Wednesday, September 4, 2019

Materials Management

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MATERIALS MANAGEMENT


Materials Management has always been an area of scrutiny for organizations. This has become a central focal point as trends from the supply chain arena have indicated that substantial operating cash can be freed with leaner and more efficient handling of inventory.


As organizations examine the state of their inventory, they often find that visibility across locations and warehouses are inadequate, stock levels are inconsistent, demand is uncertain, and communication between stocking locations or warehouses may be minimal or non-existent. Among other things, the lack of an integrated interaction between peripheral systems and materials managers leads to unnecessary purchasing and overstocking.


The concepts of "materials management," "physical distribution management," and "logistics management" are the primary materials organizational tools-tools which have been used successfully in the past and will be used increasingly in the future to achieve closer coordination and control of a firms various materials activities.


In general materials management is concerned with bringing materials from outside of an organization to the point of production and moving in processes inventory. It deals with moving material inputs from suppliers into the organization and within the organization. The materials management concept advocates the assignment of all major activities, which contribute to materials' cost to a single materials management department. This includes the primary responsibilities which are generally found in the purchasing department, plus all other major procurement responsibilities, including inventory management, traffic, receiving, warehousing, surplus and salvage, and frequently production planning and control. Some companies also include customer service, scheduling, shipping, materials handling, and physical distribution in their definition of materials management.


It's clear that top management and materials management personnel focus their attention sharply on material costs and there is no doubt that reliable long term supply of materials is an increasingly important materials.


Physical Distribution Management is related to marketing in a manner similar to the way materials management is related to production. Advocates of the physical distribution organization traditionally refer to it as "the other half of marketing." This view divides marketing into two parts (1) conventional marketing (market research, product development, sales promotion, advertising, and selling) and () physical distribution. To people holding this view, physical distribution consists of the following minimum functions


· Sales order processing, Traffic and transportation, Production control, Inventory control, Materials handling, & Sales planning


Physical distribution can also include additional functions such as customer service and technical service.


Many of these materials function are plainly the same functions claimed by materials management. For the most part, however, the functions are concerned with different materials and are performed at different points in time in the materials system (cycle). For example, the inventories controlled by physical distribution management are finished goods inventories. The warehouses controlled by physical distribution are primarily finished goods warehouses, field warehouses, or distribution centres; those controlled by materials management are the raw materials and production stores warehouses. On the other hand, traffic and production control frequently constitute points of contention between physical distribution management advocates and materials management advocates. In the case of both of these functions, each organizational group can lay legitimate claim to them. The optimum location for traffic and production control will vary from one company to another, depending on specific operating and organisational factors within each firm.


Logistics management is a combination of materials management and physical distribution management. On the basis of the preceding discussions of the latter two concepts, it is clear that a number of similarities exist between them. Not only are the activities involved in both concepts a part of the same overall materials system, many of the skills required to perform the respective operating activates are also similar. The same skills required to perform the respective operating activities are also similar. The same skills and knowledge required to control production inventories are also those used to control finished goods used in traffic, materials planning, and materials handling are identical skills. Although physical distribution is the final stage of the marketing process, the training and orientation of physical distribution personnel is much more akin to that of the materials management personnel. These factors have combined to produce the logistics management concept.


Historically, these similarities and relationships were first recognized by military officers, and the organizational concept of logistics was initially developed in the armed forces. In industry today, logistics management includes all of the functions of both materials management and physical distribution management. In the broadest sense, logistics management views a firm as a single operating system; it seeks to minimize total costs associated with the acquisition and handling of materials from the inception of materials requirements to the final delivery of finished products to their users.


I. What is Logistics?


Logistics is the management of the storage and movement of goods and information. Good logistics cuts costs, speeds work, and improves customer service.


