Globalisation,Transnationals and Economic Development in Uk(78114003) Essay

Globalisation,Transnationals and Economic Development in Uk(78114003) - Essay Example sult of such a trend, the globalization - as an idea or an activity – has been expanded in most of countries around the world creating specific obligations and rights for both the states and the individuals. Current paper examines the effects globalization in the local economic development of UK particularly in relation with the position and the activities of the transnationals. It should be noticed that the analysis of the above subject is taken place presenting at a first stage the current situation in the international community (regarding this particular issue) and at a next level, the findings are compared with the ones of the UK financial market in order to formulate a secure assumption on the problem. On the other hand, a series of particular issues are been exposed (with reference to the UK market) which should be considered before arriving in any conclusion regarding the specific subject. The post-World War II ‘phenomenon of globalization-the increasingly close international integration of markets both for goods and services, and for capital - may in many ways be viewed as a resumption of a trend observed in the world economy a century ago; by some measures, international economic integration increased just as much in the 50 years before World War I as in recent decades, and reached comparable levels; then, as now, integration was driven in large part by the proliferation of markets and rapid technological change. The process was interrupted and reversed from 1914 to after World War II’ (World Economic Outlook, 1997) Globalization is a term ‘variously employed, even by experts within a single discipline; moreover, there is substantial debate, not only about its definition, but also about whether it is actually occurring, its significance, and how it shapes our future’ [8]. At its most accepted form globalization ‘rests upon, or simply is, the growth in international exchange of goods, services, and capital, and the increasing levels of

