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This experience appeared to be a frustration shared by others in the group, with two participants also describing that they had no control over the budget with one stating: “I have not really got control over a budget at all but I’ve got this budget responsibility”. Another elaborated on this point, noting “We don’t have any control over our budget we have got the ability to order equipment up to [$XXX]…. and anything that is above that you have to write a proposal …. [which] can sit on someone’s desk for quite a long time before it is approved”.

One participant suggested that the position description had to be changed to reflect what the CNL actually does in relation to budget and I asked: “How much input do you have in equipment then if we are saying that perhaps we want to retain that”? This led to dialogue about whether to retain product input from the CNL to management that allowed purchase of large equipment attached to their areas. Another participant cautioned the group about the risks of removing the CNL’s input into product purchase. She thought

it would be quite dangerous in some ways for the CNL not to have input into it because if you have people outside of the service deciding what is required and also how much money …. just on the type of equipment.

A third participant agreed that the CNL should have input into choice of product and equipment for their area but as for the overall budget responsibility suggested that the CNL has no input into amount set adding: “and who gave me that figure how do they know”? The dialogue continued with other participants questioning the accountability versus input or control on budget ceiling. “Are we responsible or accountable?” with “that’s the other issue” and “I’m accountable for the budget for…. but I can’t do anything about it”. One participant then captured that what was actually happening for some of the Clinical Nurse Leaders was that they were experiencing a tension between managing the budget versus directing patient care requirements. She stated: “We probably don’t focus too much on budget we focus on patient care”.


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