As a Director of Nursing, I've found myself in the hot seat more times than I'd like to admit, all because I struggled with managing a budget. The truth is, this isn't something we're taught in nursing school. You don't learn how to manage a budget until you're sitting in the director's chair, and by then, the stakes are high.
I’ve met with many Directors of Nursing who, like me, weren't fully prepared to tackle this aspect of the role. When you're hired as a Director of Nursing, it's crucial to sit down with your administrator right away and ask, "What exactly am I budgeted for?" This includes everything from positions to supplies to census targets and medical equipment.
I had to learn the hard way, and let me tell you, it wasn’t fun. Picture this: sitting in a finance review with my Regional Vice President, my stomach in knots, dreading the moment when I’d have to admit that I didn’t know how to manage the numbers. It was a painful experience, but one that taught me invaluable lessons.
The Turning Point: Learning to Manage the Budget
One of the first things my RVP taught me was how to establish PAR levels for every item in the supply closet. This was a game-changer. By setting these levels, I began tracking everything in the facility—from residents who were incontinent to those with Foley catheters, oxygen needs, PEG tubes, dentures, you name it. I knew exactly how many of my residents were using these items and how much we were spending. An area that I would lose sight of, would be returning equipment once a resident was discharged. That's a biggie.
We also dove deep into our monthly pharmacy bills, scrutinizing every detail to see what could be covered under residents' Medicare Part B plans. I learned what our census needed to be to show a profit and, yes, I heard the dreaded phrase, "Until we meet census, there will be no spending." I’m sure many of you can relate to that! It's why sometimes you find yourself accepting admissions that you know are less than ideal, just to make some financial headway.
You're Not Alone: Budgeting Help is Available
If you're struggling to establish and manage your budget, know that you're not alone. This is a challenge many of us face, especially early in our careers as DONs. But there are steps you can take to get a handle on it.
First, meet with your central supply manager weekly to review spending. This will help you keep track of what's going out and what's coming in. Second, have daily check-ins with your staff coordinator to monitor overtime and staffing costs. Meet with your admissions coordinator to establish a plan to improve census. And finally, sit down with your administrator to develop a financial plan tailored to your facility's needs.
Budgeting as a DON isn't easy, but it's a skill you can master with the right guidance and support. Trust me, if I can learn it, so can you. And once you do, you'll find that managing your facility's budget becomes less of a burden and more of an opportunity to lead your team and facility to success.
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