Cases in Financial Management Essay Example for Free

Cases in Financial Management Essay Case Synopsis Founded in 1984 Laurentian Bakeries Inc. operates in the industry of manufacturing a vast variety of frozen baked products within their three operating plants in Montreal, Winnipeg and Toronto. The operating plants produce items such as frozen pizza in Winnipeg, MB, pies in Montreal, QC and Cakes in Toronto, ON- with each representing 30%, 30% and 40% of the total revenue stream respectively. The buyers for this company include large institutional clients such domino’s pizza, etc. which have a significantly higher level of power whereas the seller of the products consists of several food producers which have a relatively low level of power. With the cost of setting up a plant of this scale being high, substitute products will also remain high in the market causing the overall profit margin to be low. With the company’s ongoing effort for continuous improvement Danielle Knowles (VP of operations) proposed to expand one of the operating plants in Winnipeg-which was based on the opportunity if the company expanded into the U.S. market. Statement The statement of the problem is how Danielle Knowles will prepare a capital project expenditure proposal to expand the company’s frozen pizza plant in Winnipeg; which is consistent and in line with the company’s capital allocation policy. The proposal should also satisfy the company’s continuous effort for improvement, identification of lost opportunities, satisfaction of HR and environmental impacts and provide sufficient ROI. Situational Analysis The strengths of the company are clearly visible through the company’s effective operations and reputable image in the industry. Being one of the top five in the industry, Laurentian Bakeries has established themselves as a dominant player in the market; however, with a shortage in capacity it can  potentially overpower the strengths due to its negative impact on the company. This includes a decrease in sales and potential decreases in retailer support. Nevertheless, with the acknowledgement of a capacity shortage and an opportunity to expand and grow in the U.S. market the company seems to be in good standing. Moving aside to a different area amongst the competition, all the products are similar which indicate there is heavy competition. The presence of numerous suppliers makes this industry highly competitive, as a result, there is high aggression amongst competitors. This is a leading factor that indicates this is not an attractive business to be in. SWOT ANALYSIS Strengths * Danielle Knowles has experience in the food industry for 13 years. This is a great benefit for the company, because she is able to use her knowledge and experience and apply it for Laurentian Bakeries in order to improve operations or even avoid errors. This in return can potentially save the company from incurring additional expenses. * Danielle has her Master’s in Business Administration which indicates that she is educated and has the credentials to maintain her position as the VP of operations. Also, Danielle is able to use that knowledge and apply it to everyday operations of the company. * Laurentian has above average consideration for human resource and environmental impacts. This benefits the company to the extent that it creates a public awareness which shows their commitment to the community which in return can potentially be used as a marketing tool to attract more sales. * Laurentian company is one of the five large firms that produce frozen foods dominating 21% of the market. This indicates that they are a dominant player in the market and have survived many difficulties from various competitions. * Well established and profitable company which indicates that they have survived one full economic cycle and have withstood their competition. * The company has a diversified revenue stream with three operating plants located in major cities which are not as risky as a single revenue stream. * All three segments are profitable. * Low cost pizza producer which is helping to expand into the US. Market. * Laurentian Bakeries has an integrated workforce such as sales, marketing, etc. for all of their operating plants. Weakness * Shortage of capacity. If this weakness is not dealt with the company can face losses in their sales because of the shortage. This in return lowers the overall profit of the company and can potentially decrease buyers if they cannot meet the demand due to the shortage. * Class 1 products are too risky and by taking such a great risk any wrong doing can have a negative impact on the company. Opportunities * Arrangement to supply large U.S. based grocery chain with private label brand. If the opportunity is taken to its advantage the company can potentially see higher figures in sales and profits. * Since U.S. pizza consumption is 3x bigger than the Canadian segment the overall US market is bigger which can potentially lead to a higher market share. * Within N.A. the economy is recovering modestly and is expected to grow. This indicates that consumer spending on discretionary items such as food products will remain strong. Threats * Inflation is forecasted to remain between 3-5%. This may cause interest rates to rise causing the cost of capital to increase higher than its current level. Capital projects such as expansion may suffer. * North American growth rate of gross domestic product slowed down which may lower the company sales. * Threat of new entrants will increase competition and is always a factor that makes the sales aggressive. * Health Conscious consumers will potentially affect sales due to the products offered by Laurentian Bakeries are considered â€Å"unhealthy.† With on-going health awareness the products offered by Laurentian Bakeries might not meet the changing demand of consumers. Porter’s Five Forces Buyer’s Power * Mixed Power. * There are two types of buyers: large institutional buyers such as  domino’s pizza pizza pizza as well as large retailers. Thousands of smaller clients have less power because of their current low clientele base. Supplier Power * Low Power. * Pizza suppliers distribute production to pizza stores, restaurants and grocery chain stores. Since there are numerous suppliers in the market for ingredients such as cheese, flour, vegetables, etc. they have low power. Barriers to Entrant * High * Due to high capital costs, skilled workforces, environmental regulations, high distribution channels, entry into this industry is high. Threat of Substitute * High * The products offered by Laurentian such as their Pizza can be made at home or even purchased fresh from fast food restaurants. Also they can easily be substituted for other products such as calzone, sandwiches, tacos, etc. Competition * High * There is high competition for the items offered by Laurentian Bakers. Competition for their pizza baked items can easily be substituted through franchised restaurants such as Pizza Pizza, Boston Pizza, Pizza Hut, etc. also competition is high through other companies offering the same goods. In addition, this company is also competing against other food products rather than frozen pizza alone. Financial Analysis Financial Summary: Laurentian Bakeries is seeing a cash increase from $6.2 million in 1993 to almost double its value of $13.1 million in 1995. At the same time long term debt for the company has increased by $7.23 million which indicated that Laurentian Bakeries is funded by its long term debt and has not utilized its cash and therefore has incurred additional interest expenses. Moving over to the sales figures, Laurentian Bakeries has seen an increase of 11% from 1993-95; however, net income is flat which indicates that their COGS and operating expenses have also risen almost at the same pace as sales. This setback has no advantage to the shareholders. Alternatives 1. Continue original plans to continue expansion in Winnipeg. 2. Build a plant in U.S. to cater to that market. 3. Buy an existing plant. 4. Expand the Toronto plant as it is the strongest plant for the company. Recommendations By carefully analyzing all the alternatives, we recommend alternative one as the best fit solution to this company due to it being most practical at the company’s current situation. We strongly believe that continuing original plans to expand in Winnipeg is the beneficial solution for the company as they already produce the same type of products and have the additional land to carry forward the expansion, because this plant is a low cost producer and is ideal to utilize the U.S private label sector. In addition, this alternative is beneficial because it is consistent with the company’s overall objectives. Given the discount rate of 18% and a $5.2 million capital investment the NPV of the expected cash flow is positive. Moreover, recommendation one is the best suited for this company because: * There is land readily available in Winnipeg. This can save the company some money in terms of the expansion because these will incur less of an expense due to Laurentian owning the extra land space. * Building a plant in U.S. will require a lot of capital, additional expenses for hiring, training, etc., and potential change in production, management or other techniques due to different regulations in U.S. * Expanding in Toronto will also require additional capital and additional time to hire and train the workforce to produce the pizza products which aren’t produced in the Toronto facility.

Personal Narrative- Transformation of a Hurting Teen Essay -- Personal

Personal Narrative- Transformation of a Hurting Teen Before I lost my innocence I was care-free, and full of love. But I grew up and my peers began to tease me. â€Å"Am I really fat, ugly, stupid and dorky†? I thought. Every loving part of me was torn apart piece by piece by my young peers like wolves on the prowl. Every fault and every flaw I owned was brought to my attention. This teasing spawned an anger in me so strong that every aspect of my life was destroyed. I began to rebel towards any kind of authority as a way to protect myself. I felt that every breathing thing was out to hurt me. When I was fifteen years of age, this rebellion turned juvenile and I began to get into quite a bit of trouble with my parents and teachers. I was sent to House of Hope, a home for hurting teen...

