Decentralized budgeting: holding the purse strings, part 1.

A decentralized nursing structure allows the head nurse to become actively involved in the planning and budgeting process. In Nursing Decentralization: The El Camino Experience (published in November 1981 by Nursing Resources) the authors describe the development of a budgeting system that supports autonomy, accountability, and authority at the practitioner level. For JONA readers, we present, in two parts, an abridged version of the chapter "Budgeting: Holding the Purse Strings." Part 1, which follows, outlines important steps for the development of a successful and efficient budgeting program that can be adapted to meet the needs of other decentralized organizations. Part 2, which details a typical budget session, will appear in the next issue of JONA.

Nurse staffing in a decentralized organization: part II.

It must be emphasized that none of the steps described in this planning process emerged overnight. Rather, they were achieved through a process of evolution, sometimes through trial and error, and always with consultation and participation by many members of the hospital nursing staff. Participation by many in the process of planning for a workable staffing system has been essential to its success. Indeed, creative scheduling by the head nurse is possible because of the way in which the system has been organized. The fact that head nurses are responsible for staffing their own units makes it infinitely easier for them to see what they need to make their units operate effectively and efficiently. Creative scheduling includes the possibility of arranging nurses' hours outside the rigid three-shift schedule used by so many hospitals. Many El Camino nurses now report for work at different hours. In addition, the use of flexible work weeks has proven valuable. Some head nurses now allow for a ten-hour, four-day work week; in emergency staffing situations there have, on occasion, been twelve-hour days. Even as this system evolves, it faces change. Just as the requirements for staff cannot be rigid, so must problem solving be flexible and constantly under review. The fact that El Camino believes in constant monitoring of its system is essential to its success. A key philosophical foundation of decentralization is that it must be subject to change. This is no less true in staffing than in other parts of the decentralization structure. By agreeing that change is constant and necessary and that participation is required at all levels of the staffing planning process, we have constructed the outlines of a system that will work in the future as well as it does in the present. Our system centers around the head nurses. It involves their planning; thus it also involves the support of those members of the nursing staff who can provide essential information. But the decisions about how to use the information remain with the head nurse. And that, as much as anything, is at the heart of the decentralized nursing structure.