| Course | NUR-7120 Nursing Administration Resource Acquisition and Management |
|---|---|
| Module | Module 1 |
| Paper type | Administration paper: fiscal resources and budgeting |
| Length | About 1,003 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Nursing Administration |
| Updated | October 2026 |
Free sample paper for NUR 7120 Module 1
Over Budget, Under Water: Reading a Personnel Variance on a Telemetry Unit
Student Name
M.S. in Nursing, Nursing Administration, Thomas Edison State University
NUR-7120: Nursing Administration: Resource Acquisition and Management
Mentor Name
Month Day, Year
Over Budget, Under Water: Reading a Personnel Variance on a Telemetry Unit
The Problem
When the third quarter closed, the finance office flagged our telemetry unit: salary and wage expense was $186,000, or 9 percent, above budget. Our chief financial officer wanted both an explanation and a plan before the next budget cycle. Staff, meanwhile, said they were working extra shifts and still could not keep up. Both views were true, and a good variance analysis needed to show why. A vague answer would invite an across-the-board cut.
Budget Concepts
Finkler et al. (2013) explain that a static budget sets expected spending for a fixed level of activity, while a flexible budget adjusts expected spending to the volume actually experienced. A personnel variance can then be divided into three parts. The volume variance reflects how much of the difference comes from caring for more or fewer patients than planned. The rate, or price, variance reflects paying more or less per hour than budgeted, for example through overtime, agency nurses or differentials. The efficiency, or quantity, variance reflects using more or fewer hours per unit of service, here hours per patient day, than the budget assumed. Separating these parts lets a manager explain which causes are within her control and which are not.
Analyzing Our Variance
Our budget assumed an average daily census of 26 and 9.2 nursing hours per day of care for each patient, at a $48 average hourly wage. The actual census averaged 28.4, about 9 percent above budget. Applying the budgeted hours and rate to the actual census showed that about $103,000 of the overspend was volume variance: we cared for more patients, and caring for them properly required more hours. Our actual average hourly rate was $51.20, because vacancies were covered with overtime paid at 1.5 times base and with agency staff, producing a rate variance of about $71,000. Actual hours per patient day were 9.3, close to budget, producing a small efficiency variance of about $12,000.
| Variance part | Cause | Within manager's control? |
|---|---|---|
| Volume, about $103,000 | Census 9 percent above budget | No, but should prompt a budget revision |
| Rate, about $71,000 | Overtime and agency nurses covering vacancies | Partly, through recruitment and retention |
| Efficiency, about $12,000 | Hours per patient day slightly above target | Yes, but small |
What the Analysis Shows
Most of the overspend came from more patients and from the cost of covering vacancies, not from inefficiency. Cutting hours would have reduced care for a higher census and likely worsened outcomes. The real lever was the rate variance: three open registered nurse positions, filled with overtime and agency nurses at premium rates.
The Business Case for RN Staffing
Needleman et al. (2006) estimated the costs and savings of changing nurse staffing in US hospitals. Giving registered nurses a larger slice of the same total nursing hours meant shorter stays, fewer adverse outcomes and fewer deaths and produced a net cost savings. Increasing total nursing hours prevented more deaths but cost more than it saved in hospital spending alone. The authors argued that the value of better outcomes should be weighed alongside costs.
Dall et al. (2009) put a dollar value on professional nursing by combining evidence on staffing and outcomes with costs. They concluded that adding registered nurses to hospital staffing would prevent thousands of deaths and complications each year and that the resulting medical savings and gains in productivity, from patients returning to work sooner, offset a substantial share of the added cost.
| Source | Key point | Use in the proposal |
|---|---|---|
| Finkler et al. (2013) | Flexible budgets and three-part variance analysis | Explained the overspend |
| Needleman et al. (2006) | Higher RN proportion cut adverse events at net savings | Supports skill mix change |
| Dall et al. (2009) | Added RNs produce medical savings and productivity gains | Frames nurses as value, not only cost |
The Proposal
I proposed three steps. First, revise the budget to a census of 28, since the higher volume had persisted for two quarters and reflected a new cardiology practice referring to our hospital. Second, fill the three registered nurse vacancies, using a sign-on bonus funded by the reduction in agency spending, which costs nearly twice the hourly rate of a staff nurse. Third, adjust the skill mix on night shift by converting one unfilled patient care technician position into a registered nurse position, raising the RN proportion of hours from 68 to 72 percent without increasing total hours, the approach Needleman and colleagues found cost-saving.
Projected Effect
If vacancies are filled by the end of the next quarter, the rate variance should fall by about two thirds. The skill mix change adds about $14,000 a year in salary difference, which the analysis by Needleman and colleagues suggests should be offset by fewer adverse events and shorter stays. I asked the quality department to follow length of stay, rapid response calls, falls and pressure injuries to test that expectation.
