Personality analysis - Carlos Ghosn free essay sample

1. Depict Carlos Ghosn utilizing the â€Å"Big Five† components of character †¢ Extraversion mirrors the inclination to encounter positive passionate states and like oneself and one's general surroundings. His own style is energetic and direct, however not without warmth. He accepts each open door to impart his vision and need. He additionally goes legitimately to the people.He tends to the whole organization all the time. Wherever he goes he tries to converse with Nissan workers at all levels, regularly in little gatherings. He likewise consumes significant exertion to interface with general society. He knows about imparting his vision to the organization and make them feeling genuine piece of it †¢ Agreeableness is the propensity to coexist well with others and participates. Ghosn is agreeable to straightforwardly discussing significant issues, giving everybody the likelihood to talk about and present his perspective He holds a solid lucidity of vision and capacity to impart all through the association. We will compose a custom exposition test on Character investigation Carlos Ghosn or then again any comparative point explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page His messages are clear, direct, and basic. His need is clear. He has faith in giving his administrators exact and quantifiable goals Motivation is his definitive weapon. His administration style is enlivened by this. He is exceptionally requesting about execution, requesting on himself, and extremely requesting of the individuals around him. His tought is:† To have the option to be requesting, you need to engage individuals. You cannot be requesting of somebody who isnt engaged, it isnt fair† He is happy to tune in to the pundits, yet without planning to prevalence at any expense †¢ Conscientiousness is identified with the degree to which an individual is cautious, trustworthy, and saving. Ghosn stresses activity, speed, and results. He follows up intently. On the off chance that there are any deviations he follows them right away. He is persevering in following up. Ghosn thinks the most critical to create stunning outcomes is to show clear objectives and methodology, engage individuals, watch the outcomes cautiously and watch out for the truth †¢ Emotional Stability intends to be genuinely and truly unsurprising and not promptly moved. Individuals that are sincerely steady can endure the everyday strains and worries by not getting genuinely annoyed, on edge or irate. Ghosn had the option to confront the everyday pressure, and did well even in troublesome circumstances: for instance as wh en propelling a three-year plan for expanding Renault’s proficiency, in a deadened market and a nearby disapproved of setting, confronting social clashes, as the French were notâ willing to acknowledge change. An other troublesome circumstance where he showed to have a compelling passionate security was as ‘cost killer’ for Nissan. He went directly to his objective, daring about a certainly not famous errand Openness to Experience: mirrors the degree to which an individual is unique, has wide interests, and is eager to face challenges. Ghosn credits his prosperity to the way that he works through cross-utilitarian groups. He believes that when individuals from various foundations cooperate under tension they think of progressively innovative arrangements . â€Å"What is diverse is the main way we can develop by going up against ourselves† he says He is likewise ready to face challenges, as he exhibit being the primary official to attempt to run two major carmakers on the double. A major test

Julius Caesar Comparsion :: essays research papers

A considerable lot of the issues that Julius Caesar looked during his standard are still issues that the world despite everything faces today. In William Shakespeare’s Julius Caesar the issues are unmistakably clear. The principle issue is the acquire doubt in individuals of government that is brought about by precarious governments.      One connection between the PRI in Mexico and the Government of J.C. is that the individuals may believe that they are running the administration yet they really are definitely not. For instance in Mexico the PRI delegates each political workplaces and selections. A similar occasion occurred in J.C. Brutus didn't care for the way J.C. was administering things and was anxious about the possibility that that he was going to take the crown. Brutus and some different companions planed a trick and killed J.C. That attaches in to Mexico’s issue in light of the fact that the individuals like having J.C. managing yet Brutus couldn't have cared less about the individuals. That is happing in Mexico too the PRI is simply watching out to assist them self’s they don’t care about the well charge of the individuals. One other relationship is that Brutus depicts the PRI such that the PRI couldn't care less about the manner in which the legislature is working at this point. Brutus will flip around it I one moment to attempt to make it they way he want’s. At the point when Brutus slaughtered Caesar it disordered the administration until the war over and Mark Anthony dominated. At the point when a nation has a common war it makes a genuine vonerable time for the nation, when Mark Anthony and Brutus split up the Roman Empire for a common war it left Rome amazingly exposed. Any enormous district could smell devastation over Rome which simply had there most loved pioneer killed by a confided when all is said in done with a ton of respect. A similar occasion is happing right now in Mexico the peso is dropping each day and for as long as twenty years the president has promising that they will quit being an underdeveloped nation. As should be obvious having trust in a pioneer is fundamental to the prosperity of a district, do you think if the residents realized that there president would not get them out of being a third world province they would have picked them. Obviously not, however Mexico likewise has some different issues like debasement a great deal of the political stuff that occurs in Mexico is under the table.

