A COMPARATIVE ANALYSIS OF THE BUDGET-RELATED ACTIVITIES USED IN THE EVALUATION OF CLINICAL NURSE MANAGERS, CLINICAL SUPERVISORS AND NURSE EXECUTIVES.Historically, nurse managers have been evaluated primarily on intangibles such as dedication, caring and a sense of responsibility in giving service. With the advent of healthcare reform, increased emphasis within the healthcare industry on fiscal management has changed the scope of nurse managers' practice. Nurse managers, often involved in managing direct and indirect patient care, have had to adapt to these changes by developing new management skills. Driven by integrated delivery systems integrated delivery system Integrated provider Medical practice A coordinated health care system formed by physician groups and hospitals which ↑ efficiency and ↓ redundancy in providing health care; IDSs coordinate delivery of a broad range of health , organizational changes related to managed care and capitation CAPITATION. A poll tax; an imposition which is yearly laid on each person according to his estate and ability. 2. The Constitution of the United States provides that "no capitation, or other direct tax, shall be laid, unless in proportion to the census, or require the nurse manager to improve efficiency and control healthcare costs (Schmidt 1999). Performance evaluations Performance evaluation The assessment of a manager's results, which involves, first, determining whether the money manager added value by outperforming the established benchmark (performance measurement) and, second, determining how the money manager achieved the calculated return are used by organizations to measure and evaluate productivity. Productivity is evaluated as the ability to effectively use both capital resources and human resources The fancy word for "people." The human resources department within an organization, years ago known as the "personnel department," manages the administrative aspects of the employees. as they relate to an organization's mission. Evaluations are based upon a comparison of the individual's accomplishments with previously determined goals (Fletcher Fletcher may refer to one of the following: Ideas and companies
The expectation that nurse managers will be proficient pro·fi·cient adj. Having or marked by an advanced degree of competence, as in an art, vocation, profession, or branch of learning. n. An expert; an adept. in fiscal management suggests that budgeting behaviors will be reflected in their evaluation. Because the roles and responsibilities of various types of nurse managers have changed to include increasing fiscal responsibility over the past several years, the Years, The the seven decades of Eleanor Pargiter’s life. [Br. Lit.: Benét, 1109] See : Time appraisal process should reflect these changes as well. Therefore, the purpose of this study was to analyze the extent to which various nurse manager groups perceive performance evaluation as inclusive of inclusive of prep. Taking into consideration or account; including. financial management expectations in light of their participation in actual budget behaviors. NURSE MANAGERS AS FISCAL GATEKEEPERS Nurse managers, through the systematic planning and management of budgets at the unit level, link resources and strategy. Because nurse managers, at all levels, are a vital link between financial/managerial accounting departments and controllable costs, they have a profound effect on the productivity of the organization through their management skills. For example, to be successful, nurse managers must be familiar with and understand the importance of budget variance The discrepancy between what a party to a lawsuit alleges will be proved in pleadings and what the party actually proves at trial. In Zoning law, an official permit to use property in a manner that departs from the way in which other property in the same locality information on labor, materials and overhead. They appreciate the need to use various accounting reports to plan and control budgets. Financial management requires the ability to understand cost determination, activity forecasting, internal benchmarking, functional cost center budgeting, performance reporting on a product level, workforce composition and labor cost, and performance reporting on a functional level (Finkler & Kovner 2000; McDermott et al. 2000; Schmidt 1999). The ability to manage financial and operational standards is a critical link in the organization's capacity to remain fiscally viable. Several levels of nursing management have developed over the last few years. Titles, as well as roles and responsibilities, vary widely across organizations. The functions of first-line managers are to plan, organize, oversee and control direct patient care. Increasingly, managers are responsible for services or product-lines across more than one unit, program, or department. Ultimately, they have 24-hour responsibility for adequate staffing and cost effective, quality patient care. Clinical nurse managers plan operating budgets Noun 1. operating budget - a budget for current expenses as distinct from financial transactions or permanent improvements budget items, operating cost, operating expense, overhead - the expense of maintaining property (e.g. . In addition they must analyze and control revenue and costs associated with services provided, personnel, materials and equipment. Since nursing labor budgets can account for a large proportion of the total expenses, there is significant pressure to increase efficiency and effectiveness. Nurse executives, commonly referred to as directors of nurses or chief nurse officers/executives, have 24-hour responsibility for the entire organizations delivery of healthcare, Increasingly, they manage ancillary Subordinate; aiding. A legal proceeding that is not the primary dispute but which aids the judgment rendered in or the outcome of the main action. A descriptive term that denotes a legal claim, the existence of which is dependent upon or reasonably linked to a main claim. departments as well. Many nurse executives communicate with administrators and interface with other nurse managers on many levels. Clinical supervisors manage resources throughout the organization, but are typically not primarily responsible for evaluating healthcare workers. Instead they manage staff and resources on a "as needed as needed prn. See prn order. " basis. They frequently take call, or work within the organization during set shift hours. All levels of nurse managers need skills necessary to project costs based on current and anticipated needs. Monitoring and budget control skills are essential to predict trends in census and patient acuity acuity /acu·i·ty/ (ah-ku´i-te) clarity or clearness, especially of vision. a·cu·i·ty n. Sharpness, clearness, and distinctness of perception or vision. . PERFORMANCE APPRAISALS To reflect the wide range of competencies of nurse managers, the development of effective performance reviews and appraisals has been initiated (Aderhold et al. 1996; Buechleim et al. 1993). The impetus Impetus is a stimulus or impulse, a moving force that sparks momentum. Impetus may also refer to:
