Adolescent Eating Habits Essay

Many teenagers fall into unhealthy eating habits for a variety of reasons; stress, the desire to lose weight, peer pressure etc. These unhealthy eating habits, may not cause damage immediately (although they sometimes do) but they are followed by a host of health issues. Sound nutritious habits play a role in the prevention of common chronic diseases such as obesity, heart disease, cancers, stroke, and type 2 diabetes. Investigating and understanding adolescent eating habits is necessary to preventing diet-related diseases later in the future. This paper discusses characteristic adolescent eating habits; skipping meals, fast food consumption, frequent snacking, and other dieting practices of adolescents. The nutritional requirements for adolescents are also discussed. Unhealthy Dietary Habits Teens engage in dieting practices that maybe less than beneficial, including eating very little, cutting out whole groups of foods (like grain products), fasting, and skipping meals. These practices can leave out important foods that are vital for growth to occur. Other weight-loss strategies such as self-induced vomiting, smoking, and diet pills or laxatives can lead to health issues. See more: Sleep Deprivation Problem Solution Speech Essay Unhealthy dieting can actually cause weight gain since it often leads to a cycle of eating very little, then binge eating. Adolescents may miss meals because of unbalanced schedules. Breakfast and lunch are the meals most often missed, school, and social activities may cause the skipping of evening meals. 12 to 50 % of adolescents miss breakfast; and girls are more likely to do so than are boys (35 and25 % respectively). More than one-half of the adolescents participating in the National Adolescent School Health Survey reported that they ate breakfast less than twice per week. Reasons for missing breakfast include rushing off o early school classes or activities, and poor appetite first thing in the morning. Missing breakfast can negatively affect school performance and contribute to a negative overall diet [ (Americans, 2010) ]. Hunger and food insecurity (i. e. , disrupted eating patterns because of financial strains) might increase the risk for lower dietary quality and under nutrition. In turn, under nutrition can negatively affect overall health, cognitive development, and school performance. Benefits of Healthful Eating Eating a healthy breakfast is associated with improved cognitive function (especially memory), and mood. Healthy eating helps prevent high cholesterol and high blood pressure and reduces the risk of developing chronic diseases such as cardiovascular disease, diabetes, and cancer. Healthy eating helps reduce the risk of obesity, dental caries, iron deficiency, and osteoporosis Most U. S. youth do not meet the recommendations for eating 2? cups to 6? cups of fruits and vegetables each day. Teenagers in the U. S. A tend not to eat the minimum recommended amounts of whole grains (2–3 ounces each day). Teenagers tend not to eat more than the recommended maximum daily intake of sodium (1,500–2,300 mg each day) (CDC, 1998). Empty calories contribute to 40% of daily calories for children and adolescents aged 2–18 years, affecting the quality of their diets. About half of these empty calories come from the following sources: soft-drinks, fruit drinks, pizza, grain desserts, dairy desserts, and whole milk. Adolescents drink more full-calorie soft-drinks per day than milk. Males aged 12–19 years drink roughly 22 ounces of full-calorie soft-drinks per day, more than twice the intake of milk (10 ounces), and females drink roughly 14 ounces of soft-drinks and only 6 ounces of milk (Kushi LH, 2006). Eating Disorders Adolescents are especially susceptible to eating disorders because of the development of their self-image around this time of their lives. Bulimia, anorexia and binge eating are all eating disorders that teenagers suffer from. Results of Anorexia nervosa can prove to be fatal; as the body is starved so are the muscles. The heart, being a muscle, can consequently begin to weaken, and heart failure will very likely become a reality. The low levels of sodium, zinc, potassium and calcium, associated with anorexia can cause unusual heart rhythms. Sudden death caused by electrolyte and mineral disorder may happen. The blood bone marrow is also interrupted. Anemia is related with the amount of weight lost and the decreased capability to fight pathogens and infections [ (CDC) ]. Obtaining the accurate figures, in terms of the prevalence and other facts about eating disorders is difficult. It is not mandatory for Anorexia Nervosa and Related Eating Disorders (ANRED) to report eating disorders; this, the secretiveness, and denial of people with eating disorders makes it difficult to obtain an accurate idea of the prevalence of eating disorders in the U.  S. A. According to the National Eating Disorders Association (NEDA), in 2005, 10,000,000 Americans had an eating disorder. The National Association of Anorexia Nervosa and Associated Disorders (ANAD) reports 7,000,000 women and 1,000,000 men are affected by eating disorders in America. 3. 6% and 12. 9% of the American population is estimated to suffer from an eating disorder at some time in their lives, according to the Eating Disorders Coalition (EDC) [ (Americans, 2010) ]. Junk Food The percentage of adolescents snacking on any given day increased from 61% in 1977-1978 to 83% in 2005-2006; the percentage of adolescents who had three or more snacks in a day rise more than twofold, from 9 % to 23% during the same time period. The rise in rates of overweight and obesity among children and adults of late has led researchers to evaluate the relationship between different eating patterns and weight status. A habit that has received significant attention is that of eating more frequently, particularly in the form of snacking. Although some research has shown that eating habits, including snacking, may help people meet their nutrient requirements, other research indicates that snacking lowers the nutrient density (the amount of nutrients per calorie) of the total diet (Forshee RA, 2006) (Brown, 2011). Snacking more times per day was related to higher intakes of calories. Many of the foods that made the largest contributions to adolescents’ intakes (My Pyramid) at snacks were also high in solid fats, added sugars, or both. The effects of frequent consumption of junk food, such as fast food, soft-drinks, potato crisps and other snacks, include the increased risk of : Clogged arteries- his occurs when fats and cholesterol become oxidized and build up inside the blood vessels, increasing the risk for heart attack or stroke. * Heart disease. * Diabetes later in life. * Obesity, immediately or later in life. * Hypertension. * Cancers related to excess fat and sugar consumption. (Brown, 2011) Many teens eat at fast food restaurants often, taking in extra calories from added sugar and fat. One fast food meal of a sandwich, fries, and sweetened soft-drink can have more fat, calories, and sugar than one should eat in an entire day. The best approach is to limit the amount of fast food consumed. Choosing a grilled chicken sandwich or a plain, small burger instead of a large fried burger, ordering garden or grilled chicken salads with light or reduced-calorie dressings, choosing water, fat-free, or low-fat milk instead of sweetened sweet-drinks can go a long way towards minimizing fat, sugar and calorie intake when eating out. At times, people forget what they drinking and focus only on what they are eating. Soft-drinks and other sugar filled drinks have replaced water and milk as the drinks of choice for teens. These drinks are more like desserts because they are high in calories and added sugar. In fact, soft-drinks and sugar-filled drinks may contribute to weight problems in kids and teens. Saturated fat and trans fat, found in many types of fast food including fries, and fried chicken, contribute to high cholesterol levels. High cholesterol increases the risk of blocked arteries. The resulting reduced blood flow to the heart and brain, increases risks for heart attack or stroke. Trans fat, also found in many baked goods such as cookies, snack cakes and crackers, should be avoided to reduce your risk of cardiovascular problems.

