Nurse Staffing free essay sample

Abstract Nurse staffing has always been an issue in the hospital setting. Different units with different patient acuities are staffed accordingly usually based on the patient census. While nurses who are in direct contact care with patients feel that a decreased patient load will lead to greater benefit for the patient, others who are usually in managerial positions are not persuaded that such a correlation exists. As of this time, no such research has been done with an intentional change in staffing ratios that has shown actual proof of such connection with nurse staffing and patient outcome. In the hospital setting, no matter what unit a Registered Nurse (RN) works on, there always exists a nurse to patient ratio. The actual number of patients per nurse depends on the type of unit. Usually, the Intensive Care Unit (ICU) always has the least number of patients per nurse, while the general medical floor is one of the units which has the most number of patients assigned per nurse. We will write a custom essay sample on Nurse Staffing or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The staffing ratio of RNs to patients has always been a great debate between nursing staff with direct patient care and management. While nurses who have direct patient contact argue that a lower patient load will help lead to increased patient satisfaction and increased positive outcome, some members of management do not see this to be true. In order to tackle this debate properly, there must be a study of whether an actual change in staffing ratios will lead to greater good for the patient. Currently, there has been no research of an intentional change in RN staffing to see the effects on patient outcomes (Shekelle, 2013). The reasoning behind this is mainly due to financial restraints. Nursing staff costs money, and hospitals are not willing to spend resources to for a study that does not guarantee a positive outcome. However, there is still some research on whether nursing staffing ratios actually have an impact on patient outcome. According to Shekelle (2013), it was found that there existed a consistent relationship between higher RN staffing and lower hospital related morbidity. It was found that an increase of RN per shift was related to a 9% reduction in the odds of death in the ICU, a 16% reduction in the surgical setting, and a 6% reduction in the medical setting. Other findings including lower rates of hospital acquired pneumonia, pulmonary failure, unplanned extubation, failure to rescue, and nosocomial bloodstream infections were related to higher RN staffing which were found by other studies. However, there was no clear relationship to staffing with incidents of falls, pressure ulcers, and urinary tract infections, when these were thought to also be highly sensitive to nursing staffing. This finding was the meta-analysis of 28 other research studies aimed to find a correlation between nurse staffing and patient outcome. Legislation recently passed in California called for an increase in nurse staffing. However, this law does not require the strict use of RNs. As a result, Licensed Practical Nurses (LPNs) as well as Licensed Vocational Nurses (LVNs) were used to fill the staffing requirements, more than the increase of the RN staff (Harless et al. , 2013). This increase in staff allowed the RNs additional time in enhanced surveillance to assess and help prevent the deteriorating conditions of the patients. This ultimately led to reduced missed care and decreasing failure to response rates. This early detection resulted in increased prompt treatment and decreased patient length of stay. However, not all of the findings were positive. There was no obvious decrease in the number of falls, pressure ulcers, or restraint use following the increased staffing. There was also a finding that there was an increase in postoperative infections and sepsis significantly more in California that other states due to medical care with the increased use of LPN and LVN staff, as compared to RN staff used by other hospitals (Harless et al. , 2013). A study performed in Thailand tried to show a connection between nurse staffing and burnout. It was found that nurse burnout was directly related to the nurse staffing ratios. For each patient added to the nurse’s load, there was an increase of 1. 02 times in the odds of the nurses to report higher emotional exhaustion (Aiken et al. , 2011). This was directly related to the nurses reporting a lower perception of patient quality of care. Nurses with favorable work environments were 30% less likely to report a lower patient quality of care score than those with less than ideal environments. More favorable nurse staffing and work environments led to more favorable nursing outcomes such as reduced burnout and lower turnover rates, which then lead to a better quality of care (Aiken et al. , 2011). On the other end of the spectrum, a study performed by surveying management members found that there was no direct correlation between an increased staffing ratios and increased quality of care (Chapman et al. , 2009). Nurse satisfaction did increase after implementation of the ratios, but was not found to be clearly linked to job retention or quality of patient care. Budget cuts were made to ancillary staff, which ultimately lead to decreased patient satisfaction. Based on these findings, there are some elements of nurse staffing that could be changed. The use of LPNs or LVNs to increase staffing might look great on paper, but they cannot replace the role of the RN. Limiting the use of LPNs and LVNs can help decrease incidences in patient care. Increasing the number of RNs on staff to decrease patient load can lead to decreased burnout, which can prevent the decline of the nurse’s perception of patient care. For those who believe that the number of RNs used on a shift might not make a great difference in patient care, then the use of higher quality RNs can. Registered Nurses who are certified in their special units are usually more competent than their non-certified counterparts. This can lead to earlier detection of declining patient status and decreased failure to save rates. Hiring of more nurses might not be practical due to financial reasons, but the hiring of certified nurses without increasing the staff count is another alternative that is not necessarily more expensive in the long term. Based on these mixed results, it is not very clear whether nursing staffing has a direct connection with improved patient outcome. A study of intentionally increasing the staff would be necessary to properly test this research study, but that is the major problem. While staff nurses might feel that it is necessary to deliver higher quality of care, management might not be willing to accept it without researched proof of its benefits.?

