City Hospital is a city government owned and operated hospital
City Hospital is a city government- owned and operated hospital providing basic health care to low-income people. Most of the hospital’s revenues are from federal, state, county, and city governments. Some patients covered by private insurance are also admitted, but most of the patients are covered by government assistance programs (Medicare and Medicaid).
Maxine Jones is the director of nursing for the 40- bed pediatrics unit at City Hospital. She is responsible for recruiting nurses, scheduling when they work (days, evenings, weekends), and pre-paring the nursing budget for the pediatrics unit. A variety of different nursing skills is needed to staff the unit: There are nursing aides, nurse practitioners, registered nurses, nursing supervisors, and clinical nurses. Each type of nurse provides different patient care services ( care and feeding, drawing blood samples, giving injections, changing dressings, supervising, etc.). Not all types of nurses can provide all services, and each type of nurse has a different wage rate. Minimum nurse staffing levels per patient must be maintained. If the minimums are violated, new patients cannot be admitted.
Over 45 full- time nurses are required to staff the pediatrics unit. The number of each type of nurse is set in the budget (8 nurses aides, 12 nurse practitioners, 14 registered nurses, etc.). To change the mix of nurse types or their wage rates during the year requires time- consuming approval from the nursing administration, the hospital administration, and finally the city council. The direc-tor can change the staffing mix and pay scales in the next budget year by submitting a budget with the revised staffing levels and wage rates and having the budget approved through a lengthy review process that ultimately requires the city council’s agreement.
In selecting where to work, nurses evaluate working conditions, pay, and amenities, as all em-ployees do. A key working condition for nurses is flexibility in choosing their schedule. Because of the shortage of nurses in the community, all hospitals have become competitive in terms of work schedules and hours. Some private hospitals allow nurses to schedule when they want to work and how many hours a week they are willing to work. City Hospital often finds its nurses being hired away by private hospitals. If a nurse practitioner is hired away, Jones must replace her or him with another nurse practitioner. The private hospitals do not have such a constraint. If a nurse practitioner position is open, a private hospital will temporarily move a registered nurse with a higher level of skills into the position until a nurse practitioner can be found.

a. What type of specialized knowledge does Maxine Jones acquire in preparing the nursing schedule for the upcoming month?
b. What are some of the consequences of the constraints Jones must operate under?
c. Explain why City Hospital does not allow Jones as much freedom in her staffing decisions as her counterparts in private hospitals.

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