n.pr the United States body that accredits healthcare organizations. Joint Commission on Accreditation of Healthcare Organizations (JCAHO/TJC), n. (JCAHO JCAHO Joint Commission on Accreditation of Healthcare Organizations, see there ) which requires acute care facilities to assess the competency COMPETENCY, evidence. The legal fitness or ability of a witness to be heard on the trial of a cause. This term is also applied to written or other evidence which may be legally given on such trial, as, depositions, letters, account-books, and the like. 2. of all employees on a continual basis (JCAHO 1999). This mandate applies to all levels within the organization, including nurse managers. The benefits of performance appraisal to the overall organizational structure  This article has no lead section.To comply with Wikipedia's lead section guidelines, one should be written. has been well documented. Less frequently documented is the structure and format of the evaluation process. Because little is known about the context of performance evaluation of nurse managers, research is needed that examines congruency con·gru·en·cy n. pl. con·gru·en·cies Congruence. between role expectations and the evaluation of their performance. Literature regarding performance appraisal often addresses the rationale rationale (rash´  nal´),n the fundamental reasons used as the basis for a decision or action. for appraisal or the difficulty many managers find in evaluating others. What remains unclear is an examination of the context of the nurse managers' evaluation process. More specifically, there is a need to examine the appraisal process of nurse mangers as it relates to the extent and impact of their fiscal role within the healthcare system. Research on performance appraisal between 1950 and 1980 was concerned with improving instruments used to derive performance ratings See benchmark. (Arvey & Murphy 1998). As organizations became more decentralized de·cen·tral·ize v. de·cen·tral·ized, de·cen·tral·iz·ing, de·cen·tral·iz·es v.tr. 1. To distribute the administrative functions or powers of (a central authority) among several local authorities. and moved toward team-based methods of production, research focused on the impact of the changes on the process of performance appraisals within organizations (Cascio 1995; Fletcher 1995). The effects of systems such as "Total Quality Management" and their impact on performance evaluation has also been studied (Cardy & Dobbins 1994). More recent research on performance evaluation has focused on defining job performance. Several models have been proposed demonstrating good fit with theoretical testing. Performance evaluation is conceptualized as multi-faceted, focusing on characteristics of the individual, outcomes, and immediate work environment (Waldman & Spangler 1989). A number of studies have examined the impact of self evaluation (Yu & Murphy 1993), peer evaluation (Borman et al. 1995), and multiple source evaluation Source evaluation is the skill of analysing information sources in order to assess their credibility. The ability to assess different sources of information is highly relevant to the task of operating within a complex information society. used in 360-degree performance measures (Tornow 1993; London & Smither 1995) on improving the effectiveness of management intervention A procedure used in a lawsuit by which the court allows a third person who was not originally a party to the suit to become a party, by joining with either the plaintiff or the defendant. . To date little research has been performed that examines, from the perspective of those being evaluated, whether the evaluation process is congruent con·gru·ent adj. 1. Corresponding; congruous. 2. Mathematics a. Coinciding exactly when superimposed: congruent triangles. b. with job expectations. We identified no research that examines the appropriateness of fiscal management as a component of performance appraisal for nurse managers. ROLE FUNCTIONS At the same time research was focusing on models of performance evaluation, nurse managers were attempting to redefine Verb 1. redefine - give a new or different definition to; "She redefined his duties" define, delimit, delimitate, delineate, specify - determine the essential quality of 2. their roles and contributions to healthcare organizations. The American Organization of Nurse Executives (AONE AONE American Organization of Nurse Executives AonE Animeone (anime fansub group) ) identified six role functions of nurse managers (AONE 1992). These functions include management of clinical nursing practice and patient care delivery, management of human, fiscal and other resources, development of personnel, strategic planning Strategic planning is an organization's process of defining its strategy, or direction, and making decisions on allocating its resources to pursue this strategy, including its capital and people. , and fostering relationships within the organization. Given these expectations, it stands to reason that the nurse manager's performance is appraised based on the ability to successfully operate within these role functions. While the literature addresses many of these role functions, we identified no research that examines the nurse manager's contribution to fiscal management within the healthcare system. Adequate and effective utilization of budgeting and resource allocation resource allocation Managed care The constellation of activities and decisions which form the basis for prioritizing health care needs , both human and material, is important to the overall performance of nurse managers. METHODS Nurse managers were recruited to participate in this project. The sample was drawn from a mailing list An automated e-mail system on the Internet, which is maintained by subject matter. There are thousands of such lists that reach millions of individuals and businesses. New users generally subscribe by sending an e-mail with the word "subscribe" in it and subsequently receive all new provided by the Louisiana Louisiana (ləwē'zēăn`ə, l  ē'–), state in the S central United States. It is bounded by Mississippi, with the Mississippi R. State
Board of Nursing, consisting of 5,195 nurses who had self-identified as
nurse managers at the time of licensure licensure(lī´s  nsh renewal. A systematic random
sample of 575 nurse managers was selected from all nurse managers in the
state. Of those sent, nine packets were undeliverable un·de·liv·er·a·ble adj. Difficult or impossible to deliver: undeliverable mail. un . Due to financial constraints CONSTRAINTS - A language for solving constraints using value inference. ["CONSTRAINTS: A Language for Expressing Almost-Hierarchical Descriptions", G.J. Sussman et al, Artif Intell 14(1):1-39 (Aug 1980)]. , no follow-up was made following the initial mailing. A self-addressed, stamped envelope with written instructions was provided. The survey packet included survey instruments and a demographic form. Standard procedures for gaining approval and clearance for studies involving human subjects were followed. Protection of human subjects was assured by following the guidelines guidelines, n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. set forth by the university's Internal Review Board (IRB IRB See: Industrial Revenue Bond ). To be eligible for the study, nurse managers had to (1) be employed by a healthcare agency, (2) supervise others, (3) be evaluated by someone in an administrative position, and (4) prepare and implement activities requiring budgetary considerations. One hundred-twenty useable survey packets were returned for an overall response rate of 20.9 percent. INSTRUMENTS Financial Accountability Performance Evaluation Scale The Financial Accountability Performance Evaluation Scale was used to measure the extent respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. believe that budgetary activities and financial resource monitoring are used in their performance evaluation (Carruth 1979). Because the literature emphasizes the importance of the fiscal responsibility as an emerging role, an examination of the congruency between expectation and performance is needed. This is best understood from the nurse managers perspective since the process of evaluation is thought to contribute to professional growth, which leads to the promotion of overall organizational success. The instrument consists of 5-items in a Likert type format where responses range from strongly agree (5) to strongly disagree (1). Scores range from 5 to 25 on this scale. Items for this scale were generated following an extensive review of literature on managerial behavior and performance evaluation. Items reflect the extent nurse managers believe behaviors influencing controllable costs, as well as other financial considerations, are used in the evaluation of their performance by superiors. The scale's validity and reliability were assessed. Content validity content validity, n the degree to which an experiment or measurement actually reflects the variable it has been designed to measure. of the scale was endorsed by three experts in nursing management and one expert in managerial accounting Managerial Accounting The process of identifying, measuring, analyzing, interpreting, and communicating information for the pursuit of an organization's goals. Notes: . Cronbach's Alpha Cronbach's  (alpha) has an important use as a measure of the reliability of a psychometric instrument. It was first named as alpha by Cronbach (1951), as he had intended to continue with further instruments. was used for estimating internal consistency In statistics and research, internal consistency is a measure based on the correlations between different items on the same test (or the same subscale on a larger test). It measures whether several items that propose to measure the same general construct produce similar scores. reliability ([varies]
= 0.77). Internal consistency was high for a 5-item scale. Factor
analysis with orthogonal At right angles. The term is used to describe electronic signals that appear at 90 degree angles to each other. It is also widely used to describe conditions that are contradictory, or opposite, rather than in parallel or in sync with each other. Varimax rotation resulted in clear confirmation
of a single scale. Psychometric testing psychometric test Any test used to quantify a particular aspect of a person's mental abilities or mindset–eg, aptitude, intelligence, mental abilities and personality. See IQ test, Personality testing, Psychological testing. of this scale among nurse
managers is consistent with findings among managers of various
industrial firms (Carruth 1979).
Budget Activities Budgeting activities were measured using six questions that reflect three areas of budget behavior: (1) Participation in Budget Preparation; (2) Use of Budgets for Planning and Control, and (3) Manipulation of Accounts. Engaging in the behavior was determined by a response of "always" or "often." In the event respondents engaged in the behavior "seldom" or "never," their responses were coded as no. Nurse Manager Profile To describe the nurse managers' position and to determine management demands, the Nurse Manager Profile was developed. Current position title, years at agency, years in current position, average hours worked each week, and number of people supervised su·per·vise tr.v. su·per·vised, su·per·vis·ing, su·per·vis·es To have the charge and direction of; superintend. [Middle English *supervisen, from Medieval Latin were recorded in an open-ended format. Position was grouped as clinical nurse managers, supervisors, and nurse executives. These categories were grouped from written responses to the question "what is your current title?" Clinical nurse managers are individuals with 24-hour responsibility for the management of one or two units (Mark 1994). Therefore, nurse titles reflecting unit and/or departmental duties were coded as clinical nurse managers. Nurses self-identifying as supervisors were categorized cat·e·go·rize tr.v. cat·e·go·rized, cat·e·go·riz·ing, cat·e·go·riz·es To put into a category or categories; classify. cat as clinical supervisors. Clinical supervisors use managerial skills during the time they are at work, and typically do not have 24-hour/day responsibility for the organization. The last category coded was nurse executives and included nurses self-identifying with titles such as Assistant Director of Nursing, Director of Nursing, or Chief Nursing Officer. Responses for position were coded as one of three types of managers, each mutually exclusive Adj. 1. mutually exclusive - unable to be both true at the same time contradictory incompatible - not compatible; "incompatible personalities"; "incompatible colors" . Type of salary was recorded as fixed or hourly. Respondents were asked for the title of the person that conducts performance evaluation. Demographic Data Form Demographic data, including age, gender, marital status marital status, n the legal standing of a person in regard to his or her marriage state. , and educational level were determined by self-report. DATA ANALYSIS Data were analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. using SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. 9.0/win version. One-way ANOVA anova see analysis of variance. ANOVA Analysis of variance, see there and Chi-square tests chi-square test: see statistics. were used to evaluate differences within and between groups with regard to the use of budget-related activities and performance evaluation. Frequencies and percentages were used to describe various roles and responsibilities. RESULTS With the exception that nurse executives were, on average 4 years older than clinical nurse managers, demographics The attributes of people in a particular geographic area. Used for marketing purposes, population, ethnic origins, religion, spoken language, income and age range are examples of demographic data. from this survey showed substantial similarity Similarity is some degree of symmetry in either analogy and resemblance between two or more concepts or objects. The notion of similarity rests either on exact or approximate repetitions of patterns in the compared items. between clinical nurse managers and nurse executives (Table 1). A higher proportion of clinical supervisors were male and educated at associate or diploma DIPLOMA. An instrument of writing, executed by, a corporation or society, certifying that a certain person therein named is entitled to a certain distinction therein mentioned. 2. programs. There were not as many similarities when examining the nurse manager profile. Nurse executives were more likely to supervise greater number of employees (range 7-250), be paid by fixed salary (78.3%) and be evaluated by an administrator (77.3%). Clinical supervisors were more often male (31.6%) compared to clinical nurse managers (7.7%) and nurse executives (4.3%). Clinical supervisors also tended to be employed at the agency (Mean = 11.6 yrs., SD = 6.9) and in present position (Mean = 7.1 yrs., SD = 5.8) a greater length of time. Clinical supervisors averaged less than 40 hours/week (Mean = 38.2, SD = 18.6) compared to clinical nurse managers (Mean = 48.1, SD = 10.2) and nurse executives (Mean = 45.7, SD = 8.5).