What Type of Nurse Are You

What Type of Nurse Are You There are so many different types of nurses. These include registered nurses, travel nurses, nurse practitioners, and operating room nurses just to name a few. Have you ever wondered what type of nurse you might be if you decide to pursue nursing as a career? Or maybe if you are in the right field of nursing based on your wants? This quiz is perfect to help you decide based on your likes.  Source [ Playbuzz ]

How to Identify Types of Trees in North America

How to Identify Types of Trees in North America The easiest way to identify North American trees is by looking at their branches. Do you see leaves or needles? Does the foliage last all year or is it shed annually? These clues will help you identify just about any hardwood or softwood tree you see in North America.  Think you know your North American trees? Hardwood Trees Hardwoods are  also known as angiosperms, broadleaf, or deciduous trees. They are  abundant in the eastern forests of North America, though they can be found throughout the continent. Broadleaf trees, as the name suggests, bear leaves that vary in size, shape, and thickness. Most hardwoods shed their leaves annually; American holly and evergreen magnolias are two exceptions. Deciduous trees reproduce by bearing fruit that contains a seed or seeds. Common types of hardwood fruit include  acorns, nuts, berries, pomes (fleshy fruit like apples), drupes (stone fruit like peaches), samaras (winged pods), and capsules (flowers).  Some deciduous trees, such as oak or hickory, are very hard indeed. Others, like birch, are fairly soft.   Hardwoods have either simple or compound leaves. Simple leaves are just that: a single leaf attached to a stem. Compound leaves have multiple leaves attached to a single stem. Simple leaves can be further divided into lobed and unlobed. Unlobed leaves may have a smooth edge like a magnolia or a serrated edge like an elm. Lobed leaves have complex shapes that radiate either from a single point along the midrib  like maple or from multiple points like white oak. When it comes to the  most common North American trees, the red alder is number one. Also known as Alnus rubra, its Latin name, this deciduous tree can be identified by oval-shaped leaves with serrated edges and a defined tip, as well as rust-red bark. Mature red alders range from about 65 feet to 100 feet in height, and they are generally found in the western U.S. and Canada. Softwood Trees Softwoods  are  also known as  gymnosperms, conifers or evergreen trees. They are  abundant throughout  North America. Evergreens retain their needle- or scale-like foliage year-round; two exceptions are the bald cypress and tamarack. Softwood trees bear their fruit in the form of cones. Common needle-bearing conifers include spruce, pine, larch, and fir. If the tree has scale-like leaves, then it is probably a cedar or juniper, which are also coniferous trees. If the tree has bunches or clusters of needles, it is pine or larch. If its needles are arrayed neatly along a branch, its  fir or spruce. The trees cone can provide clues, too. Firs have upright cones that are often cylindrical. Spruce cones, by contrast, point downward. Junipers dont have cones; they have small clusters of blue-black berries. The most common softwood tree in North America is the  bald cypress. This tree is atypical  in that it drops its needles annually, hence the bald in its name. Also known as  Taxodium distichum, the bald cypress is found along the coastal wetlands and low-lying areas of the Southeast and Gulf Coast region. Mature bald cypress grows to a height of 100 to 120 feet. It has flat-bladed leaves about 1 cm in length that fans out along twigs. Its bark is gray-brown to red-brown and fibrous.

