Are you finding yourself spending more time with a budget sheet, calculator and bottle of Tylenol these days? If you answer yes, that makes you normal as a Nurse Manager. With all your fiscal responsibilities do you ever wonder how much accountability staff should have?

Of course, their first response will be, "you make the big bucks you should take care of the money stuff. I'm here to take care of sick people and be a nurse, not an accountant". Sound familiar to anyone? You might be wondering, where is Shelley going with this? Think about your role as a manager as it relates to sound fiscal practices in your department. With that in mind, how do you see your role as it relates to holding staff accountable from a fiscal perspective?

Have you wondered what goes on in the mind of the staff nurse when he/she reaches for supplies? You may be hoping they are calculating the cost to purchase the item vs the amount you are actually reimbursed. But, let's be real here, after all a good professional blog prides itself on reality. When I work my prn shifts as a staff nurse and I am in need of a supply for a patient, my thoughts are (in order of priority);

Do I remember where this item is stored?

• Will the item actually be there on the shelf?
• What is going on with my other patients while I am in the supply closet?
• When can I finally get to the bathroom (ok, maybe this is a number 2 priority)?
• What time is lunch?

Can you put yourself  in the position of your staff as they make selection decisions related to supply use? How can the manager educate and coach staff to lead to a more fiscally realized use of supplies? If the nurse needs one sterile 4x4 for a procedure and they have the following to choose between, how do they make their decision?

      Option 1  package with 2 4x4's
      Option 2  package with 4 4x4's

Some staff will select the item based on which one they see first. Another staff person may consider/rationalize the following;

        If a liter of irrigating solution costs the same as a 250cc bottle, maybe the same applies to other supplies.

What do you think your staff consider as they make decisions about selecting supplies for their patients? How have you educated staff to details regarding costs vs reimbursement? If you had the opportunity, what would you implement that would hold staff more accountable to areas related to the costs of providing health care?