TABLE 1
DEMOGRAPHIC AND NURSE MANAGER PROFILE
Character Clinical Nurse
Manager
n = 78
Demographics
Age
Range 27-59 yrs.
Average 42.4 (SD = 8.1)
Gender
Male 6 (7.7%)
Female 72 (92.3%)
Marital Status
Married 54 (70.1%)
Not Married 24 (29.9%)
Level of Education
AD/Diploma 28 (36.3%)
BS Nursing 36 (46.8%)
MS Nursing 5 (6.5%)
Other 8 (10.4%)
Manager Profile
Length of time employed at Agency
Range 0.25-25
Average 10.6 (SD = 6.1)
Length of rime in present position
Range 0.25-19
Average 5.7 (SD = 4.4)
Supervision
Range 2-140 individuals
Average 34.2 (SD = 34.8)
Number of hours/work
Range (hours) 32-90
Average (SD) 48.1 (SD = 10.2)
Paid
Hourly 27 (34.2%)
Fixed Salary 33 (41.8%)
Unknown 19 (24.1%)
Evaluated by:
Divisional Director-Nurse 13 (16.9%)
Divisional Director-Non-nurse 18 (23.4%)
Nurse Executive 41 (53.2%)
Administrator 5 (6.5%)
Character Supervisor
n = 19
Demographics
Age
Range 30-58 yrs.
Average 45.7 (SD = 7.8)
Gender
Male 6 (31.6%)
Female 13 (68.4%)
Marital Status
Married 13 (68.4%)
Not Married 6 (31.6%)
Level of Education
AD/Diploma 9 (47.4%)
BS Nursing 7 (36.8%)
MS Nursing 2 (10.5%)
Other 1 (5.3%)
Manager Profile
Length of time employed at Agency
Range 3-33 yrs.
Average 11.6 (SD = 6.9)
Length of rime in present position
Range 1-25 yrs.
Average 7.1 (SD = 5.8)
Supervision
Range 1-60 individuals
Average 18.2 (SD = 18.4)
Number of hours/work
Range (hours) 17-50
Average (SD) 38.2 (SD = 18.6)
Paid
Hourly 13 (68.4%)
Fixed Salary 5 (26.3%)
Unknown 1 (5.3%)
Evaluated by:
Divisional Director-Nurse 7 (36.8%)
Divisional Director-Non-nurse 6 (31.6%)
Nurse Executive 6 (31.6%)
Administrator --
Character Nurse
Executive
n = 23
Demographics
Age
Range 28-68 yrs.
Average 46.6 (SD = 9.2)
Gender
Male 1 (4.3%)
Female 22 (95.7%)
Marital Status
Married 16 (69.6%)
Not Married 7 (30.4%)
Level of Education
AD/Diploma 7 (30.4%)
BS Nursing 13 (56.5%)
MS Nursing 3 (13%)
Other
Manager Profile
Length of time employed at Agency
Range 1-37 yrs.
Average 8.3 (SD = 9.2)
Length of rime in present position
Range 1-20 yrs.
Average 5.3 (SD = 5.6)
Supervision
Range 7-250 individuals
Average 52.3 (62.1)
Number of hours/work
Range (hours) 24-65
Average (SD) 45.7 (SD = 8.5)
Paid
Hourly 5 (21.7%)
Fixed Salary 18 (78.3%)
Unknown N/A
Evaluated by:
Divisional Director-Nurse --
Divisional Director-Non-nurse 2 (9%)
Nurse Executive 3 (13.7%)
Administrator 17 (77.3%)
To evaluate the relationship between budget activities and financial accountability performance, a correlation matrix Noun 1. correlation matrix - a matrix giving the correlations between all pairs of data sets statistics - a branch of applied mathematics concerned with the collection and interpretation of quantitative data and the use of probability theory to estimate population was designed (Table 2). All correlations were significant at the 0.01 level, suggesting an association between budget activities and the perception by nurse managers of their use in performance evaluation by superiors.
