Date of Graduation

Winter 12-11-2020

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Dr. Cathy Coleman


Problem: Several nurse executives (Waxman 2018; Massarweh, 2017; Hunt, 2018) agree that in today's increasingly complex health care environment, the reality of decreasing reimbursements and increasing focus on value-based metrics reflects a crucial knowledge base for nurse managers. Therefore, it is imperative for unit-based nurse leaders to receive education and support to attain and maintain the requisite business competencies to achieve both fiscal and quality targets in their microsystem (McFarlan, 2020). In an integrated managed care delivery system in northern California, no education curriculum exists for nurse managers and assistant nurse managers that addresses gaps in financial knowledge, skills, and confidence. An improvement project was undertaken over three months to develop and implement a comprehensive initial education and simulation program to support ongoing professional development.

Context: A microsystem assessment and gap analysis conducted in a 24-bed ICU within a 233-bed urban hospital, indicated that one Nurse Manager (NM) and five Assistant Nurse Managers (ANM’s) would benefit from more structured financial training to successfully manage the unit budget. Baseline data was collected and indicated that this ICU was allocated an Hours Per Patient Day (HPPD) of 17.75, and in pay periods 11-13 during 2020, the actual HPPD was 21.2 which was deemed unacceptable. In response to this knowledge gap an administrative clinical nurse leader (CNL) utilized a systems approach to develop and implement an innovative and interactive financial education series.

Intervention: The course consisted of one-hour weekly education classes with the administrative services director and the Business, Finance, & Strategy manager. One hour of pre-work was required and included targeted assignments prior to each weekly session.

Measures: The primary outcome measure reflected data collected during twelve pre and post class assessments. A second outcome measure and collective aim was to achieve an HPPD of 17.75 for 12 days each month between July 2020 to September 2020.

Results: The pre and post class assessments indicated that the team went from the majority having 20% knowledge to 60% knowledge improvement. The secondary project results from pay periods 15 through 20 revealed the HPPD target was met twice. Another significant finding indicated during such a critical care emergency of the COVID-19 pandemic, unit management was able to maintain an average HPPD 21.0, which was unanticipated but welcomed accomplishment.

Conclusions: Time is of the essence to give our nurse leaders the skills to optimize their financial performance. Nursing and business leaders have the opportunity to empower systems level managers with targeted financial programs such as finance 101 intended to decrease financial knowledge gaps, optimize unit-based decisions making, and decrease nurse manager turnover within a positive culture of continuous learning.