Logistics involves the co-ordinated management of material and information flows throughout the organisation. Supply chain management deals with the same issues throughout the chain from sources to customers. Its objective is to simplify the supply chain to control total cost, improve total quality, maximise customer service, and increase profit. Logistics is a complex discipline getting the right balance between ways of buying, moving and storing goods involves juggling a lot of balls at once. But getting it right is extraordinarily rewarding. Immediately, good practice can take a lot of non-value-added waste out of a system. Perhaps more importantly, it will add value to activities it will make the firm more competitive.


People have different names for these activities when they are managed together. Supply chain management, logistics and materials management are terms widely (and interchangeably) used. People mean different things when they discuss logistics they often concentrate on transport, and limit themselves to systems, which move goods from factory gate to customer and supply chain concentrate on transport, storage, information flows, and commercial relationships.


a. Logistics and supply chain management


Supply chain management is about getting a smooth and efficient flow from raw material to finished goods in customers hands. It is a concept which is increasingly replacing traditional fragmented management approaches to buying, storing and moving goods.


Traditionally, the management of material flows has centred around stocks of product on trains and boats and trucks; in warehouses and stores and factory-floor queues. Managing those stocks meant buying enough goods far enough in advance to ensure that long, steady production runs were seldom jeopardised by shortages of components. Tougher competition has brought shorter product life cycles and made that approach increasingly expensive. Replacing these inventory-driven systems are service-driven systems. This type of system, pulled by customer demand rather than pushed by a supply system, is long familiar in retailing and over the last decade has become a necessity in many manufacturing sectors.


b. Where logistics fits in businesses?


Before managing supply chain its better to know


· What it's needed/wanted from the business?


· What the customers want from the firm?


· How well the competitors meet customer needs?


The place of the logistics discipline in business depends on the answer to these questions. For some companies - largely those which assemble physical goods in volume and ship them to customers - there is an argument that managing the business is indistinguishable from managing its logistics. Procurement, transport, manufacturing, sales and customer service can all benefit from an integrated logistics function, leaving just marketing, personnel, finance and research as separate functions. In other firms, the role of time and place is less critical. Most service companies, and many low-volume manufacturing businesses would pay less attention to logistics skills.


c. What is the supply chain?


Traditionally, companies have dealt with moving and storing goods in a disparate way, and under a number of different managers. In manufacturing, transport from supplier to plant was handled by suppliers themselves or by purchasing departments. Transport and storage within the plant was handled by the stores department (in the stores) and by manufacturing operations (within the plant). Transport from plant to customer was handled by transport or distribution departments; buying was handled by purchasing; sales forecasts by marketing and communicated to manufacturing and procurement in a generally one-way information flow.


This approach splits functional departments into watertight compartments when, as every manager knows, business isnt like that. Particularly in this area, where the essence of supply chain management is managing flows across departments, sites and - often - companies. So a high degree of management integration is needed.


Logistics deals with geography, time and value. Many of its concerns are with things in places and transport between the places. In this view logistics deals with everything from raw materials through their movement into and between various stores and processes to the customer. It looks at material flows within sites as much as between sites.


Materials Management Physical Distribution Management


Procurement Activities1. Materials specifications. Value analysis. Supply market research4. Negotiation5. Buying6. Quality assurance7. Buying transportation inbound Inventory DecisionsRaw materialsSubassembliesManufactured partsPacking materials


Receiving


Transportation


Storage


Goodsin-process inventory Finished goods inventory


Materials


Handling


Production


Scheduling


&


Control


Transportation


Logistics Management


Figure-1


Systems management concepts imposed in the flow of materials and related activities in a firm's materials system.


II. Types of materials


There are different ways of classifying materials. The following is an example of the categories of classification of materials.