The World trade organisation Essay Example | Topics and Well Written Essays - 500 words

The World trade organisation - Essay Example Their mission is to help firms and producers of goods and services, importers and exporters improve their profit.† Advantages WTO has a number of benefits. Firstly, WTO’s trading system encourages peace between nations. In particular, when nations carry out trading with each other without any conflict, they subsequently resolve a number of trading issues and build long-term relationships. This leads to the creation of peace between them. In addition, the trading system also forces enhancement of confidence and teamwork between nations. For example, earlier, people who sell products and services used to hesitate due to trade disputes with their international customers. However, after WTO, the trading has now become a smooth process, and both the seller and the buyer are satisfied with the exchange, leading to a good relationship. In other words, political arguments now occur on a lesser level. An easygoing trade helps nations all around the globe to feel safe. People who are satisfied and successful with international trade are less likely to have fights and disagree with one and another, In other words, wars are less likely to happen between countries. Secondly, the trade system enables effective management and resolution of conflicts and disagreements on international level.

International Relations Essay Example | Topics and Well Written Essays - 500 words

International Relations - Essay Example This would involve the Americans thinking the worst about Iran and to act out of self-interest. This probably would mean that Iran would be bombed. The second approach could be a liberal one which would involve the U.S. acting within the bounds of the international system. Both of these approaches will be explored in this brief essay. Realism involves looking at the political system in a way that takes self-interest as the paramount motivator for actors. There is not really any such thing as altruism in this theory, only power and efforts to accumulate power. In order to have power, a country must have security (Bell, 2008, p. 25). For the United States, Iran represents a serious security threat to the world order it has established. Iran threatens Israel and to a less extent Saudi Arabia. A lot of the rhetoric from Iran is poisonous and also suggests Iran is a threat. Washington can only take Iran at its word when it says that it wants to destroy Israel, America's ally. The way that Iran treats its own people lends all of this credence too. Because of these factors, the United States should act decisively. Clearly, negotiation has not been successful. For many American realists, the only thing that Iran will understand is force. Following this theory through to its conclusion, it seems necessary for America to bomb Iran. Politicians like Dick Cheney might be described as realists.

Gibbons v Ogden Decision Fair or Unfair :: essays papers

Gibbons v Ogden Decision Fair or Unfair The decision in the Gibbons v. Ogden case is, in my opinion, a very just and fair one. Many believe it to be the first anti- trust decision in U.S. history. The economic results cannot be over-estimated, a different decision could have resulted in completely different circumstances than with which we are accustomed to today. The free flow of commerce, which we seem to almost take for granted in modern economics and business, may have never been a possibility without decisions such as this. Monopolies did not allow for equal division of business and therefore was unjust. If all men are created equal they should be given equal opportunities. The New York Livingston-Fulton monopoly clearly subjected any potential competition to harsh conditions that would make it impossible for them to keep up in their business. Travel by steamboat was much faster than any other means in the time of this case and to give complete control to only one partnership was unfair. Under the constitution Congress has the right to regulate commerce. Although the monopoly was a form of internal state trade regulation it directly impacted on inter-state trade after a number of states passed laws to come back at the New York monopoly. Therefore, Congress had the right to intervene and end the monopoly. To completely understand the impact of the Gibbons-Ogden decision it is necessary to understand the situation surrounding it. In 1798 Robert R. Livingston secured an exclusive twenty year grant from the New York legislature. By the terms of this grant he could exclusively navigate by steam the rivers and other waters of the state, provided that within two years he should build a boat which would make four miles an hour against the current of the Hudson River. The legislature had no faith whatsoever in the project but the decision was still made against the many jeers. The terms of the grant were not met and it was renewed in 1803, this time to Livingston and his new partner, Robert Fulton. It was renewed once more in 1807 and finally that August Fulton’s steamboat made its first successful trip from New York to Albany. The following year the Legislature, fully aware of the practical significance of Fulton’s achievement, passed a law stating that for each new boat navigated on New York waters by Fulton and Livingston that they should be provided with a five year extension to their monopoly, which may not exceed thirty years.