Coca Colas Brand

Coca Colas Brand Coca Colas Brand Home›Marketing Posts›Coca Colas Brand Marketing PostsCoca cola’s brand policy is crucial for the success of the company. The proof is that Coca Cola had became the worlds most valuable  brand. Coca Cola manages a brand of more 3500 products in over 200 countries such as diet beverages, fruit juices, energy drinks, teas, coffees, milk…(coca cola company, products, 2011). Coca Cola ‘s brand portfolio includes brands such as   Coca-Cola, Diet Coke, Coke Zero, Coke Classic, Sprite, Fanta, Dasani, Powerade, Minute Maid already marketed successfully on the market, but, in addition, the company is always involved in enhancing its brand portfolio by developing new products. A balanced product offering- they constantly expand the range of product brands and flavours offered to their consumers and customers across he growing non-alcoholic beverage categories in order to respond to new tastes and preferences. By broadening their product brands portfolio, they are off ering their consumers more choices than before. By the end of 2010, their water and still beverages was approximately 36% of their total volume, with more than 30 water brands in their portfolio.Expanding consumer choice with innovation-Coca Cola prides itself on thinking   ‘outside the bottle’ by often considering new strategies to broaden their beverage portfolio of brands through packaging and brand innovation.They are present in every occasion of consumption, with the correct brand, in the best package across all sale channels. Nutritional labeling information-in 2007, they began introducing labels in the EU member states in order to help customers understand the content of calories in beverages. New packaging solutions-they continue to broaden their brands offering to address  by making the product more accessible and that it always meet the ever changing consumer needs for instance by introducing new package forms. As an extreme example, one of the extensions, Cherry Coke , was successful despite a near absence of advertising support (Pitta, D., Katsani, L., 1995).Cola has been aiming to market a new products by exploiting a well-developed image by introducing new products such as Diet Coke, Caffeine-Free Coca-Cola,  Coca-Cola Cherry,  Coca-Cola Zero,  Coca-Cola Vanilla. Recent history shows that more than half of the new brands marketed during the 1980s were extensions of existing products, marketed under existing brand names. The most famous of these is Diet Coke, which is a major diet cola. Other Coke products are Caffeine free Coke, Cherry Coke, Coke ZERO, etc. On the other hand, Coca Cola has been marketing new product under new names.   They are given their own brand names such as Fanta, Sprite, Schweppes, etc. By analyzing Coca Cola’s brand portfolio it can be seen that Coca-Cola is an example of a hybrid brand architectureLooking closely at the Diet Coke drinkers,they would acknowledge the fact that the product is related to Coca-Cola, but to them it is not a sub-brand, it is their brand. Where some brands benefit from association with the Coca-cola brands, whereas others are driver brands on their own. In fact Coca-Cola set up different brand strategies in different products by using a Hybrid brand strategy in cola drinks that are under the Coke brand name.Coca-Cola Company deploys various techniques to acquire a considerable market share in the beverage industry. Development and expansion of the company is vested on various policies introduced to enhance its marketing prowess as well as meet respective customer preferences in the globe. The Branding architecture of the company has played a pivotal role in enhancing development and market maximization. Coca-Cola Company deploys hybrid mode of system through wishing the name Cola to one of its brands in the globe. Also, the company has been in front in producing other brands in different regions in the society aimed at enhancing its market share globally through diver sity brand system (Benedetto, 1999).

Excellence and the Fulfillment of Ones Purpose is the...

An ancient philosophy of classical Greece, in its most basic sense, Arete means â€Å"excellence of any kind†, but more specifically to the culture of the period in which it originated meant â€Å"the notion of excellence and the fulfillment of one’s purpose and/or function: in other words, the act of living up to ones full potential†. Example: Aeneas, from the Aeneid, is an example of someone who possesses the foundational aspects of the Arete philosophy. As a Trojan leader, Aeneas respects prophecy and attempts to incorporate the idea of his own destiny into his actions, in spite of emotional impulses that conflict with his fated duties. His ability to accept his destined path despite his unhappiness in doing so makes him a graceful hero and a worthy recipient of the honor and favor the gods bestow upon him. His compassion for the sufferings of others, even in conjunction with a single-minded devotion to his duty, is another aspect of his heroism. Sympathetic to the weariness of others on the journey, he delivers speeches to his fleet to keep the men’s spirits high. Aristeia* A scene in the rhetorical devices of epic poetry where a hero in battle has his most excellent and glorified points. Aristeia can be the effect of the loss of life for the protagonist. Example 1: Book 5 of the Iliad is an example of aristeia, in which Diomedes prays to Athena for revenge, and the goddess endows him with superhuman strength and the extraordinary power to discern gods on the field ofShow MoreRelatedSustainability : The Moral Dilemma2065 Words   |  9 Pagesspecial obligations for the well-being of our current society. Obligations that take priority over the needs of those yet to be. These conflicting ideas bring forth the ever important ethical question for the modern engineer: in order to fulfill our purpose for the public, should we design predominantly for future needs at the expense of the present? As an engineer, my objective is to plan, design, and construct for the good of the public. I see this as a personal responsibility, and because of thisRead More Aristotelian Ethics and its Context Essay6933 Words   |  28 Pagesproposition: that ethics (in the classical sense) (1) requires politics as the venue of its implementation; indeed, that ethics in a fundamental sense is politics. Ethics is politics inasmuch as the achievement of human happiness—the activity of the soul in accordance with excellence, lasting a lifetime—is public, both in that the achievement requires the presence of co-equals as the condition of its emergence, and in the sense that the excellence achieved (ones character) is publicly recognizableRead MoreBanking Concepts and Practices39548 Words   |  159 Pagesit and in the mean time they lend it to others to ‘gain’ some returns. †¢ According to Kent, â€Å"bank is an organization whose principal operations are concerned with the accumulation of the temporarily idle money of the general public for the purpose of advancing to others for expenditure.† †¢ According to Crowther, â€Å"bank is one that collects money from those who have it to spare or who are saving it out of their incomes and lends the money so collected to those who require it.† †¢ AccordingRead MoreLibrary Management204752 Words   |  820 Pages. 12 . 13 . . . . . . . 16 . . . . . . . 17 2—The Evolution of Management Thought . . . . . . . . . . . 19 Management in Ancient History . . . . . . . . . . . . . . . . . . . 20 The Effects of the Industrial Age on Management . . . . . 22 Classical Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Scientific Management Movement . . . . . . . . . . . . . . . . . 23 Bureaucratic School . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 vii viii Contents Read MoreManagement Course: Mba−10 General Management215330 Words   |  862 Pagestechnology value creation in companies. This key consists of leadership emphasis on the management principle that by digitizing a flawed process, all one does is enable that flawed process to operate faster. THE DRIVERS OF BUSINESS GROWTH: â€Å"GENERAL-PURPOSE† TECHNOLOGY AND SHAPING NEW MANAGEMENT The powerful results of the American business economy through the end of the 1990s continued to defy and fundamentally challenge many of the traditional approaches regarding how corporate growth and earnings