TABLE 2
CORRELATIONS AMONG BUDGET ACTIVITIES AND
FINANCIAL ACCOUNTABILITY PERFORMANCE EVALUATION
[X.sub.1] [X.sub.2]
[X.sub.1] Prepare Future Budgets 1.0
[X.sub.2] Use Budgets to Plan Activities 0.58(***) 1.0
[X.sub.3] Investigate Budget Variances 0.73(***) 0.74(***)
[X.sub.4] Submit explanation about 0.55(***) 0.55(***)
causes of budget variances
[X.sub.5] Stop Activities when 0.29(***) 0.40(***)
no available funds
[X.sub.6] Direct corrective 0.59(***) 0.69(***)
action for budget variances
[X.sub.7] Financial Accountability 0.26(***) 0.29(***)
Evaluation Score
[X.sub.3] [X.sub.4]
[X.sub.1] Prepare Future Budgets
[X.sub.2] Use Budgets to Plan Activities
[X.sub.3] investigate Budget Variances 1.0
[X.sub.4] Submit explanation about 0.72(***) 1.0
causes of budget variances
[X.sub.5] Stop Activities when 0.44(***) 0.32(***)
no available funds
[X.sub.6] Direct corrective 0.72(***) 0.65(***)
action for budget variances
[X.sub.7] Financial Accountability 0.33(***) 0.37(***)
Evaluation Score
[X.sub.5] [X.sub.6]
[X.sub.1] Prepare Future Budgets
[X.sub.2] Use Budgets to Plan Activities
[X.sub.3] investigate Budget Variances
[X.sub.4] Submit explanation about
causes of budget variances
[X.sub.5] Stop Activities when 1.0
no available funds
[X.sub.6] Direct corrective 0.33(***) 1.0
action for budget variances
[X.sub.7] Financial Accountability 0.32(***) 0.31(***)
Evaluation Score
[X.sub.7]
[X.sub.1] Prepare Future Budgets
[X.sub.2] Use Budgets to Plan Activities
[X.sub.3] investigate Budget Variances
[X.sub.4] Submit explanation about
causes of budget variances
[X.sub.5] Stop Activities when
no available funds
[X.sub.6] Direct corrective
action for budget variances
[X.sub.7] Financial Accountability 1.0
Evaluation Score
(***) Significant at the 0.01 level
Clinical nurse managers averaged higher on financial accountability performance evaluation (Mean = 14.8, SD = 4.1) compared with nurse executives (Mean = 13.9, SD = 3.2) and clinical supervisors (Mean = 12.3, SD = 2.6). To examine potential differences in mean scores among nurse managers on the measure of financial accountability performance evaluation, a One-way ANOVA was conducted. The independent variable, nurse managers, included three levels: (1) clinical nurse mangers, (2) clinical supervisors, and (3) nurse executives. The dependent variable was the nurse managers' perception that the ability to conduct aspects of financial management was evaluated as part of their performance. The One-way ANOVA was significant. (F = 3.53, df = 2, p = 0.03). Follow-up tests were conducted to evaluate pairwise differences among the means of the three groups of managers. Because the variances among the three groups ranged from 6.9 to 16.40 and because the ANOVA analysis passed the Levine's test for equality of variance, the assumption was made that the variances were homogeneous The same. Contrast with heterogeneous. homogeneous - (Or "homogenous") Of uniform nature, similar in kind. 1. In the context of distributed systems, middleware makes heterogeneous systems appear as a homogeneous entity. For example see: interoperable network. . Therefore, post hoc post hoc adv. & adj. In or of the form of an argument in which one event is asserted to be the cause of a later event simply by virtue of having happened earlier: comparisons using the Scheffe technique were conducted. The results of these tests, as well as the means and standard deviations In statistics, the average amount a number varies from the average number in a series of numbers. (statistics) standard deviation - (SD) A measure of the range of values in a set of numbers. for the three groups, are reported in Table 3. Follow-up with Scheffe's procedure indicated that the clinical nurse managers scored significantly higher (p [is less than] 0.05) than the clinical supervisors.
TABLE 3
DIFFERENCES AMONG GROUPS ON
FINANCIAL ACCOUNTABILITY PERFORMANCE EVALUATION SCORES
Range Mean SD Clinical Clinical
Nurse Supervisors
Managers
Clinical Nurse Managers 5-25 14.8 4.1
Clinical Supervisors 8-17 12.3 2.6 (*)
Nurse Executives 6-20 13.9 3.2 NS NS
Note: NS indicates non-significant differences between pairs of
means, while as asterisk (*) indicates significance using the
Scheffe technique.
Table 4 summarizes nurse managers' participation in budget activities. Clinical supervisors participated less often than other types of managers in all budget activities. Slightly greater than half reported participating in budget preparation activities (preparing and using them to plan activities). However, less than half of the clinical supervisors use budgets for planning and control (investigate budget variances and submit explanations) and manipulation of accounts (stop activities and take corrective action A corrective action is a change implemented to address a weakness identified in a management system. Normally corrective actions are instigated in response to a customer complaint, abnormal levels if internal nonconformity, nonconformities identified during an internal audit or for budget variances). A much higher proportion of clinical nurse managers and nurse executives, on the other hand, engaged in these activities on a regular basis.
TABLE 4
PARTICIPATION IN BUDGET ACTIVITIES
Clinical Clinical Nurse
Managers Supervisors Executives
n = 78 n = 19 n = 23
Participation in Budget
Preparation
Prepare Future Budgets 87.2% 57.9% 73.9%
Use Budgets to Plan
Activities 76.6% 52.6% 86.9%
Use of Budgets for Planning
and Control
Investigate Budget Variances 70.1% 36.8% 82.6%
Submit an explanation about
causes of budget variances 62.3% 42.1% 56.5%
Manipulation of Accounts
Stop Activities when no
available funds 55.8% 36.8% 65.2%
Direct corrective action for
budget variances 62.3% 26.3% 78.3%
Two-way contingency table contingency table n. A statistical table that shows the observed frequencies of data elements classified according to two variables, with the rows indicating one variable and the columns indicating the other variable. analyses were conducted to evaluate whether nurse managers were more or less likely to participate in various budget activities. The two variables were (1) nurse managers with three levels (clinical nurse mangers, clinical supervisors, and nurse executives) and (2) the budget activity (participate and not participate). The comparisons of nurse managers and several budget activities were found to be significantly related (Prepare future budgets: Pearson [chi square chi square (kī), n a nonparametric statistic used with discrete data in the form of frequency count (nominal data) or percentages or proportions that can be reduced to frequencies. ] = 8.85, p = 0.012; Use Budgets to Plan Activities: Pearson [chi square] = 6.89, p = 0.032; Investigate Budget Variances: Pearson [chi square] = 10.73, p = 0.005; Submit an explanation of budget variances: Pearson [chi square] = 2.57, p = 0.28; Stop Activities when no available funds: Pearson [chi square] = 3.51, p = 0.17; Direct corrective action for budget: Pearson [chi square] = 12.31, p = 0.002). Follow-up pairwise comparisons were conducted to evaluate the differences among these proportions. Table 5 shows the results of these analyses. The Holm's sequential Bonferroni method was used to control for Type I error at the 0.05 level across all three comparisons. Clinical nurse managers participated in preparing future budgets more often than clinical supervisors ([chi square] = 8.61, p = 0.003). Nurse executives, on the other hand, used the budget to plan activities more often than clinical supervisors ([chi square] = 6.01, p = 0.014). Clinical managers and nurse executives personally investigated budget variances ([chi square] = 7.29, p = 0.007, and [chi square] = 9.24, p = 0.002, respectively) and directed corrective action for budget variances ([chi square] = 7.99, p = 0.005, and [chi square] = 11.33, p = 0.001, respectively) more often than clinical supervisors.