Comparative Literature in an Age of Globalization

COMPARATIVE LITERATURE IN AN AGE OF GLOBALIZATION: Utrecht University The bylaws of the American Comparative Literature Association stipulate the writ-ing every ten years of â€Å"a report on the state of the discipline. † The present collection Comparative Literature in an Age of Globalization represents the latest in the series and is a follow up to Charles Bernheimer's Comparative Literature in the Age of Multiculturalism (1994). The structural similarities between the two titles, with their repetition of â€Å"Comparative Literature in the age of † is striking, and I will corne back toit.The nineteen essays in the collection have been written by a team of eminent scholars and they respond not only to Bernheimer's collection and to the general theme of â€Å"globalization† but also to each other. The resuit is an interesting series of kaleidoscopic interventions, some highly readable and pulling lots of punch; others less user-friendly and, in attempting to ar ise to the occasion, somewhat convoluted and over-written.Granted: the â€Å"report† is a very awkward genre for which there are no rules and, given this need to improvise, the editer Haun Saussy has made a good job of providing a nuanced and multiperspectival account of the â€Å"state of the discipline†. It would have enhanced the impact of the present volume, however, had it been at times less an inward looking colloquy among seniors and more inviting to the as-yet not initiated graduate student.As it is, it makes very interesting reading for the diehard senior member of staff (and presumably the members of the ACL A) while being less accessible to the future scholar or to those working in other disciplines and interested in finding out what Comparative Literature stands for, where it is going to, and why it might be important. Canadian Review of Comparative Literature / Revue Canadienne de Litterature Comparee CRCL DECEMBER 2008 DECEMBRE RCLC 0319-051Ãâ€"708/35. 4 /353  ©Canadian Comparative Literature Association 54/ CRCL DECEMBER 2008 DECEMBRE RCLC ANN RIGNEY | COMPARATIVE LITERATURE IN AN AGE OF GLOBALIZATION/ 355 A survey attempting to do justice to the complexity of an academie field and what is at issue in it, almost inevitably leaves the reviewer less with a single argument than with a variety of perspectives on a variety of issues (on among other things, the importance of historical approaches, the value of study of graphie novels and other visual forms alongside texts; the nature of comparative literature as a â€Å"metadiscipline† or exploratory space).So what is really surprising about this collection, then, is the degree of convergence that it nevertheless manifests. To begin with, the majority of contributors do address some issue within the broad frame of â€Å"globalization† taking their eue from the substantial introductory essay by Saussy, himself a specialist in Chinese literature.Where the 1994 report focuse d on questions of the boundaries between literature and other cultural expressions, ten years later the main emphasis here is on themes that are in many ways more traditional within the multilingual field of comparative literature: the concept of world literature or â€Å"literatures of the world† and how best to teach it (David Damrosch and Katie Trumpener provide interesting solutions); the cultural role of translation and its status as a medium in teaching and research (Steven Ungar); the nature of comparison itself and the grounds upon which texts or movements from different cultural and linguistic traditions, even from different periods, may usefully be compared with each other and if indeed, as Emily Apter argues following Alain Badiou, if grounds for comparison are always needed; the future role of (East) European literature and theory within the much larger body of world literature now becoming available (Caryl Emerson). Even Marshall Brown's enthusiastic celebration of the close reading of particular texts, using the example of Effi Briest, reflects the concern with globalization: the very fabric of Effi's provincial life is woven through, as Brown shows, with the impact of more distant and general developments.Such concerns suggest that we are witnessing the return of Comparative Literature to its origins as the inter-cultural and multilingual study of literature. As if to con-firm this, the polyglossic Zeitschrift fur Vergleichende Literatur established by Hugo Meltzl de Lomnitz in 1877 is cited on more than one occasion as the foundational text of the discipline (rather than say, the Russian Formalists' programme for a general literary science as promoted among others by Rene Wellek). The phrase â€Å"return to origins† might