The Principle of Beneficence vs Patient Autonomy and Rights

Special Feature – Medical Ethics Essay Singapore Med J 2002 Vol 43(3) : 148-151 Deconstructing Paternalism – What Serves the Patient Best? N H S S Tan (This Essay won the Singapore Medical Association Ethics Essay Award (Non-medical Undergraduate Category) in 2001.) ABSTRACT On the motion that â€Å"medical paternalism serves the patient best†, this essay reviews current arguments on medical paternalism vs. patient autonomy. Citing medico-ethical texts and journals and selected real-life applications like electroconvulsive therapy (ECT) and the advanced medical directive (AMD), the essay argues that medical paternalism cannot serve the patient best insofar as current debates limit themselves to â€Å"who† wields the decision-making power. Such†¦show more content†¦Paternalists would claim that physicians have a â€Å"medical tradition to serve the patient’s well-being†, with the prerogative to preserve life and thus have the patient’s best interests at heart (Mappes and DeGrazia, 1996; p.52). Singapore Med J 2002 Vol 43(3) : 149 Far from paternalism understood as a dogmatic decision made by the physician, James Childress in his book â€Å"Who Shall Decide?† further expounds paternalism into multi-faceted dimensions. Pure paternalism intervenes on account of the welfare of a person, while impure paternalism intervenes because more than one person’s welfare is at stake. Restricted paternalism curbs a patient’s inherent tendencies and extended paternalism encompasses minimising risk in situations through restrictions. Positive paternalism promotes the patient’s good and negative paternalism seeks to prevent an existing harm. Soft paternalism appeals to the patient’s values and hard paternalism applies another’s value over the patient. Direct paternalism benefits the person who has been restricted and indirect paternalism benefits a person other than the one restricted. Whatever the case may be, the guiding principle of modern paternalism,† says Gary Weiss, â€Å" remains that the physician decides what is best for the patient and tries to follow that course of action† (1985; p.184). That the physician determines ‘what is best’ is questionable. The medical profession’s back-to-basicsShow MoreRelatedA Careful and Meaningful Consideration of my Journey in Nursing Ethics1614 Words   |  7 Pagesresort that showcases the function of reason and knowledge in understanding the complex nature of relationship that exist between the Healthcare System, the patient, and the Healthcare provider. For a safe and effective nursing practice, a proper knowledge and understanding of nursing code of ethics, the definitions, concepts and principles of all stakeholders need to be recognized. My journey in Nursing Ethics has provided me with an opportunity to think over some of my life and clinical practiceRead MoreThe Ama Code Of Medical Ethics1520 Words   |  7 Pagesis the backbone to honorable physician patient interactions. Unfortunately, throughout history there have been many cases where physicians have used a patient’s lower socioeconomic status to manipulate the obtaining of informed consent. The AMA Code of Medical Ethics predates back to 1847, yet cases continue to arise directly breaking their key principles. These principles include autonomy, justice, beneficence, non-maleficence; and if followed ensure patients receive a high quality of care. InformedRead MoreJohn Stuart Mill s Ethical Theory865 Words   |  4 Pagesinform a patient of an untreatable cancer, or to not inform. This case in my opinion has the most merit, and can be applied to Mill’s Utilitarian Ethical Theory, the Kantian ethical theory, as well as the Principle of Beneficence and the Principle of Respect for Autonomy in order to determine an appropriate response for the doctor to act upon. Utilitarianism is an idea generated by John Stuart Mill and encompasses the idea of Principle of Utility. The Principle states that acts are right when theyRead MoreEthical Issues Facing The Healthcare Industry905 Words   |  4 Pageshospice agencies specifically. In this program, I will reference ethical principles used today as well as reference historical ethicists and philosophers that backup the items outlined in this ethics program. There are two major topics to be discussed. The first will be how to treat patients that are at the end of their life, which includes their loved ones as well. A specific issue to be addressed in terms of patient care will be the option of doctor-assisted suicide, often called euthanasiaRead MoreThe Ethical Dilemma Of Artificial Nutrition And Hydration Essay1390 Words   |  6 Pagesartificial nutrition and hydration in terminally ill patient. Artificial nutrition is very important in terminal ill patients in their end stage of life. It is v ery helpful to provide nutrients and fluids to the patient who is unable to take it by himself. In palliative units, AHN help to enhance the comfort and quality of care of patient. The purpose of this paper is to narrate how ethical issues can become challenging for health professional, patient and their family members. In following paragraphRead MoreCommon Disorders Commonly Occur And Rare Ones Rarely Happen Essay1481 Words   |  6 Pagesof generalist physicians per 1 million people was 26% lower than the number of specialty physicians (Hing Schappert, September 2012). In addition to that statistic, patients visited their general practitioner 30% more annually than a specialty physician, and general practitioners spent 31 hours or more per week with their patients than specialty physicians, despite the fact that there are more specialty physicians than general physicians (Hing Schappert, September 2012). If the statement wereRead MorePrinciples Of Ethics : Respect For Autonomy, Beneficence, Non Maleficence And Justice1450 Words   |  6 Pageswhich should be the uttermost purpose and outcome of any treatment. Ethical Aspects There are four principles of ethics: Respect for autonomy, Beneficence, Non maleficence and Justice. This four principles offers comprehensive thought of the ethical issues in clinical settings (Beauchamp and Childress 2001 cited in UK Clinical ethics Network 2011). Respect for Autonomy Cambridge (2016) defines autonomy as the ability to make a decision without any influence from any individual. Similarly, it is theRead MoreEthical Aspects Of Organ Allocation1169 Words   |  5 Pageshow organs are dispersed to their recipients. It does not mean giving all patients the equivalent or saving only the sickest patient, but, instead, offers that uniform respect and apprehension be assumed to all patients. Medical utility means accomplishing the greatest net medical good overall and making the finest use of limited resources to be allocated. For example, there are several questions which ask about the patient, which are, is the child medically ready for transplant? Is the child tooRead MoreShould Vaccines Be Government Enforced?1584 Words   |  7 Pagesdefinition, run counter to every relevant set of medical ethics. Particularly the principles of Autonomy, beneficence, and nonmaleficence (AMA). Autonomy argues a patient obtain autonomy of thought, intention, and ac tion when making decisions in regard to medical procedures. Beneficence requires medical actions be performed for the good of the patient and others. Nonmaleficence requires that a procedure does not harm the patient involved or others in society (Pantilat). All three of these ethical practicesRead MorePregnancy Is The Best News For Individuals3563 Words   |  15 Pagesbloodline, or only the love for children make people want to have babies. When the first child comes, his or her arrival redefines people from a couple to a family. It bonds people for life in many inexplicable ways that are too big to be apparent right away after the birth. Most individuals, and couples want to plan the timing and spacing of their childbearing, and also want to avoid unintended pregnancies, for a range of social, economic and psychological reasons. Pregnancy is not always the best

