Financial challenges and complexity in the management of an intensive care coronary care unit: a case study

This case study, written by the manager of an intensive coronary care unit of an Ontario hospital, demonstrates the difficulties faced by health care managers in controlling costs and dealing with complexity in the current health care and hospital environment. The case describes actions taken to reduce staffing expenditures in an intensive care unit through a rearrangement of nursing duties and the introduction of a different level of nursing staff to take over some of the nursing duties previously carried out by registered nurses. Although the actions were unsuccessful, the careful documentation and analysis of the results of the actions brings to the fore the multi-faceted nature of the problems faced by hospitals in managing their costs and at the same time meeting their medical mandate. Concludes by pointing to the ongoing nature of the cost problem as nursing professionals are caught in the squeeze between providing the service they are trained for, and their need for appropriate compensation under conditions of increasing work pressure.