Huawei Technologies

Huawei Technologies How is Huawei’s internationalisation endeavour a good success story example for other companies wanting to pursue global growth? Introduction Huawei Technologies Co. , Ltd. provides telecommunications equipment and solutions to operators in China and internationally. The company’s products include wireless and networking equipment, applications and software, and terminals; smartphones for French users; and metro services platforms, which help operators to build broadband metro area networks. It also offers mobile network, broadband network, IP-based and optical network, and telecom value-added services. Huawei Technologies Co. , Ltd. has strategic partnerships with IBM, the Hay Group, PwC, FhG, Intel, Texas Instruments, Freescale Semiconductor, Qualcomm, Infineon, Agere Systems, Microsoft, Sun Microsystems, and HP. Huawei Technologies is a Chinese company. It was established in1988 by Ren Zhengfei, a former People’s Liberation Army officer and telecom engineer. Huawei’s headquarters site, of modern and impressive building fittings, is situated in Shenzhen, southern China (Guandong province). In 2006, Huawei Technologies was among the ranks of China’s â€Å"National Champions†, along Haier, Lenovo TCL, and the Wanxiang Group, poised to compete with global leaders in the international market place. Huawei has also been dubbed as the Cisco of China. It is thus a multinational corporation with branch offices in 100 countries which serves over one billion users worldwide. The question is then begged as to why Huawei is so competitive? What were and could be the challenges the Chinese-based company faces? What are the implications of Huawei’s strategy? In this paper I will attempt to analyse Huawei Technologies strategy to internalisation by taking in account the company’s starting point in China, and by setting the stage for the comparison of Huawei’s to that Cisco’s strategy. I will then proceed with some recommendations on what a Chinese company could have done to better prepare for competition in the US telecom industry. And conclude with some remarks on the progress made by Huawei since 2006, when the case study on which the analysis is based was compiled. Company Overview From its very beginnings, the company’s vision has been to become a lighthouse of innovation which would successfully enable it to compete first in its home market, and then proceed with international expansion. When the company was still operating only in China, Huawei’s methodology around its goals, to not be set up in joint ventures with foreign companies, to pursue global cutting-edge technologies, persist on self-development, and expand internationally, largely consisted in extensive investment in research and development (R&D) capabilities, and hiring a highly-qualified workforce from China. Huawei was created almost single-handedly under the strong vision and leadership of Zhingfei. He fostered a unique and rigorous management culture, by building a â€Å"pack-of-wolves enterprise†. He instilled a management philosophy within the company which meant to view competition and market opportunities with a keen smell, react to with an aggressive push and always confront both in unified groups. Under Zhengfei’s lead, who had been successful to create and manage a large relationship network, few other competitors could match, the company had relied on big contract orders from the military to secure a foothold in the telecom network market in its early years. Moreover, extended army and government ties had provided the company with relatively easy access to financing. Huawei was undoubtedly the largest Chinese telecom equipment manufacturer, with annual revenue of US$6. 7 billion in 2005. Market capitalisation was estimated to be up to US$10 billion. In China, Huawei’s major customers included all the big names such as China Telecom, China Mobile, China Netcom and China Unicom. Huawei’s networks in China served over 400 million people communicating across the country, occupied 25% market share in the mobile networks, and supplied 80% of all short messaging services from China mobile. Therefore, Huawei’s strategy to focus on R&D to lead technological advancement, its attention to choose high-calibre and yet inexpensive labour from China, as well as foster a consolidated sense of corporate culture none but confirmed Huawei’s stable, long-term oriented organic growth strategy. The company’s competitive advantage in its home turf had built up to be low-cost engineering, enabling Huawei to compete with large indigenous and foreign competitors. Cisco, Huawei, and the International Market of Telecom Equipment and Services Cisco, which global presence spurred with the enlarging footprint of the internet across the globe in 1991, decided to focus its growth strategy in China by the end of the 1990s. Cisco’s strategy in China consisted in recruiting and training employees to service high-end markets of telecom service providers and enterprise markets. Instead of forming joint ventures with local partners (like most of its international competitors did in China), Cisco opened its own subsidiary in China, Cisco Networking Technology Co. Ltd. to promote education, demonstration and development of network technology. Educational initiatives presented Cisco with an opportunity to develop favourable relations with Chinese authorities and to cultivate new areas of business within China. Moreover, recognising the large, low-cost and skilled labour force in China, Cisco continued its commitment in the country by investing in an R &D centre in Shanghai. Cisco’s CEO plans for the facility were to allow Cisco access to technology and local talent so as to leverage Cisco’s newness to the corporate culture of China and be able for it to buy into the local Chinese local market. Cisco’s goal was by all means to maintain its leadership position in cutting edge technology. While at the same time, Chinese competitors were using their aggressive pricing strategies to expand into the international markets, and were rapidly using their low-cost advantages to move up the value chain. And Huawei was among the Chinese companies that were expected to make further inroads into international markets in the next few years, competing head-to-head with established Western players for the same global accounts. Internationalisation: Phase 1 Having secured a strong foothold in its home market in China, Huawei started to look for diverse sources of growth internationally, in the first half of the 1990s. However, it was able to conclude its first significant international contract only in 2000, in Russia. In order to avoid outright competitive confrontations with well-established Western telecommunication multinationals, Huawei went global by first entering growing markets in developing countries. Considerable contracts extended later on beyond Eastern Europe, in South America (Brazil’s fixed line carrier) and Asia (Thailand’s largest mobile service provider). Huawei’s path toward the matured Western European markets, the company’s next challenge, would not come without tradeoffs. In the early 2000s, Huawei was a new company competing for market share with established global communications technology suppliers. Chinese products were then suffering from a common perception of being cheap and unreliable, forcing Huawei to thus pursue aggressive tactics to win contracts. With 30% lower pricing points than established competitors, a commitment to offer trial periods for its products and hiring local personnel to tailor technologies and services to customers' needs, led the company to win contracts in tough-to-please markets such as France (Neuf Telecom, 2001). The biggest success, however, and the one that signified Huawei’s breakthrough in Europe, was in 2004 when the company was selected by a Dutch mobile operator to build its 3G mobile phone network, by then Huawei’s hallmark capability. Internationalisation: Phase 2 In order to highlight the key points of Huawei’s internationalisation strategy, the case of the company’s entrance in the U. S. calls for an analytical stop. The challenges Huawei faced in the North American market revolve around several axes, but overall the endeavour highlights the general lack of preparation and some strategic blunders which made the company’s top management decide to update Huawei’s strategy and draft one that caters to long term sustainable development. When it opened its first office in Plano, Texas, the company made every effort to blend into the local culture. It shared the building with law offices, realtors and the regional office of the lingerie company Victoria’s Secret. A Texas state flag and an American receptionist welcomed visitors on the ground-floor lobby. Shortly after the US-launch, however, the defect of not having carefully planned for cultural differences eventually surfaced. Chinese employees had a difficult time adapting to the Texas accent and other aspects of the local culture. Huawei executives also realised that Americans had difficulty pronouncing the company’s name. They came up with a working name, Futurei, which although facilitated to a better pronunciation, only confused targeted customers even more, and Huawei’s infant brand came under great shock. In the US telecommunications industry, a mature market where lower prices often are not enough to land a deal, winning customers and contracts would demand for a lot more effort. Phone companies and equipment suppliers had long term ties with their equipment suppliers, customers looked for exceptionally leading-edge technology and a compelling reason to switch. Moreover, trying to switch to a virtually unrecognised brand in the US market meant that telecom service providers – Huawei’s classical customers – would request exhaustive testing of equipment quality and reliability, lasting several months, before committing to buying it; a common procedure for sourcing from an unknown company. Another hurdle Huawei encountered was a lawsuit Cisco launched, only six months after Huawei had set up its subsidiary in the US. Analysts observed that Huawei’s steep discounting of low-end routers [Cisco’s] products in its home turf, the US market, had prompted the lawsuit [of alleged infringement of Cisco’s patents and copyrights]. This was Cisco’s first intellectual property lawsuit despite its huge intellectual portfolio. Huawei ended up by agreeing to withdraw from the market place Quidway routers and other related products. Three years after its US launch, the company was able to land its first contract with a US wireless carrier in 2004, and subsequently securing other contracts with small wireless carriers. Huawei had serious intentions for the U. S. market. Yet cultural risk and Cisco’s buying power in its home turf, led to a substantial delay of results, and thus loss of revenue and opportunity for Huawei. Despite having a powerful and well recognised brand name, when Cisco started its venture into China (in 1998), it began by first building on local labour-skill capabilities and government network to leverage on its inexperience in the Chinese market and thus buy into market sales power among corporate customers. Huawei, on the other hand was literally unknown in the US market. And it was naive enough to assume that American corporate customers would be sufficed with high-quality low-cost equipments from an unknown Chinese company. Or that its organisation was rightly prepared to face global competition as aggressively and in the right way as it had done in China. Cisco’s entry strategy into China was aggressive not because it offered low-cost high quality products, but expensive and exclusive technology, reinforced further via R centres spread across the country. Enterprises in China knew about and trusted Cisco’s product quality nd reliability. The same cannot be said about Huawei’s products. In spite of success in winning deals in developing countries, Huawei could not reach US corporate customers if they would not pass that easily the wall of perception that Chinese products were cheap and merely copied versions of other recognised telecom equipment and software. Recommendation Recommendations, or lessons to be drawn from Huaweiâ₠¬â„¢s experience, would capture the overall need for Chinese companies to acclimate to new surroundings first – just as the foreign companies that entered China did . Acclimatisation, for Huawei could have proceeded by: 1. Improving assessment of risk – economic, political, regulatory, cultural, organisational to avoid cultural and regulatory (the lawsuit) blunders. Huawei could have also better prepared to build a network before out rightly starting to target enterprise and corporate customers. 2. Preparing better for the entry strategy in the US– be it Greenfield, acquisition, merger or alliance. Cisco, to show its commitment for China, announced a US$100 million investment, stirring curiosity and interest among corporate customers and Chinese authorities. Huawei went into the US â€Å"quietly† opening a branch office! 3. Developing global talent – R investment and international top managers with a global experience and extended local market knowledge, in order to enhance buying power into the local market. 4. Creating a global brand – to be accepted in the market place by using local industrial public relations companies can facilitate brand recognition in the initial stages. 5. Assessing and redesigning organisation and management style to one that caters four dimensions: †¢co-orientation, the temporal dimension – being able to balance between short-term results for survival and long-term performance for sustainable profit growth; †¢co-competence, the relationship dimension – persist on the dual possession of both transactional and relational competence; †¢co-opetition – the capability to win market share through simultaneous competition and cooperation for reasons that range from brand name strengthening and market share growth; o be agile and flexible to re-adjust to shocks efficiently, and flexible enough to re-balance short-term results with long-term performance, and †¢co-evolution – the pursuit of organisational adaptation to and proactive influence on the external environment facing a firm [Huawei] Concluding Analysis and Discussion The future of business is in its course to re-establishing itself in a [somewhat] changed order. The recent financial crisis has certainly tested the best and the worst of yesteryear strategies and management styles. Thanks also to a revived wave of globalisation companies are in the quest for profit, at a time when there are possibilities – probabilities – and uncertainty. The US market continues indeed to be a litmus test of endurance for non-American companies . Luckily, Huawei had sufficient financial cushion and top management agility to learn quickly and be able to modify its corporate business model strategy to fit the demands of its targeted customers – corporate clients. â€Å"Huawei Technologies Co. , Ltd. announced it will unveil a new mobile broadband solution †¦ at Mobile World Congress 2010. This solution will accommodate the tremendous increase in mobile broadband traffic, reduce the per-bit cost by over 95%, and make mobile broadband services more profitable for operators worldwide. Today, mobile broadband services are growing exponentially, but operators have not yet been able to convert this into significant revenue streams. Huawei estimates that global data traffic on mobile broadband networks will grow 1,000 times over the next decade, from the current 85 million Giga-bytes per month in 2009. As the number of mobile broadband users continues to climb, subscribers will increasingly look for low tariffs with unlimited, high-speed access and abundant mobile broadband service, while operators will need network capabilities that allow them to accommodate the expansion pressures of mobile broadband network and profitable operation mode. Huawei would seem to be â€Å"swimming† in a blue ocean now because it has been able to grow in scale and revenue while keeping a low cost structure. The R investment and ability to simultaneously fill a gap in telecom infrastructure by putting forward a unique value proposition to telecom end user customers and telecom serv ices suppliers. Mobile broadband users, growing exponentionally in numbers, are now being offered the possibility of low tariffs for unlimited, high-speed access and abundant broadband services. In turn, operators will need network capabilities that allow them to accommodate these expansion pressures on the mobile broadband network and retain profit margins. The case of Huawei Technologies certainly reflects a good example of success story in dealing with all the above issues. Chinese-based companies planning to become global may well benchmark Huawei’s management structure and organisation in turning around the focus from high-tech products to customer-centric high-tech products and services, under an internationally accepted brand label. Huawei’s top management certainly took a step back after the initial limping performance in the U. S. It now â€Å"believes that cooperating with customers, suppliers and leading players in the industry to face challenges together through a win-win strategy is essential in today's business world† . Huawei has formed numerous partnerships [†¦ ] with leading multinationals such as ADI, Agere, Altera, HP, IBM, Intel, Microsoft, Motorola, Oracle, SUN, TI and Xilinx to improve the time to market of [†¦ ] products, and to incorporate the latest technologies and best management practices into [the] company. [Such] will enhance [its] position [and brand image] in key international markets, [†¦ ] and improve [its] response speed and service advantages in [the] supply chain† . As of 2010, Huawei has 87,502 employees, of whom 43% are dedicated to R&D. Huawei’s most recently reported sales counted at US$18. 33 billion, a 75% increase from the 2006 sales, and with US$1. 15 in net profit. In 2009, it was named the world's top patent seeker, it was the first Chinese company to head the United Nations World Intellectual Property Organization (WIPO) list, its contract orders rose 46% to US$23. 3 billion (75% of which came from overseas), overtook Alcatel-Lucent to become world's No. 3 mobile network gear maker, and during the third quarter of 2009, Huawei passed Nokia Siemens Networks for the No. 2 position in the global mobile infrastructure equipment (according to research firm Dell'Oro)—a sign of the changing fortunes of the two vendors . Huawei’s change in the strategy style is noticeable right at its formulation of the new vision – it is now â€Å"to enrich life through communication†. The company continues to maintain a leading competitive position in the international industry of telecom technology and services, and only these days was elected 5th most innovative company in the World â€Å"behind only Facebook, Amazon, Apple, and Google† ! ________________________________________ Bibliography: Business Week, retrieved 2 March 2010 from (http://investing. businessweek. com/research/stocks/private/snapshot. asp? privcapId=1259829) Zeng, M. and Williamson, P. (2003)  « The Hidden Dragons  », Haward Business Review, October. Quoted in The Asia Case Centre, The University of Hong Kong, Ref 06/300C Huawei Technologies Corporate Website – http://www. huawei. com/corporate_information/global_operations. do Huawei Technologies Annual Report 2009 Farhoomand, A. , The Asia Case Centre, The University of Hong Kong, â€Å"Huawei: Cisco’s Chinese challenger â€Å", 2006 Chen, J. Giant Rises in the East  », National Post, June 10th 2005, Quoted in T he Asia Case Centre, The University of Hong Kong, Ref 06/300C The McKinsey Quarterly, Strategy,  « How Chinese companies can succeed abroad†, May 2008. Lou, Y. and Rui, H. â€Å"An ambidexterity Perspective Toward Multinational Enterprises from Emerging Economies†, Academy of Management, November 2009. http://investing. businessweek. com/research/stocks/private/snapshot. asp? privcapId=1259829, Retrieved 2 March 2010. http://www. huawei. com/corporate_information/partnerships. do, Retrieved 2 March 2010. http://en. wikipedia. org/wiki/Huawei http://eon. businesswire. com/portal/site/eon/permalink/? ndmViewId=news_view