1. Production Items


a. Raw materials


b. Manufactured and fabricated parts


c. Component parts


d. Finished goods


. Capital Items


a. Installation items


b. Accessory equipments


. Consumable Items


a. Maintenance


b. Repair


c. Operating supplies


4. Industrial Services


Production Items are those materials that are used as an input for the production of the final product. These materials or items become part of the physical make-up of final product. It includes


Raw materials they are the basic materials that actually become part of the physical make up to the final product. They are natural or near natural resources. Natural such as minerals, iron ore, forest products, stone, etc. Near natural such as grains, cotton, and dairy products.


III. Objectives of materials management


The objective of materials management include


1. Customer Service aims at the satisfaction of the customer needs and wants through customers relations and by making materials available


a. Material Management attempts to create and maintain favourable relations with its customers (users of materials) by providing the right quantity, at the right quality and at the right price.


b. Material management should aim at making materials available to the users when they need them in order to avoid the risk of stock out and interruption of operation and production.


· Availability of materials = Satisfied need


Total Need


. Economic Operations Materials consumes the largest proportion of expenditures of the organization and is a fertile ground for reducing costs and increasing profit.


. Assure timely delivery of goods and services to meet company requirements. Provide high-quality products that meet all specifications.


4. Offer cost-effectiveness that will assure a firm's position in its markets, including obtaining the best overall value for each purchasing birr/dollar expended.


5. Continuously search for new products, equipment, and services to improve the quality of product offered to customers.


6. Cultivate mutually beneficial long-term relationships/partnerships with suppliers.


7. Adhere to the highest ethical standards in all business dealings. Comply with all company policies and procedures. Conduct negotiations ethically and without attempts to influence through personal gifts or entertainment


8. Keep all dealings confidential.


. Keep company's informed of changes in the economy or other conditions that may effect purchasing decisions


IV. Functions of Materials Management


The functions of materials management are a series of activities that are related and help the functioning of the management of materials. They include


a. Forecasting materials demand


Forecasting demand for materials is an estimate of the level of demand for materials for some period in the future. If there will not be an accurate forecasting for a level of demand for materials, organizations may end-up in having too much materials or too few materials. Therefore managers should


· Recognize the increased importance of forecasting in both manufacturing and service giving organizations.


· Know how to go about implementing forecasting at all levels in the organization.Understand how to use the various forecasting methods to decide when to add manufacturing capacity and where to locate retail service outlets for maximum sales


Types of forecasting


· Qualitative Techniques


o Non-quantitative forecasting techniques based on expert opinions and intuition. Typically used when there are no data available.


· Time Series Analysis


o Analysing data by time periods to determine if trends or patterns occur.


· Causal Relationship Forecasting


o Relating demand to an underlying factor other than time.


Comparing the Costs and Benefits of Forecasting


Components of Demand


· Average Demand for the Period, Trends, Seasonal Influence, Cyclical Elements, & Random Variation


i. Time Series Analysis


· Simple Moving Average


o Average over a given number of time periods that is updated


o By replacing the data in the oldest period with that in the most recent period.


· Weighted Moving Average


o Simple moving average where weights are assigned to each time period in the average. The sum of all of the weights must equal one.


· Exponential Smoothing


o Times series forecasting technique that does not require large amounts of historical data.


§ Benefits of Using Exponential Models


· Models are surprisingly accurate, Model formulation is fairly easy, Readily understood by users, Little computation is required, & Limited use of historical data.


§ Exponential Smoothing Constant Alpha (a)


· A value between 0 and 1 that is used to minimize the error between historical demand and respective forecasts.


· Use small values for a if demand is stable, larger values for a if demand is fluctuating.


· Adaptive forecasting


o Two or more predetermined values of alpha


o Computed values of alphaLinear Regression Analysis


o A forecasting technique that assumes that the relationship between the dependent and independent variables is a straight line.


· Standard Error of the Estimate


o A measure of the dispersion of data about a regression line.


o How well (or closely) the regression line fits the data.


ii. Causal Relationship Forecasting


· Leading Indicator


o An event, whose occurrence causes, presages or influences the occurrence of another subsequent event.