TABLE 5
RESULTS FOR THE PAIRWISE COMPARISONS USING
HOLM'S SEQUENTIAL BONFERRONI METHOD
Comparison Pearson P
Chi-square
Prepare
Future Budgets
Clinical nurse managers
vs. clinical supervisors 8.61 0.003
Clinical nurse managers
vs. nurse executives 2.34 0.126
Clinical supervisors
vs. nurse executives 1.20 0.273
Use Budgets to
Plan Activities
Clinical nurse managers
vs. clinical supervisors 4.34 0.037
Clinical nurse managers
vs. nurse executives 1.14 0.286
Clinical supervisors
vs. nurse executives 6.01 0.014
Investigate
Budget Variances
Clinical nurse managers
vs. clinical supervisors 7.29 0.007
Clinical nurse managers
vs. nurse executives 1.39 0.237
Clinical supervisors
vs. nurse executives 9.24 0.002
Direct
corrective action for
budget variances
Clinical nurse managers
vs. clinical supervisors 7.99 0.005
Clinical nurse managers
vs. nurse executives 2.00 0.157
Clinical supervisors
vs. nurse executives 11.33 0.001
Comparison P required Signif.
for signif.
Prepare
Future Budgets
Clinical nurse managers
vs. clinical supervisors 0.0167 (**)
Clinical nurse managers
vs. nurse executives 0.025 NS
Clinical supervisors
vs. nurse executives 0.05 NS
Use Budgets to
Plan Activities
Clinical nurse managers
vs. clinical supervisors 0.0167 NS
Clinical nurse managers
vs. nurse executives 0.025 NS
Clinical supervisors
vs. nurse executives 0.05 (**)
Investigate
Budget Variances
Clinical nurse managers
vs. clinical supervisors 0.0167 (**)
Clinical nurse managers
vs. nurse executives 0.025 NS
Clinical supervisors
vs. nurse executives 0.05 (**)
Direct
corrective action for
budget variances
Clinical nurse managers
vs. clinical supervisors 0.0167 (**)
Clinical nurse managers
vs. nurse executives 0.025 NS
Clinical supervisors
vs. nurse executives 0.05 (**)
(**) p < 0.05
DISCUSSION This study represents one of the few large survey initiatives examining the extent and impact of budget activities on performance evaluation among nurse managers. Changing roles of first and second-line managers is evident in the literature (Byers, 2000; Fedoruk & Pincombe 2000; Fralic & Denby 2000; Kerfoot 2000; Krejci 1999). What is less evident is research examining expected budget behaviors of nurse managers that are viewed as necessary in order for them to function successfully in the healthcare environment, and the relationship between these expectations and performance appraisal by their superiors. Performance appraisal systems are used throughout organizations as one of the means of demonstrating increased organizational productivity. Clinical nurse managers and nurse executives are often responsible for providing clinical leadership for nursing practice, with 24-hour accountability for one or more designated units. It is clear from the results of this study that clinical nurse managers, as well as nurse executives, participate in financial management. The use of these skills to effectively manage healthcare is not, however, evident in their performance evaluation. While clinical nurse managers and nurse executives participate extensively in various budgeting activities, just over half of the nurse managers agreed that they were evaluated based on these skills. These findings support other research studies that demonstrate nurse executives and clinical nurse managers engage in fiscal management behaviors (Aroian et al. 2000; Coyle & Mills 2000). In this study, clinical supervisors were not found to participate in budget activities to the same extent as clinical nurse managers and nurse executives. No other study in the literature was found that addressed the use of the budgeting process among clinical supervisors. Thus, we believe examination of the extent this group plans and controls future operations by comparing actual results with planned expectations is warranted. The role of clinical supervisors in various healthcare settings may influence their opportunity to participate in the budgeting process. Nevertheless, clinical supervisors impact the financial status on a day-to-day basis. For example, after first-line nurse managers leave the organization for the day, clinical supervisors must make staffing and patient care decisions. Decisions impacting controllable costs include patient-nurse ratios and new admission bed assignments. In many cases the budget for nursing care involves millions of dollars on an annual basis. The degree to which those involved in staffing decisions have freedom to control financial resources has a major impact on the organization's ability to compete in a rapidly changing marketplace. While the clinical nurse manager is able to closely manage staffing issues on a daily basis, there are many staffing crises handled by a supervisor once the clinical nurse manager is off-duty. Therefore, clinical supervisors also influence the management of financial resources. Because clinical supervisors were not as likely to participate in fiscal decisions, they may in turn be less likely to believe they were evaluated based on this expectation. Interestingly, clinical supervisors may not understand their role as financial managers because they are not directly involved in preparing or managing a budget or explaining budget variances. Future research is needed to determine the extent clinical supervisors understand and participate in various budgeting behaviors across various healthcare organizations in different regions of the world. In one of the few surveys examining the fiscal management role of nurse executives, researchers from Massachusetts investigated the frequency with which various roles and responsibilities should be carried out. Nursing directors and vice presidents agreed that the development of new programs, capital budgets, and operating budgets for the division should be based on annual budget proposals from nurse managers (Pilette & Kirby 1991). The present study underscores the engagement of nurse executives in fiscal management. Because nurse managers make administrative decisions that impact the financial viability of an organization, it stands to reason they would also be expected to participate, and in tutu tutu coriariaarborea. be evaluated, on their effectiveness in planning and controlling various aspects of the budget process. Very few studies examine performance evaluation of nurse managers. Indicators of performance feedback usefulness were examined among 17 nurse managers (Schoonover 1995). Sense of personal control related to budgeting was found when nurse managers used reports for information cues to maintain or improve performance. One reason nurse managers in this study may not perceive their financial management skills were evaluated is because the evaluation instrument is worded with general expectations for managers within the organization. This leads to a performance evaluation process where several types of skills/activities are grouped under one broad heading (e.g. decision making skills). In order for performance appraisal to work effectively, an examination of the value of