The Power of the Sun in F. Scott Fitzgeralds The Great Gatsby :: F. Scott Fitzgeralds The Great Gatsby

The Power of the Sun in F. Scott Fitzgerald's The Great Gatsby In F. Scott Fitzgerald's novel, The Great Gatsby, there is a constant feeling of movement and the desire to get away. Nick, Gatsby, Wilson, Tom and Daisy all move, or have the intention of moving. Not only does this movement seem to foreshadow events in the book, but it also seems to lead to the conclusion that society as a whole in the 1920's was rather unstable and was undergoing constant change. Not all the characters move in the same way, and this shows how different their backgrounds and lifestyles are. The main movement seems to be from west to east. Throughout the decades man is said to be progressing through the steps of evolution and toward the setting sun, or east to west. The characters move in opposite direction from which the sun sets, which seems significant to the physical and psychological patterns of the characters. The two main characters that movement affects are Nick and Gatsby. The movement of Nick and Gatsby in this direction shows us how their personalities and feelings change as the sun goes down. There are also the various meanings that the sun has, that seems to map out, or affect their near future. The sun foreshadows Nick and Gatsby's actions and emotions, which in turn are affected by the many representations the sun has. Jay Gatsby is a character that the sun affects in such a way that it becomes a symbol of his ability to direct his will and, when put together with his dream, this gives him a sense of purpose. Jimmie Gatz was born in a town in Minnesota. After changing his name to Jay Gatsby, he moved to West Egg, Long Island in order to start a new life revolved around impressing Daisy. Here the sun represents a psychological belief that surpasses time and place, otherwise known as Gatsby's dream. This means that Gatsby's dream is so important to him that the sun rises and sets in the sky, but he still doesn't see the

The Scarlet Letter: Themes Alive Today

Mike Esposito Mrs. Forstrom American Literature – 1 7 November 2012 The Themes Are Still Alive Today Ah The Scarlet Letter, whether we like it or not, it is now a book we have all read and have most likely come to hate. Whether it be because of the old setting in the Puritan Massachusetts Bay Colony in Boston that we cannot relate to or the old English language in which it is written, Nathaniel Hawthorne just failed to create a novel that most teenagers of the early twenty-first century can enjoy and appreciate.It must be pointed out that first, it’s doubtful he cares, and more importantly that this just simply should not be the case. We juniors should pay more attention to the novel, especially with the thought that the messages Hawthorne tries to convey are still relevant today. Think about it. With all of the experiences of Hester Prynne and other characters in the novel, we interpret concepts that are still correlated with those of today.In Hawthorne’s the Sc arlet Letter, two crucial themes of sin and what it can do to people and the different degrees of evil directly relate to today’s society and modern ideas. As it is known, Hester committed a sin in the novel with Reverend Arthur Dimmesdale that the Puritans in her society thought to be one of the worst that could ever be committed: adultery. They conceived a child together, their daughter Pearl, which is a sin that takes a toll on both characters in many different ways.Beginning with Hester, the protagonist, the sin is something that identifies her, and she becomes one with it. At the beginning of the novel, you should recall that she has to take her first punishment of being humiliated on the scaffold and ridiculed by many people of the community while wearing the letter â€Å"A† on her chest to indicate that she committed adultery. But she does not just stick any regular printed letter on her.She goes beyond, as Hawthorne describes, â€Å"But the point which drew al l eyes and, as it were, transfigured the wearer—so that both men and women, who had been familiarly acquainted with Hester Prynne, were now impressed as if they beheld her for the first time—was that Scarlet Letter, so fantastically embroidered and illuminated upon her bosom. It had the effect of a spell, taking her out of the ordinary relations with humanity and enclosing her in a sphere by herself† (51-52). Hester makes the Scarlet Letter so beautiful because it is a part of who she is and it determines her identity.Also, throughout the book, Hester shows she accepts her sin, especially through the fact that she wants to stay in Boston instead of leave to go elsewhere. She does this because she does not want to pretend that the situation never happened and deny a part of who she is. This tremendously demonstrates the message that sin can give someone fortitude. In addition, forgiveness is something that can also result of sin. This is demonstrated very creative ly through the changing of the letter A on Hester’s shirt.It first symbolized the sin she committed, but later in the novel, changes to mean other positive things, such as â€Å"able† and â€Å"awe†. The change of what the letter means shows that her sin was made up for and that she is forgiven. However, in complete contrast to Hester is Dimmesdale, the father, who shows what can also result from sin. No one ever finds out that until late that he was on the other end of the affair with Hester, which was not a good thing for Dimmesdale. Throughout the novel, his psychological turmoil worsens as he unintentionally inflicts his own punishment of self hatred and guilt.He gets vitally ill and sicker as time progresses, which is reinforced with him always