1. You are a new administrator at Jonestown Medical Center. You receive a telephone call from the nurse manager of the emergency room. Dr. Smith, an emergency room physician who is an employee of your hospital, has just reported for duty. The nurse manager suspects that Dr. Smith is intoxicated. What do you do?

2. You are the CEO of Sleepy Hollow Retirement Community and Nursing Center. A resident’s family has come to you to complain that their loved one, who is on pain medication, is in intolerable pain. Her medications appear not to be working anymore. One of the family members states, “My 90-year-old mother saw the nurse put the pain medicine in her pocket.” What do you do?

3. You are the practice manager of Docs R Us, Ltd., a large multispecialty medical practice employing more than 100 physicians. You are conducting a random review of billing for doctors in the practice and you discover that one of the internists in your group who treats mostly Medicare recipients has been checking off the wrong code for her procedures on the billing form. The procedures on the patient record do not match the billing form codes. You pull up her files for the past 3 months and find a pattern of upcoding. When you meet with her to review this miscoding, she becomes very defensive and angry. What do you do? How could you have prepared better for the meeting with the physician?

4. You are the assistant director of the hospital medical staff office at the Rural Outreach Community Hospital in a tiny town in Arkansas. It is your job to verify physician credentials for staff privileges. Your hospital receives an application from a physician for staff privileges. On his application, it states that he graduated from medical school in El Salvador. When you call to verify this, you are told that the medical school burned down two years ago and all the records were destroyed. What do you do?

5. You are a new administrator at a hospital, well known for pulmonary medicine. The physicians in the ICU, the ER, and the department of pulmonary medicine have demanded to meet with you about the shortage of respiratory therapists. You stall them for 48 hours so you can gather data. What types of information will you need to collect to have an intelligent conversation with this powerful group of physicians?

6. Dr. White ordered an unusual dose of a medication. May Patterson, RN, sees the order and believes it to be the wrong dose.
She calls Dr. White, who insists that she give the medication—as written. Nurse Patterson calls you, the administrator on call for the weekend, to resolve this crisis. What do you do?