Customer Service At The Hospitality And Tourism Industry

TOPIC - CUSTOMER SERVICE IN THE HOSPITALITY AND TOURISM INDUSTRY NAME - FAISAL ALLISSA COURSE - TABLE OF CONTENTS Introduction Operation Organizational Chart Job Description Training Program Department Area Research Interview of colleague Bibliography Introduction and Overview Customer service is very important in any job and industry, but hospitality and tourism it is especially important because people as in customers are paying for the customer service of the hotel or the restaurant. I have heard this many times and I have done it myself that I would recommend a place based on their customer service and my overall experience when I was in that place. According to popular belief customer service is very important at any place, and it is true, receiving good service should be a priority at for any service industry. According to North West Business Life magazine, there are things every service industry should do, especially hospitality and tourism industry first of all always meet and exceed customer expectations. Satisfied customers are looking for a memorable experience and an energetic service, where it matters the most. Businesses need to be aware that it’s becoming ever more popular for guests to leave a review of th eir experience on a number of feedback sites, whether their experience was a good or bad one. Hospitality outlets need to me mindful of this as bad feedback can be extremely damaging (North West Business Life). IShow MoreRelatedCustomer Satisfaction in the Tourism and Hospitality Industry: Analysis on Service Quality and Service Failure1986 Words   |  8 Pages1.0 TITLE OF THE STUDY Customer Satisfaction in the Tourism and Hospitality Industry: Analysis on service quality and service failure 2.0 BACKGROUND OF THE STUDY / INTRODUCTION Customer satisfaction plays a crucial role for success and survival in today’s competitive market. Customer satisfaction is considered a prerequisite for customer retention and loyalty, and obviously helps in realizing economic goals like profitability, market share, return on investment, etc. (Scheuing, 1995; Reichheld,Read MoreIdentify the fundamental characteristics of the Hospitality, Tourism and Event industries, their focus on customer service and satisfaction...2733 Words   |  11 PagesCOVER PAGE Name: Student Number: Subject: Introduction to Hospitality, Tourism and Events. Code: MGT102 Lecturer: Trish Powers Assignment Name: Research Report Due Date: 2012 Table of Contents 1. 1. Executive Summary The purpose of this report is to identify the fundamental characteristics of the Hospitality, Tourism and Event industries, their focus on customer service and satisfaction, how they converge and how they have relied upon each otherRead MoreHospitality Provision964 Words   |  4 PagesASSIGNMENT Introduction Hospitality provision is one of important services in travel and tourism. The hotel is a basis for short accommodation needs of travellers. Depending on the content and using that object classification stay in hotel, tourism, resort, etc. According to the level of amenities available, they are classified according to the number of stars from 1 to 5 stars. In recent year, the economics and society are developing. People are getting busier with their work and their life. TheyRead MoreNotes On The Hospitality Industry Essay1616 Words   |  7 Pages.101 Principles of hospitality management Lecturer:-Zaina Therasia Student name: - Mohammed Sakil Student ID:-20151471 Student name: - Amanpreet Singh Dhanoa Student ID:-2015475 TOPIC: - NOVOTEL Hotel Contents Introduction†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦1 1.1 outline of the report†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. Hospitality Industry†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦2 2.1 History †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Read MoreThe Interrelationship Between Core Sectors In The Hospitality1336 Words   |  6 PagesThe interrelationship between core sectors in the hospitality industry The hospitality industry is one of the most important service providers in the international tourism industry. It includes all the tourists and passengers who travel to other destinations. They are part of the overall experience and must meet the standards set by the customer and industry. Modern websites, such as travel consultants, also set standards based on people s assessments of their experiences. â€Å"TheseRead MoreA Brief Note On The Country Of Nepal Essay1494 Words   |  6 Pages Importance of Hospitality tourism in Nepal Nepal is a land locked country, share boarder with two big countries India at east, west and south and China at the north. Being in the middle of these countries Nepal is marvellous and beautiful country. Nepal is rich in natural beauty and the unique geographical position has made Nepal more attractive and lucrative. Besides being naturally beauty it is also home for different world heritage monuments. Nepal rank in the bucket list for travellersRead MoreGlobalization in the Hospitality Industry1167 Words   |  5 PagesTourism is an industry that gives people the opportunity to explore and discover different cultures and many different countries. People are able to view attractions, dabble in local cuisine and experience life in a different country. Tourism is an industry that is rapidly growing as more and more people are traveling abroad. People have a genuine interest in learning about new cultures and experiencing all that a country has to offer. More countries are moving clos er to globalization and this inRead MoreEssay on Similarities and Differences Between TH1700 Words   |  7 Pages1.1. Tourism: according to F.W. Ogilvie (1933), tourism can be defined as ‘persons who go to somewhere rather than home or workplace for a period of time and spend money in that place’. But this definition has its limitations as it is too broad and it does not have specific standards or criteria to define tourism. Many organizations have been tried to come up with an accurate definition of tourism, but till now they only commonly accepted some factors that help to define tourism. Tourism is anRead MoreThe Influence of a Hotel Quality of Service and Image and its Effect on Tourism Customer Loyalty1569 Words   |  7 PagesI. Statement of Problem Hospitality and tourism have evolved into truly global industries are dispersed worldwide. Due to changes in lifestyle, the services offered by hospitality businesses are now considered to be necessities. Consequently, during the past decade, there has been an exponential growth in hospitality businesses to meet the demands of the growing market. Today, hospitality organizations are faced with intense competition. Hence, in the scheme of business, it has become apparent thatRead MoreThe Theory Of Unique Selling Elements, Restaurant And Hotel Owners784 Words   |  4 Pagesmarket drivers for which the standard of living of the customers are increasing day by day. The customers always want to get value out of the product. So the market leaders can show the path to the market leaders, which leads to overall economic development. It also encourages the investor to invest more they are ready to take the risks. Applications of relevant theories Various management theories can be applied in case of hospitality industry. In the theory of â€Å"unique selling elements†, restaurant