having his hand over his heart. One night his agony and remorse sleepwalks him to the scaffold that Hester was embarrassed on years earlier, as Hawthorne words it, â€Å"he had been driven hither by the impulse of t hat Remorse which dogged him everywhere† (144). This clearly portrays the message of hiding a sin can be too much to handle and can destroy a person. Now that the theme of the different things sin can lead to is discussed in The Scarlet Letter, let’s relate it to our life.As the Christian religion will preach, everyone in the entire world sins all the time. Whether the sins are small or really serious, they are a part of our life all the time, and mostly those that are seriously poor decisions can have a great affect on us. As is illustrated with Hester in the novel, those poor choices can be made up for and can give us strength in our later life. For example, steroid use in baseball is a very popular issue. Ryan Braun, outfielder in the MLB, was suspected to have used performance enhancing drugs after a failed urine test.Clearly, taking steroids was a bad choice for him to make, and although it is not commonly thought of as one, it is a sin. However, Braun came back th e next season after the scandal and had a career year. He recognized his mistake and came back stronger than ever, which is quite relatable to Hester and how her sin made her bold. Also, on the other side, sins can lead people today into having too much guilt to be able to handle, no matter how venial or mortal the sin may be. You may lie to your parents and just not be able to hold back a confession because you feel bad.Or, it may be as serious as a murderer who could not live with himself anymore and turned himself in. Whatever the case may be, what Hawthorne wrote about sin in the 1800’s in The Scarlet Letter still relates to aspects of life today. Roger Chillingworth, that doctor that we know and love, presents another major theme in the novel: there are many levels of evil. As we know, Chillingworth was the husband of Hester before she had the affair with Dimmesdale, which obviously is an evil to the Puritans of the colony.One of the details that you may have missed is t hat the marriage between Chillingworth and Hester was arranged, and that she had no say in it. On a side note, Chillingworth was about double Hester’s age, which makes the marriage worse, and kind of gross. But this plays a role in that Hester more likely committed the sin because she wasn’t really in love with Chillingworth, and was with Dimmesdale. This is the justification of her doing what she did. And in addition to the evils that Hester and Dimmesdale carried out, Chillingworth also does.You should remember that as Dimmesdale was sick, Chillingworth, the â€Å"brilliant acquisition†, was chosen to be his doctor and he had to try to save the colony’s well loved minister. As he did this, he suspected something interesting going on with Dimmesdale, and he figured out that he was involved with Hester and realizes his suspicions are correct. So instead of curing him, he begins to torture the minister. This act of malice is definitely more widely consider ed evil than the acts of Hester and Dimmesdale to us, which is exactly what Hawthorne wants us to think.He demonstrates the theme bluntly in Dimmesdale’s speech to Hester when he talks about Chillingworth’s evil, â€Å"There is one worse than even that polluted priest! That old man’s revenge has been blacker than my sin. He has violated, in cold blood, the sanctity of a human heart. Thou and I, Hester, never did so! † (191). Hawthorne clearly wants you to realize that the evil found in Hester and Dimmesdale’s lovemaking is not nearly as bad as evil in its most poisonous form of the cruel revenge taken by Chillingworth.Evidently, the theme of different levels of evil is clearly presented in the novel, but it also occurs in real life. It is a very upsetting fact, but it is true: evil has not gone away. It existed in the eighteenth century, the time period where The Scarlet Letter takes place, the nineteenth century, when the novel was written, and ri ght now, where it is still around today. We know that evil can be something that is somber, such as a serial killer that just doesn’t have a conscience and will never grasp the concept that death is something so mind bogglingly terrible and should never be done to a person.That is one extreme. Evil can also be used to describe your teacher, even if the only reason why is because you didn’t like that she gave you a pop quiz that you failed. This may seem barely related to evil talked about in The Scarlet Letter, but it is not, however. This is because as the Puritans call the acts of love of Hester and Dimmesdale â€Å"evil†, we still don’t really think that they were necessarily evil for doing so, just like the hypothetical teacher probably does not have much of an evil soul.So, there are many different degrees of evil, and they exist in modern context as well as in the wonderful novel. As you now well educated pupils should realize, the novel written hun dreds of years ago, The Scarlet Letter, about a world that we can’t seem to be able to relate to, is still very useful in today’s modern society because of the relation between the novel’s major themes and their relation to today’s modern society.Sin and what it can do to people is a large concept that is a lot to grasp, and it is discussed thoroughly in the book and is clearly alive today. Additionally, the different degrees of evil in the world is definitely a focus of both the novel and our current lives. So no more calling the book bad and difficult and boring. Respect its greatness. Works Cited Hawthorne, Nathaniel. The Scarlet Letter. New York: Tom Doherty Associates, 1988. Print.