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OCD (obsessive compulsive personality disorder) Research Paper - 1

OCD (obsessive compulsive personality disorder) - Research Paper Example However, clinically, that is not true. Toates and Toates (2002) say that OCD i â€Å"†¦classified in psychiatric thinking as an anxiety disorder†¦Ã¢â‚¬  (pp. vii). What is currently known about obsessive-compulsive disorder is that it is basically consisting of two functions: there is an obsession (or obsessions), and a compulsion (or compulsions). The two interact with each other, playing off each other and feeding the fear that is inherent in this disease. For example, some people check the locks on doors over and over in order to ensure that everything is secure. Some people retrace their steps until things â€Å"feel right.† Some people have a compulsion with hand-washing, and must rub their skin clean until it is red and smarting. Some people must check that the lights are turned off in their room before leaving. Some people avoid stepping on cracks in the sidewalk for fear that they will not have good luck. As one can see, these â€Å"compulsions† go far beyond just worrying about simple bad luck. These compulsions become the centerpiece of the person’s day, and, clinically speaking, more than an hour focusing on compulsions is part of what is considered part of the patient’s diagnosis. Basically, what is another part of the diagnosis is the necessity of the patient to have to focus on an obsession. Now, an obsession can be almost anything. The obsession itself could be the light. The obsession itself could be the sidewalk’s cracks. Whatever that thing is upon which the patient is focusing so intently, that is the obsession which is problematic for the patient. The patient becomes so intently focused upon this object or thought that it consistently invades his or her mind and makes him or her almost crazy with checking, washing, or some other repetitive behavior or ritual that becomes a focus of one’s daily life. Indeed, Collie (2005) describes the OC D diagnosis as a function of â€Å"†¦mental or behavioral rituals†¦Ã¢â‚¬  (pp. x). One

HUMAN RESOURCE RESEARCH PAPERS Paper Example | Topics and Well Written Essays - 1250 words