My values Free Essays

It has been reiterated from our class discussions that values are the things that really matter to us. (Lopper, 2006) And, as we further discussed this subject, we have discovered that it really has a big influence on our wants and needs. Our values guide us to make decision and even how to run our everyday lives. We will write a custom essay sample on My values or any similar topic only for you Order Now In assessing our wants and needs, we are unconsciously contributing betterment or demise to the world. So, it is important to channel in to our inner selves to know what really want and need so that in the end, we will find the things that we most cherish and cultivate it to add some goodness in the world. Our values can either be our belief, our principles and sometimes, even our family. Even voicing out your opinion is considered a value. Now, as I sit and write the values that I treasure most, I found out that aside from my family, I also deeply care about the environment and love. As clichà © as it may sound, we should take care of our environment because after all, we are all going to benefit from it and our future children as well. With the onset of technology and our desire to acquire what is the latest, it is heartbreaking to know that a lot of trees, tribes, etc. must be sacrificed just to have out wants. But, to compensate for our advancing technology, it is also glad to know that we are now beginning to take into considerations the environment—this can be best epitomized by the commercialization of the hybrid cars and the abundance of solar-generating houses in some parts of the world. Still, there are â€Å"quite† parts of the world wherein we continue to manipulate their resources so that we can have our personal satisfaction and gains. Now, from what I have learned from our discussions, all I can say is that, we should all make an effort, no matter how small it is, to make this world a little cleaner. For my part, I have started doing so through my small ways like throwing my trash in the trashcan (or if ever there is no trashcan, I make sure that I keep it in my pocket and dispose it in our house) and religiously segregating the biodegradables from the non-biodegradables. Also, I started to make a compost pit at our house so that I can grow organic vegetables in the future. Lastly, I tell smokers to quit the habit because it only adds up to air pollution. As for the other value that I treasure most, it is so overrated but if we analyze it thoroughly, it is surprising to know that we can only achieve the things that we want in this world (i.e. peace, justice, unity, etc.) if we love ourselves enough. I believe that if we love ourselves enough, it is the only time that we can share that love and consequently, build respect for others. And with respect, there comes understanding and then justice and peace. It is a very extraordinary concept but it just all boil into that. I also have to emphasize that this love that I deeply value is not filial in nature but for the greater good. And, as a first step in achieving this idealistic want (or need), I must admit that I do not have enough love with me to share with others but I am starting to gather love by knowing myself more and talking to my inner self more often and appreciating the value of everything that I see and treasure. The two values that I treasure most seem conventional but the way I see it, there is nothing too conventional if we want to have a better world. As said in our discussions, we should know our wants and needs because it leads to some make-or-brake decisions in our lives and in the course of the world as well. We all want and definitely need a better world and we can achieve this through the values that are instilled in us or our beliefs and principles that we genuinely cherish. After all, all our values should be for the improvement of ourselves and for others. And I believe that for us to have a better living environment, it must start from ourselves. In conclusion, for us to have a better world and a proper knowledge of ourselves, it is imperative to have a step-by-step procedure to achieve those desires and these can be done even in the most modest ways. And these steps will only begin from us if we only consider our wants and needs and integrate it to our values but we have to keep in mid that these values should be for the benefit of us. REFERENCES: Lopper, J. (2006). What are values? [Electronic Version]. Retrieved September 27, 2007 from http://personaldevelopment.suite101.com/article.cfm/what_are_values_.    How to cite My values, Essay examples

Management Problem Solving Case of Volkswagen

Question: Discuss about theManagement Problem Solvingfor Case of Volkswagen. Answer: Introduction: The report mainly depicts the overall problems, which was faced by Volkswagen in designing their Engine Management Software (EMS). In addition, the software that was developed for detecting the emission rate in cars was mainly rigged. Furthermore, the novice effectively reviews the overall problems, which mainly reduced the viability and brand image of the company. Moreover, the report with the help of chosen pathway is able to solve the problems faced by Volkswagen. Lastly, the novice effectively suggests the recommendation for Volkswagen, which could be used in near future for reducing any unethical process in the organisation. Review of the Problem: During 2009, the EA 189 engine was mainly designed by Volkswagen, which had fault in their emission system. In addition, the engine management software that is been used by the company was mainly rigged to provide the reduced emission rate (volkswagenag.com, 2016). Furthermore, the software used for detecting the overall emission rate of the car was been manipulated, which mainly depicts wrong emission rate of the engines. In addition, the main aim of the company was to cheat the overall Environmental Protection Agency (EPA) of US and to allow EA 189 engine diesel cars. In this regard, Balbi (2015) stated that Volkswagen with the help of deceiving technology are able to manipulate the engine reading. In addition, Volkswagen by using the overall defaulting software in their diesel cars was able to create a buzz for its products. In addition, the company depicted the low emission rate of their cars in their marketing strategy, which in turn helped in boosting the overall sales. The software was mainly designed by the company to depict the adequate emission rate, which was allowed by the US authorities by using the safety mode. However, after the schedule testing time the safety mode of the cars was changed, which mainly emitted nitrogen oxide pollutants up to 40 times (volkswagenag.com, 2016). Zhou (2016) mentioned that around 90% of the overall diesel cars produced by Volkswagen mainly generated high emission, which was not allowed in US. Figure 1: Showing the drop in net income faced by Volkswagen (Source: volkswagenag.com, 2016) Figure 1 mainly depicts the overall fall in net income, which incurred due to expenses occurred from taking back the faulty tasks. In addition, around 6.2 billion in loss was mainly incurred in 2015 due to the extra expenses incurred by Volkswagens in calling back the 35,000 cars (volkswagenag.com, 2016). Furthermore, Volkswagen has also agreed for the unethical practises conducted by the organisation for promoting the low emission diesel car, which was mainly depicted as emissiongate or diselgate scandal. Krall Peng (2015) mentioned that due to emission scandal the overall image and share price of Volkswagen was negatively impacted. On the contrary, Apte (2016) criticises that carbon emission manipulation was mainly conducted to reduce the RD expenditure of Volkswagen. Moreover, due to the scandal overall Volkswagens creditability among potential investors and customers had been drastically declined. In addition, the emissiongate scandal was the major turning point for companys rev enue and profitability (volkswagenag.com, 2016). Analysis of the Problem: The overall pathway of the analysis is mainly conducted from the theoretical lenses of CSR / Ethics. In addition, the scandal of Volkswagen has mainly depicted the overall violation of ethical and CSR activities. Furthermore, the unethical measures used by engineers in designing the emission software mainly portrayed the overall lack of CSR activities. Hoi, Wu Zhang (2013) stated that CSR activities are mainly used for reducing the unethical measures conducted by companies for boosting their profitability. However, Lee, Park Lee (2013) criticises that companies to increases their overall profitability reduce the overall impact of their CSR activity. The first problem was