The Hanging Gardens of Babylon

The Hanging Gardens of Babylon According to legend, the Hanging Gardens of Babylon, considered one  of the  seven Ancient Wonders of the  World,  were built in the 6th century BCE by King Nebuchadnezzar II for his homesick wife, Amytis. As a Persian princess, Amytis missed the wooded mountains of her youth and thus Nebuchadnezzar built her an oasis in the desert, a building covered with exotic trees and plants,  tiered so  that it  resembled a mountain. The only problem is that archaeologists are not sure that the Hanging Gardens ever really existed. Nebuchadnezzar II and Babylon The city of Babylon was founded around 2300 BCE, or even earlier,  near the  Euphrates River just south of the modern city of Baghdad in  Iraq. Since it was located in the desert, it was built almost entirely out of mud-dried bricks. Since bricks are so easily broken, the city was destroyed a number of times in its history. In the 7th century BCE, Babylonians revolted against their Assyrian ruler. In an attempt to make an example of them, Assyrian King Sennacherib  razed the city of Babylon, completely destroying it.  Eight years later, King Sennacherib was assassinated by his three sons. Interestingly,  one of these sons ordered the reconstruction of Babylon. It wasnt long before Babylon was  once again flourishing and known as a center of learning and culture. It was Nebuchadnezzars father, King Nabopolassar, that liberated Babylon from Assyrian rule. When Nebuchadnezzar II became king in 605 BCE, he was handed a healthy realm, but he wanted more. Nebuchadnezzar  wanted to expand his kingdom in order to make it one of the most powerful city-states of the time. He fought  the Egyptians and the Assyrians and won. He also made  an alliance with the king of Media by marrying his daughter. With these conquests came the spoils of war to which Nebuchadnezzar, during the course of  his 43-year reign,  used to enhance the city of Babylon. He built an enormous ziggurat, the temple of Marduk (Marduk was Babylons patron god). He also built a massive wall around the city, said to be 80 feet thick, wide enough for four-horse chariots to race on. These walls were so large and grand, especially the Ishtar Gate,  that they too were considered one of the Seven Ancient Wonders of the World until they were bumped off the list by the Lighthouse in Alexandria. Despite these other awesome creations, it was the Hanging Gardens that captured  peoples imagination and remained one of the Wonders of the Ancient World. What Did the Hanging Gardens of Babylon Look Like? It may seem surprising how little we know about the Hanging Gardens of Babylon. First, we dont know exactly where it was located. It is said to have been placed close to the Euphrates River for access to water and yet no archeological evidence has been found to prove its exact location. It  remains the only Ancient Wonder whose location has not yet  been found. According to legend, King Nebuchadnezzar II built the Hanging Gardens for his wife Amytis, who missed the cool temperatures, mountainous terrain,  and  beautiful scenery of her homeland in Persia. In comparison, her hot, flat, and dusty new home of Babylon must have seemed completely drab. It is believed that the Hanging Gardens was a tall building, built upon stone (extremely rare for the area), that in some way resembled a mountain, perhaps by having multiple terraces. Located on top of and overhanging the walls (hence the term hanging gardens) were numerous and varied plants and trees. Keeping these exotic plants alive in a desert took a massive amount of water. Thus,  it is said, some sort of engine pumped water up through the building from either a well located below or directly from the river. Amytis could then walk through the rooms of the building, being cooled by the shade as well as the water-tinged air. Didthe Hanging Gardens Ever Really Exist? There is still much debate about the existence of the Hanging Gardens. The Hanging Gardens seem magical in a way, too amazing to have been real. Yet, so many of the other seemingly-unreal structures of Babylon  have been found by archaeologists and proven  to  have really existed. Yet the Hanging Gardens remains aloof. Some archaeologists believe that remains of the ancient structure have been found in the ruins of Babylon. The problem is that these remains are not near the Euphrates River as some descriptions have specified. Also, there is no mention of the Hanging Gardens in any contemporary Babylonian writings. This leads some to believe that the Hanging Gardens were a myth, described only by Greek writers after the fall of Babylon. A new theory, proposed by Dr. Stephanie Dalley of Oxford University, states that there was a mistake made in the past and that the Hanging Gardens were not located in Babylon; instead, they were located in the northern Assyrian city of Ninevah and were built by King Sennacherib. The confusion could have been caused because Ninevah was, at one time,  known as New Babylon. Unfortunately, the ancient ruins of Ninevah are located in a contested and thus dangerous part of Iraq and thus, at least for now, excavations are impossible to conduct. Perhaps one day, we will know the truth about the Hanging Gardens of Babylon.

mythology Research Paper Example

mythology Research Paper Example mythology Paper mythology Paper The role of women in ancient Greek life was insignificant compared to that of Greek men. A womans Job was to take care of the children and to cook and clean unless she had servants or slaves that would do it for her. Yet, in Greek mythology, women were often written as major characters. Well-known Greek plays contain many well- written, complex, female characters. Female individuals in Greek mythology were often seen as very powerful and fierce Greek mythology is the body of myths and teachings that belong to the ancient Greeks, concerning their gods and heroes, the ature of the world, and the origins and significance of their own cult and ritual practices. It was a part of the religion in ancient Greece. Modern scholars refer to and study the myths in an attempt to throw light on the religious and political institutions of Ancient Greece and its civilization, and to gain understanding of the nature of myth-making itself. l] Greek mythology is explicitly embodied in a large collection of narratives, and implicitly in Greek representational arts, such as vase-paintings and votive gifts. Greek myth attempts to explain the origins of the world, and details the lives and dventures of a wide variety of gods, goddesses, heroes, heroines, and mythological creatures. These accounts initially were disseminated in an oral-poetic tradition; today the Gre ek myths are known primarily from Greek literature. The oldest known Greek literary sources, Homers epic poems Iliad and Odyssey, focus on the Trojan War and its aftermath. Two poems by Homers near contemporary Hesiod, the Theogony and the Works and Days, contain accounts of the genesis of the world, the succession of divine rulers, the succession of human ages, the origin of human woes, and the origin of sacrificial practices. Myths are also preserved in the Homeric Hymns, in fragments of epic poems of the Epic Cycle, in lyric poems, in the works of the tragedians of the fifth century BC, in writings of scholars and poets of the Hellenistic Age, and in texts from the time of the Roman Empire by writers such as Plutarch and Pausanias. Archaeological findings provide a principal source of detail about Greek mythology, with gods and heroes featured prominently in the decoration of many artifacts. Geometric designs on pottery of the eighth century BC depict scenes from the Trojan ycle as well as the adventures of Heracles. In the succeeding Archaic, Classical, and Hellenistic periods, Homeric and various other mythological scenes appear, supplementing the existing literary evidence. [2] Greek mythology has had an extensive influence on the culture, arts, and literature of Western civilization and remains part of Western heritage and language. Poets and artists from ancient times to the present have derived inspiration from Greek mythology and have discovered contemporary significance and relevance in the themes. [3] mythology By monicalhouston