HUMAN RESOURCE PAPERS - Research Paper Example The employees at all levels have a major part to play in this regard and they should take the collective effort to prevent any such situation in the organization. If any such situation arises in any organization then the management of the organization has to pay a very high price for that in terms of legal compensation or the ruining of the reputation of the company (Decenzo, 2013). Thus it is important to understand the issue from the perspective of the employees and that of the victims and how it can be prevented or dealt with in case any such situation arises. Since prevention is always better than cure hence the employer or the managers should always take a necessary step to prevent the occurrence of any such situation. They should ensure that there is no gender discrimination and every individual working in the organization should have respect for the sexual orientation of the fellow colleagues. The managers should implement a policy such that any such situation can be prevented and the code of conduct that the employees should follow in the organization should be mentioned to all the employees working (Paludi and Paludi 2003). The employees should be aware of the actions and legal steps that would be taken against the person who would commit such a belittling crime. In case such an incident occurs immediate investigation and timely action needs to be taken against the person committing the crime. The company in no way should try to safeguard such an employee even if he holds some high position in office. The employees of a company also have the duty to ensure that there is no prevailing hostility in the environment of their particular department. If an employee is apprehensive about the behavior of any co worker then the person should immediately report it to the higher management and seek for corrective action. Immediate action has to be taken by the

Haqqani Network Research Paper Example | Topics and Well Written Essays - 2000 words

Haqqani Network - Research Paper Example The Haqqani Network operates under the supervision of Maulvi Jalaluddin Haqqani, a highly dangerous fighter and anti-soviet resistance commander, and his son Sirajudin Haqqani, who now handles the important affairs of this enemy network. This group has been existing in Pakistan since Soviet era and is spread across Kabul (Clarke, R, 2011, p.105). The Haqqani Network is claimed to have been in alliance with many intelligence groups such as Central Intelligence Agency (CIA), Osama Bin Laden and Saudi Arabia’s Spy Service (Takashi, 2012, para.2). The Haqqani Network runs under the leadership of Haqqani family. Jalaluddin Haqqani and his sons now lead this insurgent group. Acording to Mazzetti, Shane & Rubin (2011) the Haqqani family is the Sopranos of the Afghanistan war, a family that made out its earnings and rose from the bottom through exercise of all kinds of illegal activities like trafficking, kidnapping, extortion, and so forth (para. 1). That being said, they are also reported to acquire protection money from the American reconstruction funding that was particularly aimed at construction of schools and roads in Afghanistan. With increasing network horizon and an enormously vast web of connections, this group has many top-tier leaders that operate different parts of the group secretly. That being said, the pioneer of the group, Jalaluddin Haqqani is considered a chief figure in the leadership of this network. Jalaluddin acted as a mujahedin leader in his fight against Soviet forces where he received significant help from the ISI and CIA (Bowman, 2009, p.26). The leader himself focused more upon his hometown Zadran, which is a central territory that connects nine tribally linked districts at the border of Paktika, Khost and Paktia province. Since the leader Jalaluddin has turned old and weak due to illnesses, most of the network’s responsibilities and activities have been transferred upon

Childcare system Essay Example for Free

Childcare system Essay Many parents that have kids want to stay at ome during the early years of the childrens youth, but after those years they cant afford to go back to work. Over 50% of moms that usally stay home and want to go to work but just cant afford to acording to Ms. Truss. About 17% of moms that did work couldnt earn enough to be able to have money that would last awhile. While 12% cited a lack of job opportunities. Ms. Truss believes that stuff like this shouldnt stop people from helping the 52% of moms find an affordable childcare so that they can go out and looks for an affordable job. Mrs. Truss wants to have a deregulated childcare system, unlike the other childcares, to have a sinle nursery double with the amount of children they are responsable for. Anand Shukla, Chief Executive of the Family, Parenting Insitute, and Daycare Trust wonder if carers and the self-employed will be eligible for this financial support and said something about the devil will be in detail. The Labour has warned if they cut the nursery staffing levels, it could threaten child safty of the children that are being taken cared of while there parents are working. If stuff like this keeps happening, and they do cut nursery staffing levels, i think the problem would get worse, kids might be killed from carlessness from the lowered class nursery staff, more parents would stay home to protect there kids. If they want to provent stuff like this, they cant cut the nusery staffing level and have to find something that is less important they can cut to be able to let mothers keep there jobs and so there kids can be safe. They could cut off stuff like entertainment or stuff like amusment parks, just some examples but in my oppion, taking care of the future generation is more important than these two examples. As long as they dont take drastic messures like cutting nursery staffing levels, the future for them looks pretty good as long as they cut stuff of less important value.

Finding The Energy Given Off From Various Fuels Essay Example for Free

Finding The Energy Given Off From Various Fuels Essay Research Question: Which of these fuels (ethanol, methanol and butanol) releases the most kinetic energy per ringitt? Hypothesis: Ethanol will release the most kinetic energy per ringitt because it has an average amount of CH compounds ( Materials: Spirit burner with ethanol 3 aluminum cans Spirit burner with methanol Logger Pro Spirit burner with butanol Insulated container Matches Ring Stand Graduated Cylinder 150mL of water Procedure: 1. Pour 50mL of water into the first aluminum can 2. Place the can 7cm above the ground on the ring stand 3. Place the Logger Pro inside of the can 4. Light the spirit burner of the fuel under the can. 5. Close the container around the ring stand and the spirit burner 6. Stir the Water inside of the can constantly. 7. Record the temperature of the water for 3 minutes. 8. Repeat the steps for each type of fuel. 9. Find the number of kilojoules released by each of the fuels 10. Find the amount of kilojoules of each fuel when there is 1 liter of that fuel. 11. Divide the amount of kilojoules/litre by the cost/litre of each fuel. 12. Choose the fuel with the most kilojoules released per litre. Data Collection and Processing: Ethanol: Measuring the Mass of Ethanol Time Alcohol Container Was Burnt Mass of Alcohol Container (g) Before Burning 160.2 After Burning 158.9 Measuring Temp. of Ethanol Time Temp of Fuel (à ¯Ã‚ ¿Ã‚ ½C) Before Bunrning 24.6 After Burning 93.8 Methanol: Measuring the Mass of Methanol Time Alcohol Container Was Burnt Mass of Alcohol Container (g) Before Burning 191.4 After Burning 190.1 Measuring Temp. of Methanol Time Temp of Fuel (à ¯Ã‚ ¿Ã‚ ½C) Before Bunrning 25 After Burning 60.8 Butanol: Mass of Alcohol Container (g): Methanol: Ethanol: Butanol: Before burning 191.4 160.2 190.8 After burning 190.1 158.9 190.5 Temp of fuel C Methanol: Ethanol: Butanol: Before burning 25 24.6 23.8 After burning 60.8 93.8 44.8 Finding the Energy Released by The Fuels (Q = m x C x ?T) Step 1: Finding the ?T (change in temperature) ?T= ending temperature starting temperature Step 2: Finding the Heat Capacity of Water (C ) Heat capacity of water = 4.18 J/g Step 3: Find the mass of water Each can had 50mL of water 1mL = 1 g Each can had 50 g of water Energy released by Ethanol: Q= 50 x 4.18 x 69.2 Q= 14.5 kilojoules Energy Released by Methanol Q= 50 x 4.18 J/g x 35.8 Q= 7.5 kilojoules Energy Released by Butanol: Q= 50 x 4.18 J/g x 21 Q= 4.4 kilojoules Energy Released by ethanol per ringitt: Kilojoules/litre = 11153.8 Energy Released by Methanol per ringitt: Kilojoules/litre = 5769.2 Energy Released by Butanol per ringitt: Kilojoules/litre = 14666.7