financial management skills for each type of manager should be undertaken by the healthcare system. More importantly, open lines of communication "Lines of Communication" is an episode from the fourth season of the science-fiction television series Babylon 5. Synopsis Franklin and Marcus attempt to persuade the Mars resistance to assist Sheridan in opposing President Clark. between superior and manager on the level of proficiency pro·fi·cien·cy n. pl. pro·fi·cien·cies The state or quality of being proficient; competence. Noun 1. proficiency - the quality of having great facility and competence with skills should be part of the goal setting process. Another reason financial accountability was not perceived as part of performance appraisal was that nurse managers did not place value on their own skills in contributing to the financial viability of the organization. This lack of understanding of the fiscal gatekeeper In an H.323 IP telephony or video environment, a gatekeeper is a device that manages domains and provides call control. It is used to translate user names into IP addresses, to authenticate users and to manage network resources. role may be perpetuated by a management environment that does not allow shared decision making in resource allocation and budget control among nurse managers. One final reason may be that informal feedback on financial indicators addressed through intermittent intermittent /in·ter·mit·tent/ (-mit´ent) marked by alternating periods of activity and inactivity. in·ter·mit·tent adj. 1. Stopping and starting at intervals. 2. analysis of budget variance reports and strategic planning eliminates the need or desire to be formally evaluated on these behaviors. There were several limitations of the study. Even though the sample was randomly selected, the fact that nurse managers were recruited from one state limits the generalizability of the results. The survey was conducted in a southern state, less penetrated by managed care than other eastern and pacific coast states. This may influence administrators' expectations of budget behavior among nurse managers. Comparisons were made with a relatively small sample size. Future research should examine the congruence con·gru·ence n. 1. a. Agreement, harmony, conformity, or correspondence. b. An instance of this: "What an extraordinary congruence of genius and era" between role expectation and performance on variables that impact healthcare delivery from the superiors' and nurse managers' perspective. An issue for all nurse managers is the extent to which they are given the authority to take corrective action and make final fiscal-related decisions. The ability to advocate for the needs of the organization requires input into the allocations of limited resources. Given an opportunity to negotiate for, and manage, the allocation of resources allocation of resources Apportionment of productive assets among different uses. The issue of resource allocation arises as societies seek to balance limited resources (capital, labour, land) against the various and often unlimited wants of their members. , nurse managers are in a unique position to more actively participate in fiscal decisions, based on the needs of the organization. When there is opportunity for input in the resource allocation process, they in turn should be evaluated based on attaining goals and performance standards that focus on financial management skills. Job performance among nurse managers is more than just the execution of specific tasks, and involves a wide variety of organizational activities. By being evaluated on broad taxonomies that cut across all types of management positions, nurse managers can continue to survive rapidly changing work roles and assignments and continue to contribute to the organization's effectiveness. REFERENCES Aderhold, L., N. O'Keefe & D. Burke The name Burke (from Irish Gaelic de Burca, of Norman origin). In English the meaning of the name Burke is "fortified hill." See also Berkley. Places Australia
Aroian, J.F., C.A. Patsdaughter & M.E. Wyszynski (2000) "DONs in Long-term Care Facilities long-term care facility n. See skilled nursing facility. : Contemporary Roles, Current Credentials CREDENTIALS, international law. The instruments which authorize and establish a public minister in his character with the state or prince to whom they are addressed. If the state or prince receive the minister, he can be received only in the quality attributed to him in his credentials. , and Educational Needs ... Directors of Nursing," Nurse Economics, 18(3):149-156. Arvey, R.D. & K. R. Murphy (1998) Annual Review of Psychology, 49:141-169. American Organization of Nurse Executives (1992) "The Role and Functions of the Hospital Nurse Manager," Nursing Management, 23(9):36-38. Borman, W.C., L.A. White & D.W. Dorsey (1995) "Effects of Ratee Task Performance and Interpersonal in·ter·per·son·al adj. 1. Of or relating to the interactions between individuals: interpersonal skills. 2. Factors on Supervisor and Peer Performance Ratings," Journal of Applied Psychology Journal of Applied Psychology is a publication of the APA. It has a high impact factor for its field. It typically publishes high quality empirical papers. www.apa. , 80(1):168-177. Buechleim, T., Y. Bilak, M. Merrick, M. Reich & D. Stein Stein , William Howard 1911-1980. American biochemist. He shared a 1972 Nobel Prize for pioneering studies of ribonuclease. (1993) "Nurse Manager Performance Appraisal: A Collaborative Approach," Nursing Management, 24(10):48-50. Byers, J.F. (2000) "Professional Development: Knowledge, Skills, and Attributes Needed for Nurse and Non-nurse Executives," Journal of Nursing Administration, 30(7/8):354-356. Cardy, R.L. & G.H. Dobbins (1994) Performance Appraisal, Alternative Perspectives, Cincinnati, OH: Southwest. Carruth, P.J. (1979) Behavioral behavioral pertaining to behavior. behavioral disorders see vice. behavioral seizure see psychomotor seizure. and Attitudinal Implications of Different Styles of Performance Evaluation: An Empirical Study, unpublished doctoral dissertation dis·ser·ta·tion n. A lengthy, formal treatise, especially one written by a candidate for the doctoral degree at a university; a thesis. dissertation Noun 1. , Baron baron Title of nobility, ranking in modern times immediately below a viscount or a count (in countries without viscounts). The wife of a baron is a baroness. Originally, in the early Middle Ages, the term designated a tenant of whatever rank who held a tenure of barony Rouge Rouge, river, United States Rouge (r zh), river, c.30 mi (50 km) long, rising in S Michigan and winding S and SE to the Detroit River at the city of River Rouge. , LA: Louisiana State
University Louisiana State University and Agricultural and Mechanical College, generally known as Louisiana State University or LSU, is a public, coeducational university located in Baton Rouge, Louisiana and the main campus of the Louisiana State University System. .