seem at first sight a merely conservative retreat to older positions, but re-engaging with roads taken earlier in comparatism is not a symptom in this case of burnout.Instead, the present concern with intercultur al and interlinguistic â€Å"comparatism† as the basis for the common pursuit of literary studies represents not just a return, but also a revitalization: a return to a well-established tradition that had been marginalized as long as other theoretical formations, taking a more universalist approach to literary texts, dominated the academie study of literatures, as they did from the 60s on. But it also represents a revitalization and expansion of this tradition: at a time when globalized communication networks, intercultural exchanges and human mobility are such dominant features of our lives, some of the traditional concerns of comparative literature a la Meltzl de Lomnitz and Paul van Tieghem among others have become relevant in new ways and have the possibility of taking central stage in the field of literary studies at large.Ail of this is good news for those who continue to want to disengage the study of literature from the inevitable parochialism of the separate language departments and who are committed to the study of literature as a trans-national medium that has long been crossing borders—before ever the term globalization was invented—both in the original and in the form of translations. The report thus bespeaks confidence in the Comparatist project and a certain excitement at the sense that literature has become an even richer domain now that we in the West are becoming belatedly aware of the variety of literatures in the world and, thanks to work done in the last years to make it more accessible in the form of anthologies, a little better equipped to talk about nonEuropean literatures.As several contributors point out, the success of comparatist concerns in the field of literary studies at large along with the more general acceptance of translation as a legitimate medium for teaching, may mean that Departments of Comparative Literature as such may become less distinctive. The even greater risk is also there that the inter-lingu istic and inter-cultural aims of the Comparatist project may end up being reduced to the derivative study of â€Å"literatures of the world† through the monolingual filter of a globalizing English. For globalization, of course, is always double-edged: while providing a greater awareness of cultural diversity it also tends to reduce that diversity by the very fact that it makes cultures more widely accessible in an homogenizing lingua franca.Given this downside of globalization, the distinctive aims of Comparative Literature as the multilingual study of literature have become ail the more urgent. As the present collection demonstrates, however, the traditional demand that students of Comparative Literature be at home in three (European) languages is no longer enough for the task at hand. More language skills are needed. But since there are presumably also limits to the number of languages any individual scholar can master, there is new need for different forms of collaboration between specialists in various fields-a point implied by a number of contributors, though not extensively thema-tized in the present collection.Indeed, given this need for collaborative projects, the core of Comparative Literature may no longer be in a particular â€Å"disciplinarity† (i. e. that it is carried out by individuals who are skilled in various languages, though hopefully these people will continue to exist) but in its function as a platform for research and teaching: the fact that it brings together scholars who are committed to exploring in a collaborative way the cross-currents and exchanges between literatures written in different languages across the world at different periods. This report on â€Å"the state of the discipline† thus gives not only food for thought but also reasons for confidence.Nevertheless, it also leaves me with some niggling doubts about the very way in which we as literary scholars think about our work. My concern centres on the ge neric title: â€Å"Comparative Literature in the age of†¦ † The problem lies not so much in the epochal tone, suggesting as it does that in the course of 10 years we have moved from the â€Å"age of multiculturalism† to that of â€Å"globalization† (as if mul- 356/ CRCL DECEMBER 2008 DECEMBRE RCLC ANN RIGNEY | COMPARATIVE LITERATURE IN AN AGE OF GLOBALIZATION/ 357 ticulturalism were somehow no longer relevant or globalization a new thing). The problem is more with the implicit assumption that one should define â€Å"the state of the discipline† by looking at ils relation to â€Å"the age† around