Throughput Accounting: Theory of Constraints

Throughput Accounting: Theory of Constraints Dr. Goldratt’s Throughput Accounting revolutionized the methods by which companies viewed their costs and associated them with profits. Unlike the traditional cost accounting methods, Goldratt argues that accounting should seek to maximize the movement of products through an organization to eliminate potential bottlenecks that prevents efficiency and speed. Goldratt argues that the current costing systems in use were developed almost a hundred years ago based upon the business practices and business designs of that particular era. The traditional accounting system therefore can be understood in the context of a â€Å"Cost World†. This cost world focuses all aspects of business value and decision making upon the cost of products themselves. In order to connect all of the subsequent aspects of business to costs, very elaborate allocation of expenses had to flow through to products. These â€Å"cost schemes† in effect have many different errors and assumptions that impacts the accuracy of accounts and therefore causes misjudgments within management decision making. Goldratt proposes within his book that accounting should be viewed through a â€Å"throughput† perspective. Throughput rests upon three specific elements: throughput, inventory and operating expense. Throughput can be defined as the monetary gain a business makes from selling its products. Investment is the monetary value of all fixed assets which enables throughput to occur. Finally, operating expense is all of the operational expenses spent on producing throughput. The reasoning behind Goldratt’s analysis for the need of throughput accounting is that the world is no longer based upon flat delineations of costs. Businesses today, unlike the last century, do not commit the majority of their resources on factors, plants and other vehicles of heavy capital investment. Even more important, workers were thought of as variable costs because they were mostly low-skilled and thus easily varied through workforce demand. In today’s world, these two moving forces, resources and labor are moving in opposite directions. Resources are becoming much more variable and formerly fixed costs are becoming flexible as a result of changing workflows. At the same time, skilled labor especially in key high skilled industries are becoming much more fixed and necessary than before as well. Thus, allocation of costs to labor or specific products is no longer accurate and rests on faulty assumptions. The foundational principle of Godratt’s throughput accounting is that decisions are focused upon the goals of the organization rather than on its costs. All of the decisions made by the business can be related to their ultimate goal. Under this accounting system, individuals are viewed as assets rather than expenses, and traditional mechanisms of inventory and throughput are carefully analyzed and reconfigured to align with organizational goals. Goldratt argues t hat there are three fundamental relationships established through throughput accounting mechanisms, these are described below. Throughput accounting at the core is the â€Å"summation of all the gain from sales of all the individual products† (NOTATION): T= à ¯Ã†â€™Ã‚ ¥pTp(p=individual products) This is the first principle of throughput accounting. At the same time, Operating expense is the summation of the individual subsets of operating expense. This would include all subsets of operating expense including employees and their manager resources, interest levels, energy costs, etc. OE = à ¯Ã†â€™Ã‚ ¥cOEc(c=individual categories) The role of cost accounting within financial analysis was to develop a mechanism to search for a very good estimation in understanding how production lines impact each other and thus impacts the net profitability of companies. Goldratt argues that cost accounting was intended to make â€Å"apples and oranges into apples and apples†. This would allow companies to have a true metric for cross-comparison. Throughput accounting solves the problem of allocation simply by dividing a company into product by product classes. It uses the formula: NP = à ¯Ã†â€™Ã‚ ¥p (T – OE)p The reason that Throughput accounting is necessary according to Goldratt is that cost accounting has become too ineffective in forming solutions for modern corporate problems and diversification. Concepts such as cost drivers and activity based costing are both ineffective in their methodology in truly assessing corporate profit and stakeholders. These above principles make up the foundation of Godratt’s Throughput Accounting analysis.By focusing upon the mechanisms for consistent business improvement, Throughput Accounting works to eliminate bottlenecks throughout an organization and focuses upon how to achieve sustainable development through maximizing organizational goals rather than focusing upon costs and expensing. Godratt’s overall theory is meant to provide accurate business decision data that focuses upon tailored organization needs rather than standardized costing. Despite the widespread acceptance of throughput accounting within the managerial finance community, it is not a perfect solution. Many different developments within the field have strongly impacted its sustainability and usability in the near term. One of these most fundamental changes is the concept developed by Caspari and Caspari called â€Å"Constraint Accounting†. While throughput accounting is often described as a transition from variable costing, constraint accounting also derives from the Theory of Constraints but is directed towards a systematic solution for corporate financial analysis. Throughput accounting is not perfect because it attempts to evaluate â€Å"global throughput paradigms† with the current local efficiency cost paradigm. Thus, Caspari describes throughput accounting as a â€Å"legacy system†, thus something more systematic must be used to judge global criteria. Constraints accounting can be understood as a global throughput accounting pa radigm, rather than evaluate transitive states, global throughput decisions are measured through internally consistent metrics. Its goal is to bring the effect of identifiable constraints to the concept of profit and loss statements and effectively overcome the traditional management accounting functions of the firm, moving them to the goal of on-going improvement model. Constraints accounting allows for the recovery of investment in breaking constraints down as operating expenses at the same rate as throughput. The result is that it creates a means of â€Å"global congruence† through financial incentives to â€Å"bust constraints†. Thus Constraints accounting allows for aligning business perspectives in both the short term and long term through broad principles which is similar to the developments of Kaizen and Continuous Improvement dynamics. Constraints accounting can be defined as â€Å"an accounting reporting technique, consistent with a process of ongoing improv ement and implementation of the theory of constraints, including: Explicit consideration of the role of constraints, Specification of throughput contribution effects Decoupling of throughput from operational expense Constraints accounting has dramatically impacted the dynamics of businesses through the understanding of global perspectives on constraints decision making. It impacts accountants because it changes the dynamics within business decision making by extending a systematic methodology for examining business impact and bottlenecks. Constraints accounting focuses on the explicit consideration of the role of constraints and the actual throughout contribution by understanding the separate value of throughput and operating expense. Constraints accounting is widely used as a methodology for understanding future costs and controlling future costs as an effect on constraints. Constraints accounting impacts one specific area, organization wide consulting. While traditional throughput accounting mechanisms had consultants focus their attention on the limitations of business in their bottlenecks, CA focuses instead on the development of continuous mechanisms for optimized business practice. This ha s transformed how consultants analyze business functions by decoupling throughput and operational expenses. Consultants no longer pursue a specific understanding operational expenses and thus tailor their recommendation on how to decrease OE in order to take away bottlenecking. However, CA focuses instead on the specific effects of throughput upon an organization and how to instill continuous improvement at this level. Deviating from a transitive model towards a greater understanding of the global and systematic viewpoint. New developments and expansions of throughput accounting have helped to answer of many of the criticisms that have been leveled at this TOC (Theory of constraints). There are four main criticisms that have been leveled at the concept of Throughput Accounting. The first is that throughput accounting is just another form of variable costing. Second, that throughput is only valid when there is a tangible production bottleneck. Third, that it regards all operating exp enses of a company as fixed, and finally, that it can only be used as a short term decision tool rather than a long term decision making calculus. Although there is some validity to these criticisms, the majority of them rest upon misunderstandings of how throughput accounting works and what its specific methods are. Throughput accounting is not a costing analysis in that its primary concern is with the relevant costs and revenues associated with a decision. The majority of companies in the modern world still use a form of cost accounting as their primary management accounting system. Although this system has been used widely its founding premise is that if a company can reduce the cost of a product, then it will simultaneously increase the company’s overall profitability. However, throughput accounting does not attach cost to production. Rather it attempts to answer three primary questions using throughput accounting measurements. How will decisions impact the overall amount of money the company generates? How will decisions impact the overall operating expenses of the company? How will decisions impact the overall return captured by the company? Constraints accounting answers the primary fault of throughput accounting, which is that it is a natural extension of variable costing. There is much truth to this statement because variable costing at a definitional level implies a transitive analysis of controlling costs as they are related to the throughput. The ultimate difference between variable costing and throughput accounting is that local decision making is based on the role of constraints and the contributions due to the constraints themselves. Constraints accounting eliminates the transitive view by taking on a global and systematic viewpoint. It extends the logic that costs are incurred irrespective of the different fixed components of costs and are better management decisions about product cost. Throughput accounting argues that direct labor is no longer considered variable, rather production cost is avoided by instead considering throughput analysis. Constraints accounting is the only methodology that can in reality be considered systematic and global optimum in its approach. Constraints accounting also changes the perspective of understanding bottlenecks. Bottlenecks within companies are streamlined through the existence of throughput analysis rather than focusing on cost of production. The main criticism that throughput only works when bottlenecks exists is counter-intuitive, bottlenecks will always exist purely because production can never be completely efficient. Using the constraints accounting approach, a process of re-assessing the process of production and the constraints applied to them develops a continuous model for improvement that is comparable with the Kaizen model. This means that there is a response mechanism and systematic approach to understanding constraints fast enough to develop a counteractive means to continuously develop an understanding of constraints. Thus, constraints accounting seeks to continuously improve businesses even when bottlenecks are less noticeable, whereas throughput accounting focuses at the transitive level. One o f the chief criticisms of throughput accounting is that it regards all operating expenses as fixed costs. Constraints accounting takes this into consideration by decoupling T and OE. This implies that throughput and thus, understanding of business optimal functions does not entail operating expense considerations at all. Operating expenses are for the most part a fixed cost because of the current state of world capital flow and labor