Misconception of Gender Roles in Islam Free Essays

Misconception of gender roles occur in everyday aspect of life and religion is no exception to this case. Especially in the religion of Islam, current debates occur over gender roles. Although this monotheistic religion has been around for centuries, It wasn’t long ago that it became so prevalent in main stream media; especially since the occurrence of 9/11. We will write a custom essay sample on Misconception of Gender Roles in Islam or any similar topic only for you Order Now As much as this religion Is celebrated, it Is also highly scrutinized for the preconception of the role of man and woman. This Is all based upon the interpretations by Non-Muslims and Muslims alike, due to the fact that ultra biases conflict with actual teachings of Islam. Negative connotations have been made In regards to how women do not receive equal treatment and how men are treated like kings. Though many claim that Islam has monolinguals view points, this religion In fact has high Importance of women. It’s the truth that has to be reexamined to get Americans to reconsider their perception of Muslim women and their Important roles In Islam. To understand this debate over women’s role In Islam, one has to understand the religion Itself. The actual meaning of the word â€Å"Islam† according to Encyclopedia Britannica is an Arabic word that means submission to God. Specifically it is the act of compliance to one single God, which is why it is a monotheistic religion. This religion is carried out by their holy book called the â€Å"Curran†. The main objective of this religion is to live a full life through the teachings of Curran, rid one’s self of negative attributes such as Ego that pollutes the mind. This religion is meant to be practiced on a continual basis and that is why it incorporates domestic issues such as, how to dress, personal hygiene, what to eat, and civil issues such as marriage and divorce. Islam has survived through many centuries and remains to be the fastest growing religion in America to date. According to Time Magazine, by 2030 the global population is set to reach over 8 billion and 26. 4% of that population will be Muslim. One of the main problems in understanding Islam is due to the language barrier. Most of the important teachings are written in Arabic. Majority of the world does not speak this language. Therefore, it is up to the translation to decipher the teachings. Through translation meaning gets lost and is up to interpretation to understand what topics are presented. Interpretations are based off of opinions and are subjected too bias that develops with the interpreter. As a result, it is challenging to get an objective viewpoint to understand Islam. In addition, Immoral practices are administered within the religion of Islam because of cultural standards conflicting with the actual teachings. This makes it difficult for Muslims already part of the religion to understand the religion further, let alone the Non-Muslims who absolutely have no knowledge about the religion, that are basing their understanding off of bad sources. Such misconceptions result In people developing their criticisms of a religion that Is so far from the actual truth. In the religion Islam, both women and men are spiritually equal because they encompass a soul. The basic meaning behind that Is both partners have the same sense of hearing, speaking, breathing, touching, and assisting. They also have the ability to choose between what Is right or wrong. What separates a woman from a man is women’s capability to procreate. This is purely who do not follow a religion. There is nothing in the Curran verses that implement that men are superior to women. It is purely society’s misinterpretation of Islamic teachings that otherwise state the equality between a man and woman. It is social, economic, and biological aspects that differentiate the role of each gender, and thus a role of women should be civil to that of a man. How to cite Misconception of Gender Roles in Islam, Papers

