1. Doucette, Jeffrey N. DNP, RN, CEN, NEA-BC, FACHE

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Budget reduction woes

Q My organization recently asked all department heads to reduce operating expenses by 5% to meet our budget targets. What suggestions do you have for how to approach this issue?

This is always a challenging situation for any nurse leader. With the recent changes in reimbursement and payment models, many organizations are looking for ways to reduce expenses while maintaining and improving quality metrics. In almost every nursing unit budget, salaries are the largest expense and, generally, the last place you want to start with reductions.

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The first thing you'll want to do is become very familiar with your monthly budget reports. Review each line item and look for red flags or irregularities that cause concern. Pay special attention to items that you purchased. Are the supplies on your report all for your unit? Often, items are charged to the wrong units or cost centers and you can gain savings just by making sure your budget reports are correct.


After you fully understand your unit's financial reports, have a crucial conversation with the people who have the best ideas for controlling costs-your staff. No one knows the unit better than the people doing the work every day, so tap into this critical resource for ideas early and often. Next, look for the low-lying fruit and make necessary adjustments. For example, is your overtime greater than 1%? If so, you have opportunities to reduce this expensive cost. Monitor clock in and out times for employees. Early or late punches of 10 or 15 minutes can really add up. Managing incremental overtime is one of the easiest and quickest ways to reduce unnecessary expenses.


Other easy opportunities include reducing par levels for supplies, ensuring proper linen utilization, reducing nourishment costs, and limiting the type and amount of office supplies ordered for the unit. Finally, you'll want to explore your current staffing patterns and look for opportunities to right-size staffing levels based on volumes and patient flow needs.


Although these decisions are never easy, the best way to rein in expenses is to always be on top of your unit's financial performance and manage variation in real time.


Stress busting tips

Q My stress level is at an all-time high; I never feel like I'm getting ahead of the issues on my team. Is this normal, and what can I do to have more balance?

These are challenging times to be in healthcare, and many of my friends and colleagues report your same sentiment. There are myriad pressures facing nurse leaders, and stress has been shown to be a leading cause of nurse leader turnover. One of the most important things you can do to better manage stress is to recognize when it's getting in the way of your overall work-life satisfaction. After you know that stress is an issue, there are numerous ways to reduce it.


One strategy that I really enjoy for resetting my stress level during the day is to take a walk. I check my schedule and find a meeting that can be accomplished on a walk and, instead of sitting at a desk, we have a walking meeting. I'm still able to get the work done but with a little activity and a change of venue, my stress level tends to reset to my baseline. Breathing and visualization exercises can also help reduce your stress response when leaving the situation you're in isn't an option.


I recently attended a wellness seminar and saw a demonstration of several stress management apps for smart phones and tablets. I downloaded a virtual koi pond and Zen garden and was surprised at how relaxed I became after playing with these apps for just a few minutes. I also encourage you to explore the employee-assistance program at your facility, along with your own health insurance plan. Many health plans cover wellness activities, such as yoga and massage, and these are also great options for improving health while reducing stress.


If you don't manage your stress, you'll experience a breakdown. This may manifest itself as a health crisis, a job turnover, or a broken relationship. Get ahead of stress so it doesn't get a hold of you!