Your financial position could get worse unless your nursing managers take serious account for what is being spent and what revenue is being generated at their level.  Devolving budget management is essential to getting unit managers to really buy into 'your' financial problems - then they become 'our' financial problems. 

Many many years ago I was involved in a Commonwealth Government initiative called devolution of clinical budgets.  It was around the time that case mix funding was taking shape and the thinking was that this would enable first line managers to take over the management of their own budgets.  So there was a bunch of projects funded under this initiative to enable first line managers to take over the management of their own budgets.  

While many hospitals and aged care services have devolved their management to the unit level, many have not.  Which in this day and age seems a bit short sighted.  Let's face it, if I am not responsible for my budget, then why should I care if I am going over it or not?  We are coming into the budget building time of year and if your nurse unit managers are not actively engaging in building their own budgets or discussing them with the finance people, then it is possible that the budgets are nothing more than a wish list or one of your more boring fictions.  Either way, it is unlikely to reflect reality or foster commitment to maintaining it.   And even if it is close to the mark, if the NUM is not held to account for their budget then there is no reason to expect them to manage within it.

Even if unit managers are in charge of their budgets, can you assume that they are full bottle on all things budgeting?  Do they have all the blocks needed to build their budgets, find savings, generate new revenue?

If you are worried about blowing out the budget then:

1. Engage your unit managers in building them now.  

2. Give them the skills through training or mentoring

3. Clarify the processes and give them the tools

4. Give them the authority, clarify their delegation

5. Given them accountability - ask them to report on their budgets routinely.

6. Ask them to provide strategies for finding new revenue and savings.