen to how we staff the floors?”  asked the Director of Nursing at the start of our meeting.

For the next few minutes, I learned from an incredible Director of Nursing how nursing staffing was tied to patient census and how actual scheduling was determined on a daily and weekly basis.

“What if we monitor on a timely basis nursing hours per patient day?” I asked. After doing this calculation, it was realized that nursing salary expense was actually ahead of budget.

It wasn’t long before it was decided that actual to budget results would be monitored on a timely basis using an agreed upon hours per patient day key performance indicator (KPI). After that, when the Executive Director called me with a concern about nursing being over budget, the hours per patient day KPI was readily available.  If staffing was above the agreed upon KPI, it was quickly dealt with and corrected.  Unnecessary nursing staffing tensions with administration soon moved to the back burner.

Behind every number is a story.  So grateful for a Director of Nursing who took the time to not only educate a brand new budget manager but a manager with no prior health care experience whose previous employer was the Internal Revenue Service.