mainly detected on the software developed by engineers of Volkswagen in 2009 (volkswagenag.com, 2016). In addition, the software that was designed by the engineers was mainly manipulated and depicted the unethical measures. Furthermore, the EMS software also manipulated the emission section, which depicted low pollution rate of Volkswagen diesel cars. This manipulation of emission software mainly depicted the low CSR practised by the company, which in turn reduced its overall ethical practise (Yoo Chon, 2013). In addition, the root cause of the unethical behaviour from Volkswagen was due to low independent management control conducted in its operations. In addition, the overall problems that was mainly faced by Volkswagen depicted the low control or the motivation provided by top-level management for conducting unethical practises in the organisation. Furthermore, the resignation of Martin Winterkorn mainly stated the CEO took the whole responsibility of not following the depicted CSR rules. Lee, Cho, Arthurs Lee (2015) mentioned that the scope of the Volkswagen scandal mainly depicts the motivations that might have been provided by the CEO for manipulating their emission software. However, Kim, Kang Mattila (2012) argued that due to the reduced mileage provided by the diesel engine the fraud conducted by the company escalated, which in turn affected both creditability and image of the company. With the help of the following depicted actions, the overall CSR activities of the company can be effectively maintained. Ethical CSR: The ethical CSR mainly depicts the legal requirements, which could be followed by Volkswagen in their operations. In addition, the ethical CSR is blend of legal and ethical requirements, which are needed from the car manufacturers in US and European countries (volkswagenag.com, 2016). Esen (2013) cited that increasing ethics and CSR activities in an organizations mainly helps in gathering increased trust from both investors and customers of the company. In addition, Volkswagen could effectively increase the impact of CSR activities by effectively monitoring activities of their staff. On the contrary, Govindarajan Amilan (2013) argued that CSR activities only reduce their impact if the company mainly aims in making high-end profits from their activities. Continuous Monitoring by Independent Directors: The mainly problems of Volkswagen mainly came from less monitoring conducted by independent directors. In addition, if the monitoring process of the independent directors was effectively conducted then operations of the company might be conducted ethically in fear from loss of reputation. Thus, the independent directors of Volkswagen can effectively evaluate the overall operations, particularly the manufacturing and financial report process (volkswagenag.com, 2016). In this regard, Wirl, Feichtinger Kort (2013) mentioned that monitoring process is mainly helpful in reducing the unethical practices, which might be conducted in an organisation to support their CSR activities. On the other hand, Park, Kim, Oh Chung (2016) criticises that increased implementation of CSR activities might hinder manufacturing companys ability to maintain the required level of profitability. Strengthening the Ethical Use of Technology: In addition, Volkswagen was able to use the unethical approach in their car manufacturing because of manipulated technology. Thus, strengthening the overall ethical use of technology might mainly help in reducing the unethical measures, which was previously conducted in Volkswagen. In this context, Krall Peng (2015) cited that the implementation of advanced technology might mainly help in improving the monitoring process, which in turn could reduce the overall unethical measures conducted in the business. Furthermore, Volkswagen could effectively use advanced technology for reducing the pollution conducted by the manufactured cars. On the contrary, Hoi, Wu Zhang (2013) argued that implementation of high-end technology in the manufacturing process mainly increase the overall expenditure of the company. Recommendations for Volkswagen and your Conclusions: The overall study mainly helps in evaluating the Volkswagen scandal that reduced viability and authenticity of the company. In addition, the report effectively analyses the overall scandal and depicts the relative actions that is been taken by Volkswagen. Moreover, the novice effectively depicts and evaluates the scandal based on relative theoretical pathway. In addition, the report uses ethical and CSR theoretical pathways to understand the scandal, which desecrated the image of Volkswagen in US and Europe. Furthermore, the relative measures are also depicted by the novice, which could be used by Volkswagen for strengthening its CSR activities. The main recommendations that might be helpful for Volkswagen are depicted as follows. Volkswagen could implement high-end monitoring process for increasing the impact of its CSR activities. In addition, the focus of the company is to ensure non-repetition of the unethical measures that was conducted in Volkswagen. Moreover, Volkswagen directors could also use continuous survey for ensuring the ethical practises conducted in the overall business operations. In addition, the strengthening of CSR activities in Volkswagen could also help the directors and management to endure the ethical practises conducted in research and development section. Moreover, Volkswagen could also provide relative training to its employees regarding the CSR activities and its use for increasing the trust of its employees. In addition, with the help of recommended actions Volkswagen could effectively improve their current CSR activities and conduct its activities ethically. Moreover, the recommendation could effectively help in developing the ethical practices among management and engineers of Volkswagen. Furthermore, implementation of effective CSR activities might help Volkswagen in reducing the augmentation of any future scandal conducted in their products. Reference: Apte, S. (2016). Can analytical testing of excipients be volkswagenized?.Journal of Excipients and Food Chemicals,7(2). Balbi, A. (2015). Update: Volkswagen scandal: one of the world's largest automakers has admitted to unethical decision making and is working on clarifying the" inconsistencies.".Strategic Finance,97(6), 9-10. Blackwelder, B., Coleman, K., Colunga-Santoyo, S., Harrison, J. S., Wozniak, D. (2016). The Volkswagen Scandal. Esen, E. (2013). The influence of corporate social responsibility (CSR) activities on building corporate reputation.International Business, Sustainability and Corporate Social Responsibility (Advances in Sustainability and Environmental Justice), Emerald Group Publishing Limited, 133-150. Govindarajan, V. L., Amilan, S. (2013). An influence of CSR initiatives with financial performance: Evidence from petrogas products industry in India.ACADEMICIA: An International Multidisciplinary Research Journal,3(8), 1-27. Hoi, C. K., Wu, Q., Zhang, H. (2013). Is corporate social responsibility (CSR) associated with tax avoidance? Evidence from irresponsible CSR activities.The Accounting Review,88(6), 2025-2059. Kim, E. E. K., Kang, J., Mattila, A. S. (2012). The impact of prevention versus promotion hope on CSR activities.International Journal of Hospitality Management,31(1), 43-51. Krall, J. R., Peng, R. D. (2015). The Volkswagen scandal: Deception, driving and deaths.Significance,12(6), 12-15. Lee, E. M., Park, S. Y., Lee, H. J. (2013). Employee perception of CSR activities: Its antecedents and consequences.Journal of business research,66(10), 1716-1724. Lee, G., Cho, S. Y., Arthurs, J. D., Lee, E. K. (2015, January). Keeping up the Fame: Celebrity CEOs' Engagement in Earnings Management and CSR activities. InAcademy of Management Proceedings(Vol. 2015, No. 1, p. 14117). Academy of Management. Park, G., Kim, W., Oh, J., Chung, K. (2016). Study on the Structural Relationship among CSR Motivations, CSR Activities, Trust and Loyalty: Focused on Korea Retailing Sector.International Journal of u-and e-Service, Science and Technology,9(5), 169-180. volkswagenag.com. (2016).Sustainabilityreport2014.volkswagenag.com. Retrieved 13 October 2016, from https://sustainabilityreport2014.volkswagen Wirl, F., Feichtinger, G., Kort, P. M. (2013). Individual firm and market dynamics of CSR activities.Journal of Economic Behavior Organization,86, 169-182. Yoo, J. M., Chon, M. L. (2013). The Effects of CSR Activities on Firms' Financial Performance: Investigating in terms of CSR Development Stages.Journal of Convergence Information Technology,8(12), 414. Zhou, A. (2016). Analysis of the Volkswagen Scandal Possible Solutions for Recovery.