Mine Essay Example For Students

Mine Essay In William Goldings Lord of the Flies, the boys who are stranded on the island come incontact with many unique elements that symbolize ideas or concepts. Through the use ofsymbols such as the beast, the pigs head, and even Piggys specs, Golding demonstratesthat humans, when liberated from societys rules and taboos, allow their natural capacityfor evil to dominate their existence. One of the most important and most obvious symbols in Lord of the Flies is the object thatgives the novel its name, the pigs head. Goldings description of the slaughtered animalshead on a spear is very graphic and even frightening. The pigs head is depicted asdim-eyed, grinning faintly, blood blackening between the teeth, and the obscene thingis covered with a black blob of flies that tickled under his nostrils (William Golding,Lord of the Flies, New York, Putnam Publishing Group, 1954, p. 137, 138). As a result ofthis detailed, striking image, the reader becomes aware of the great evil and darknessrepresent ed by the Lord of the Flies, and when Simon begins to converse with theseemingly inanimate, devil-like object, the source of that wickedness is revealed. Eventhough the conversation may be entirely a hallucination, Simon learns that the beast, whichhas long since frightened the other boys on the island, is not an external force. In fact, thehead of the slain pig tells him, Fancy thinking the beast was something you could huntand kill! You knew, didnt you? Im part of you? (p. 143). That is to say, the evil,epitomized by the pigs head, that is causing the boys island society to decline is thatwhich is inherently present within man. At the end of this scene, the immense evilrepresented by this powerful symbol can once again be seen as Simon faints after lookinginto the wide mouth of the pig and seeing blackness within, a blackness that spread (p. 144). Another of the most important symbols used to present the theme of the novel is the beast. In the imaginations of many of the boys, the beast is a tangible source of evil on the island. However, in reality, it represents the evil naturally present within everyone, which iscausing life on the island to deteriorate. Simon begins to realize this even before hisencounter with the Lord of the Flies, and during one argument over the existence of abeast, he attempts to share his insight with the others. Timidly, Simon tells them, Maybe,maybe there is a beast What I mean is maybe its only us (p. 89). In response toSimons statement, the other boys, who had once conducted their meetings with somesense of order, immediately begin to argue more fiercely. The crowd gives a wildwhoop when Jack rebukes Ralph, saying Bollocks to the rules! Were strong we hunt!If theres a beast, well hunt it down! Well close in and beat and beat and beat! (p. 91). Clearly, the boys fear of the beast and their ironic desire to kill it shows that the holdwhich societys rules once had over them has been loosened during the time they havespent without supervision on the island. The evil within the boys has more effect on their existence as they spend more time on theisland, isolated from the rest of society, and this decline is portrayed by Piggys specs. Throughout the novel, Piggy represents the civilization and the rules from which the boyshave been separated, and interestingly, as Piggy loses his ability to see, so do the otherboys lose their vision of that civilization. When the story begins, Piggy can see clearlywith both lenses of his spectacles intact, and the boys are still fairly civilized. For example,at one of their first meetings, the boys decide that they cant have everybody talking atonce and that they have to have Hands up like at school (p. 33). However, after sometime passes, the hunters become more concerned with slaughtering a pig than with beingrescued and returning to civilization. When they return from a successful hunt in the junglechanting Kill the pig. Cut her throat. Spill her blood, Ralph and Piggy attempt to explainto the hunters that having meat for their meals is not as important as keeping the signal fireburning (p. 69). In an ensuing scuffle, Jack knocks Piggy specs from his face, smashingone of the le nses against the mountain rocks and greatly impairing his vision. Finally, afterJack forms his own tribe of savages, he and two of his followers ambush Ralph, Piggy,and Samneric, and in the midst of a vicious snarling in the mouth of the shelter and theplunge and thump of living things, Piggys specs are stolen, leaving him virtually blind (p. .uc388d16181685e7e3963f91c100f271e , .uc388d16181685e7e3963f91c100f271e .postImageUrl , .uc388d16181685e7e3963f91c100f271e .centered-text-area { min-height: 80px; position: relative; } .uc388d16181685e7e3963f91c100f271e , .uc388d16181685e7e3963f91c100f271e:hover , .uc388d16181685e7e3963f91c100f271e:visited , .uc388d16181685e7e3963f91c100f271e:active { border:0!important; } .uc388d16181685e7e3963f91c100f271e .clearfix:after { content: ""; display: table; clear: both; } .uc388d16181685e7e3963f91c100f271e { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .uc388d16181685e7e3963f91c100f271e:active , .uc388d16181685e7e3963f91c100f271e:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .uc388d16181685e7e3963f91c100f271e .centered-text-area { width: 100%; position: relative ; } .uc388d16181685e7e3963f91c100f271e .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .uc388d16181685e7e3963f91c100f271e .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .uc388d16181685e7e3963f91c100f271e .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .uc388d16181685e7e3963f91c100f271e:hover .ctaButton { background-color: #34495E!important; } .uc388d16181685e7e3963f91c100f271e .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .uc388d16181685e7e3963f91c100f271e .uc388d16181685e7e3963f91c100f271e-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .uc388d16181685e7e3963f91c100f271e:after { content: ""; display: block; clear: both; } READ: Anthropology Of Capitalism Essay167). Meanwhile, Jack returns to Castle Rock, trotting steadily, exulting in hisachievement, as he has practically abandoned all ties to civilized life (p. 168). The storys setting presents two more symbols that assist in showing the decline of civilityon the island. A majority of the island is taken up by the jungle, which is used by manyauthors as an archetype to represent death and decay. In fact, since the jungle is the lair ofthe beast, it, too, symbolizes the darkness naturally present within humans that is capableof ruling their lives. This evil eventually spreads to almost every boy on the island, just asin the jungle, darkness poure d out, submerging the ways between the trees till they weredim and strange as the bottom of the sea (p. 57). At one end of the island, where the planecarrying the boys most likely crashed, there is a long scar smashed into the jungle (p. 1). While Golding does not include a large amount of description about the scar, the image ofbroken trunks with jagged edges is sufficient to give the reader an idea of thedestruction caused to the island (p. 1, 2). Symbolically, this scar represents the destructionthat man is naturally capable of causing and can be related to the harm the boys ultimatelycause to one another, including the deaths of three boys, before they are rescued. The degeneration of the boys way of life is also very evident through the symbolic masks. When concealed by masks of clay paint, the hunters, especially Ralph, seem to have newpersonalities as they forget the taboos of society that once restrained them from giving into their natural urges. For example, when Jack first paints his face to his satisfaction, hesuddenly becomes a new, savage person. He began to dance and his laughter became abloodthirsty snarling. He capered toward Bill, and the mask was a thing of its own, behindwhich Jack hid, liberated from shame and self-consciousness (p. 64). Certainly, Jackwould not have acted in such a way if he had been in his home society, but behind themask of paint, Jack feels free to act like a savage. It is also noteworthy, that the first maskthat Jack creates is red, white, and black. These colors archetypically symbolize violence,terror, and evil, respectively, and in this novel, Golding uses these colors to illustrate thosecharacteristics that are inherently present in humans. The feeling of liberation that results from wearing the masks allows many of the boys toparticipate in the barbaric, inhumane pig hunts. Those hunts can be interpreted assymbolizing the boys primal urges or even anarchy. In fact, many of the boys become soengulfed in their quest for the blood of a pig that they seem to forget about their hopes ofreturning to civilization and neglect to keep the signal fire burning. When Ralph tries toexplain how important the signal fire is, Jack and the other hunters are still occupied withthoughts of the successful, gruesome hunt in which they just participated. There waslashings of blood, said Jack, laughing and shuddering, you should have seen it!' (p. 69). Also, during a later celebration over another successful hunt, the boys become carriedaway while reenacting the slaughter. However, the boys have become so much likesavages that they are unable to control themselves, and for a moment, they mistake Simonfor the beast. The sticks fell and the mouth of the circle crunched and screamed. Thebeast was on its knees in the center, its arm folded over its face (p. 152). As a result oftheir uncontrolled urges, the boys soon kill one of their own. Finally, one of the most memorable symbols that is used to show the violence anddarkness which comes to rule life on the island is the rock, which Roger releases to killPiggy. As an archetype in literature, a rock can symbolize strength and power, and sincethis rock is red, it also represents violence. It is Roger who feels strong and powerful as hestands on the ledge above Piggy. High overhead, Roger, with a sense of deliriumabandonment, leaned all his weight on the lever (p. 180). When the rock land s below, itnot only strikes Piggy, but it also shatters the conch shell. Up to that point, Piggy and theconch had been two of the few representations of civilization and common sense on theisland. However, when the rock causes both of these to cease to exist, all order on theisland is brought to an end, and the boys, who express no regrets over the death of Piggy,have fully become savages. In conclusion, Lord of the Flies is a story that portrays the dark, deteriorating life thatresults from mankinds inherent capacity for evil, which is allowed to control humans whenthey are freed from the rules of society. Throughout the novel, Golding uses manydifferent objects as symbols to illustrate this theme. Some of those objects would beinsignificant in real life and would most likely be taken for granted. However, in Lord ofthe Flies, each of the previously mentioned symbols is vital to the storys theme. Words/ Pages : 1,590 / 24

