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'Know your spreadsheets as well as your bedsheets'


I think we need to talk about money.

I know a lot of nurses don’t like to speak about cold hard cash. It’s a dirty word - and I am sympathetic to that view. In my early career, journalists never mentioned money either. We thought it was like sex or haemorrhoids - something you know happens but you really shouldn’t be seen speaking about. Now it’s a different story - editors have to be as mindful of the bottom line as they do their headlines.

There was a time when nursing was just about caring - providing the best environment, treatment and outcomes for patients. Other people thought about the money - usually just before cutting it or debating where to spend it. But the world has changed, and efficiency savings being impressed upon staff make everyone concerned about waste.

Redesigning services will be the real opportunity for getting the NHS back to black, and that’s where an understanding of the numbers will play its part. At the Nursing Times Awards last week, nurses proved how vital they are to improving outcomes - and saving money - through their initiatives. Those who did well could show the sustainability and tangible value of their schemes.

To ensure you are heard by your managers, you’ll need a grasp of the balance sheet and to understand how much every district nurse visit, hospital overnight stay or missed appointment costs. Often a detached look at how a process works can lead to improvements and savings - as our awards winners proved.

You don’t need to become a calculator-obsessive. Your main focus has to be the patient - but finances do play a huge part in the care you provide. So be as hands-on with your spreadsheets as you are the bedsheets to make a real difference.

Finally, congratulations to our winners at the Nursing Times Awards. We salute you. Read all about them at

Follow me on Twitter @nursingtimesed


Chat live with the editor and other nurses at every Wednesday at 1pm about this column.


Readers' comments (7)

  • I still get a vaguely dirty, unpleasant feeling in my mouth whenever this topic is mentioned.

    Regardless of what the reality of the situation is Jenni, and you are right in what you say, we are clinical staff and should not HAVE to think about the spreadsheets. We have enough to do. At the end of the day, if all the money that is wasted at the upper echelons of the NHS on the vast army of non clinical staff on band 8 pay or more and all their personal budgets was actually used on frontline staff and patient care instead, we wouldn't even have to have this conversation!

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  • Jenni Middleton

    That's interesting Mike. As I say, I have some sympathy with that view. What do other readers think? Is it your job to think of how you can improve care bearing in mind the financial implications - or can you provide care in isolation?

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  • Mike's view is - for anyone who's on - say - Band 5 or below, a fair enough comment. For anyone who's on a Band 6 or above, you really ought to have some awareness of what your care costs. How else can you contribute to good team working?
    To duck this responsibility is, at the end, to fail your patient.

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  • Mike

    It is sadly the case that such views are one of the main reasons that nursing as a profession continues to loose influence and credibility. You cannot play your part as a nurse unless you understand the financial context of your practice or the need to be accountable for the outcomes you deliver for your patients. Poor quality care is costly, excellent care and productivity are right for patients, and for nursing. How will you influence CCG's if the innovation you want to take forward does not stack up financially. Why should nursing pay no attention to the money it spends. These views are naive and restrictive. Understand the finaces and you will see more clearly how you can influence the decisions.

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  • It is disgusting that in the cut back climate the country is in at the moment that NHS trusts think it wise to bring in ways of doing something that works in an acute setting but cannot possibly work in a community setting. Where it uses more paper, more ink, more nurses time and therefore more money...for example: 14 printed pieces of paper a week now to 280 pieces of printed paper a week. 14 that the nurses complete, 280 that the patients complete (cannot do it because elderly, dementia, cant see properly, cant read, cant write, cant understand what it all means etc), so the nurses have to do it for them, which takes more nurses time....2000% more work, time, is this economical with budgets.

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  • For once I disagree with Mike. I think it is important that everyone - regardless of banding - needs to be aware of the costs involved in providing the service and equipment relevant to their role. The cost of production of a sterile dressing pack for example, I can remember as a student nurse seeing as common practice whole packs being opened and then disposed of just to get a pair of forceps or a sterile bowl. Everything that we work with has a price and whilst some things may cost pennies, the old adage says "Look after the pennies and the pounds will look after themselves". Suggesting people who are in the lower pay bands don't need to know about money is like suggesting people who have never had a fire in their ward or department doesn't need fire safety training.

    I'm not suggesting that HCAs need a thorough grounding in fiscal policy, but they along with everyone else should have an awareness of costs involved in day to day work.

    In my opinion this is a rare lapse in Mike's normally erudite and enlightening posts.

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  • George Kuchanny

    Hi Jenni,Mike and other commenters,
    As requested here is my view. It is part way between Mike's and the article.
    The heaviest emphasis of all must and always should be care of the people who depend on you. Then comes cost. The higher up the bands you go the more capacity you should have for keeping this in mind. That is why you are on the higher band after all.

    One thing I would like to say is that efficiency is cost. More efficient, less useless effort = more concentration and thought for what you need to do for your client(s). I note that Mike is one of our most prolific contributors, and like many who scan this site I find that his contributions are always valuable and based in reality. A few of my own contributions have been frankly flippant for which I now apologise. I shall desist from being flippant for the near future. Humour sometimes has a valuable place but it has to be appropriate naturally.

    We are all seeing a sea level change being introduced into the way the NHS shall be managed in the future.

    This article is a pointer toward the future change. And a timely one. Personally I think that the future is going to be better than some may think. For staff and patient alike. Being forced to be a cog in an inefficient machine is really no fun at all. In fact it is soul destroying. At the worst end of this scale (we have all been there) is the nighmare of working like a dog to deliver barely adequate care. At the best end - here I draw on working in a Circle run hospital as an example, you have to be more awake and perceptive than in some environments but, trust me your day in far more rewarding in all senses of the word. Surprisingly, not least because of environmental factors.

    Which brings me on to Hinchinbrooke and Mid Staffs. Hinchinbrooke is effectively under new management. Mid Staffs has such a poor rep now that recruiting has become a real problem. We also have BHRUT. Let us keep halk an eye on these Trusts for a couple of years and see. My prediction is this. The Hinchinbrooke staff will be a far happier bunch than the folk at Mid Staffs and BHRUT.

    Why? Modern care has no place for ideology or palliative lying any more. These drivers have run their course and are now pushing the NHS into a dead end. A no escape dead end. Evolve. Modernise. Most especially the culture. Thrive.

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