Vulnerable Populations Victims of Violence Essay Example

Vulnerable Populations: Victims of Violence Paper Running Head: ‘Vulnerable Populations: Victims of Violence’ ‘Vulnerable Populations: Victims of Violence’ Norita Prather BSHS/302-BSAE0ZSH3 University of Phoenix Instructor: Tami Frye September 26, 2011 Each domestic abuse relationship is unique, and has a pattern that holds certain signs, clues, and characteristics that could have helped decide if one were in an unhealthy or abusive relationship. There are significant indicators that are common to all virtual cases of domestic abuse, mainly because people have heard much about domestic abuse, but did not think it applied to their situation. What is domestic abuse, how is it defined for someone to recognize and seek help; coming from someone that has a damaged cornea as a result of domestic abuse, I will give my definition. I think a single incident usually does not constitute abuse. Domestic abuse usually involves a pattern of abusive events, where victims typically experience a repetitive, cyclic pattern of destructive or violent behaviors that generally escalate over time. I think the main contributor of domestic abuse if based on power and control. There are many misconceptions of what taking control means, in a domestic abuse situation, taking control to one may think that is a sign of caring and wanting only the best for the other. Furthermore, there is no reason for anyone to go through domestic abuse whether it is physical or verbal. I would advise victims to be smart, and safe, and get awaysomeone’s life might depend on the choice you make. The history of domestic violence has been prevalent throughout the United States and other parts of the Worldand intimate partner abuse has been a art of many cultures for many generations. From my understanding, British common law had allowed a man to â€Å"chastise† his wife with â€Å"any reasonable instrument†. In the United States, throughout the 1800’s, state laws and cultural practices continued to support a man’s right to discipline his wife. It was not until 1895 that a woman could even divorce her husband on ground of abuse. Domestic abuse af fects men and women, but one out of four women will be a victim at some point of their lifetime (Roberts, 2002). We will write a custom essay sample on Vulnerable Populations: Victims of Violence specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Vulnerable Populations: Victims of Violence specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Vulnerable Populations: Victims of Violence specifically for you FOR ONLY $16.38 $13.9/page Hire Writer The first shelter for battered women and their children was opened in London, England within a few years of 1975, emergency shelters for battered women opened in different parts of the United States such as the one in New York City; St. Paul, Minnesota; and Fresno, California. In 1994, the Violence Against Women Act was adopted. The act encouraged research into domestic abuse and generated the legal and financial support for law enforcement and social services to protect battered women. Because of the traumatic nature of domestic violence, it is recognized worldwide with major initiative to improve the continual efforts regarding policies and courts responses to battered individuals. Today, there are many policies, programs, intervention strategies, and legal enforcers for dealing with victims and abusers of domestic violence. Being a victim/survivor of domestic abuse creates numerous issues and experiences including, readjustment, insecurities, anger, confusion, and self-doubt. Oftentimes, abused individuals lose family and friends as a result of the battering. Generally, the abuser isolates them from family and friends. The level of inflicted abused becomes an embarrassment and the abused individual usually withdraws from their support system to avoid embarrassment. Feelings of anxiety sometimes emerge if you decide to exit the situation and are reentering into a new world free of violence. Social problems also surfaces from domestic abuse; it creates feelings of isolation and exclusion. According to authors, John Hamel and Tonia Nicholla (Hamel Nicholla, 2007), domestic abuse is not abusive at all times. It follows a three-phase cycle known as ‘The Cycle of Violence’. The cycle starts in the honeymoon phase, and over time, tension builds and then the abuse starts. The domestic abuse cycle is continual and people often stay because the honeymoon phase comes back around and displays remorse. Victims usually choose to stay because promises have been made that the violent acts will never happen again; do not ever believe it will never happen again because it will, and now, the abuse will become more frequent and oftentimes, more severe. Unfortunately, domestic violence is a worldwide epidemic, and is one of the most chronically underreported crimes. Your socioeconomic class, religion, race, or ethnic group, etc. does not have an influence on whether or not you become involved in the cycle of domestic abuse. Although there is no distinctive category at identifying who is at risk for domestic violence, there are some common situations among people who experience domestic violence, such as being abused as a child, witnessed domestic violence as a child, isolated socially from family and friends, physical or mental disability, unemployment, poverty or poor living situations, previously in an abusive relationship, simply planning to leave or has recently left an abusive situation, etc. The Bureau of Justice Statistics crime data brief reported that 85% of domestic abuse is women, and women of all races are about equally vulnerable to violence by an intimate partner. Allstate Foundation conducted a national poll on domestic abuse and reported that nearly three out of four (74%) of Americans personally knew someone who is or has been a victim of domestic violence. Thirty-percent of Americans say they know a woman who has been physically abused by her husband or boyfriend in the past year. Getting out of a domestic violence situation is not easy, but there are many domestic violence abuse programs for victims and their children within the criminal justice and child welfare systems. The wide array of services are unlimited and range from advocacy and support services, anonymous telephone hotlines where you can call, and seek advice, abused and battered shelters where you can stay, counseling, community-based services, non-profit resources and organizations, local, and state government services and assistances. Additionally, there are plenty of national resources for domestic violence that fosters discussion forum where victims can talk with others involved in domestic violence and prevention to nurture empowerment and belonging among one another. The effectiveness of future intervention strategies depend upon human service workers, law enforcement officers, educators, domestic abuse, and child welfare organization personnel to all play collaborating roles in the prevention and intervention of cases of harmful domestic violence. Once domestic violence has been identified, future intervention should include follow-up and referral services, evaluations of the victim(s) for immediate needs, a safety plan that is personalized, and gone over with someone with a knowledgeable background with domestic violence; and efficient review of the pattern and history of the domestic violent cases to prevent future risk of death or significant injury/harm. In closing, domestic abuse is an unfortunate situation that profoundly affects everyone that is involved in the situation and intervention process. Domestic violence should not happen to anyone, but it does, and when it occurs there is help. Domestic abuse can cause major long-term troubles for battered individuals such as physical and mental difficulties. Overall, any type of abuse whether it is physical or verbal is unacceptable and should not be tolerated. Everyone deserves to live free of fear, and be safe and happy. References Allstate Foundation National Poll on Domestic Violence, 2006. Lieberman Research Inc. Tracking Survey conducted for The Advertising Council and the Family Violence Prevention Fund, July – October 1996. Bureau of Justice Statistics Crime Data Brief, Domestic Violence, 1993-2001, February 2003. Hamel, J. , Nicholla, T. , (2007). Family Intervention in Domestic Violence. New York, NY: Springer Publishing Company, LLC. Roberts, A. , (2002). Handbook of Domestic Violence Intervention Strategies. New York, NY: Oxford University Press, Inc.

Earth Day Essay

Earth Day Essay Earth Day Essay As people living on a planet to ourselves, working, producing products, expanding as a society whether it be new houses, buildings, jobs, food places and etc. When we first had all of these new things we didn’t think about the affects they would have on our earth. Considering this, who would have thought that those big buildings that constantly had smoke pouring out of them that also made the fancy cars, new dishwashers, T.V.’s, and microwaves could also be bad for us? It was said that the air was so dirty sometimes that tourists couldn’t see the city below from the Empire State building observation deck. It was then brought to Richard Nixon’s attention something had to be done. He then created the Environmental Protection Agency that would enforce laws that would protect public health and the environments as well. This set of laws then lead to the Clean Air act, a law that was designed to reduce air pollution. At the time cars would use lead gasoline, whi ch contained lead that could be a brain stunt in development. As I said before not everyone was thinking about the effects these new products would bring. As always though, someone was. Being the year 2014 and seeing how far we have come, could you imagine being the person who started Earth Day. The founder Gaylord Nelson, first had the idea after the 1969 massive oil spill in Santa Barbra. They figured if they could get enough of the public’s attention something could be done. And that is exactly what happened. On April 22nd 1970, 20 million people participated in the first ever Earth Day. The movement received what was seemed to be rare and unique support from people of every different background. Rich, poor, farmers, city slickers, labor leaders, even democratic and republicans. The first Earth Day was such a success that when the year 1990 came around environmental leaders were asking for another. The next Earth Day went global. This time they were 200 million people fro m 141 countries. The earth day of 1990 the main focus was have the importance of recycling made known to anyone and everyone. Reduce, Reuse, and Recycle. Now to this day we are still fighting for a cleaner earth. The average person generates about 4.5 pounds of trash every day, which makes about 1.5 tons of solid waste per year. It is also estimated that 75% of solid waste is recyclable while only about 30% is recycled. Although that doesn’t seem like a lot there is still effort for a greener earth. With new recycled products such as paper and water bottles. The idea of using recycled products to make more of the same product is a sustainable and smart way to produce a product and although not every company knows that there are still many improvements from what was. Earth day 2014 consisted of over a billion people in 190 countries. This year their main

Straight-Tusked Elephant - Facts and Figures

Straight-Tusked Elephant - Facts and Figures Name: Straight-Tusked Elephant; also known as Palaeoloxodon and Elephas antiquus Habitat: Plains of western Europe Historical Epoch: Middle-Late Pleistocene (1 million-50,000 years ago) Size and Weight: About 12 feet tall and 2-3 tons Diet: Plants Distinguishing Characteristics: Large size; long, slightly curved tusks    About the Straight-Tusked Elephant Understanding the Straight-Tusked Elephant requires a quick primer in modern elephant classification. Living elephants are represented by two genera, Loxodonta and Elephas; the former comprises two species (Loxodonta africana and Loxodonta cyclotis) of African elephants, while the latter contains but a single species: Elephas maximus, the Asian elephant. Long story short, most paleontologists consider the Straight-Tusked Elephant to be an extinct species of Elephas, Elephas antiquus, though some assign it to its own genus, Palaeoloxodon antiquus. As if thats not confusing enough, this prehistoric relative of the Asian elephant was native to western Europe! Classification issues aside, the Straight-Tusked Elephant was one of the largest pachyderms of the Pleistocene epoch, standing 12 feet tall and weighing in the neighborhood of two to three tons. As you might expect given its name, this elephants most distinctive trait was its exceptionally long, slightly curving tusks, which it used along with its unusually long tongue and trunk to strip the leaves off trees. Judging by fossil remains, the Straight-Tusked Elephant roamed the European plains in smallish herds of a dozen or so individuals, and was eventually out-competed in its increasingly frigid ecosystem by the well-insulated Woolly Mammoth. (By the way, some experts believe it was the Straight-Tusked Elephant that spawned the Dwarf Elephants of the Mediterranean basin.)