§ Warning strips on the highway


§ Prerequisites to a college course


§ An engagement ring


· Reliability of Data


o Coefficient of determination


§ The proportion of variability in demand that can be attributed to an independent variable.Mean squared error�A measure of the variability in the data about a regression line.Multiple Regression Analysis


o Forecasting using more than one independent variable; measuring the combined effects of several independent variables on the dependent variable.


· Neural Networks


o A forecasting technique simulating human learning that develops complex relationships between the model inputs and outputs.


b. Purchasing


i. The role of the purchasing department


· Many different items are not purchased by the Purchasing Department, but by Management, Accounting, and Administration etc.


· The Purchasing Department is mainly involved in the procurement of indirect materials, some less in production-related items and least in investment goods


· The involvement of the Purchasing Department is limited during the first stages of the purchasing process


· Purchasing role is most dominant in the last stages of the process, when contracts have to be drawn up and when orders have to be placed


ii. Objectives of Purchasing


A key step in the corporate procurement planning process is the specification of the objectives to be achieved through the department's/agency's purchasing activities. These activities should be consistent with the objectives of the overall organization.


Purchasing organization is the focal point for all contacts with suppliers concerning the commitment of company funds for materials and services. It is instrumental in establishing and managing effective supplier relationships. It is purchasing's responsibility to locate and maintain the best source of supply. The mutual success depends on every supplier supporting in achieving the following strategic objectives


1. Total Quality


In order to achieve excellence and customer satisfaction, the focus must be on continuous improvement in the quality of all products, processes and services. The organization and its suppliers must strive to examine and improve all of the systems by which to get things done. By making suppliers an integral part of the overall quality process, it's possible to build better products right from the start.


. Supplier Collaboration


Success in achieving Total Quality depends on viewing suppliers as a valuable extension of own business. The goal in purchasing is to build long-term business relationships with a select group of supplier who share total quality vision by consistently delivering the highest quality products and services. Ultimately, this focus means selecting fewer but better suppliers.


. Availability


Suppliers must be responsive to the rapid changes in design and manufacturing strategies. Reducing the time it takes to deliver materials and services to manufacturing facilities helps to bring products to market sooner and to reduce inventory exposure for both the organization and suppliers. The speed of technological changes drives the need for reduced cycle times, shorter lead-times, 100% defect-free materials, and on-time delivery.


4. Other Objectives


Ø To support the organization operations with an uninterrupted flow of materials and services.


Ø To Purchase competitively and wisely. This includes two distinct considerations to purchase competitively involves keeping abreast of the forces of supply and demand that regulate prices and availability of materials and services; to purchase wisely involves a constant search for better values that yield the best combination of price, quality and service.


Ø To develop and maintain reliable sources of supply.


Ø To develop good and continuing supplier relationships. Under such relationships the myriad of problems that inevitably arise between buyer and seller are readily solved.


Ø To achieve maximum integration with other departments of the firm. This requires understanding the needs of other departments in order that these needs can be translated into support actions.


Ø To train and develop highly competent personnel who are motivated to help the firm, as well as their department, meet its objectives.


Ø To develop policies and procedures which permit accomplishment of the preceding six objectives at the lowest possible operating cost.


iii. Purchasing Procedures


a. Purchase Requisition


Purchase requisition is a step used to stimulate purchasing of materials by purchasers. It will emanate directly from the user or from the stores or inventory control. Organizations have policies on how purchase requisitions will be originated. Purchase requisitions for stock items will be originated from the stores or inventory control. Purchase requisition for no-stock items may be originated from the users. Purchase requisition is usually made by using a requisition form, which contains several information such as the name and indentification of materials, quantity, the quality in terms of specification, the time it is needed, the user, recommended supplier.


b. Verification of purchase requisition


When purchasing receive purchase requisition, it will verify the following


· Is the requisition properly filled and is it clear?


· Is it authorized?