demand. However, constraints accounting focuses on a systematic and global optimum viewpoint which disassociates these two concepts unlike throughput accounting. Finally, the concept that throughput accounting can only be used as a short term decision making tool is also changed through constraints accounting. While it is true that throughput accounting deals only with bottlenecks in business at the microscopic level, and it is a transitive analysis that can be closely related to variable costing, constraints accounting is very much a global and systematic understanding. Since constraints accounting specifies the role of throughput, it takes a global optimum view of constraints and their function on specific organizational components. The implication is simple, this takes away the fundamental derivative of demand at a cost level. Which means that continuous improvement is possible using constraints accounting, taking away the primary complaint of the Throughput accounting model? The development of constraint accounting goes one step further than throughput accounting. It uses an explicit consideration of the theory of constraints to understan d the role of constraints as bottlenecks on a global/systematic view rather than the transitive view. This new development within the understanding of constraints theory is a derivative of throughput accounting. It answers many of the primary concerns of throughput, and thus changes the differing leverage points of TA analysis. Goldratt’s original assumptions of throughput are very valuable in creating an optimal understanding of modern business practice and function, however it still contained many errors. From the above discussion it is evident that cost accounting is no longer the strongest and most credible method of managerial accounting. Changes must be made to this model to accommodate the growth of organizations from focusing on individual products towards integration of product lines that deviates from cost. Throughput accounting focuses on improving businesses through focusing on goals rather than on costs, this was a revolution within managerial accounting. However , many problems still existed with TA that prevented it from systematic adoption. However, the development of constraints accounting has dramatically changed the nature of the theory of constraints and its direct application. It has allowed for the use of continuous improvement models within managerial finance. An understanding of throughput and the theory of constraints have inevitably changed managerial finance and changed its direction from costing to focus on end business goals. Bibliography Goldratt, E. M., and Cox J., (1994) The goal: a process of continuous improvement, 2nd Revised Edition. The North River Press, 337pp. Caspari, J. A., and Caspari, P., (2004) Management Dynamics: merging constraints accounting to drive improvement. John Wiley Sons Inc., 327pp. Corbett, T., (1998) Throughput Accounting: TOC’s management accounting system. North River Press, 174pp. Goldratt, E. M., (1994) It’s not luck. The North River Press, 283pp. â€Å"The Haystack Syndrome, by Eli Godratt, published in 1990 by North River Press, McMullen, T. B. C., (1998) Introduction to the theory of constraints (TOC) management system. St. Lucie Press, 320pp. Noreen, E., Smith, D., and Mackey J. T., (1995) The theory of constraints and its implications for management accounting. The North River Press, 187pp. Nursing shortages: Effect of patient care Nursing shortages: Effect of patient care Do nursing shortages affect patient care within an acute setting? Abstract The nurse is one of the most important components of the health care hierarchy in that they see to the moment to moment care needs of patients after the doctor has performed his diagnosis and or services. Their responsibilities broach a wide spectrum of services with one of the most important being the administration of acute care. This type of care is one rung below critical care, however it is just as important in the recovery of a patient. The decline in nursing graduates over the past ten years coupled with the aging of populations, both in the United Kingdom as well as globally, has created a crisis in the health services industry whereby the number of patients per nurse has increased to unmanageable proportions. The United Kingdom’s National Health Service has been importing skilled ‘Registered Nurses’ for decades to fill the shortfall in developing nursing professionals and along with Ireland they are the most dependent of developed countries in filling this void through importation. This practice fails to address the problem in the United Kingdom of training and maintaining nurses to meet demands. The aging of the population, whereby the number of individuals entering the age categories require additional serious medical care has grown disproportionate to the number of nursing staff members entering the profession which further exacerbates the problem. The importance of qualified nurses in an acute care setting is a prime example of how this shortage is affecting hospitals in that many have or are scaling back in response to this problem due to the quality of care as well as legal liability issues. Chapter 1   Introduction Understanding acute care from a clinical perspective means that one is approaching the question in an objective and analytical manner.  This perspective dictates that an understanding of the historical contexts leading to the present state of the nursing shortages in the acute care setting need to be examined to provide a perspective on the problem as well as potential solutions. And while the United Kingdom is the focus for the examination of the question â€Å"Do nursing shortages affect patient care within an acute setting?† with the exception of the importation of nurses as a historical solution, the foundational issues are almost identical in Canada, France, the United States and other industrialized nations. One common denominator that is at the root of the global nursing shortage is the growth in the percentage of people entering or at the age 60 years. As individuals age the onset of maladies, as well as the need for health care, increases dramatically. In 1900 the percentage of the world’s population above the age of 60 stood at 6.9%, by the year 2000 this had risen to 10% and is projected to climb to 22.1% by 2050. And while the preceding figure for the year 2000 on a global basis does not on the surface seem to be staggering, when one factors in that the number of people has increased from 2.7 billion in 1950 to 6 billon by the year 2000 and is projected to rise to 9.3 billion by 2050 this point takes on more meaning. More telling is that by 1999 37% of Europe’s population was 60 years of age or older, with this figure expected to reach 47% by 2050. The preceding increase in patients where acute care is more of a potential has put tremendous pressures on hospitals and nursing staffs as the proportion of nurse to patient ratios have increased. Medical technologies and advances have seen a number of formerly fatal illnesses curtailed by surgical techniques. These breakthroughs have meant that there has been an increase in the number of patients thus requiring acute care, as well as an increase in the technical skill and expertise required by nurses in this health care segment to see to the demands of patients who have undergone such techniques and or treatment. And while the number of nurses qualified in acute care has actually risen by 21% (35,541) during the period 1999 (165,643) to 2003 (201,184), the rate of increase has not keep pace with the acute care increase required by patients as a result of expanded acute care instances as indicated by the aforementioned improvements in technology, surgical procedures and increased sur vivability. Other factors are also acting upon the shortage of qualified nurses in acute care, aging. The specialized skills, experience and training it takes for an acute care nurse precludes this segment from receiving the immediate benefits of increased enrollments in the nursing field. The implications of the nursing shortage become clearer when the age of nurses is factored in. There are 100,000 nurses who are 55 or older as well as an additional 75,000 between the ages of 50 to 54, these nurses on average do not work full time.  When these numbers are brought into perspective by the total headcount of nurses in the NHS (450,000 as of 2003)  the shortages become more telling. And while acute care represents a segment of health care for which a patient receives treatment for immediate and/or severe (termed acute) episodes of illness as well as injuries or trauma such as surgery.  The importance and seriousness of this care means that it is usually performed at a hospital by specialized individuals who use sophisticated as well as complex equipment and materials. The difference between acute care and chronic care is that it is (acute care) usually required for only short periods of time, however this does not belie the quality, expertise and importance of such care. Acute care patients usually come from the Intensive Care Unit (ICU) after their condition has been upgraded thus permitting the move. Patients in acute care are still subject to relapses and other reversals after leaving ICU or critical care. Acute care is usually the final phase where the hospital watches the patient prior to either home release or observation in a general ward. While the intensity of observation, in terms of the propensity for a relapse, is not as great as in ICU or critical care the likely of an occurrence and or other complications is potentially there thus the reason for the existence of this unit. Nurses as a rule usually oversee several patients at once and are distinctly familiar with their case histories as well as what conditions or symptoms to look for. There are instances where patients are admitted to acute care directly from surgery or after treatment in the emergency room. The doctor in charge of the patient entrusts the acute care nurse with the history of the patients and conditions to be mindful of in watching the patient’s progress as well as providing parameters that will determine their readiness for release. Acute care program components can consist of or include specialized diet, liquids, exercise, therapy as well as visits from the immediate family and other activities as prescribed by the physician.  The exis tence of acute care helps to reduce the potential for liability on the part of the hospital whereby releasing them too soon might open them to malpractice or other forms of litigation if a reversal of the patients condition can be tied to them being released too early or without proper follow up. The monitoring of patients in the acute care setting permits nurses to record and observe their progress as well as reactions to the prescribed treatment and report these findings to the physician so that the program can either be continued or amended as required. In addition, the existing patient recovery plan for when they are released is either confirmed or amended within the hospital setting via observation and monitoring of the patient’s progress. The acute care nurse can also familiarize the patient as well as family with the prescribed routine and medication, correct dosage, exercise, diet plan(s) which the patient needs to follow after their release thereby helping to ensure a higher level of permanent recovery and lessening of potential complications. Changes in the health care industry as a result of improved treatment, surgery techniques, medication and other advances has modified the medical landscape. The shortage of acute care nurses, which is a specialized discipline, increases the potential for mistakes in observation and monitoring techniques brought about from having too many patients being assigned to the nursing staff in this department. The importance of the acute care nurse in assisting the physician in determining the extent of patient recovery as well as reaction to the prescribed after care medication, dosage, diet, exercise or other programs is extremely important in terms of the eventual patient release. Their importance as a critical component of the health care industry can not be overstated. Acute care can encompass the monitoring of cardiac surgery and telemetry, ENT, neurology, oncology, neurosurgery, orthopedics, clinical trial study observation, trauma and other areas. Chapter 2   Literature Review The contemporary nature of the question â€Å"Do nursing shortages affect patient care within an acute setting?