Boeotian black figure tripod kothon Essay Example | Topics and Well Written Essays - 750 words

Boeotian black figure tripod kothon - Essay Example The komos is a parade of masked men costumed as satyrs and an occasion of feasting, joyous drinking and dancing.1 According to Maurice Emmanuel, representations of komos was much affected by the painters of vases and the fashion spread over the whole of Hellenistic world, to Boeotia and its kothons.2 The homosexual theme painted on the kothon served its purpose because; the kothon was the preferred drinking-vessel by soldiers taken on campaigns because it is easily carried in a knapsack. Greek men are known to practice pederasty and soldiers were known to fight with their lovers in battle. In the Constitution of the Lacedaemonians, Critias wrote about the vessel: â€Å"The reason why it is so well adapted to military use is that it is often necessary to drink water that is not pure. It is first of all useful because the liquid to be drunk cannot be seen with any clarity.†3 The Boeotian black figure tripod kothon further demonstrates this with its inward turning edges which wou ld inevitably catch a residue of the impurities inside its lip. One man, in dancing depiction, stretches an inviting reach toward the other dancing figures chin in the depiction of hopeful gesture for a romantic response. It appears that the dances are part of Dionysian rites with its revelry and wine-involved dances. Dionysius or his representation, however, is not depicted in the painting. According to Csapo and Miller, it is difficult to establish a connection to Dionysius on the basis of available iconography because the kothon paintings only show general associations such as the use of wine in the ritual and the masked satyrs.4 In the previously cited kothon artifact housed in Staatliche Museen zu Berlin, there is a more detailed depiction of the komos in the Boeotian kothon (see the picture below). In this case, the komos is collocated with a sacrifice ceremony, involving wine-poring, piper playing and

Geology of Qatar Essay Example | Topics and Well Written Essays - 1000 words

Geology of Qatar - Essay Example These natural resources contribute actively towards the realization of the skyrocketing economies experienced in the nation. For instance, there are several places in the country of Qatar supplied with natural gas and oil deposits2. These are some of the powerful natural resources that make the country gain international recognition, respect as well as realize robust economies. In addition to natural gas, Qatar also has several deposits of oil fields. This makes the nation on e of the largest oil producers in the world. This works well with boosting as well as expanding the economies of the state of Qatar. Other than the natural reserves, it is of crucial significance to note that the country of Qatar also boasts of a collection of beautiful sceneries, geological features as well as landscapes. Some of these geological features as well as scenic beauties have contributed massively towards strengthening the economy of Qatar in several diverse ways. For instance, the myriad of features have ensured heavy flow of tourists into the nation of Qatar to have an experience as well as identify with some of the natural features. This has ensured generation as well as creation of foreign exchange, improved employment conditions as well as upholding nation’s pride. The foreign exchange as well as income earned from such tourism activities has led to massive eco nomic growth in the region. This paper is going to explore some of the geologic features found in the sovereign state of Qatar. In addition, the paper is going to focus on some of the surface features, the terrain as well as landscape of the nation of Qatar. It is of critical significance to note that Qatar is one of the states with sabkhas forming some of the geologic landform features. The sabkhas are always characterized with dry burrows. This presents greater risks to geologists due to the fact that such dry burrows may always host deadly animals like snakes that can bite geologists. This presents one

Macbeths Letter Essay Example for Free

Macbeths Letter Essay I am writing to you as I know that you will keep the contents of this letter a secret. The last few days have been very strange and unreal to me. I cannot believe how much my life has changed in such a short space of time. I ask you to please destroy this letter once you have read it and not tell a soul about what it contains as I have committed a terrible crime. A couple of days ago I was a noble warrior fighting against Norway and now Im king of Scotland. With my brandishd steel I approached the leader of the Norwegians, Macdonald, and unseamd him from the nave to thchaps and fixd his head on our battlements to show everyone he was dead. Norway were defeated. After the battle, Banquo and I walked along the moors and we came across three weird sisters that looked nothing I had ever seen on this earth. They greeted me by saying All hail Macbeth, hail to thee Thane of Glamis, All hail Macbeth, hail to thee Thane of Cawdor, All hail Macbeth that shalt be king hereafter. At this greeting I was rather shocked and confused. True I was Thane of Glamis but Thane of Cawdor and king? The Thane of Cawdor lived and as was the king. I was puzzled. Were these prophecies real? Whilst I was lost in my thoughts, Banquo asked them to predict something for him as they had for me. They told him that his children shall be kings but he will not be king himself. I ordered them to stay and tell me more but they were unwilling to be ordered by me and vanished into thin air. I do not think Banquo believed his prophecies as much as I did mine. We carried on walking and talked about the witches. Then we saw two men coming towards us. They said that the king had sent them because he had heard of my success in battle. One of the men said the king bade him to call me Thane of Cawdor! I asked him why he was dressing me in borrowd robes. He explained to me that the old thane of Cawdor was a traitor and would be executed. I could not help thinking that the greatest was behind. I then thought a terrible thought. Murdering king Duncan to become king. I pushed the thought out of my head and told myself if chance will have me king, why chance may crown me without my stir. I did not have to get involved in order to become king. We made our way to the kings headquarters and king Duncan told me how grateful he was for what I had done in battle. I told him it was an honour to fight for him and I felt it was my duty to him. He then made a startling announcement. His eldest son Malcolm was named the Prince of Cumberland! I could not help feeling angry on hearing this. Malcolm stood in my way of becoming king. I felt as though I was not in control of my feelings. One minute I was loyal and the next I had these evil thoughts. They disturbed me but I could not stop them. I pleaded, stars hold your fires, let not light see my black and deep desires. I did not want anyone to see these terrible thoughts I had. Duncan said that he was to stay at my castle that night so I left at once to inform my wife of his arrival. I sent a letter on to Lady Macbeth to inform her of the meeting with the witches, their prophecies and my becoming Thane of Cawdor. I know she thinks that I cannot act on my ambitions and that I am too kind to act on the information that the witches gave to me. When I arrived I told her I told her about Duncan coming to stay. She encouraged the idea of murdering him. She told me to look like thinnocent flower but be the serpent undert. I was to look innocent but be ready to strike. I felt she was taking control of this situation. She overpowered me. I was not allowed to speak. I told her I needed to think about it but she did not listen and told me to leave all the rest to her. When Duncan arrived, Lady Macbeth greeted him as my mind was too full with other thoughts. I know she showed gratitude towards him and showed fake loyalty. I could not have been false to his face. I left the feast to be alone. I thought that if I were to murder Duncan it would be best to do it quickly. But how I hoped it would be the end of it without any consequences because I knew that with murder would come horrible consequences. I was confused as to what I should do. I was his subject. I looked up to him as king. I was his host. I should be protecting him not murdering him. I thought Duncan is no enemy of mine. He is my king. He has been a good king so far. If he was to be murdered then everyone would be horrified and there would be a wild protest. Everyone would be looking for the murderer. The only thing I had to make me murder him was my ambition and that alone is not alone. Lady Macbeth came to me and I told her we would proceed no further in this business. She called me a coward and said that if I told her to kill her child then she would do so. She had managed to change my mind. If we should fail? I asked her. She told me we would not fail and that Duncan would sleep easily after his long journey. She then said that she would convince his two guards to have some wine. They would be unaware of what is happening. Then when Duncan was dead we would smear blood on their limbs and let them bear the guilt of our great quell. At that moment I could not help admiring Lady Macbeth. I told her she should only have male children for she has great strength and courage. She told me that no one would suspect us because we would be distraught with sadness at the news of his death. My mind was made up. I told her that every bit of me was going to work at this murder. Part of me wanted to show I could do this and that I was not a coward. I was walking around the castle later that night when I came across Banquo and his son. Banquo told me he dreamt of the witches and how their prophecies had come true for me. I lied to him and told him that I did not think of them. I had to lie as I was about to kill the king. After Banquo left I saw in front of me a dagger. It looked as real as the one I had in my belt. It was pointing towards Duncans chamber. I saw blood on the dagger that was not on there before. My disturbed mind was showing me things that were not there. Suddenly a bell rang and I made my way towards Duncans chamber. When I returned to my wife from Duncans chamber I heard her say that she would have murdered him herself if he did not remind her of her father. I was anxious. I looked at my hands. It was a sorry sight. Lady Macbeth tried to get me to snap out of it. I told her that as I came out of the chamber I had heard someone saying their prayers in their room and how I could not even bring myself to utter the word amen. I felt cursed. She told me I should not think about it. I could not help thinking that it was the end of me. My wife warned me that to dwell on these things would make me mad. I felt mad at that moment. I had lost all control. I had murdered sleep. I did not think I would ever be able to sleep again. My wife told me to go and wash my hands. It was then that she noticed I still had the daggers. She ordered me to go and put them back. I told her I would not go back into that room. I was frightened. I couldnt find any ounce of bravery within me. I could not face going in there again. She was disgusted with me and told me I was acting like a child. She told me to leave it all to her. She took control once again. She returned the daggers and smeared the guards with Duncans blood. I became jumpy. I looked down at my hands again. I believed that I had so much blood on them that it could change the whole sea red if I were to put them in it. I felt a sense of disgust as I stared down at the blood. Lady Macbeth returned from the chamber and her hands too were covered in blood. She called me a coward. She seemed so certain that a little water would clear us of this deed. I was not so sure. I did not feel like myself anymore. I did not feel like the noble warrior I once was. I heard knocking and wished that it would wake Duncan up and rewind this whole tragedy. Now I am king. I will not bore you with how it all happened. I fear that people will suspect me. I think Mcduff already does. I fear that I will have to kill again to ensure that Lady Macbeth and myself are not found out. I only hope you will be able to forgive the terrible sins I have committed.