Perspective on Conflicts and Disputes an Example of the Topic Psychology Essays by

Perspective on Conflicts and Disputes Long before the rule of law and dispensed decisions that effectively dictated who is wrong and who is right, long before policies and procedures governed the way things were done, long before the principles with which we have to live by were set in stone, people used to rely on trust as the primordial and highly reliable standard by which order is maintained, and business is conducted. In this setting, sans a formal legal structure, ones reputation is a valued characteristic. Need essay sample on "Perspective on Conflicts and Disputes" topic? We will write a custom essay sample specifically for you Proceed In this particular structure, when relationships deteriorate, disagreements are settled either through violence --- the proverbial an eye for an eye --- or through the early biblical notion of justice as exemplified by King Solomons decision to settle who truly is the mother of the infant child. In earlier times, the leader of a group, clan, or tribe will be the judge, mediator, or arbitrator of any form of strife that may arise between and among members of the group. Clashes between members of different groups almost always resulted in violence. It was fairly basic then and formulaic: goods and even services were exchanged in fair value determined often by the contracting parties themselves. Fast forward a few centuries and a formal legal structure should have been established to reinforce the ideals of trust, equality, justice and fair dealing. Conflict is a social phenomenon arising from personal as well as group relations and interactions. Depending on ones perspective, it is both a deterrent and a facilitator of change and progress. In a civil society, reliance on a framework of order and governance has been instituted and enforced to limit the counterproductive effects that conflicts and disputes beget, if not its exacerbation, that can and may lead to the dissolution of relationships. Relationships between inpiduals are the glue that holds a society together. In the case of Albo and Jeder, it is an early symptomatic illustration of a burgeoning dispute between inpiduals and which can go deeper as far as splitting the clan itself. The very structure by which a civilized society restricts conflict or its effects thereof is founded on the concept of Justice. It can be said that conflict brought about the need for the concept of justice or in other words, the concept of justice may never have been as fully established or defined as it is today if not because of the conflicts that has beset human history. Justice comes in many terms --- fairness, moral rightness, etc. --- and comes in a multitude of forms. The legal definition of Justice is the proper administration of laws. (Black, 1990, p. 864) More precisely, In Jurisprudence, it is the constant and perpetual disposition of legal matters or disputes to render every man his due. (Black, 1990, p. 864) The role that justice plays in dealing with conflicts is that it presupposes a world of scarce resources in which people are pressing conflicting claims for the protection of competing interests. One of the functions of a theory of justice is to offer normative criteria for arbitrating between such conflicting claims. (Mautner, 1991, p. 103) Further, it is comprised of three major types: retributive justice, concerned with criteria for the punishment of wrongdoers; corrective justice, concerned with the protection of entitlements from injury or appropriation; and distributive justice, concerned with the distribution of scarce resources to competing claimants on the basis of criteria such as equality, desert, or need. (Mautner, 1991, p. 103) These types of justice are important in the resolution of conflict. In the US Constitution, the concept of justice is embedded in the Bill of Rights, particularly, the 1st amendment, to wit, No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws. The essential elements of justice, especially in dealing with conflict involving persons, are due process --- which operates on the fairness of the creation and of the application of the law --- and equal protection --- which operates on the fairness of the treatment or rights accorded by the law to inpiduals. In the case of Albo and Jeder, there was a shift in the status quo when Jeder offered less of what was expected. The exercise of giving every man his due was perturbed. Conflict is the opposition of response (behavioral) tendencies, which may be within an inpidual or in different inpiduals. (Coombs is a normal product of persity in beliefs and values, differences in attitudes and perceptions, and competing socioeconomic and political interests among inpiduals, social classes, ethnic groups and states. (Rabie, 1994, p. 3) From these definitions, it can be derived that the backbone of conflict is social interaction. There are several types of conflict. However, one that is relevant to the Albo and Jeder case is the Type II conflict. In general, so long as the parties to a conflict want different things but seek a single option among the possibilities, one that is to hold for both of them, then the conflict is Type II. (Coombs & Avrunin, 1988, p. 68) A dissection of the Albo and Jeder case indicate that there is clearly an imbalance. The imbalance stemmed from Jeder giving Albo a portion of meat that is less than what Albo is giving to Jeder resulting in Albo offering less to the community and Jeder offering more. A rule of the clan of never rejecting any offering of food prevents Albo from repudiating Jeders insufficient contribution. The pertinent law of the clan, taken alone, can be perceived as tilted in Jeders favor and is somehow restricting the avenues of relief for Albo, that is, not accepting the inadequate portion. What are the options then for Albo? One possible solution, as mentioned in the case, was for Albo to match Jeders offer everytime they hunt separately. This would restore justice, as this would give every man his due. However, this may prove detrimental to the dynamics of the clan. Taking the premise of matching of offers a step further, what will happen then when Jeder decides not to give Albo any portion of his kill? The solution put forth above will still hold but it will not be good for the propagation of social interaction among the members of the clan. Albos proposed solution may create a sort of pisiveness among the clan members an Albo versus Jeder standoff. And when pisiveness creeps in, defection from the clan is not too far off. What alternative solutions are available to Albo then --- one that can mitigate the foreseen drawback of the first solution? Conflict resolution processes should emphasize reforming existing relationships through