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Financial Management for Nurse Managers and Executives,9781416033424
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Financial Management for Nurse Managers and Executives

by
Edition:
3rd
ISBN13:

9781416033424

ISBN10:
1416033424
Format:
Paperback
Pub. Date:
4/4/2007
Publisher(s):
Elsevier Science Health Science div
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    Financial Management for Nurse Managers and Executives




Summary

Covering the financial topics all nurse managers need to know and use, this book explains how financial management fits into the healthcare organization. Youll study accounting principles, cost analysis, planning and control management of the organization's financial resources, and the use of management tools. In addition to current issues, this edition also addresses future directions in financial management. Chapter goals and an introduction begin each chapter. Each chapter ends with Implications For The Nurse Manager and Key Concepts, to reinforce understanding. Key Concepts include definitions of terms discussed in each chapter. A comprehensive glossary with all key terms is available on companion EvolveŽ website. Two chapter-ending appendixes offer additional samples to reinforce chapter content. Four NEW chapters are included: Quality, Costs and Financing; Revenue Budgeting; Variance Analysis: Examples, Extensions, and Caveats; and Benchmarking, Productivity, and Cost-Benefit and Cost-Effectiveness Analysis. The new Medicare prescription bill is covered, with its meaning for healthcare providers, managers, and executives. Coverage now includes the transition from the role of bedside or staff nurse to nurse manager and nurse executive. Updated information includes current nursing workforce issues and recurring nursing shortages. Updates focus on health financing and the use of computers in budgeting and finance. New practice problems are included.

Table of Contents

A Financial Management Frameworkp. 1
Introduction and Overviewp. 3
Chapter Goalsp. 3
Introductionp. 3
A Financial Management Frameworkp. 3
The Health Care Environmentp. 3
Financial Management and Nursing Leadership in the Health Care Organizationp. 4
Key Issues in Applied Economicsp. 4
Quality, Costs, and Financingp. 5
Financial Accountingp. 5
Accounting Principlesp. 5
Financial Statement Analysisp. 6
Cost Analysisp. 6
Cost Managementp. 6
Determining Health Care Costs and Pricesp. 6
Recruiting and Retaining Staffp. 7
Planning and Controlp. 7
Strategic Managementp. 7
Budgeting Concepts and Budget Preparationp. 7
Controlling Operating Results and Variance Analysisp. 8
Benchmarking, Productivity, and Analysis of Costsp. 8
Managing Financial Resourcesp. 8
Short-Term Financial Resourcesp. 9
Long-Term Financial Resourcesp. 9
Additional Management Toolsp. 9
Management Information Systems and Computersp. 9
Forecasting and Other Decision-Making Methodsp. 9
Marketingp. 10
The Nurse as Entrepreneurp. 10
Nursing and Financial Management: Current Issues and Future Directionsp. 10
The Health Care Environmentp. 11
Chapter Goalsp. 11
Introductionp. 11
The Key Participants in the Health Care Systemp. 12
Providersp. 12
Nursesp. 12
Physiciansp. 13
Hospitalsp. 14
Governmentp. 14
Other Providersp. 15
Suppliersp. 15
Consumersp. 15
Regulatorsp. 16
Payersp. 17
Individual Consumersp. 17
Insurersp. 18
Employersp. 18
Governmentp. 19
Financing the Health Care Systemp. 19
The Medicare and Medicaid Programsp. 20
The Insurance Systemp. 21
Moral Hazardp. 22
Coinsurance, Deductibles, and Co-Paymentsp. 22
Customary and Reasonable Chargesp. 23
Other Sources of Financingp. 23
Alternative Payment Approachesp. 24
