afford childcare. However, she too had noticed Renee coming to work midrotation looking exhausted and not as cheery as she was on the first few days of her rotation. Next, Pam had to consider the implications of the formal grievance and how it would affect her department and ultimately the hospital. Felix's increased length of stay would already prevent the hospital from being reimbursed for his care, but Pam had to consider whether firing an employee over a single mistake was at all justified to further protect the reputation of the hospital. Questions for Discussion . How should Pam handle the complaint by the patient? What is the danger of disregarding the patient's complaint? Should Pam consider changing Renee's shift schedule? Are there any limits to the number of shifts or hours that nurses should work? Do you think there should be? . How should Pam respond to Felix's wife's demand that Renee be fired? .Should this situation be addressed by a QI team, or is this simply an unfortunate situation arising from a troubled employee? . .Could this situation have been avoided if the organization's human resources management systems had been different? If so, what HR systems might have played a role in this situation