Cascio, W.F. (1995) "Whither whith·er adv. To what place, result, or condition: Whither are we wandering? conj. 1. To which specified place or position: Industrial and Organizational Psychology Industrial and organizational psychology (also known as I/O psychology, work psychology, work and organizational psychology, W-O psychology, occupational psychology, personnel psychology or talent assessment in a Changing World of Work?" American Psychologist The American Psychologist is the official journal of the American Psychological Association. It contains archival documents and articles covering current issues in psychology, the science and practice of psychology, and psychology's contribution to public policy. , 50(11):928-939. Coyle, S.K. & M.E.C. Mills (2000) "Nurse Executives Champion Change in Integrated Health Systems," Nursing Management, 31(2):32-34. Fedoruk, M. & J. Pincombe (2000) "The Nurse Executive: Challenges in the 21st Century," Journal of Nursing Management, 8(1):13-20. Finkler, S & C.T. Kovner (2000) Financial Management for Nurse Managers and Executives, (2nd Ed.), Philadelphia, PA: W.B. Saunders Saun´ders n. 1. See Sandress. . Fletcher, C. (1995) "New Directions for Performance Appraisal: Some Findings and Observations," International Journal of Selection Assessment, 3(3):191-201. Fletcher, W. (2000) "Sitting in Judgment of Others," Management Today, (August):30. Fralic, M.F. & C.B. Denby (2000) "Retooling the Nurse Executive for 21st Century Practice: Decision Support Systems," Nursing Administration Quarterly, 24(2):19-28. Joint Commission on Accreditation of Healthcare Organizations (1999) Comprehensive Accreditation accreditation, n a process of formal recognition of a school or institution attesting to the required ability and performance in an area of education, training, or practice. Manual for Hospitals, Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations. Kerfoot, K. (2000) "On Leadership: Balancing From the Balcony Balcony (from Italian balcone, scaffold; cf. High German balcho, beam, balk; probably cognate with Persian term بالكانه bālkāneh or its older variant ," Nurse Economics, 18(3):157-159. Krejci, J.W. (1999) "Changing Roles in Nursing: Perceptions of Nurse Administrators," Journal of Nursing Administration, 29(3):21-29. Kulbok, P. (1999). "Managing Care: Knowledge and Educational Strategies for Professional Development," Family and Community Health, 22(3):1-11. London, M. & J.W. Smither (1995) "Can Multisource Feedback Change Perceptions of Goal Achievement, Self-evaluations, and Performance-related Outcomes? Theory-based Applications and Directions for Research," Personnel Psychology, 48(4):803-839. Mark, B.A. (1994) "The Emerging Role of the Nurse Manager," Journal of Nursing Administration, 24(1):48-55. McDermott, R.E., K.D. Stocks & J. Ogden (2000) Code Blue, Syracuse, UT: Traemus Books. Pilette, P.C. & K.K. Kirby (1991) "Expectations and Responsibilities of the Nursing Director Role," Nursing Management, 22(3):77-80. Schmidt, D.Y. (1999) "Financial and Operational Skills for Nurse Managers," Nursing Administration Quarterly, 23(4):16-28. Schoonover, S. (1995) The Usefulness of Formal Objective Performance Feedback: An Exploration of Meaning, unpublished doctoral dissertation, University of Kansas The University of Kansas (often referred to as KU or just Kansas) is an institution of higher learning in Lawrence, Kansas. The main campus resides atop Mount Oread. . Tornow, W.W. (1993) "Perceptions or Reality? Is Multi-perspective Measurement a Means or an End?" Human Resource Management, 32:2211-2229. Waldman, D.A. & W.D. Spangler (1989) "Putting Together the Pieces: A Closer Look at the Determinants of Job Performance," Human Performance, 2(1):29-59. Yu, J. & K.R. Murphy (1993) "Modesty Modesty See also Chastity, Humility. Bell, Laura reserved, demure character. [Br. Lit.: Pendennis] Bianca gentle, unassuming sister of Kate. [Br. Lit. Bias in Self-ratings of Performance: A Test of the Cultural Relativity cultural relativity, n technique for understanding the various ways in which people explain their behavior. Hypothesis," Personnel Psychology, 46(2):347-363. Address for correspondence: Paul J. Carruth, Department of Accounting, Southeastern Louisiana University Southeastern Louisiana University is a state-funded public university that is located in the city of Hammond, Louisiana. It was originally founded in 1925 by Linus A. Sims, the principal of Hammond High School, as Hammond Junior College, located in a wing of the high school , SLU SLU Saint Louis University SLU Southeastern Louisiana University (Hammond, LA, USA) SLU St Lawrence University SLU Suomen Liikunta Ja Urheilu (Finnish Sports Federation) SLU Starting Lineup 10468, Hammond, LA 70402 USA, pcarruth@selu.edu. Paul J. Carruth Southeastern Louisiana University (USA) Ann K. Carruth Southeastern Louisiana University (USA) |
|
||||||||||||||||||||
Printer friendly
Cite/link
Email
Feedback
Reader Opinion