Finance and nursing the business of caring: we speak a different language. We get on each other's nerves. But go below the surface, and you'll find that finance and nursing have the same goal: caring.

"You don't justify to finance. You fight with them."

"The lens that a CFO sees through is completely different than the lens we see through. They look at us only when they're losing money, and when they're losing money, they look at each one of us because we have the biggest budget."

"My CFO? I used to view him as an irritant in my butt. I saw us as two people who were talking a totally different language, and two people with totally opposing priorities. But I realized that if I was going to represent the needs of my division at the table and be heard, I had first of all to understand the needs of the organization. At this point, my financial counterpart has become my colleague."

--Quotes from nurse executives at HFMA focus groups

No doubt about it: We finance types can be frustrating to nursing. Nurse managers often believe that we just "don't get it," with "it" being the importance of high-quality patient care. Nursing feels they hear from us when the news is bad--like a negative variance on the P&L. And then we discuss the matter with finance jargon like "a negative variance on the P&L."

But let's be honest--nursing executives and managers frustrate us sometimes, too. Many are business-savvy, but some don't seem to understand that the well of money for patient care is not infinitely deep, and that if money isn't spent wisely, there will be no care to provide--good or bad--to those people who need care so desperately.

It's like nursing and finance are driving in opposite directions around a racetrack. We both have the same finish line: providing the best, safest care to our communities. We're just approaching this finish line from opposite directions.

This situation has deep roots in the personality types and the professional concerns inherent in finance and nursing. But no matter how deep-rooted the situation, the quality of interaction between finance and nursing must change--and quickly.

Let's take a look at the reasons change is necessary and some specific actions that will make this change happen.

The Alignment of Quality and Cost

Perhaps the single most pressing issue that finance and nursing can rally around is patient safety. The Institute of Medicine reports To Err Is Human and Crossing the Quality Chasm were a wake-up call for all healthcare professionals about the need to improve patient safety and the quality of care. According to those reports, many patient safety issues can be linked to a lack of teamwork among all levels and components of a healthcare system. Blame the silo effect that is omnipresent in many healthcare organizations. Groups like finance and nursing tend not to work together as a team, which causes faulty handoffs. For example, if finance doesn't know that the reason a nurse manager is requesting new equipment is to reduce patient falls or infections, the needed dollars may not be approved.