Paying Health Care Providersp. 25
Hospital Paymentp. 25
Cost-Based Reimbursementp. 25
Charity Carep. 26
Prospective Payment Systemsp. 26
Negotiated Ratesp. 27
Pay-for-Performancep. 27
Nurse Paymentp. 28
Physician Paymentp. 29
Home Health Agency Paymentp. 29
Nursing Home Paymentp. 29
Methods Use to Control Payments for Carep. 30
Managed Carep. 30
Health Maintenance Organizationsp. 30
Preferred Provider Organizationsp. 31
Point of Servicep. 32
Implications for Nurse Managersp. 32
Key Conceptsp. 33
Suggested Readingsp. 34
The Role of Financial Management and Nurse Leadership in Health Care Organizationsp. 35
Chapter Goalsp. 35
Introductionp. 35
The Role of Managementp. 36
The Hierarchy of Health Care Organizationsp. 36
The Top Management Teamp. 37
Line vs. Staff Authorityp. 38
Formal Lines of Authorityp. 39
Informal Lines of Authorityp. 42
Centralized vs. Decentralized Organizationsp. 43
The Role of the CFO and Other Financial Managersp. 44
The Finance Functionp. 45
The Financial Accounting Functionp. 46
The Managerial Accounting Functionp. 46
Internal Control Functionp. 47
The Role of the CNE in Financial Managementp. 47
The Role of Mid- and First-Level Nurse Managers in Financial Managementp. 48
Transition from Staff Nurse to Nurse Managerp. 49
The Role of Staff Nurses in Financial Managementp. 50
Interactions Between Fiscal and Nurse Managersp. 50
Responsibility Accountingp. 51
Responsibility Centersp. 52
Incentives and Motivationp. 52
Power and Politicsp. 53
Networkingp. 53
Implications for Nurse Managersp. 54
Key Conceptsp. 54
Suggesting Readingsp. 55
Key Issues in Applied Economicsp. 56
Chapter Goalsp. 56
Introductionp. 56
Fundamental Concepts of Economicsp. 57
Economic Goodsp. 57
Utilityp. 57
Marginal Utilityp. 58
Marginal Costp. 58
Savingsp. 58
Supply and Demandp. 58
Free Enterprisep. 58
An Example of Supply and Demandp. 59
Elasticity of Demandp. 60
Economies of Scalep. 61
Increasing Returns to Scalep. 61
Decreasing Returns to Scalep. 61
Economics and Incentivesp. 62
Market Efficiencyp. 62
Redistribution of Resourcesp. 63
Collective Actionp. 63
Equity Improvementp. 63
Market Failurep. 63
Government Interventionp. 63
Lack of Full Informationp. 65
Lack of Direct Patient Paymentp. 65
Monopoly Powerp. 65
Monopsony Powerp. 66
Government-Induced Inefficiencyp. 67
Externalitiesp. 67
The Market for Nursesp. 67
Implications for Nurse Managersp. 68
Key Conceptsp. 69
Suggesting Readingsp. 70
Quality, Costs, and Financingp. 71
Chapter Goalsp. 71
Introductionp. 71
What Is Quality and How Is it Measured?p. 72
The Impetus for Integrating Quality, Cost, and Financingp. 75
Quality Reportingp. 79
Balanced Scorecardsp. 81
The Magnet Movementp. 82
The Baldridge Awardp. 83
Relationships Among Health Care Quality, Costs, and Financingp. 84
A Business Case for Qualityp. 86
Implications for Nurse Managersp. 87
Key Conceptsp. 90
Suggested Readingsp. 91
Financial Accountingp. 93
Accounting Principlesp. 95
Chapter Goalsp. 95
Introductionp. 95
The Basic Framework of Accountingp. 96
The Key Financial Statementsp. 97
The Statement of Financial Positionp. 97
The Operating Statementp. 98
Accounting Terminologyp. 98
Assetsp. 98
Liabilities and Owners' Equityp. 100
Revenues and Expensesp. 102
The Recording and Reporting Processp. 103
Journal Entriesp. 103
Ledgersp. 103
Reporting Informationp. 104
Generally Accepted Accounting Principlesp. 104
The Entity Conceptp. 104
Going Concernp. 105
The Matching Principle and Cash vs. Accrual Accountingp. 105
The Cost Principlep. 105
Objective Evidencep. 105
Materialityp. 106
Consistencyp. 106
Full Disclosurep. 106
Fund Accountingp. 107
Implications for Nurse Managersp. 107
Key Conceptsp. 108
