SUMMARY
The healthcare industry is an ever changing system in which there is constant pressure for it to provide quality care while maintaining rising cost. The pressure exerted on a healthcare system is exemplified by managed healthcare. This type of care involves integrating and comprehensive systems of health care providers, insurance, companies and government programs. University Hospital is a very large teaching hospital which scores well on accreditation tests and is known for its high quality level of care. Like all hospitals, they need to work on improving their financial situation. In order to alleviate financial stress, the hospital has taken on a “differentiated nursing practice” which has registered nurses as care coordinators. These care coordinators would be in charge of coordinating patient care from admissions to discharge. These nurses will also communicate with other hospital staff and families of the patients. The nurses selected are considered the best in their field. This case study argues that while this may sound like a good change, but these nurses were traditionally trained and may not be fully able to embrace the new system. They now must talk to people they have never interacted with before and without training this could be a difficult change process. These nurses were told they could design their own job in the “best way possible”. An individual is asked to step in to help the leaders of the nursing department especially the care coordinators and other nurses.

KEY PLAYERS
Hannah is a nurse in charge, along with Jen, of the nursing department. She has been with the department for a long time and understands the nursing departments through and through. She guides the nursing department with her wisdom, but is not comfortable with the new changes being instituted.

Jen is a newer nurse and really enjoys new situations. She