Black Holes Essay -- essays research papers fc

Black holes are one of the many things in the universe that scientists still have a muddy understanding about. However, with the incredible advances of technology, we are able to understand more than what we have in the past. Today, the only way to observe these incredible objects are by looking for radiation from the gas surrounding it. What are they? Black holes are no more than a  ³dead star. ² A star that is considered  ³alive ² would be our sun. The sun still produces energy by converting hydrogen into helium, thus considered to be  ³alive. ² Once a star has run out of hydrogen, it begins its dying process. The final stage may result in a black dwarf, which is a small cool object no longer radiating energy, or if the star harbors enough mass it could result in a black hole. Black holes are defined as a collapsed star. The difference between a black dwarf and a black hole is the original mass of the star, which determines whether or not that star will have enough gra vitation force to collapse upon its self and form a suction, or to remain as that small cool object, a black dwarf. Why do black holes suck everything in? To understand why material that enters a black hole is unable to escape, one must understand the concept of escape velocity. This is the velocity (speed) at which any material needs to exceed in order to escape from something. Because, as Einstein said,  ³What ever goes up must come down! ² In other words, in order for a space craft to exit the Earth ¹s atmosphere so that it must not come down, it must exceed a certain speed. In order to figure out the Earth ¹s escape velocity one takes the square root of the planet ¹s mass divided by the planet's radius. PLANET ¹S MASS / PLANET ¹S RADIUS = ESCAPE VELOCITY On Earth with a radius of 6,500 km, the escape velocity would be 11 km/sec. Therefore to launch any object away from Earth, the object must travel (escape) faster than 11 km/sec. All of this is of course the result of gravity. However, imagine a huge vise that squeezed the Earth to one-quarter its present size. What would then happen to the escape velocity? The velocity would increase because the mass would increase as the radius increased. Thus, taking the square root of a larger number, ending up with a larger number that being the escape velocity. The actual escape velocity of this hypothetical question would double it making it 22 km/sec. Taking ... ... horizon, which would emit radiation because of this. The thermal radiation is so hot that it is expected to be x-ray types of radiation. Once the radiation surpasses the even horizon, the x-rays cease and the material inside continues in great distortion. This is what scientists are trying to link to their observation of such radio active areas within out universe today. Bibliography Abell, George O. Exploration of The Universe. Holt, Rinehart and Winston, 1975. Berger, Melvin. Quasars, Pulsars and Black Holes In Space. Canada: Longman Canada Limited, 1977. Bisnovatyi-Kogan, G.S.  ³At The Border of Eternity. ² Science. February, 27, 1998: 1321- 1322. Chaisson, Eric. Relatively Speaking. Canada: The Readers Digest Association Ltd., 1990.  ³Down The Galactic Drain. ² Discover. April 1998: 25. Shipman, Harry L. Black Holes, Quasars, and The Universe. Boston: Houghton Mifflin Company, 1976. Sullivan, Walter. Black Holes- The Edge of Space, The End of Time. New York: Anchor Press, 1979. Taylor, John G. Black Holes: the End of The Universe?. New York: Random House Inc., 1973.  ³The Astronomers- Searching for Black Holes. ² Community television of Southern California, 1991.