attitudinal, institutional, and structural changes as well as change in the laws that govern societal processes. (Rabie, 1994, p. 22) A remedy that will not eventually break down a group should be sought. Conflict resolution must aim to expedite the long and often dangerous path from strife to peace and harmony. The Israeli Palestinian conflict has transcended time, religion, and international community intervention among others. The proportion of meat in question is land. Albo and Jeder are the Israelis and the Palestinians. One is not willing to give the other a certain portion of what the former may have and what the latter may not have. Originating as potential conflicts (conflicts in the making), they go on to move through confrontation and contest into internecine violence involving army, paramilitary recruits and a civilian population voluntarily or compulsorily implicated. (Whittaker, 1999, p. 10) There are particularly three approaches to conflict resolution. They are negotiation, mediation by a third party and authorised intervention. (Whittaker, 1999, p. 4) Negotiation is oftentimes conducted by the parties involved themselves. When negotiation fails, mediation by a third party usually follows. Mediation is adopted when violence tends to spill over into neighbouring areas. (Whittaker, 1999, p. 4) Mediation is done usually by another state duly appointed or recommended by the two parties in conflict. The third option --- authorized intervention --- requires an enabling provision from a law giving the intervening body the power to resolve the issue. The body that is authorized to resolve conflict between and among nations is the United Nations. Moreover, Chapter VI of the Charter of the United Nations --- The Pacific Settlement of Disputes --- enables the UN to engage and take over matters that cannot be resolved by the nations in conflict. Three criteria have conventionally underpinned UN involvement in any internal crisis. Is an internal conflict becoming so dangerous that it constitutes a serious threat to international peace and security? Is the state in question willing and competent to deal with its internal conflict? Is there any feasible alternative to intervention by the UN? (Whittaker, 1999, p. 112) These criteria are weighed by the Security Council of the UN. The Security Council is a group of nations, elected by the UN members themselves and is the body that has the power to authorize remedial action. Before any action can be proposed and implemented, it is incumbent upon the Council that an appraisal which must be objective and not excited by the publics sense of frustration and futility at the scale of conflict and its violations is carefully carried out. (Whittaker, 1999, p. 112) The conflict between the Israelis and Palestinians are far from over. Stop gap measures are being proposed, and will continue to be proposed to contain the violence --- the primeval solution to conflicts --- for the meantime as the resolution process , or the peace process as it is called, is being ironed out. One of the resolutions put forth is the shared homeland model. (Rabie, 1994, p. 180) The shared homeland would meet the need to address the legitimate rights of national minorities to freedom and self-determination, while posing no threat to neighboring states or endangering the rights of other minorities to similar entitlements. In addition, it protects the rights and properties of inpiduals living outside their own ethnic homelands, while allowing them to peacefully and voluntarily relocate as they may wish. As such, it facilitates cultural homogenization by choice, not "ethnic cleansing" by force. (Rabie, 1994, p. 180) Moving towards a more harmonious societal relations therefore require looking beyond seeking merely a resolution to a conflict. Reconciliation between the parties must be sought. Reconciliation, in this context, can be defined as the process of promoting an integrated community consequent upon group and inpidual preparedness to make concessions for the sake of tolerance and civilized behavior. (Whittaker, 1999, p. 114) In achieving a societal nirvana, a series of push-and-pulls need to be undertaken. Oftentimes, the number of pulls outnumbers and outweighs the number of push. In the Albo and Jeder case, the approaches to resolve conflict mentioned --- negotiation, mediation by a third party, and authorized intervention --- can be applied. Albo can negotiate with Jeder to come to terms on the definite portion of their kill that they will give each other. They can seek the advice of the leader of their clan to mediate if they cannot agree on the portion and on the conditions of the agreement. Authorized intervention in this case would be the intervention exercised by an outside court, which should be within its jurisdiction to take on and adjudicate issues of this nature, to a sovereign, independent body such as Albos and Jeders clan. If the clans legal structure is found inadequate, Albo can bring his issue to the court which has jurisdiction over the matter. Conflicts essentially expose a certain nations legal vulnerabilities or inadequacies to address a particular concern. It therefore, although indirectly, assists in strengthening the legal framework and keeping it as robust as possible. Reconciliation will come in when the court which has proper jurisdiction over the matter has heard the issues, and have come down with a decision that is rooted in law. The case law, along with the ancillary laws that will be enacted pursuant to this matter, will then form part of the body of jurisprudence that hopefully, will prevent future conflicts of this nature as well as promulgate or facilitate a kind of healthy exchange of goods and services where parties are satisfied and more importantly, where their rights are adequately protected. References Avruch,K. Black, P.W. Scimecca, J.A. (1991). Conflict Resolution: Cross-Cultural Perspectives. Wesport, CT.: Praeger. Black, H. C. (1990). Blacks Law Dictionary 6th ed. St. Paul, MN.: West Publishing Co. Coombs, C. H. Avrunin, G.S. (1988). The Structure of Conflict. Hillsdale, NJ: Lawrence Erlbaum Associates. Kober, A. (2002). Coalition Defection: The Dissolution of Arab Anti-Israeli Coalitions in War and Peace. Wesport, CT.: Praeger. Kollock, P. (1998). Social Dilemmas: The Anatomy of Cooperation. Annual Review of Sociology, 24, 183. Mautner, M. (1991). The Eternal Triangles of the Law: Toward a theory of priorities in conflicts involving remote parties. Michigan Law Review, 90, 95 156. Rabie, M. (1994). Conflict Resolution and Ethnicity.Westport, CT.:Praeger. Whittaker, D.J. (1999). Conflict and Reconciliation in the Contemporary World. London: Routledge. Zartman, I. W. (Ed.). (1997). Governance as Conflict Management: Politics and Violence in West Africa. Washington, D.C.: Brookings Institution.