· Is it within the budget?


c. Request for Quotation


Possible suppliers are invited to bid through request for quotation. This could be through any communication way.


d. Evaluation and selection of Suppliers


When suppliers quote and return quotations evaluation of suppliers will be made. Evaluation is made on the basis of the criteria set in the request for proposal (RFP).


The criteria include quality factors, delivery factor, quantity, service, etc. each factor has weight based on its importance and there are methods of supplier evaluation including a weighted point method and cost ratio method.


e. Purchase order / contract


A purchase order can be made to the best supplier you have been selected. Purchase4 order can be make in a number of coped depending on te parties entitled to receive it.


f. Follow-up and expedition


Once purchase order has been made purchasing may not need to wait until materials are sent. It may require follow-up. Follow-up is contacting a supplier in order to ensure that he is taking measures to send the materials on the agreed upon time without delay.


Expediting - sometimes supplier may need materials to be delivered earlier than agreed upon date. This is requirement to enhance the delivery. This requires separate agreement with the supplier since he is not obliged in the contract.


g. Receiving, inspecting and storing


When materials are sent by the supplier they are received, inspected, and stored. In a very small organization all these activites can be done by one unit. In big organizational there may be separate units.


Receiving deals usually with general make-up of quantities, packages, damages, overages and shortages.


Inspection is concerned with find out whether the materials meet the specifications such as quality. Inspection procedures and methods are applied such as the use of census or sample.


Store make the final receipt and place the materials in stores. The receiving and stores makes the respective reports.


h. Payment


Payment will be made by finance or accounts after comparing the purchase order in various reports and assuring that the supplier has fulfilled the requirements of the agreement.


i. Post Purchase Evaluation


Post purchase evaluation is made to find out whether the supplier has supplied the materials according to the agreement and whether the materials purchased have satisfied the needs of the users. This is very crucial for future decision of purchasing of the same material and in considering the supplier.


iv. Considerations in Purchasing


There are several considerations that will be made during purchasing, which includes


a. Organization of Buying


Centralized Vs Decentralized Purchasing


Ø Decentralized purchasing


Individual departments or separate locations handle their own purchasing requirements.


Advantages


· Direct responsibility for profit centers


· Stronger customer orientation towards internal user


· Less bureaucratic purchasing procedures


· Direct communication with suppliers


Disadvantages


· Dispersed purchasing power, lack of economies of scale


· No uniform attitude towards suppliers


· Scattered market research


· Limited possibilities for building up specific expertise on purchasing and materials


· Probably different commercial purchase conditions for different BU's


Ø Centralized Purchasing


In basic terms, centralized purchasing simply describes the type of organization in which there is some form of centralized control over the purchasing function.


Ø Centralized versus decentralized purchasing some criteria to consider


· Commonality of purchase requirements. The greater the commonality of the purchased products required, the more benefits can be obtained from a centralized or co-ordinated approach.


· Geographic location. When the BU's are situated in different countries or regions this may hamper co-ordination efforts considerably because of differences in trading, management practices and culture.


· Supply Market structure. A company can be confronted with one or a limited number of suppliers in some of its supply markets. In such a situation a co-ordinated purchasing approach makes sense to adopt for a better negotiating position vis a vis these powerful suppliers.


· Savings Potential. Prices of some types of raw materials are sensible to volume in such situation buying higher volumes may immediately lead to cost savings


· Expertise required. Sometimes very specific knowledge is required for effective buying, as in the purchase of high-tech semiconductors and microchips. In such cases purchasing is centralized.


· Price fluctuations. If materials (e.g. fruit juices, coffee) prices are highly sensitive to the political and economic climate, a centralized purchasing organization is favored.


· Customer demands. Sometimes a customer will dictate to the manufacturer which products to purchase (e.g. aircraft industries). This practice will clearly obstruct any efforts aimed at purchasing co-ordination.


b. Quality Considerations


What is Quality?