Court Issues

The criminal justice system has changed tremendously over the decades and so has society. It is important that the court system make changes to keep up with the times. There are parts of the court system that need to be identified to have these changes occur. One of these areas is the way courts are managed including their problems and resolutions. A new trend that has emerged is victims’ rights. Victims can now intervene in the cases before sentencing. In the future, courts could lose cases to arbitration and mediation also known as the private sector of the courts. Understanding these changes and issues are important so that the courts can correspond with the trends as they occur. The courts are an important piece of the justice system. In order to meet the domains of the criminal justice system the courts evolve with the new processes and trends as they happen. Below the paragraphs will analyze and explore future management issues dealing with technological innovations and how the new technology is impacting the courts. Along with how victims’ rights are impacting the courts. One of the main issues that the courts are facing in the future is the possible division between the private law sector and the courts. The technological innovations also impacts the courts staff and judges. Current and future trends facing the courts and administrators One of the issues facing the court system today is judges are not able to see many cases because of their administrative role. Judges spend the majority of their time â€Å"papering budgets, scheduling cases, supervising employees, and maintaining court records† (Robinson, 2009, pg. 208, para 5). The courthouse employee’s work together getting cases dispensed as quickly as possible. Some of these cases are dismissed before even being seen because of how many cases there are. Many of the minor cases are plea bargained so that the more serious cases can be seen. In doing this the judges and the courts have more time to spend on the very serious cases such as murder cases. The court system has to make adjustments due to the many cases that they have coming through the courts and they would never caught up because of the fact that there are many people having run in with the law enforcement. Another problem that courts are facing today is the imbalance of power. In the courtroom today the prosecutors have more power because there are the ones that decide if there is going to be charges filed against someone. This means that if the prosecutor does not prosecute a case the judge and defense attorney will have no say in the outcome of that case. One former United States Attorney General has stated â€Å"the prosecutor has more control over life, liberty, and reputation than any other person in America† (Robinson, 2009, pg. 209, para 4). The power that the judges have has been reduced because of the changes in sentencing and rules. The mandatory sentencing laws has given prosecutors the increase power of prosecution control over cases and how they are disposed of. With the power that prosecutors have the justice system is being threatened. If the law was still equal the defense attorney would have the resources they need to help the defendant. The defense attorneys have heavy caseloads because they work for the government and their resources are limited that they can access. Issues and trends regarding language interpretation services Throughout the United States individuals rely on the court system to solve issues and controversies in their lives. Language barriers between an individual and the courts cause the process to get delayed because it causes communication and understanding problems. When a witness is on the stand testifying that speaks a different language that interpreters need to understand what the witness is saying so they can communicate their true meaning of their statement. The United States accepts many different immigrants and the way of communicating. One of the fundamental rights that the United States has is to recognize the important reason why immigrants come to the United States, â€Å"in our country’s belief in equal justice for all, but to have equal justice, every victim, every witness must understand what is happening in the courtroom† (Board of Directors, 2007, pg. 3, para 2). With the increasing population of immigrants that do not speak English is making it harder to accommodate for people because the courts have to make sure that the interpreter fully understands the language and can translate what the witness is saying. New York courts employ approximately 300 full and part time court interpreters, and 1,200 interpreters on the per diem bases, to provide services in over 100 languages† (Board of Directors, 2007, pg. 4, para 2). The multi-faceted type of communication makes it harder for interpreters in the courtrooms because of the words meaning different things in the different cultures in the Un ited States. An interpreter of the courts also needs to understand legal terminology and procedures of the cultural content that impacts all individuals involved in the case. Interpreters will succeed in their jobs if they can convey what the speaker is meaning to say without altering the expression or tone of the speaker. There are three types of interpreting, which are; consecutive, simultaneous, and sight. Consecutive interpreting is when the interpreter waits for a group of words to be spoken before they interpret what was said. Simultaneous is when the interpreter listens and interprets in a different language at the same time. The last is sight and this is when interpreters read one language and translates it aloud in another. Language interpretation services is a permanent component in the criminal justice system so that the constitutional rights requirements are meet for all individuals. Courts are now required to appoint an interpreter when defendants and witnesses do not speak English in a case. Impact that victim rights laws have on court proceedings (past, present, future) Thirty years ago, victims’ rights did not exist. The victims were not notified about the courts processing or if the case was dropped and the defendant was released. Today, every state has an extensive body of basic rights and protections for victims within its statutory code† (Office for Victims of Crime, 2013). Activists discussed amending the Constitution of the United States to recognize victims’ rights statutes in the criminal justice proceedings. It was not until 1982 that a President’s Task Force on victims of crime suggested for the Sixth Amendment of the Constitution to be amended so that victims are included in the judicial proceedings. California was the first state to adopt the constitutional amendment in 1982 and by the end of the 21 century 49 states passed the victims’ Bill of Rights and this gave victims benefits and options in their case. Two presidents supported the amendment of the constitution at the end of the 21st century. The amendment gave victims the right to receive information, protection, and restitution from the offender. This also gave the victim the right to express their views on sentencing, bail, and parole. Victims’ rights has come a long way sense the early 1970’s and will continue to change as it needs too. There are several issues facing the courts and courts administrators system today. The analysis above discussed these issues and give information to support the findings. The information of future management issues and trends regarding language interpretation was discussed in the analysis. The past, present, and future impact of victims’ rights laws on the court proceeding were discussed in detail.

Before and After the Cellphone Essay

Cellphones have gradually become an imperative part of peoples lives today. 70% of the world’s population have cellphones. These days, people and their mobile phones seem to be inseparable. Texting or calling someone when we wake up has become a usual habit just like brushing our teeth in the morning. For many of us, it’s hard to imagine a time before cellphones. Having a cellphone has changed our manners, the way we communicate, and our safety. Before cellphones there seemed to be more peace and quite. People seemed to have manners. Today people don’t always remember their manners when using their cellphones. People constantly carrying on personal conversations in a public place can be very annoying. Some people talk really loud and don’t care that everyone around them can hear every word they are saying. It can be extremely disturbing to someone when they are walking in a mall or down a street and someone starts speaking right beside or behind them. They turn to respond, only to find out he or she beside them has an earbud active. Before we had cellphones people would actually write letters. During my elementary school days it was â€Å"cool† to pass notes. We actually used complete sentences and words that were in the dictionary. Also before cellphones if someone was to leave the house, they didn’t make a phone call unless they popped 10 cents into a pay phone. People never received any calls away from home. People actually had to be out of touch with friends and family when they weren’t at home. Now that we have cell phones letters are rarely sent. Today note passing is rare. If kids want to communicate during school they simply just shoot each other a text message. Also, today if someone is to leave the house, making a phone call is easy. With a quick dial on a cellphone people can make a call at any time. Cellphones have not only changed the way we communicate but they have changed our safety. Texting and driving has become common and has caused many deaths in the United States. It was reported in 2005 that cellphone distraction causes 2,600 deaths and 330,000 injuries in the United States every year. Another safety issue with cellphones is privacy. Say someone’s at an airport, or on the bus. Several people are on their cellphones, some talking business, and others talking about personal information. Any information shared has now become available to anyone else who might have been around to hear their phone call. Others may now know their address, information about their family, or financial records. Before cellphones life were more safe. Before cell phones people didn’t have to constantly worry about someone overhearing their conversation. Also people didn’t have to worry about others driving them off the road because of the careless mistake of texting while driving. The cellphone is loved by many and hated by the few for ruining society. Although cellphones have changed society I have a hard time imagining my life without one. Cellphones have had a major impact on our lives and have vastly changed our manners, the way we communicate and our safety. Many of these changes are apparent, while others we may not even be aware of.

18 vs. 21 Essay

18 vs. 21 Essay 18 vs. 21 Essay Position Details Page 1 of 2 IT Technician I Type:Part Time Non Benefited Salary:$18.95-$25.10 Status:Recruiting Closing Date:03/21/13 Job Summary Provide assistance and support to in-house computer users; installing, maintaining, and servicing individual PC’s; and advising and supporting the in-house training programs. Please note that the current vacancy is for a project position; however, this recruitment may lead to an eligibility list to fill any future vacancies for the same classification for up to six months. EOE The "Ideal" Candidate Perform a variety of professional and technically skilled tasks in the installation, maintenance, operation, and coordination of the City's computer information systems. Effective Public Relations skills. Establish and maintain effective working relationships. Essential Functions Assist and coordinate a City-wide preventive maintenance program. Develop and implement policies, procedures, and standards relating to information technology activities. Deal with confidential information and develop security strategies for the maintenance of the computer network system. Insure that new City facilities are appropriately equipped with all necessary computer equipment. Produce and distribute statistical data, reports and computer printouts as necessary. Interpret and follow technical manuals and develop, maintain, and update training guides and procedural manuals. Oversee information technology functions, such as, electronic mail and printer sharing. Provide assistance to departments to meet current and plan for future data processing/computer/automated information technology needs. Maintain systems and standards for data base design, backup and recovery.Coordinate activities to resolve program and system problems. Conduct product research. Assist with selection of new hardware and software. Operate, maintain, and repair hardware. Install computer equipment and software, and customize installed software to the specific requirements of the user department. Monitor "back-up" systems and file servers. Interface with vendors and customers in a professional and courteous manner. Monitor computer maintenance and repair contracts. Provide assistance, recommend, and evaluate software-training courses. Oversee, advise and support the City’s Computer User Group.Provide assistance to the public, City staff, and other Governmental agencies.Provide information at the public counter, in writing, and on the telephone. Knowledge of: Principles and techniques of computer system programming, networking and software strategies. Techniques and procedures pertaining to installation and maintenance of

