Finding balanced; budgeting; leading and managing

AORN Journal,  Oct, 2005  

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Frazzled, Fried ... Finished? A Guide to Help Nurses Find Balance Joan C. Borgatti 2004, 132 pp $15.95 softcover

The title says it all. Who has not felt frazzled, fried, and finished at some point during his or her career? New nurses are trying hard to learn prioritizing and time management, and seasoned professionals are dealing with more and sicker patients than ever before. Nurses do not want to leave a profession that they love and have worked so hard for, but stress takes a huge toll on their energy and mental state.

This book is written by a nurse for nurses. The author clearly knows the problems that nurses experience and offers realistic methods for change. She uses an interactive writing style, encouraging readers to answer questions in order to determine their wants, needs, and priorities. She then calls readers to action, making them decide, with her guidance, on a resolution to their problems. For example, for a nurse who feels that he or she always gets assigned to the toughest patients, the author provides a series of steps that can help the nurse ask for support without creating an adversarial situation. Some nurses may be interested in seeing whether the grass is truly greener in a different area of nursing. The author gives a specific series of steps to help them get where they want to be.

This book covers more than just professional situations. Some stress, such as financial and family obligations, can be carried over from home life to work. The author talks about the Baby Boom generation of nurses as the middle of a sandwich, with children as the bottom piece of bread and aging parents as the top. With work and family stress to deal with, nurses still are expected to function at their highest capacity, and they do.

I recommend this book for individuals in all levels of nursing. The book also has wisdom to offer people in other professions. It is a great tool for creating change. The author discusses an old saying that everyone has heard: "If you are not part of the solution, you are part of the problem." Nurses can use this book to become part of the solution and be the best that they can be.

This book is available from Borgatti Communications, 212 Worchester St, Wellesley Hills, MA 02481.

A. LYNN LITTLEFIELD

RN, CNOR

RN FIRST ASSISTANT

VIRGINIA HOSPITAL CENTER-ARLINGTON

ARLINGTON, VA

Budgeting Concepts for Nurse Managers third edition Steven A. Finkler 2001, 439 pp $56.95 paperback

Budgeting refers to the process of making plans and quantifying the expected results of those plans. After a budget is in place and agreed on by all parties involved, it becomes a powerful tool for controlling operations and measuring success. Organizations are more effective and efficient at providing services when budgets are thoughtfully prepared and adhered to throughout the budget period. The days of going from one financial crisis to the next usually can be eliminated.

Increased computer use has brought more people into the budgeting process. In many settings, nurses are becoming involved in budget preparation, and almost every organization holds nurse managers and individual nurses responsible for budget implementation. This book is a manual that can be easily understood by people who have no accounting background. It is an excellent resource for nurses who are involved in the finances of their organization.

The author does an excellent job of relating budgeting concepts to needs that arise in health care facilities. Individual chapters are devoted to

* the budget process,

* different types of budgets,

* cost concepts,

* motivations and incentives,

* forecasting and strategic planning, and

* personnel issues.

Each chapter contains a summary that includes practical nursing implications for nurse managers.

In addition to the annual operating budget, the author describes the importance and benefits of developing capital budgets, performance budgets, and special purpose budgets. Special purpose budgets generally are not part of the operating budget--they are for special programs put together in response to a current need.

Most hospital budgets are built from department level budgets. Many facilities create budgets for specific patient groups (eg, patients undergoing heart surgery) because of economic constraints. Other specific, hospital-related budgets may determine how much money the facility is willing and able to allot to safety issues or preventing medication errors.

Budgets are always based on assumptions. In the chapter on forecasting, the author emphasizes the importance of accurately predicting changes in the demographics of the population served, as well as the insurance providers the population uses. He also discusses the types of data that should be collected and how to identify trends. These and many other identifiable factors are key to developing good budgets.

One of my favorite chapters dealt with personnel issues. In this chapter, the author delves into the nursing shortage, staff retention, nursing satisfaction, fringe benefits, burn out, career ladders, recruiting staff members, using alternate health care providers, foreign nurse recruitment, and using new technologies to solve problems within budgetary constraints.