Suggested Readingsp. 108
Analysis of Financial Statement Informationp. 109
Chapter Goalsp. 109
Introductionp. 109
The Auditp. 110
Balance Sheets and Operating Statementsp. 111
The Statement of Cash Flowsp. 111
Statement of Changes in Net Assets or Equityp. 114
Notes to Financial Statementsp. 115
Ratio Analysisp. 116
Common Size Ratiosp. 117
Liquidity Ratiosp. 118
Solvency Ratiosp. 119
Efficiency Ratiosp. 121
Profitability Ratiosp. 122
Management Reportsp. 123
Implications for Nurse Managersp. 124
Key Conceptsp. 124
Suggested Readingsp. 125
Additional Sample Financial Statementsp. 126
Cost Analysisp. 135
Cost Managementp. 137
Chapter Goalsp. 137
Introductionp. 137
Basic Cost Conceptsp. 137
Definitionsp. 138
Fixed vs. Variable Costsp. 140
Cost Graphs and the Relevant Rangep. 141
The Impact of Volume on Cost per Patientp. 142
Marginal Cost Analysisp. 143
Relevant Cost Case Studyp. 144
Cost Estimation Techniquesp. 145
Adjusting Costs for Inflationp. 146
High-Low Cost Estimationp. 147
Regression Analysisp. 148
Mixed Costs and Regression Analysisp. 149
Multiple Regression Analysisp. 151
Break-Even Analysisp. 152
Example of Break-Even Analysisp. 153
Using Break-Even Analysis for Decision-Makingp. 155
Break-Even and Capitationp. 156
Break-Even Analysis Cautionsp. 156
Implications for Nurse Managersp. 157
Key Conceptsp. 158
Suggested Readingsp. 159
Determining Health Care Costs and Pricesp. 160
Chapter Goalsp. 160
Introductionp. 160
Costs for Reporting vs. Costs for Management Controlp. 161
Traditional Cost-Finding Methodsp. 162
The Medicare Step-Down Approachp. 162
A Detailed Look at the Cost-Finding Approachp. 163
Accumulate Direct Costs for Each Cost Centerp. 163
Determine Bases for Allocationp. 163
Allocate from Cost Centers to Revenue Centersp. 164
Allocate Costs to Units of Servicep. 167
Is Good-Enough Cost Finding Good Enough?p. 168
Costing Out Nursing Servicesp. 168
Solutions to the Costing Problemp. 170
Why Change the Costing Approach?p. 173
Should Costing Be Linked to DRGs?p. 175
Specific Approach to Costing Nursing Servicesp. 176
Limitations of the RVU Approachp. 178
Patient Classification vs. Other Work-Load Measurementp. 178
Indirect Nursing Costsp. 179
Staffing Mixp. 179
Product-Line Costingp. 179
Direct Care Hoursp. 180
Standard Costsp. 181
Activity-Based Costingp. 183
Setting Pricesp. 185
Total Financial Requirementsp. 185
Rate-Setting Approachesp. 186
Cost-Based Pricesp. 186
Negotiated Pricesp. 186
Market Pricesp. 186
Financial Reimbursement for Nursing Servicesp. 187
Pay-for-Performance (P4P)p. 188
Implications for Nurse Managersp. 189
Key Conceptsp. 190
Suggested Readingsp. 191
Costs and Other Issues Related to Recruiting and Retaining Staffp. 193
Chapter Goalsp. 193
Introductionp. 193
Retaining Staffp. 194
Nurse Satisfactionp. 194
Fringe Benefitsp. 195
Retention Programsp. 196
Clinical Laddersp. 199
Determining the Costp. 199
Recruiting Staffp. 201
Marketingp. 201
Recruiting and Retaining "Older" Nursesp. 203
Use of Alternative Health Care Employeesp. 204
Agency Nursesp. 204
Foreign Nurse Recruitmentp. 204
Alternative Care Giversp. 206
The Use of Computersp. 206
The Nursing Shortagep. 207
Implications for Nurse Managersp. 208
Key Conceptsp. 209
Suggested Readingsp. 209
Planning and Controlp. 211
Strategic Managementp. 213
Chapter Goalsp. 213
Introductionp. 213
Quality Managementp. 214
Strategic Planningp. 216
The Elements of a Strategic Planp. 217
The Mission Statement or Philosophyp. 217
Statement of Long-Term Goalsp. 218
Statement of Competitive Strategyp. 218
Statement of Organizational Policiesp. 220
Statement of Needed Resourcesp. 220
Statement of Key Assumptionsp. 221
Benefits of the Strategic Planning Processp. 221