"... a perception of class, excellence, a type of referential standard or (in definition) reflecting the needs and expectations of the customer."


A range of eminent champions have contributed to definitions relating to what quality is


o A product or services nature or features that reflect capacity to satisfy express or implied statements of need (Deming)


o Conformance to requirements (Crosby)


o Fitness for purpose or use (Juran)


o Product and service characteristics as offered by design, marketing, manufacture, maintenance and service that meet customer expectations (Feigenbaum)


o Owner satisfaction - the perceived quality of some products or services as interpreted by owners. An expensive to maintain, unreliable car may offer a high status experience if it is, say, a 61 Thunderbird. A set of wine glasses purchased from Harrods may provide more satisfaction than similar ones from a street trader -albeit that the Knights bridge crystal was more expensive.


o Oakland (15) suggests perceivable (and measurable) move from mere satisfaction by a customer to delight and reputation for excellence. Customer expectations are consistently met with an after-glow of well-being.


o In materials management quality can be defined in terms of specifications (such as Chemical, Physical, Performance, and Method Specification and Blue print) and standards.


A Policy for Quality


In any business a clear policy framework is needed to guide the practices and behaviours essential for quality achievement throughout the system as a whole. The policy has to be properly and consistently implemented by all concerned.


Quality to meet requirements and delight, calls for clear understanding of


1. What customers really want and like. A marketing orientation and market research is essential.


. All players in the quality chain having the scope to contribute creatively. Continuous quality improvement (CQI) needs to be embedded into personal commitments and behaviours - from top to bottom throughout an organisation. This applies to relationships along internal as well as external supply chains. The adoption of quality circles is just one element in a CQI process.


Quality Control (QC) vs. Quality Assurance (QA)


Inspection is a QC process. It generally involves inspectors who check for defects in products or services. A statistical sample is inspected e.g. some chocolates from a batch. An inspector may be stationed at the end of an assembly line testing for defects. In a bank an inspector may infiltrate as a customer to vet how counter staff are handling clients.


Inspection doesnt stop poor products being made. Action only after inspection is insufficient. Why? Quality cannot be inspected in; it must be planned, designed and manufactured.


ISO 000 (000) and TQM


· More than Quality Control


o Quality assurance is more than quality control. Assurance encompasses control beyond just inspection and testing. QA requires a structured approach to prevention of quality problems through planned and systematic activities specification, review, monitoring and documentation. QA demands a quality management system.


· ISO 000


o ISO000 is the internationally agreed set of standards for the design, installation and operation of quality management systems. The standards have a history dating back to 168 (and with earlier antecedents). ISO 001 000 recently replaced the ISO 001 (14) standard and ISO 00 and 00 (14) standards are discontinued. The 000 QMS standards define conformance, specification and consistency in quality monitoring and action.


· Total Quality Management


o TQM is an approach to improving the competitiveness, effectiveness and flexibility of a whole organisation...a way of planning, organising and understanding each activity and it depends on each individual at each level. TQM is a way of ... bringing everyone into the processes of improvement. Oakland 15 pp 18


A TQM approach promotes quality as a strategic imperative for the business. Introduction and maintenance of a comprehensive programme of TQM will require re-evaluation of the way in which organisational members address the quality of their work - their production and service processes. TQM is underpinned by a policy commitment covering


o A change or re-emphasis in organisation culture with all staff encouraged to practice positive, initiative taking behaviours and adopt a prevention and continuous quality improvement ethic.


o Quality improvement teams/circles and use of a range of methods and techniques (tools) to structure and support a TQM programmes objectives and tasks.


TQM Doctrine - still a ubiquitous, powerful, driving force.