Learning to Write Chinese Characters by Hand

Learning to Write Chinese Characters by Hand Learning to write Chinese characters is one of the most difficult aspects of learning Mandarin Chinese. There are thousands of different characters, and the only way to learn them is by memorization and constant practice. In this digital age, it’s possible to use a computer to write Chinese characters, but learning how to write Chinese characters by hand is the best way to gain a thorough understanding of each character. Computer Input Anyone who knows Pinyin can use a computer to write Chinese characters. The problem with this is that pinyin spellings can represent many different characters. Unless you know exactly which character you need, you will likely make mistakes when using the computer to write Chinese characters. A good knowledge of Chinese characters is the only way to write Chinese correctly, and the best way to gain knowledge of Chinese characters is by learning to write them by hand. Radicals Chinese characters may seem incomprehensible to anyone who doesn’t know the language, but there is a method to constructing them. Each character is based on one of 214 radicals -   the basic elements of the Chinese writing system. Radicals form the building blocks of Chinese characters. Some radicals can be used as both building blocks and independent characters, but others are never used independently. Stroke Order All Chinese characters consist of strokes which should be written in a specific order. Learning the stroke order is an important part of learning to write Chinese characters. The number of strokes is used to classify Chinese characters in dictionaries, so an added benefit of learning strokes is being able to use Chinese dictionaries. The basic rules for stroke order are: left to right and top to bottomhorizontal before verticalhorizontal and vertical strokes which pass over other strokesdiagonals (right-to-left and then left-to-right)center verticals and then outside diagonalsoutside strokes before inside stokesleft verticals before enclosing strokesbottom enclosing strokesdots and minor strokes You can see an example of stroke order in the illustration at the top of this page. Learning Aids Workbooks designed for writing practice are widely available in Chinese-speaking countries, and you may be able to find them in cities with a large Chinese community. These workbooks usually illustrate a character with the proper stroke order and provide lined boxes for writing practice. They are intended for school children  but are useful for anyone learning to write Chinese characters. If you can’t find a practice book like this, you can download this Microsoft Word file and print it out. Books There a several books about writing Chinese characters. One of the better ones is Keys to Chinese Character Writing (English).

Case Study BA Essay Example | Topics and Well Written Essays - 2000 words

Case Study BA - Essay Example Few widely known facts about the terminal 5 are: Information Systems employed by BAA seems to have incorporated great ideas but they forgot to actually implement the ideas. They had ample car parks and had segregated car parking spaces for public and staff but people and staff could not find the car parks and spent lot of time trying to look for parking spaces. The problem being, the details of parking spaces (no. of slots, in use, empty etc.) were not updated in the information system database and were not displayed at appropriate places for people to see. One of the biggest faults in their system was that the staff at baggage handling and sorting section were not able to log on to their computers. This affected both incoming and outgoing baggage. The security checkpoints were not updated to the staff. There were no maps or location guidelines. Search facility was not ready for both staff and passengers. As far as the methodical preparations for terminal 5 are concerned, BA Authority did have some Information Systems in place. However, the Information System was highly ineffective. The reasons for it being ineffective may be incompetent people in the IT management team, lack of exposure of IT engineers with regard to such a large scale implementation as was terminal 5 of Heathrow airport or any other. The ineffectiveness of the Information Systems can be realized due to the following problems that occurred in terminal 5 on the very first day of its opening. Car Parks and parking spaces were not well managed. No software was employed to keep track of full and available parking spaces. Designated car parks for staff were not available and there were no sign board or any other means to locate the car parks due to which public and the staff spent lot of time looking for parking spaces. There was no signage at any place in the terminal. The terminal should have been equipped with monitors displaying the map of

Change Management Assignment Example | Topics and Well Written Essays - 500 words

Change Management - Assignment Example Make sure that there is active support for the change from the senior executive level within the business or organization, and engaging these sponsorships to the plans in order to achieve the desired results. Change in management comes with tension in the operation before the team adapts to the new system. The manager should gather information from both internal and external and analyze the weak points and make a quick solution to the problem. When a manager focuses on both internal and external initiatives, the company increases the chance of success. Ethics involves the individual’s moral judgment about the wrong and the right. Most of the decisions made in an organization are either made by individuals or groups who are guided or influenced by the culture of the company. The decision made by the manager to behave ethically is a moral one and therefore the employee or the managers should decide what they think is the right course of action. Ethical behavior is an integral part of everything that all the companies or organization should apply alongside good corporate governance. The manager should treat all the stakeholders in a fairly as this is an essential part of the company’s success. The manager can achieve this by creating a managed corporate and social responsibility program to the best interest of all the stakeholders. That is; the manager should focus on the employees, suppliers, customers and other partners who work together with the company. The manager can increase the ethical practices within the organization by ensuring that all  staff members  understand the company’s corporate values and principles of the business.