† has resulted in a plethora of journal articles and reports that have and are examining the problem. The foundation of the shortage of acute care nurses is rooted in the their overall decline contrasted to the rise in the general population as well as the increase in the age group of individuals over the age of 60. As a result of these varied parameters direct articles and materials solely focusing upon the shortage of acute care nurses and the correlation of how this has or is affecting patient care in that setting is contained in varied literature rather than in singular sources. The reliance of the United Kingdom on the importation of nurses to resolve its problem in staffing shortages is a wide reaching problem which affects all levels of service throughout the country. As such, literature, materials and articles tend to look at and deal with the broader spectrum rather than singular concentration on one dimension, such as acute care. The following review of materials will focus upon this aspect however it shall also bring into focus other factors which impact upon this area as well. RCN 2003 Staffing Snapshot Survey This report was utilized as the starting point as it provides general as well as specific data on the state of nursing and patient levels in the United Kingdom. More importantly the survey involved questionnaires sent to stewards in 232 acute care departments throughout the United Kingdom. Data was collected from both the general medical as well as general surgical wards and the corresponding data is based upon 76 responses. The study uncovered that: 50% of the wards surveyed indicated that RN (Registered Nurse) staffing was inadequate to meet demand and that the â€Å"†¦skill mix†¦Ã¢â‚¬  composition was incorrect. Skill mix refers to the expertise background of the nurses on duty thus providing for a cross section of differing disciplines whereby the experience and training background provides for nurse expertise to meet the demands of patient needs. It also uncovered that approximately 10% of the staff consisted of bank and agency personnel covering for regular staff who were either out sick, on leave, or as a result of shortages. The survey indicated that in one third of the wards the staffing levels did not meet the scheduled personnel number as a result of the inability to obtain either bank or agency coverage. The short staffing and skill mix problems were reported as foundations that increased both stress and the workloads for the nurses on duty and that these factors compromised patient care as well as affected morale. Item 4 addresses the core of the problem by stating that compromised patient care is a problem caused by nursing shortages and skill mix. The preceding is borne out by the following survey statistics: Table 1 – Skill Mix Problem Survey Results   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Frequency  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   % Cases  Ã‚   Stress  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  13  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   36  Ã‚   Low Moral  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã ‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   10  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   28  Ã‚   Compromised Care  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   8  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  22  Ã‚   Poor Management of Care  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   5  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   14  Ã‚   Issues in Supervision  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   5  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   14  Ã‚   Junior Staff Work Exceeded Roles  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   5  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   14  Ã‚   Unregistered Staff Performing RN Work  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   4  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   11  Ã‚   RN Performing Too Much HCA Work  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   4  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   11  Ã‚   Staff Retention  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã ‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   4  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   11  Ã‚   Limited Trained and Teaching  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   3  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   8  Ã‚   Not Enough E Grades  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  2  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   6  Ã‚   More RN’s Needed for Acutely Ill Patients  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   2  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   6  Ã‚   Staff Shortages Affecting Discharge Planning  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   1  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   3 The findings point to the shortage of qualified nurses as having a detrimental effect on the quality of care rendered in the acute care unit. The following chart devolves further into the negative impact of staffing in this area. Table 2 – Effect of Insufficient Registered Nurses on Staff   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Frequency  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   % Cases  Ã‚   Stress  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   22  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  55  Ã‚   Not Meeting Patient Needs  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   19  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   48  Ã‚   Lower Morale  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   16  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   40  Ã‚   Workload too Heavy  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  12  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   30  Ã‚   Staff Retention  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   3  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   8  Ã‚   Poor Quality of Care Management  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   3  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  8  Ã‚   Ward Manager Case Load to High  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   3  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   8  Ã‚   Supervision  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   2  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   5  Ã‚   Unsafe  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  1  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   3  Ã‚   Increased Incidents of Sickness  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   1  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   3  Ã‚   Inadequate Time for Training / Teaching  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚        Ã‚  Ã‚  1  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   3 The preceding survey responses point to staffing shortages as a serious problem. Low morale, retention, inadequate time for training and supervision as well as not enough RN’s available for duty or shift coverage and the other points clearly indicate this, and this is compounded even more in a Unit, acute care, where patient monitoring and supervision can directly affect their recovery as well as stave off additional problems or relapse. The problem of RN shortages is illustrated by the following: Table 3 – Average Number of Patients per Acute Care Staff Member on Duty   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   All Wards  Ã‚   Medical  Ã‚  Ã‚   Surgical   Ã‚   Early  Ã‚  Ã‚  Ã‚   Patients: RN’s  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   7.6  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   8.3  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   7.0  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Patients: Staff  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   4.6  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   4.6  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   4.5   Ã‚   Late  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Patients: RN’s  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  10.7  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   11  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   9.2  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Patients: Staff  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   6.3  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   6.6  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   6.6 Further evidence of the problem of staffing shortage is shown by ward attendance figures. Table 4 – Reasons Why The Number of Staff on Duty is Less Than Planned   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Frequency  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   % Cases   Ã‚   Sickness  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   25  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   78  Ã‚   Bank and Agency Staff not available  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   9  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   28  Ã‚   Vacancies / Staff shortages  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   5  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   16  Ã‚   Study leave  Ã‚  Ã‚  Ã ‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  3  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   9  Ã‚   Staff on escort  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   1  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   3 All of the preceding data indicates that regardless of how creative the management of staff is conducted, shortages are consistent due to there not being enough personnel to begin with. These figures reveal that: Wards are consistently at approximately 4/5’s of the optimum for registered nurses which means that there is a serious problem concerning the accurate diagnosis of problems which can occur at any time as a result of a patient relapse or the need for a critical decision on patient care to be made. The ongoing deficit in full staff numbers creates pressures for the staff to address this problem with no relief thus adding to job stress and the corresponding propensity for potential error(s). Staffing levels have remaining basically unchanged from 1999 levels which is behind the patient curve. With an average bed occupancy rate of 98% the indicated staffing shortages are problems that need to be addressed immediately. The increased number of the population in the United Kingdom over the age of 60, coupled with the percentages of nurses nearing retirement age, means that the problem of nursing shortages is actually critical given the fact that replacements need to be trained for the retiring experienced nurses, staffing levels also need to be increased to compensate for the rise in patient incidences. NHS Statistical Studies The Department of Health maintains and conducts ongoing research and statistical studies concerning all facets of health care. Their studies provide detailed factual information on the shortages in the acute care units which support the information reported in the ‘RCN Staffing Snapshot Survey†. The following are statistics for Vacancy Rates in the Acute Care units for 1999 through 2002: Table 5 Acute Care Vacancy Rates 1999 through 2002   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   England  Ã‚   Trent  Ã‚   N. West  Ã‚   London  Ã‚   S. East  Ã‚   S. West  Ã‚   Acute, Elderly   Ã‚  Ã‚  Ã‚  Ã‚   General Care  Ã‚  Ã‚  Ã‚  Ã‚   1999  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   3.6%  Ã‚  Ã‚  Ã‚  Ã‚   1.3%  Ã‚  Ã‚  Ã‚   2.2%  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   6.3%  Ã‚  Ã‚  Ã‚  Ã‚   5.0%  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   1.7%  Ã‚  Ã‚  Ã‚  Ã‚   2000  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   4.6%  Ã‚  Ã‚  Ã‚  Ã‚   2.4%  Ã‚  Ã‚  Ã‚   2.0%  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   8.2%  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   6.1%  Ã‚  Ã‚  Ã‚  Ã‚   3.1%  Ã‚  Ã‚  Ã‚  Ã‚   2001  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  3.7%  Ã‚  Ã‚  Ã‚  Ã‚   2.2%  Ã‚  Ã‚  Ã‚   3.2%  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   5.8%  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   4.9%  Ã‚  Ã‚  Ã‚  Ã‚   2.4%  Ã‚  Ã‚  Ã‚  Ã‚   2002  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   3.2%  Ã‚  Ã‚  Ã‚  Ã‚   2.2%  Ã‚  Ã‚  Ã‚   2.6%  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   5.8%  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   4.0%  Ã‚  Ã‚  Ã‚  Ã‚   2.1%  Ã‚   On the surface, the vacancy rates have remained relatively steady throughout the four-year period. The figures also show that management has decreased high vacancy rate figures that occurred in 2000. The numbers also reveal that while they are holding steady at a consistent rate of vacancy, the increase in the age of the population is the variable which renders a status quo policy as unworkable. The NHS, mindful of nurse shortage problems, temporarily rectified the situation in 2001 via a large influx of foreign nurses to temporarily plug this gap. The policy resulted in a 7.1% increase over a 12 month period for a total of 29,119 nurses imported from locales such as the Philippines (13,750), India (2,459), Nigeria (2,065 and South Africa (2,056) as well as other countries. The nurses underwent courses which lasted between six to nine months to prepare them for their assignments in British hospitals. The Department of Health indicated that while the preceding measures did help to alleviate staff shortages, at the same time attempts at â€Å"†¦expanding the workforce †¦Ã¢â‚¬  through increased training was also part of the overall planning program. The NHS plan to increase nurses by 20,000 over a five-year period, as announced in March of 2001, is in response to the indicated problem as well as concerning those nurses who would be either retiring or quitting. Another area that the NHS addressed is the â€Å"†¦drop-out rates†¦Ã¢â‚¬  which registered 13% for 2001 with some courses showing rates as high as 40%.   