Implementing a Strategic Management Processp. 222
Long-Range Planningp. 222
Program Budgeting and Zero-Base Budgetingp. 223
Zero-Base Budgetingp. 224
ZBB Case Study: Hemodialysisp. 225
Ranking Decision Packagesp. 227
Business Plansp. 227
What Is a Business Plan?p. 227
Implications for Nurse Managersp. 228
Key Conceptsp. 229
Suggested Readingsp. 230
Budgeting Conceptsp. 232
Chapter Goalsp. 232
Introductionp. 232
Types of Budgetsp. 233
Operating Budgetp. 233
Long-Range Budgetsp. 233
Program Budgetsp. 234
Capital Budgetsp. 234
Generation of Capital Budget Proposalsp. 235
Justification of Capital Requestsp. 236
Evaluation of Capital Budget Proposalsp. 237
Product-Line Budgetsp. 238
Cash Budgetsp. 238
Cash Budget Preparationp. 239
Cash Budget Examplep. 239
Special Purpose Budgetsp. 240
The Budget Processp. 240
Budget Timetablep. 241
Statement of Environmental Positionp. 242
General Goals, Objectives, and Policiesp. 242
Organization-Wide Assumptionsp. 242
Specification of Program Prioritiesp. 243
Specific, Measurable Operating Objectivesp. 243
Budget Preparationp. 243
Budget Negotiation and Revisionp. 243
Control and Feedbackp. 244
Implications for Nurse Managersp. 244
Key Conceptsp. 245
Suggested Readingsp. 246
Time Value of Moneyp. 247
Operating Budgetsp. 260
Chapter Goalsp. 260
Introductionp. 260
Workload Budgetp. 261
Activity Reportp. 262
Adjusting Units of Servicep. 262
Calculating Workloadp. 262
Expense Budget: Personnel Servicesp. 263
Average Daily Census and Occupancy Ratep. 264
Staffing Requirements and Full-Time Equivalentsp. 264
Productive vs. Non-Productive Hoursp. 265
Assignment of Staff by Type and Shiftp. 265
Fixed Staffp. 267
Converting Staff and FTEs to Positionsp. 267
Calculating FTEs by Type and Shiftp. 267
Establishing Positionsp. 268
Calculating Labor Costp. 270
Straight-Time and Overtime Salariesp. 270
Differentials and Premiumsp. 272
Fringe Benefitsp. 273
Special Situationsp. 274
Expense Budget: Other-than-Personnel Servicesp. 274
Budget Submission, Negotiation, and Approvalp. 275
Implementing the Approved Budgetp. 276
Implications for Nurse Mangersp. 276
Key Conceptsp. 277
Suggested Readingsp. 278
Revenue Budgetingp. 279
Chapter Goalsp. 279
Introductionp. 279
The Revenue Budgetp. 280
Why Aren't All Nursing Units Revenue Centers?p. 280
Why Are Nurse Managers Responsible for a Revenue Budget?p. 281
The Elements of a Revenue Budgetp. 281
Prices or Ratesp. 281
Volume Estimatesp. 284
Environmental Scanp. 286
Revenues from Managed Carep. 286
Capitation vs. Fee-for-Servicep. 286
Money Flows Under Capitationp. 288
Developing Capitated Ratesp. 288
Setting a Capitation Rate: An Examplep. 289
Incentive Risk Poolsp. 291
Implications for Nurse Managersp. 291
Key Conceptsp. 292
Suggested Readingsp. 293
Performance Budgetingp. 294
Chapter Goalsp. 294
Introductionp. 294
When Is Performance Budgeting Appropriate?p. 295
The Performance Budgeting Techniquep. 295
Determining Key Performance Areasp. 295
Technical Steps in Performance Budgetingp. 295
Performance Budget Examplep. 296
Developing Performance Area Measuresp. 299
Quality of Carep. 299
Staffingp. 301
Cost Controlp. 301
Increased Productivityp. 302
Patient and Staff Satisfactionp. 302
Innovation and Planningp. 303
Direct Carep. 303
Indirect Carep. 303
Otherp. 303
Multiple Measuresp. 303
Implications for Nurse Managersp. 304
Key Conceptsp. 305
Suggesting Readingsp. 305
Controlling Operating Resultsp. 306
Chapter Goalsp. 306
Introductionp. 306
The Budget as a Tool for Motivationp. 306
Motivation and Incentivesp. 308
Motivation and Unrealistic Expectationsp. 309
Communication and Controlp. 309
Using Budgets for Interim Evaluationp. 309
Variance Analysisp. 310