TELEVISION STUDIES Library Research Project Paper

TELEVISION STUDIES Library Project - Research Paper Example They therefore designed some fieldwork involving 20 under-two year olds, ten male and ten female, who watched the same episode of Teletubbies in their usual home or playgroup environment while being video-recorded. The tapes were then synchronised with the actual Teletubby recording, in such a way that the child’s movements, verbalizations and expressions can be seen as they relate frame by frame with the program. The tapes were analysed according to criteria of attention level, parasocial responses, TV literacy response, verbal echoing, cognitive response, pleasure, action around the TV set, and sharing with a companion. The study made various conclusions regarding the impressive attention spans that were demonstrated in particular sections of the program and the good basis that this data delivered for further â€Å"theorizing the interactivity of our young respondents with media texts† (p. 334). This article provides an excellent methodological model, based on observa tion and simple technology, which could be very useful for those wishing to explore issues around media designed for the under two age group or any other group who may not be able to verbalize their responses effectively. This chapter from an academic book was written by a Professor from Amsterdam in the Netherlands who leads a research center for research on children, adolescents and the media. It traces in detail the way that a child’s early development levels relate to the way that the child interacts with various media. What is interesting about this chapter is that it shows things from the child’s point of view, and warns against an adult, or parent, perception of what the child is doing or what the program is trying to do. So, for example, programs like Teletubbies which appear boring, repetitive and monotone to an adult, are in fact very sophisticated media texts which use carefully chosen stimuli like

The tattooed soldier Essay Example | Topics and Well Written Essays - 1000 words

The tattooed soldier - Essay Example Antonio and Elena are forced to flee to rural San Cristobal. But even there the dormant revolutionary zeal makes her take up the issue for the lethal practices of the local sanitation company. In retaliation, one ill-fated day, she and her young son are shot dead. Earlier they had thought of going to Mexico. Hector Tobar writes, "Perhaps they could move to Mexico. Save enough money to move to Mexico or the United States. A place where they could be safe, and their daughter or son could be educated. A place where you could speak your mind and there were no soldiers on the street." (p.118) After the death of Elena and his son, sensing danger to his life, Antonio flees to Los Angeles. Once in Los Angeles, he finds life much more difficult and risky. He cannot forget Elena and suffers from intense love pangs. The novel begins with the scene of his landlord giving him final notice of eviction and Antonio is busy packing up his meager belongings. In the process of packing, he is overwhelmed to see a photograph. What is his reaction, when he sees it? Hector Tobar writes, â€Å"He discovered a forgotten photograph of his wife and son, taken years ago in Quetzaltenango against a painted backdrop of fanciful lakes and volcanoes. Of all things. He raised the photograph to his lips and tried to fight off the rush of memories that began to gather and rumble like thunder behind his eyes. This picture is the sadness of me, the tragedy of me. (p.7)In Los Angles, he expected a better life.

Death Penalty and the American Criminal Justice Research Paper

Death Penalty and the American Criminal Justice - Research Paper Example It is aligned with the retributive justice system where there is a focus on the crime, the criminal and punishment and justice is meted within the "eye for an eye" context. Capital punishment has been sanctioned mainly because it is supposed to serve three purposes: deterrence to crime, retribution for the victim and repentance on the part of the criminal. According to Banner, these promised benefits have not been met (23). Particularly, the death penalty failed to drive a decrease in heinous crimes. In addition, claiming the life of an offender for retribution and repentance is morally inconsistent. There is the ethical challenge of weighing the lives of the innocent against that of the guilty. This is further aggravated by the position that the government is partially to blame for failing to prevent serious crimes. There is the position that individual offenders are not the sole responsible for criminality so there is the question of whether they should be made to bear the brunt of such extreme punishment. These variables tend to violate the morality and ethics of using death penalty in order to serve their stated purposes. The American Law Institute, the very organization that created the death penalty through the Model Penal Code of 1963, withdrew its approval of the capital punishment. The organization argued that death penalty is not aligned with the core legal values of the United States that is why it should never have been sanctioned in the first place (Hood & Deva, 182). This was highlighted by Zimring and Simon when they pointed out that there is always a risk of error in administering the death penalty and the consequences of this event far outweigh the potential benefits in terms of harm done and the justice being called for in the resolution of crimes (158). The US Supreme Court is also known to support its abolition. Early decisions have established the judicial view that capital punishment is  unconstitutional and it violates the Eighth Amendm ent of the US Constitution.

The tattooed soldier Essay Example | Topics and Well Written Essays - 1000 words

The tattooed soldier - Essay Example Antonio and Elena are forced to flee to rural San Cristobal. But even there the dormant revolutionary zeal makes her take up the issue for the lethal practices of the local sanitation company. In retaliation, one ill-fated day, she and her young son are shot dead. Earlier they had thought of going to Mexico. Hector Tobar writes, "Perhaps they could move to Mexico. Save enough money to move to Mexico or the United States. A place where they could be safe, and their daughter or son could be educated. A place where you could speak your mind and there were no soldiers on the street." (p.118) After the death of Elena and his son, sensing danger to his life, Antonio flees to Los Angeles. Once in Los Angeles, he finds life much more difficult and risky. He cannot forget Elena and suffers from intense love pangs. The novel begins with the scene of his landlord giving him final notice of eviction and Antonio is busy packing up his meager belongings. In the process of packing, he is overwhelmed to see a photograph. What is his reaction, when he sees it? Hector Tobar writes, â€Å"He discovered a forgotten photograph of his wife and son, taken years ago in Quetzaltenango against a painted backdrop of fanciful lakes and volcanoes. Of all things. He raised the photograph to his lips and tried to fight off the rush of memories that began to gather and rumble like thunder behind his eyes. This picture is the sadness of me, the tragedy of me. (p.7)In Los Angles, he expected a better life.