Although specific problems may have been experienced with corporate wide TQM programmes, TQM thinking and approaches remain a powerful force in business today.


o The language of TQM drives a quality movement" as an imperative, rhetorical (persuasive) language.


o The doctrine authorises management to drive business practice as a response to the demands of competitiveness and customer-orientation.


o The vocabulary of TQM, competitiveness and customer-orientation is complementary.


c. Types of Purchasing


Ø Materials Requirement Planning


Materials requirement planning (MRP) is widely used in manufacturing and construction businesses. Once a manufacturer has established its production schedule for the coming 6 or 1 months, purchasing can then order and schedule supplies. Quantity and timing requirements are dependent upon the production schedule. Thousands of items, all with variable lead times, often are involved in a production process. The starting point is the master production schedule detailing what will be produced and when. This schedule is then exploded into a bill of materials, a detailed recipe of parts and materials. It provides precise delivery dates and quantities for each component in the recipe. If components arrive any later, production may be stopped. If they arrive any sooner, there may not be space available to store them. Ideally an MRP system runs on a Just in Time basis with no buffer stocks.


Ø Just in Time (JIT)


JIT is not a technique. Its a management philosophy, now adopted by many successful manufacturing businesses, which aims to bring certainty and smoothness to the flow of materials through the supply chain, and to eliminate wasteful practices such as holding safety stocks. Businesses hold stocks because of uncertainty, either about the future level of demand or about the lead-time to manufacture or replenish stocks. As well as coping with extra demand, buffer or safety stocks are held to cover an unexpected extension of lead times or to carry if a supplier delivers a poor quality batch. The more unreliable a supplier, the bigger a safety stocks need to be.


· What is trying to develop with a JIT approach is a network of quality-assured supply partners who can deliver the right quantity to the right place at the right time, every time. The delivery point may be to a retail outlet or it may be to a production line. Suppliers are delivered against an agreed schedule with absolute certainty on the day they are required, rendering expensive safety stocks redundant. Working towards JIT will make the entire business more competitive, for its implications spread far beyond purchasing and stock management.


d. Legal and Ethical Considerations


The purchaser's action in purchasing materials is governed by the law. The purchaser creates legal and binding commitments between the company and suppliers. Therefore knowledge of the law becomes and important requirement of purchaser. Litigation is both costly and of uncertain outcomes and be avoided except as a last resort. There are many legal issues that must be considered in purchasing


1. Contract


No legal purchase contract will arise until offer and acceptance is made between the two parties. A contract is completed when the supplier makes quotation and purchaser accepts the offer through such as purchase order or contract signature within a specified period of time.


. Cancellation of contract


Once a contract is made it is not allowed to cancel the contract in favour of one party. Cancellation of a contract in favour of one party cause financial and other loses on the other party and becomes illegal.


Conditions that one party has the right to cancel the contract


§ Default when one of the party fail to perform to the terms and conditions of the contract


§ Force majure when situations are beyond control such as disasters, earthquake, war, etc.


. Shipping Terms/ Trade Terms


Shipping terms tells us


§ When the legal title of ownership passes from supplier to the purchaser?


§ Who is responsible for freight?


§ Who has the right to claim for damage in case of damage?


e. Supplier Evaluation


As a matter of good procurement practice, periodical evaluation of all major suppliers on the basis of actual performance as compared to promised delivery dates, their ability to meet rush requirements, the number of rejects due to poor quality, and adherence to purchase order prices is essential. Subsequent buying decisions are strongly influenced by this evaluation. It does also have an active cost reduction and savings program. Thus, the ability to give and maintain low prices, combined with consistent quality and service, is of great importance in selection of suppliers.


There are two major ways of evaluating suppliers


1. Weighted Point Method


§ In the weighted point method, purchase set criteria against which they can evaluate the performance of the supplier. Criteria may include quality, delivery, and price.


