By : Maryann Fralic, RN, DrPH, FAAN
Nurses who wish to grow and develop as leaders realize that in today’s healthcare environment, clinical skills alone aren’t enough. Rather, clinical decisions must be coupled with sound business decisions to provide quality care for patients. At The Johns Hopkins University School of Nursing, the Business of Nursing program proves that point.
Whether or not nurses choose to enter a formalized program such as the Business of Nursing, they need to acquire an understanding of the business side of patient care. Nurses may have good ideas for patient care, but unless they are able to interpret those ideas in terms of cost and benefits, it will likely not be supported by the institution. Ultimately, patient care suffers.
The stakes are high for nurses who must interpret and manage cost in the delivery of care. Nurses must be “bilingual” in a sense, meaning that they need to understand the language of business and finance in addition to familiar clinical language. Only then will nurses have the opportunity to exert true leadership and influence in improving the quality of care delivery systems.
With serious competition for resources, nurses must be able to interpret patient care needs in a manner that is analytic and quantitative, and can be expressed within a business context. The Business of Nursing Course at Hopkins was designed to help nurses develop these specific skills.
A Diversified Program
The 12-credit, 10-month program of intensive study is tailored for the busy working nurse. It is a serious professional commitment. Nurses have enrolled in the program from a variety of settings, including hospital, government, the military, insurance companies, home care, state agencies, HMOs, trauma centers, research facilities, and universities. They come with diverse job responsibilities — and backgrounds — ranging from senior staff nurse to hospital vice president for nursing.
The degree of commitment these students have is remarkable. They value the program as an important professional development opportunity. Students also realize that organizations value them, as the organizations frequently provide great encouragement and support to the student. Another positive aspect is that class assignments relate to situations that students actually encounter in their work world, often improving their own job effectiveness as they progress through the course.
Four Focus Areas
The program’s 12 credits are divided equally in four areas over 10 months. First, nurses learn “Emerging Healthcare Systems and Concepts.” They become familiar with the nature and terminology of new systems and gain an understanding of the major drivers of change in health care. Nationally recognized experts provide students with the latest knowledge.
Next comes “Managing Financial Outcomes,” with computer-based exercises, financial forecasting, accounting, cost allocation, balance sheets, and cash flow. Nurses learn the fundamentals of responsible financial performance. That module ends with a case study of the fictitious Bamu Community Hospital. Teams of students are required to take the necessary strategic actions to move that hospital from serious losses to elimination of deficits. A sophisticated and challenging experience, but one that students value, learning concrete skills to complement their knowledge of clinical practice initiatives.
Students next learn about “Managing Clinicial Outcomes.” They are given the opportunity to review clinical information systems and to examine outcomes through case studies. Participants develop skills in the analysis, management, and presentation of clinical outcome data. Emphasis is on the ability to critically analyze information and develop appropriate managerial strategies to enhance clinical systems. Using computer exercises, they create a variety of graphs and charts, learning to present data clearly and effectively, enabling them to better plan, guide, and evaluate patient care.
The last module, “Synthesis and Integration of Nursing and Business” is designed to “pull it all together.” Students focus on working in teams, developing a comprehensive business plan for presentation to a panel of real-world executives in a real-world boardroom. Through this process they gain a sense of confidence as well as effective personal and professional boardroom business and presentation skills. At the end of this course, students rightfully experience a true sense of accomplishment.
Applied Knowledge
Nurses in the program have applied their new skills in many different and interesting ways. Several of the senior staff nurses used what they have learned to assume increased responsibility and influence within their unit. Nurses are now able to work with others to develop basic business plans for development of clinical programs such as innovative models of care for their unit, including projections of revenue and expense. Program participants say they have gained some powerful skills.
Another example of a program participant applying her skills is a vice president for patient services who was able to develop a detailed and comprehensive plan for a major program expansion for her hospital as part of her in-class assignment. The proposal was accepted, fully funded, and successfully implemented.
The examples go on and on. The common theme, however, is that nurse leaders will increasingly require business skills if patient care is to be successfully supported. The competition for resources is intense and the essential partnership of clinical decisions and business decisions is paramount.
Partnership Sees Results
The Business of Nursing program is a partnership between Johns Hopkins University’s School of Nursing and School of Professional Studies in Business and Education. It is demanding and fast paced. Nurses who enroll have made the commitment to acquire essential management skills and expand their personal options in today’s competitive marketplace. Additionally, the program complements a bachelor’s or master’s degree in nursing.
It is gratifying indeed that nurses who aspire to leadership are willing to focus intensely on professional self-development, acquiring the necessary contemporary skills. Is this hard work? Yes. When asked if it is worth it, however, the answer is always a resounding “yes”! Such dedication and commitment by nurses, as they assume more professional leadership responsibilities, is truly admirable and bodes well for increasing nursing influence in the clinical care of patients.
Editor's Note: For more information about the Business of Nursing Course at Johns Hopkins University, visit www.son.jhmi.edu/academic_programs/certificates/bon/ bon_curric.htm.
Maryann Fralic, RN, DrPH, FAAN, is a professor and director of Corporate and Foundation Relations at the Johns Hopkins University School of Nursing. She also serves as executive advisor for the Nursing Executive Center of The Advisory Board Company, Washington, DC, and as senior consultant for the Robert Wood Johnson Nurse Executive Fellows Program.
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