Why is it important for all nurses to understand some basic concepts about making and maintaining a budget?
If you are employed, what budget information (if any) does your employer share with its employees?
Do you agree that nurses have a “fiscal responsibility” to patients and to their employer? Give a rationale for your answer.
Describe some ways — beyond those mentioned in the text — that you will practice fiscal responsibility in your clinical practice.
In today’s economic and political environment, it is imperative that nurses incorporate fiscal responsibility as an integral part of their nursing duties. These duties are a fiduciary responsibility to both the patient and to their employing institution. Comprehending and adhering to the principle of fiscal management will not only improve care of patients, but will also enhance the workplace environment and ultimately give nurses the autonomy they strive for.

The mantra "The patient first" remains the consistent priority regardless of delivering direct care or being fiscally responsible. Many nurses have difficultylll with this concept, as the business minded have always been depicted as cold hearted; a direct conflict with the view of nurturing caretakers that are nurses. This obstacle must be overcome, because the two ideas are able to co-exist and must if we are to hold true to our core values and holistic care. Many of the practices we employ as safe and competent patient care is in fact, fiscally responsible. Consistent hand washing, fall precautions and preventions for skin breakdown demonstrates quality patient care as well as saves the patients and the institution from unnecessary expense (Murray, 2009). Due to the rising costs of healthcare, nurses also have a responsibility to educate themselves about available client resources, cost of medications and policy restrictions in Medicare and Medicaid (Murray, 2009). Although this knowledge is budget savvy, it demonstrates care that will enable patients to remain compliant in their treatments.

Improving the conditions of the workplace is a universal desire felt by most regardless of profession. Stress and frustration lead to decreased productivity. For a staff nurse, the simple act of understanding the budget process will decrease frustration by giving another perspective, thereby allowing staff and managers to strive toward the same goals." Creating shared dialogue and opportunities for partnership between nurses, other caregivers, and administrators is also seen to enhance the work environment" (Beason, 2005). Rather than feel frustration because of under stocked supplies, lack of equipment or staff shortages, this new found perspective may help staff work together to formulate priorities and solutions for their units. Managers also hold some responsibility to staff to share target goals and past budget obstacles in effort to define the issue clearly. As student nurses, we too can practice fiscal responsibility while in our clinical rotations by making sure that we are aware of and follow the policies of the hospital. Avoiding waste such as medication mistakes or even something as simple as leaving more than the necessary supplies in a patients room will help keep costs down for supplies and medications. Budgets can be met without hostility if everyone understands the process and becomes an active part in formulating it.

Nurses who empower themselves with the tools and desire to be fiscally responsible have the ability to change the industry. Who better than a nurse to realize what is necessary to deliver competent patient care? Currently, nurse managers are feel the sole weight of managing the business end of nursing. When tackled alone, the job can be an overwhelming uphill battle that few are willing to take on. "In the USA and in the UK these nursing supervisory roles are in danger of extinction as more and more non-nurse managers are being hired to take over managerial functions and more nurses are becoming reluctant or even unwilling to take on this extremely stressful role. With the loss of nurses in these roles comes the loss of nursing's voice in policies that affect nurses and the care they give" (Cameron-Buccheri 1994). When the nursing industry rejects the opportunity to become part of the budget process, control is given to finacial and business experts who look at line item sheets and make blind cuts without realizing the effects it will have on patient care or the workplace. This lack of involvement in the budget process trickles down to negatively impact the nurses ability to care for their patients and ultimately leads to their budget frustration. Nurses are more knowledgeable in field and have the ability to realize areas where sacrifices can be safely made and areas where investment is necessary. They should ustilize this knowledgeable position by becoming the initiating force of change. The job description of a nurse manager already requires budget accountability and if the saying goes "follow the dollars and they will lead to nursing," than it just makes sense that nurses should be active participants in the budget process (Murray, 2009).

In conclusion, if nursing truly wishes to be reconized as a "profession" rather than an occupation, it is necessary for us to initiate change by taking responsiblity in the fiscal management of our institutions rather than putting our heads in the sand and allowing others to make budget decisions that will affect our ability to competently care for patients. We must consider captial budgets,operating budgets and unit personal budgets while considering quality patient care. Once we encompass the business aspect of caring for patients, we as professionals, can lend the expertise necessary to give quality care at a reasonable price.