Traditional Variance Analysisp. 311
Unit and Department Variancesp. 312
Line-Item Variancesp. 312
Understanding Variancesp. 312
Flexible or Variable Budgetsp. 314
Flexible Budget Variance Analysisp. 315
The Volume Variancep. 315
The Price, or Rate, Variancep. 316
The Quantity, or Use, Variancep. 316
Determination of the Causes of Variancesp. 316
The Mechanics of Flexible Budget Variance Analysisp. 317
Flexible Budget Notationp. 318
An Example of Volume, Price, and Quantity Variancesp. 319
Revenue Variancesp. 322
Implications for Nurse Managersp. 326
Key Conceptsp. 327
Suggested Readingsp. 327
Variance Analysis: Examples, Extensions, and Caveatsp. 328
Chapter Goalsp. 328
Introductionp. 328
Aggregation Problemsp. 328
Exception Reportingp. 330
Interpretation of Variancesp. 330
Rigid Staffing Patternsp. 332
Flexible Budgeting and Acuityp. 334
Fixed vs. Variable Costsp. 335
Causes of Variancesp. 335
Investigation and Control of Variancesp. 336
Performance Budgets and Variance Analysisp. 336
Implications for Nurse Managersp. 338
Key Conceptsp. 339
Suggesting Readingsp. 339
Benchmarking, Productivity, and Cost-Benefit and Cost-Effectiveness Analysisp. 340
Chapter Goalsp. 340
Introductionp. 340
Benchmarkingp. 341
Benefits of Benchmarkingp. 347
Benchmarking Approachesp. 342
The Benchmarking Processp. 343
Requirements for Successful Benchmarkingp. 344
Productivityp. 344
Productivity Standardsp. 345
Unit-Costingp. 345
Unit-Costing and Productivity Standardsp. 348
Productivity Improvementp. 348
Cost-Benefit and Cost-Effectiveness Analysisp. 350
Cost-Benefit Analysisp. 350
Determine Project Goalsp. 351
Estimate Project Benefitsp. 351
Estimate Project Costsp. 351
Discount Cost and Benefit Flowsp. 351
Complete the Decision Analysisp. 352
Cost-Effectiveness Analysisp. 352
Implications for Nurse Managersp. 352
Key Conceptsp. 354
Suggesting Readingsp. 355
Managing Financial Resourcesp. 357
Short-Term Financial Resourcesp. 359
Chapter Goalsp. 359
Introductionp. 359
Current Assetsp. 360
Cash and Marketable Securitiesp. 360
Short-Term Cash Investmentp. 361
Cash Flow vs. Revenue and Expensep. 362
Cash Budgetsp. 362
Maintaining Security over Cashp. 363
Accounts Receivablep. 363
Preadmission Data Collectionp. 364
Credit Policiesp. 364
Ongoing Data Collectionp. 364
Discharge Review and Billingp. 365
Aging of Receivablesp. 365
Cash Receipt and Lock Boxesp. 366
Inventoryp. 366
Perpetual Inventoryp. 367
Economic Order Quantityp. 367
Current Liabilitiesp. 367
Accounts Payablep. 368
Payroll Payablep. 368
Short-Term Debtp. 369
Taxes Payablep. 369
Other Payables Made on Behalf of Employeesp. 369
Implications for Nurse Managersp. 370
Key Conceptsp. 370
Suggested Readingsp. 371
Long-Term Financial Resourcesp. 372
Chapter Goalsp. 372
Introductionp. 372
Equity Sources of Financingp. 372
Philanthropyp. 373
Corporate Stock Issuancep. 374
Government Grantsp. 374
Retained Earningsp. 375
Debt Sources of Financingp. 375
Mortgages and Long-Term Notesp. 375
Leasesp. 376
Bondsp. 378
Taxable vs. Tax-Free Bondsp. 379
Bond Ratings and Insurancep. 381
Zero-Coupon Bondsp. 381
Debt Refinancingp. 382
Feasibility Studiesp. 382
The Future of Health Care Financingp. 383
Implications for Nurse Managersp. 384
Key Conceptsp. 385
Suggested Readingsp. 385
Additional Management Toolsp. 387
The Use of Computers in Financial Managementp. 389
Chapter Goalsp. 389
Introductionp. 389
Computer Hardware and Softwarep. 389
Uses of Computersp. 389
General Information Managementp. 390
Clinical Carep. 390
Financial Managementp. 390
Financial Management Informationp. 390
Special Purpose Softwarep. 393
Forecastingp. 393
Costingp. 393
Personnel Managementp. 394
Budgetingp. 395
Acuity Systemsp. 396