Out of Pocket and Singing in Tune

Out of Pocket and Singing in Tune Out of Pocket and Singing in Tune Out of Pocket and Singing in Tune By Maeve Maddox When I heard someone on NPR say that someone â€Å"couldn’t hold a tune,† in the sense of â€Å"couldn’t carry a tune,† I assumed it was an isolated misuse of the more common expression. Then I did a Google search for â€Å"hold a tune† and got more than half a million hits. Here are a few: Oh, my God, can she really be so oblivious to the fact that she cannot hold a tune? –Otago Daily Times (New Zealand) Even if your child cannot hold a tune, the fact that he loves to sing and is showing an interest in music is wonderful! –LeapFrog advertising site (California company) But thats terrifying me. I cant hold a tune to save my life. God knows how Im going to do that. –Tom Hardy (London-born actor) If I could hold a tune, I’d probably sing to her. –lyrics, Fly Union (American hip hop group from Ohio) I scurried to the Ngram viewer and discovered that â€Å"hold a tune† has been making inroads since the 1960s, although it is still way below the more common expression, â€Å"to carry a tune.† Its use is more noticeable in British English than in American. For those unfamiliar with either idiom, the meaning is â€Å"to sing on key† or â€Å"to sing in tune.† Time will tell if the altered expression has staying power. â€Å"Hold† doesn’t work as well with the colorfully embroidered version that adds â€Å"in a bucket.† For example, â€Å"Florence Foster Jenkins couldn’t carry a tune in a bucket.† out of pocket The first time I heard the expression â€Å"out of pocket† was when I lived in England. I’d bought something to use with my English class and the headmistress reimbursed me because she didn’t want me to be â€Å"out of pocket.† In this context, an â€Å"out-of-pocket† expense is something one pays for personally. For example, one might have an expense account that covered food purchases, but wine would be an â€Å"out-of-pocket† expense. When I returned to the United States, I was bewildered one day when the woman I was working for stopped at my desk to say that she’d be â€Å"out of pocket for about two hours† and walked out the door. As the expression was one she was fond of using, I soon figured out that by â€Å"out of pocket† she meant â€Å"unavailable, out of reach.† In browsing for â€Å"out-of-pocket† examples, I found that, although the â€Å"unavailable† meaning is of U.S. origin and may be found in some newspapers, the financial sense dominates with American speakers, especially on the topic of health care: After I pay $14,523, I’ll incur charges up to an out-of-pocket maximum of $12,700 for a total of $22,700. I wouldnt pay out of pocket for a test my doctor doesnt think I need. We paid out of pocket for a private nurse coordinator service in New Jersey. I rear-ended someone–Should I pay it out of pocket or let them report it to insurance? I went out of pocket for this treat. A Forbes commentator on annoying business jargon notes disapprovingly, â€Å"Many auto-reply e-mails now carry the phrase: Im out of pocket until next week.† The money-related â€Å"out of pocket† dates from 1679. The earliest documentation of the â€Å"unavailable† use is in an O Henry story: Just now she is out of pocket. And I shall find her as soon as I can. –â€Å"Buried Treasure,† 1908. Now that I have these two uses clear, I’ve come across an example that has me bewildered all over again: Youre talkin out of pocket when you told me that Ive changed –Mac Lethal 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 Expressions category, check our popular posts, or choose a related post below:60 Synonyms for â€Å"Walk†Work of Art TitlesEpidemic vs. Pandemic vs. Endemic

A CRITIQUE OF A RESEARCH ARTICLE FROM A PROFESSIONAL JOURNAL Essay

A CRITIQUE OF A RESEARCH ARTICLE FROM A PROFESSIONAL JOURNAL - Essay Example In this assignment, this reviewer will critically review a research article from a professional journal (Baldwin, K. M., & Nail, L. M., 2000). The purpose of any critical review is better understanding and learning so new knowledge is build. Moreover, critical thinking is an important acumen for the present day healthcare professionals where professional standards need to be updated in order to provide clients with the best possible care based on evidence (Fink, A., 1998). Healthcare research has advanced keeping pace with the advancement of modern technology guided healthcare practice, and the best evidence can be obtained from the professional medical journals. The most interesting fact is that evidence from professional journals from research articles needs to be gleaned with critical examination of the facts, findings, and reasoning presented there (Bailey, D. , 1997). In other words, the facts presented in a scientific research must be questioned in order to establish the logic of the findings presented there. This can be only done by a systematic review of the article in light of the theoretical paradigms of research methodology that establishes the strength and power of the findings that can serve as evidence (White S & Stracombe J., 2003). Therefore, this author has chosen an article from a journal that is related to her practice and expects that critically reviewing this article would serve to provide evidence that can be utilized in practice in order to upgrade it. The process of evidence-based practice is dependent on the theoretical framework that clinical decisions are as far as possible informed by current research evidence (Sterling,Y. M., 2001). Critical review converts the process of seeking information from research into a series of clear questions that need to be answered clearly, so the truthfulness and usefulness of the research in practice can

UK Recorded Music Industry Essay Example | Topics and Well Written Essays - 2000 words

UK Recorded Music Industry - Essay Example In 2001, four largest music companies in the world (British EMI among them) tried to combat the piracy by developing new software program that made impossible for online users to copy CD to internet. In spite of the fact that many analysts claimed that this step would reduce the quality of recording, the companies nevertheless implemented this program as they were resolved to fight online piracy by new technological means. Online sharing of music and video files had been one of the huge problems for music industry since the end of the 20th century, as such companies as Napster that distributed music files for free, gained popularity. Despite the fact that Napster’s activities were curbed, online files sharing was still widespread at the beginning of 2001. New files-sharing systems, such as MusicCity and Kazaa were used by online users instead of Napster. Many specialists and analysts insisted that online sharing could be effectively combated by selling music files through onli ne legal subscriptions of major recording companies, yet such services of recording companies had many drawbacks as it was still impossible to copy digital files to CDs as well as portable devices. Neither it was clear whether file sharing, would be as cheap as the services provided by Nepster and other file sharing system

Research Methods for Criminology Essay Example | Topics and Well Written Essays - 750 words

Research Methods for Criminology - Essay Example Series of measurements are taken to make sure that the experiment is able to measure different sets of conditions under which the person or the instrument has to work. Now the question arises how to make sure that the series of measurements are not only reliable but valid as well. Or can we make use of a measurement which happens to be reliable but low on reliability or vice-versa. This study cannot be an area specific but it cannot be generalized for all experiments as well. There might be some areas where we can use such measurements, but there might be areas where we need to be doubly sure that the measurement is both reliable as well valid. It is worthwhile here to mention that while validity can be tested and can be termed as an objective parameter, it is difficult to do exact calculation for reliability as it is subjective in nature. Reliability is therefore estimated in order to come to the nearest perfection point. Four general classes of reliability are1; While there's no doubt that a measurement with high validity and high reliability is the most sought after type of measurement, a measurement with low validity and low reliability is never used for making any calculations. Measurements low on validity and high on reliability imply that we are consistently measuring wrong values, which in a way defeats the very purpose of carrying out the research. In such cases we continue to get incorrect information quite consistently. Therefore, we seldom use such measurements. Quite often it so happens that the repeated measurements fail to show consistent patterns, but for a group of parameters, the measurements hold good. In this case, though on an average we do get the valid results, the consistency is not there. In such cases, the measurements can be useful depending upon the criticality of the usage. For example, if we are to make use of these measurements for the operation of

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