it as if it should be its mirror.Behind this conceptualization lies, of course, the legacy of Matthew Arnold and the belief that criticism's main task is to provide knowledge, not so much of literature as such, as of the world itself as this is represented or reflected through literature. â€Å"Comparative Literature in the age of † bespeaks thi s grand commitment to be the conscience of the world and to interpret the â€Å"best† that has been thought in it. This continues to be a self-evident aim within literary studies. Hence the ongoing selfsearching about what is the proper object of study fuelled by the belief that the choice of object (world literature, literatures of the world, popular fiction or highly regarded works of literature) involves an ethical decision about what is relevant at the present time or in the present world.With our present global perspective and our awareness that there is more to literature than the canon of European classics, that â€Å"worldly† task has become an even heavier one and the way to its realization more fraught by the need to select carefully. Far be it from me to trivialize the importance of cultural criticism or a commitment to seeking out interesting literary phenomena to study above more banal ones. Nevertheless, there is something paradoxically ostrich-like about the ways in which Comparative Literature defines itself in relation to the world around it and in relation to â€Å"the age† as a whole. The very moral authority accorded to literature is also a throw-back to a time when literature (vide Arnold) was the dominant cultural form.But for ail its ostensible worldliness, the present collection arguably puts its head in the sand when it cornes to the changing status of literature in the highly mediated world in which we live and where globalization has been effectuated more obviously through the medium of television, film, popular music and internet than it has through literature. In paying so much attention to world literature and how it should be defined and taught (in itself a really positive development) the collection nevertheless succeeds in ignoring the fact that literature's relation to the world, and its place in the world, has fundamentally changed. More precisely, it ignores the interface between literature and other med ia, and between literature and other forms of knowledge at the present time. In raising this point, I do not mean to uggest that we should ail drop the study of literature in favor of looking at other media (a pos-sibility raised briefly by Malti-Douglas), for that would be to perpetuate the belief that literary studies is somehow a super-discipline that provides the conscience for the humanities and has a responsibility for ail of culture. Rather it is an argument in favor of reconsidering the changing relations between literature and other cultural media, and the impact both in the past and in the present of new technologies and changing literacies on the very possibilities we have for expression and interpretation. It is also an argument for considering new forms of collaboration with specialists in other fields of culture. In other words, the next challenge is to conceive of literary studies itself from a comparative perspective, that is, in relation to other forms of knowledge about culture and media.In the last decades, certainly in Europe, media studies have been institutionalized and have been providing increasing competition for literary studies both when it comes to attracting students and to attracting research funding. The question which needs to be addressed, sooner rather than 10 years down the line, is how to reposition comparative literary studies in relation to these adjacent fields. In the first place, this will mean becoming more modest: accepting the fact that writing and reading are just one form of culture among other, albeit the one with the longest history and about which there is the greatest body of knowledge (here we should be much less modest).It will also involve becoming more pro-active as we define more clearly, and become once again surprised by the magic of language in its various manifestations, what literature can and can not achieve (Jonathan Culler's intervention hints in this direction). Instead perhaps of soul-searching c ontinuously about the identity of Comparative Literature in relation to the set of objects (world literature, counter-canons, etc) and in relation to â€Å"the age† as a whole, we need to look outside the discipline and accept that there is an outside. Hopefully the next report will focus less on â€Å"the state of the discipline† as seen from within and be more specific about what we have to offer the world of learning at large.