The NHS Statistical Studies provided confirmation that the shortages in all areas, as well as acute care, are critical. Conference Paper: Hospital staffing, organization, and quality of care: cross national findings This study examined acute care hospitals in the state of Pennsylvania in the United States, the provinces of Ontario and British Columbia in Canada, Scotland and the United Kingdom encompassed 10,319 nurses in 303 facilities. The ‘Paper’ provided a circumspect review and update of modern hospital and medical procedures as well as technologies stating that because of these advances less invasive procedures in surgery and inpatient care has been significantly been reduced, but the ability to service people on a faster basis has created excess inpatient capacity. The new procedures and advances in medical as well as surgery have increased the requirement for more sophisticated staffing to deal with these areas. As a result the internal structures and management methodologies in hospital administration necessarily had to change as well. It was found that a study of hospitals conducted in 1982 revealed that 41 had higher rates of retaining personnel as well as attracting qual ified staffing when compared against other institutions with higher vacancy and turnover rates. The sample hospitals all had some common similarities that were deemed as contributing to their success: a flat organizational structure, decentralized decision structure by bedside caregivers, chief nurse included in management decision process, flexible scheduling of nurses, self governance of units continued education and training of nurses in new procedures and treatments more nurse autonomy in bedside practice and better physician relationships, The preceding broader considerations with respect to hospital management also have direct implications with respect to acute care units. The study found that when the organizational structure is conductive to staffing interaction as well as prompting ease of communication and new instructions, higher care levels are attained. The study also uncovered that when the nurse to patient ratios as well as skill mix are optimum, the organization structure determines how quickly changes and other informational feedback can be implemented. The preceding is particularly critical in units such as acute care as well as ICU. A study on this point was conducted at 20 hospitals in the United States to either confirm or disprove the 1982 findings utilizing AIDS patients as the selection field. The study encompassed three differing organization formats: dedicated AIDS units, magnet institutions that did not utilize dedicated AIDS units, and non-magnet hospitals with a conventional organizational structure whereby the AIDS patients were dispersed throughout the institution. It was determined that the probability of patients dying from AIDS within a 30 day period after admission was significantly lower in magnet hospitals and institutions with dedicated AIDS units than non-magnet hospitals. The similarity between the two types included the following: nurses had more autonomy, as well as greater degrees of control and better relations with physicians, increased nurse staffing reflecting a lower nurse to patient ratio, organizational support by administrators resulted in a higher degree of patient satisfaction, nurse burnout was significantly lower. The core elements identified included staffing adequacy as well as strong management support in terms of decisions reached by nurses. The preceding clearly point to the institutions having a higher level of confidence in the abilities and decisions of their nurses as well as an environment which supported and contributed to the foregoing as evidenced by continued training and representation by a registered nurse in top management. Simply put, the nurses were held in higher regard, thus reducing their frustrations in having a contribution as well as voice within the system with a communication structure that provides feedback and a faster turnaround time concerning their recommendations. 2.4 More nurses, working differently? A review of the UK nursing labour market 2002 to 2003As shown in prior materials, the question of the number of nurses relative to the number of patients in the acute care setting has more to do than simply ratios, it includes factors such as: the organizational structure, nurse representation in top management, nurse autonomy and inclusion in decision making processes, improved nurse – physician relationships and interaction, a flat organizational structure, decentralized decision structure by bedside caregivers, flexible scheduling of nurses, self governance of units continued education and training of nurses in new procedures and treatments The national crisis created by the shortage of nurses has prompted the NHS to examine the method via which the entire health structure operates with the understanding that simply increasing the number of nurses might not necessarily result in improved services or increased competency. The NHS also wanted to determine if â€Å"working differently†, when the â€Å"†¦right number and mix of staff †¦Ã¢â‚¬  are in place might yield increased results in terms of patient recovery, satisfaction and services. The report did indicate that the United Kingdom has a lower ratio of physicians and nurses per population than a number of comparative countries and that the system might yield additional gains in service aspects through increased health care assistants (HCA’s) as well as more nurses with advanced skills. It was also identified that the relative pay structure needed exanimation to provide a clearer career and goal attainment structure for personnel as another me ans to increasing the nurse and HCA numbers. The determining factors were that resources need to be utilized more effectively in addition to just increasing staffing numbers if long term gains are to be achieved through all unit disciplines (which includes acute care). One positive factor noted in the report is that the United Kingdom is reaping higher rates of nurse staffing than either Scotland or Northern Ireland, but it also goes on to add that the shortage of staffing is still a critical problem due to the higher number of experienced nurses at or near retirement age (175,000). Table 6 – Percentage of Change in NHSNursing and Midwife Staffing Between 1999 and 2002   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   1999  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   2002  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   % Change  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  1999 2002  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   United Kingdom  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   250,651  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   279,287  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã ‚  Ã‚   11%  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Scotland  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   35,494  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   37,216  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   5%  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Wales  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   17,397  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   18,766  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   8%  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   N. Ireland  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   11,207  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   11,934  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   6% During this same period, the number of qualified nurses in acute care increased by 13%, the highest overall gain in the indicated categories for active care, however, the aforementioned total of nurses nearing retirement age (175,000) belies these gains. Table 7 – Numerical Change in Qualified Nurses by Specialty 1999 and 2002   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   1999  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   2002  Ã‚  Ã‚  Ã‚  Ã‚   Numerical Change  Ã‚  Ã‚  Ã‚  Ã‚   % Change  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   1999  Ã‚  Ã‚  Ã‚   2002  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     1999  Ã‚  Ã‚  Ã‚   2002  Ã‚  Ã‚  Ã‚  Ã‚   Acute, Elderly General  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   165,643  Ã‚  Ã‚   187,439  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   +21796  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   +13%Paediatric  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   16,689  Ã‚  Ã‚  Ã‚  Ã‚   18,014  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   +1325  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   +8%Maternity  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   29,258  Ã‚  Ã‚  Ã‚  Ã‚   29,524  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   266  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   -0.9%Psychiatry  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   38,999  Ã‚  Ã‚  Ã‚  Ã‚   42,654  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   +3655  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   +9%Learning Disabilities  Ã‚  Ã‚  Ã ‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  9,923  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   9,550  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   -373  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   -3%Community Services  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   48,972  Ã‚  Ã‚  Ã‚  Ã‚   53,814  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   +4842  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   +10%Education Staff  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   658  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   995  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   +337  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  +51%TOTAL QUALIFIED  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   310,142  Ã‚  Ã‚   346,537  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   + 36395  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   +12% Given the number of nurses nearing retirement age as well as increased staffing demands, the NHS has determined that the gains from improved operational efficiencies will not be significant enough to increase the nurse patient ratios in any appreciable numbers. The study concluded that the importation of nurses as a staffing methodology will have to be maintained until internal enrollments and retention rates have advanced to the point where importation numbers can be reduced. 2.5 Fragile Future? A review of the UK nursing labour market in 2003The Royal College of Nursing has undertaken a program of consistent research as well as statistical analysis of the state of the nursing workforce in the United Kingdom to evaluate how policies are affecting the known shortages as well as the delivery of services across the broad spectrum of care being provided. Government policy has been to improve staffing numbers through the expansion and improvement of NHS services utilizing increases in funding on a significant basis. The understanding of the broad implications of the long standing shortages of nurses in the United Kingdom has drawn the concern of the appropriate governmental departments and agencies resulting in efforts to define where the problems lie as well as solutions to provide immediate, intermediate and long term solutions rather than temporary patches. This report confirmed that there is significant evidence â€Å"†¦ between low staffing levels in nursing and a range of negat