Tuition Assistance Case Study Example | Topics and Well Written Essays - 500 words

Tuition Assistance - Case Study Example Additionally, the tuition-aid program suffers from a lack of internal recruiting. Supervisors are not checking internal job postings and informing the appropriate employees are these opportunities. Finally, Garden Gate does not seem to lock employees in once they receive the tuition assistance, meaning that without this they are almost free to leave and taking advantage of the generous program on offer. The table does not indicate any special problems or issues; in fact, the table shows that Garden Gate has greatly encouraged diversity because there is a balanced mix of males and females and also employees from a wide range of ethnic backgrounds. Of the 18 employees who left the company after receiving tuition aid, quite a few of the employees took on a different job from the one they held at Garden Gate. This perhaps shows that they were unsatisfied at Garden Gate and wanted a change. It is up to supervisors and managers to communicate so that it is known just exactly which direction each employee wants to go in and then how that can be facilitated. I dont think that Garden Gate should discontinue its tuition-aid program because although there have been some problems with it, there is the potential for it to create a competitive advantage over competitors. The program is very attractive for employees who wish to up-skill, so this is something that should be pursued. Also, the company holds the value of treating its employees like investors, meaning that it makes sense to invest in them. Doing anything to the contrary would be going back on the companys principles. The company has grown at 12 percent per year for the last few years, and it wants to continue this rate for at least the next five years. For Garden Gate to be able to do this, it will have to retain most if not all of its current employees before looking to hire new ones. The best way to do this is by investing in human capital, which is what the tuition-aid program was designed

Ontela Picdeck Essay Example for Free

Ontela Picdeck Essay Ontela PicDeck creative approach to have cellular customers have the ability to automatically have pictures and videos directly sent to their computer. This reduces time needed and simplifying the strenuous act of doing it manually. The U. S mobile phone service industry earned 150 billion dollars in 2007 and growing. This technology has potential of playing a role in that with critiquing the marketing strategy they have approached the market with. It is essential for a better marketing strategy for Ontela to show customers so they can better understand the benefits and how to efficiently utilize it. The qualitative research segments best defined the customer expectations. Sarah, the parent, loved the fact the pictures â€Å"just appear â€Å"on the computer automatically. Steve, the young professional, looked to not always have to lug around the digital camera. Instead have a phone that can take care of both jobs. Regina, the teen, expectation exceeded both Steve and Sarah, but still within the abilities of PicDeck. Regina wanted to manage her pictures from her phone and monitor the pictures for her social networking sites. Herzberg’s 2-factor theory can be used in this instance. Using this theory to understand and distinguishing what motivates the purchase while staying â€Å"relevant†. In other words you must keep up with the recent trends like the social networking wave. These three segments all produce various expectations but all acknowledged the expectations of a simplified and quicker method to transferring pictures. These segments age groups and lifestyles greatly vary so the solution to market them must be more specified to that target group. The improvement of creating a more knowledgeable customer base will require a critiqued advertising campaign. In the case of Regina, advertising within the social networking programs like Facebook and MySpace. This advertising will catch the attention of these teen and inform them of the product. Specifically push the simplicity, timeliness, and how the pictures are still stored even when your cellular device is lost. For the younger generation and phones being a huge commodity, phones are constantly being stolen and lost. If interpreted right, then the teen will approach their parents to have their plan changed to include PicDeck. Then the parent will be informed and furthering the utterfly effect of a strict advertising scheme to the teenage target customers. This is how Sarah would be notified. Social is a major influence in customer behavior through family, friends, and reference groups. All play as contributors to trusting a buy of a product. Continuously for people who aren’t very tech savvy like Sarah and Steve; they do though always have an email and usually check it frequentl y. So a mass email to the entire customer base informing them of the new product. Steve would be influenced more by the occupation. Besides using this program for personal use, Steve would use this for his real estate job. To be successful in a job market like Steve’s you must influence your work with newer technology so you may keep up with competitors. â€Å"With PicDeck, work assignments are accomplished more efficiently and simply†, statements like this boost the products equity and what customers like Steve would want to hear. For a product to blossom you must target the younger generation first. With constant technology improvements it’s hard for the older generation to keep up. The younger generation is constantly working with the new technologies so you inform the younger generation and it will spread to older generations. Ontela has created an inferior product and now need to raise awareness of the tech advances this product has influenced. The magazine Telephony stated PicDeck to be â€Å"helping the bridge the gap between phone and PC†. Continuous advertising is needed in magazines for the working class people to involve this program into their workplace. For instance putting an ad in the magazine SkyMall. The magazine you see on every flight you’re on. This can target a business class customer base because the individuals who travel most are individuals travelling on business. And this is the only reading material on the plane.

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