Presenting to the Chief Financial Officer
I presented a one-page summary with the variance table, the census trend and the proposal, and kept clinical evidence brief and specific. The chief financial officer agreed to revise the census assumption and approved the sign-on bonus, asking to revisit the skill mix change after two quarters of data.
Communicating With Staff
I shared a simplified version with staff at a meeting, explaining that the overspend came mainly from more patients and from covering vacancies, not from anyone working inefficiently, and asked for help recruiting.
Limits
The Needleman and Dall estimates are national models that may not match a single unit. Variance calculations depend on accurate payroll coding. The unit and figures are invented.
Conclusion
Finkler and colleagues' variance method showed that the overspend came mostly from higher volume and premium pay for vacancies, Needleman and colleagues showed that raising the registered nurse share of hours can improve outcomes at net savings and Dall and colleagues framed nurses as a source of economic value. A revised census, filled vacancies and a modest skill mix change answer the chief financial officer's question without cutting care.
References
Dall, T. M., Chen, Y. J., Seifert, R. F., Maddox, P. J., & Hogan, P. F. (2009). The economic value of professional nursing. Medical Care, 47(1), 97-104. https://doi.org/10.1097/MLR.0b013e3181844da8
Finkler, S. A., Jones, C. B., & Kovner, C. T. (2013). Financial management for nurse managers and executives (4th ed.). Elsevier Saunders.
Needleman, J., Buerhaus, P. I., Stewart, M., Zelevinsky, K., & Mattke, S. (2006). Nurse staffing in hospitals: Is there a business case for quality? Health Affairs, 25(1), 204-211. https://doi.org/10.1377/hlthaff.25.1.204
What the NUR 7120 Module 1 instructions ask for
Fiscal resources are the first resource type TESU's catalog lists for NUR-7120, and because TESU shows its module plan only to enrolled students, the opening paper is built as a budget variance analysis. Present a unit's budget assumptions and actual results, then divide the personnel variance into volume, rate and efficiency parts with the calculations shown. Explain which parts a manager can control, report evidence on the costs and value of nurse staffing and propose changes that address the controllable causes without cutting needed care. Describe how the proposal was presented to finance leaders and to staff, and how results will be tracked. Certain instructors want a complete operating budget in place of a variance study. Ask whether invented figures are acceptable or whether de-identified real unit data are expected.
How this NUR 7120 Module 1 example is built
Monique Bell, an invented MSN student who manages a telemetry unit, must explain a $186,000 personnel overspend to her chief financial officer. Using Finkler and colleagues' method, she separates volume, rate and efficiency variance in a table and finds that higher census and premium pay for vacancies account for most of it. Needleman and colleagues' business case and Dall and colleagues' economic estimate are set beside the method in a second table. Her proposal revises the census assumption, fills vacancies with a sign-on bonus funded by agency savings and shifts night skill mix toward registered nurses. The projected effect, presentations to finance and to staff, limits and a conclusion follow. A note on communicating the findings to staff without blame closes the plan.
NUR 7120 Module 1 rubric: what earns full marks
Budget papers earn high marks when the variance is calculated, not just described, and divided into volume, rate and efficiency parts with clear assumptions. Readers look for an honest account of which causes the manager controls and for remedies aimed at those causes. Evidence on the business case for nurse staffing, used accurately and with its limits, strengthens a proposal that might otherwise look like a request for more money. Presenting concisely to finance leaders, explaining the variance to staff without blame and planning to track both costs and quality outcomes show the judgment expected of a nurse administrator. Explaining a variance to staff in plain terms shows that the leader treats them as partners.
Common NUR 7120 Module 1 mistakes, and how to avoid them
Budget papers often blame overspending on staffing without showing the math. State the budgeted census, hours per patient day and hourly rate, then calculate the volume, rate and efficiency variances. Say which parts you can control and aim your proposal at them. Use evidence on the value of nurse staffing to support changes, and plan to measure both costs and patient outcomes. Explain how you will present the analysis to finance and to staff. If you lack real unit data, invent realistic figures and say so. Send the module prompt and your unit's budget figures, and a free first draft will be built around them. Show how you would explain the variance to staff as well as to finance.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 7120 Module 1 questions, answered
Where can I find a free NUR 7120 Module 1 sample paper?
The budget variance paper, from a telemetry unit's overspend to a skill mix proposal, is on this page.
What are the three parts of a personnel budget variance?
Volume variance from census changes, rate variance from pay per hour and efficiency variance from hours per patient day.
What is a flexible budget?
A budget that adjusts expected spending to the volume of patients actually cared for, as Finkler and colleagues explain.
Is there a business case for registered nurse staffing?
Needleman and colleagues found raising the RN share of hours cut adverse outcomes at a net savings.
Why not just cut hours when over budget?
If the overspend comes from higher census or premium pay, cutting hours reduces care without fixing the cause.