Collegial vs. Collegiate

Collegial vs. Collegiate Collegial vs. Collegiate Collegial vs. Collegiate By Mark Nichol What’s the difference between collegial and collegiate? Both words, and the root word college and the related term colleague, stem from the Latin word collega, meaning â€Å"colleague.† But for the most part, collegial refers to a state of mind, while collegiate is a more concrete adjective. A colleague is one with whom one works or interacts in a profession, a government office, or a religious environment, and though collegial can refer to the sharing of authority or power among colleagues in both religious and secular contexts, the primary connotation is a value-laden one of camaraderie. However, it is sometimes employed as a synonym for a specific sense of collegiate. That word’s primary usage is in reference to college students or their activities; sports contests between teams representing different colleges or universities, for example, are referred to as intercollegiate athletics. Collegiate, however, also refers to a certain type of religious entity mentioned below. College itself usually refers to an institution of higher learning, either in the sense of a building or a campus of buildings and other facilities or in the sense of its students, faculty, and administration. A college may be a traditional liberal arts institution or may specialize in professional, technical, or vocational subject areas, such as a business college. The term is also used to refer to a constituent part of a university, often consisting of multiple departments offering courses of study in the same general area, such as a college of sciences. Often, when colleges expand so much that they are subdivided for administrative and educational efficiency, they change their status to that of a university. (That word derives from the Latin term for universe; meanwhile, varsity, a shortening and alteration of university, is British English slang for university and refers in general to the primary squad on a school athletic team or, occasionally, in another competitive endeavor. Other uses of the term college are for a group of clergy members living and working together, for any body of people with the same interests or goals, or, most familiarly, in the phrase â€Å"electoral college,† referring to a group of people selected to elect a person for a political office. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Misused Words category, check our popular posts, or choose a related post below:Addressing A Letter to Two People20 Rules About Subject-Verb AgreementParataxis and Hypotaxis

ISMG Essay Example | Topics and Well Written Essays - 1250 words - 2

ISMG - Essay Example ody but it has its own way of ensuring development of the organization and this way is by putting in place good management policies to control the crisis. There are several forms of organizational crisis but with the case of ABS Canada, the kind of organizational crisis being experienced could be said to be organizational conflict because it involves a lot of agitations among the rank and file of the organization. A critical study of the case at hand at ABS Canada would be related to the Mind Frame Consulting (2000) explanation of why organizational conflicts arise as they note that organizational conflicts often result because â€Å"divisions and departments often have different objectives. If their members cannot find common values and goals, they will not cooperate.† Lack of cooperation would also worsen any form of organizational conflict. Identifying the causes and giving out appropriate solutions may however become the best remedy at hand. To this effect, a lot is tasked on Mr. Roberge to look into the causes of the conflict and appropriately devise workable solutions that will be welcomed by all stakeholders in the organization. There are three major parties that could be linked to the cause of the present organizational conflict and for that matter organizational crisis at ABS Canada. These parties are the recruiters of the project manager, out of whom Mr. Roberge may be singled out, the project manager himself and finally, the departmental leaders who team members who should have worked with the project manager. Clearly before the coming of the project manager, there was perfect peace and harmony in the organization. By organizational standards, the organization accepted to run the affairs and future of the company in a more collaborative means that involved all departments and sectors of the organization. This was evident in the meeting that agreed on the long term strategic plan for the company. Indeed, to have started implementing the strategic plan,

MicroFHess Essay Example | Topics and Well Written Essays - 1500 words

MicroFHess - Essay Example Example: as more and more fertilizers are employed by the famers, production of crops may increase by the same unit of fertilizers employed, ceteris paribus. 3. Economic profit is the difference between revenues received from the sale of output and opportunity cost (Mankiw, 1998). For example, the difference between incomes received from selling a car and forgone alternatives of making that car. 4. Law of diminishing returns states that when other factors are held constant any additional unit of input leads to an increase in output at a declining rate till at a certain point where any additional input leads to a decline in output (Hall and Lieberman, 2010). For example, if more fertilizers are added in the production of wheat the output increases till a certain point when any additional unit of fertilizers added leads to a decline in output of wheat. 5. Marginal product of labour is the additional amount of output that is being produced when a firm decide sto employ additional labour in the production process (Hall and Lieberman, 2010). For example, a firm may produces 10 units of output with a labour of 5 people, and after adding another 5 people output may increases to 20 units. 6. Monopolistic competition. Is a type of market structure with many sellers selling similar but differentiated products whereby each seller has the freedom of setting his or her own selling price (Mankiw, 2011). Example: in the United States numerous sellers differentiate their products and the prices for those products (Mankiw, 2011). 7. Sunk cost refers to the amount of money that has already been spent and can not be recovered (Hall and Lieberman, 2010). For example: Amount of money incurred by investor to start and operate a business. 8. The principal-agent problem refers to a conflict of interest that arises when the agent pursues the same interest as his principal (Mankiw, 2011). Example: car dealer hires an agent to sell his cars to particular

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