Performance Evaluationp. 398
The Futurep. 398
Implications for Nurse Managersp. 399
Key Conceptsp. 400
Suggested Readingsp. 400
Forecasting and Other Methods for Decision Makingp. 402
Chapter Goalsp. 402
Introductionp. 402
Probability Theory: Foundation for Forecasting and Decision Makingp. 403
Quantitative Methods for Forecastingp. 404
Data Collectionp. 405
Appropriate Data Time Periodsp. 405
What Data Should Be Collected?p. 406
Graphing Historical Datap. 407
Analysis of Graphed Datap. 408
Random Fluctuationsp. 409
Seasonalityp. 410
Trendp. 410
Seasonality and Trendp. 411
Forecasting Formulasp. 412
Random Fluctuationsp. 412
Seasonalityp. 412
Trendp. 413
Seasonality and Trendp. 415
Using Computers for Forecastingp. 416
Qualitative Methods for Forecastingp. 422
Nominal Group Techniquep. 422
Delphi Techniquep. 422
Other Decision-Making Toolsp. 422
Expected Valuep. 423
Linear Programmingp. 423
Inventory Controlp. 426
Planning and Tracking a Projectp. 428
Gantt Chartp. 428
Critical Path Method and PERTp. 428
Implications for Nurse Managersp. 430
Key Conceptsp. 431
Suggested Readingsp. 432
Marketingp. 433
Chapter Goalsp. 433
Introductionp. 433
The Essence of Marketing: Assessing Customer Needsp. 434
Understanding Customersp. 435
Why Is Marketing Important for Nurse Managers?p. 436
Keeping the Organization Currentp. 436
Marketing the Importance of Nursingp. 437
Marketing Conceptsp. 438
Understanding the Marketp. 438
Market Segmentationp. 438
Customer Behaviorp. 439
Market Measurementp. 439
Market Sharep. 440
Market Researchp. 440
Advertisingp. 441
Marketing Plansp. 441
Organizational Mission/Goalsp. 441
Internal-External Analysisp. 442
Strategic Marketing Planp. 442
The BCG Matrixp. 446
Life-Cycle Analysisp. 446
Choice of Strategyp. 447
Tacticsp. 448
Productp. 448
Pricep. 449
Placep. 450
Promotionp. 451
Marketing Failuresp. 451
The Role of Marketing in Nurse Recruitmentp. 452
Implications for Nurse Managersp. 452
Key Conceptsp. 453
Suggested Readingsp. 454
The Nurse as Entrepreneurp. 455
Chapter Goalsp. 455
Introductionp. 455
Characteristics of Nurse Entrepreneursp. 455
Opportunities for Nurse Entrepreneursp. 456
Starting Your Own Businessp. 456
Legal and Financial Issuesp. 458
Business Planp. 458
The Steps in Developing a Business Planp. 459
Project Proposalp. 459
Product Definitionp. 459
Market Analysisp. 459
Rough Financial Planp. 460
Detailed Operations Planp. 460
Detailed Financial Planp. 460
Pro Forma Financial Statementsp. 461
Forecasting and Capital Budgetingp. 467
Sensitivity Analysisp. 462
Examination of Alternativesp. 462
The Elements of a Business Plan Packagep. 462
Examples of Entrepreneursp. 463
p. 463
p. 463
p. 463
p. 463
Key Conceptsp. 464
Suggested Readingsp. 464
The Futurep. 467
Nursing and Financial Management: Current Issues and Future Directionsp. 469
Chapter Goalsp. 469
Introductionp. 469
Nursing Financial Management Researchp. 469
Current and Future Issues in Financial Management in Nursingp. 471
The Evolving Role of the Chief Nurse Executive in Financial Managementp. 471
Setting Organizational Policyp. 472
Continuing Organizational Responsibility for Nursing Expensesp. 472
Assuming Organizational Responsibility for Nursing Revenuesp. 473
Assuming an Organizational Role in New Venturesp. 473
Responding to Extraorganizational Changesp. 473
Government Relationsp. 473
Payer Relationsp. 474
Future Role of First- and Mid-Level Nurse Managers in Financial Managementp. 474
The Nurse as a Policymaker for Financing Health Carep. 475
Lobbyistp. 475
Policymakerp. 475
Implications for Nurse Managersp. 476
Key Conceptsp. 477
Suggested Readingsp. 477
Glossaryp. 479
Indexp. 503
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