. Cost-Ratio Method


§ The cost ratio method relates all identifiable purchasing costs including receiving to the value of total purchase. The higher the ratio of cost, the lower is the rating and selection. Quality, delivery, service, and price are the usual factors used in cost-ratio method.


f. International Buying


Ø Initial Foreign Purchases the easiest way for buyers to start making foreign purchases is for them to place initial orders wit a trading company orj an important merchant. Trading companies are large organizations that deal in imported and exported products of all types. The trading company guarantees quality, and it takes care of all the necessary documentation. Import merchants buy and inventor commodities for their own account, assume all importing risks, take care of all needed documentation, and sell through their own outlets.


Ø Unique Considerations in foreign Purchasing


1. Product categories international purchases of raw materials involve considerations different from those involved in purchases of components, subassemblies, and operating supplies.


. Distance between supplier and buyer the greater this distance, the more difficult it is to get satisfactory service and economical transportation.


. Government polices government regulations and trade polices frequently make international purchasing uneconomical or impractical.


4. Nationalism some buyers are totally prejudiced against making any foreign purchases.


5. Marketing pressures firms frequently differentiate their products to be sold in foreign markets; thus, domestic firms wanting these products are forced into foreign purchasing.


6. Supplier industry characteristics some suppliers are so powerful economically that they are capable of forcing their customers deal with domestic suppliers.


7. Buying firm characteristics some firms grow so fast that they outgrow the resources of domestic suppliers; thus they are forced to use foreign suppliers.


Ø Potential Difficulties in International Buying


Reduced tariffs, trade agreements, and the formation of free trade regions have resulted in worldwide competition and reduced prices for many materials. Nonetheless, buying in international markets presents unique situations one does not encounter when buying locally. A brief overview of some of the more difficult foreign buying situation follows


o Communications not only must the buyer and seller be able to communicate clearly in a common language, but the buyer must also understand the culture and the customs of the foreign country in which he or she is buying. Only this type of perceptiveness can give the buyer an insight into matters such as the important elements of business etiquette in the seller's country, the capabilities of the foreign country's selling agents, their honesty, their intention of keeping contract commitments, their political stability, and the specific products they produce at low unit costs.


o Financial, Legal, and Related Issues Potential difficulties in these categories, to cite some of the more important ones, arise from factors such as export-import license requirements, currency differences, non tariffs barriers, laws and ethics, exchange restraints, documentation requirements, payment terms, government controls, and transportation facilities.


Buyers and sellers work in different legal systems, and the laws affecting purchasing activities are different in each country. Consequently, the terns used in negations and the methods for setting disagreements or disputes must be explicitly defined.


Financing foreign purchases involves matters such as knowledge of currency exchange rates and documentation requirements, including bills of lading, invoices, certificates of origin, weight certificates, analysis certificates, insurance policies, and the marking of packages. Payments are another matter, including such things as terms of payment, letter payments, letters of credit, and drafts. Each of these financial issues requires decisions, which should stem from solid financial expertise.


o Quality the principal difficulties focus on two dominant factors (1) a scarcity of international standards, () the real possibility that foreign products entail greater obsolescence risks and longer corrective cycles for design changes.


o Lead Time because of the larger number of variables involved in foreign purchasing activities additional lead times, which traditionally exceed thirty days, must be considered in planning foreign purchases.


o Selecting Foreign Suppliers for foreign products and materials, buyers must search out desirable suppliers. For large dollar/birr volume and highly technical purchases, visits to selected foreign suppliers' plants are usually a necessity.


c. Inventory Control


Inventory incurs costs, ties up working capital, it consumes space and must be managed in and out. Stocks can deteriorate or get stolen. Most operations, capacity planning and scheduling, depend on inventory. Stocks serve to smooth out timing gaps in the rates of supply and demand. Inventory offers insurance and good planning/ control can minimise the associated costs and satisfy efficiency/effectiveness requirements.


In order to manage stock effectively, firms must know how much it have, its value, and where and how it is stored. Some of this is about information systems ('Information handling'); some is about analysing the physical storage, which interacts closely with materials handling systems ('Materials handling'). It must also know what inventory costs. That includes


Ø Carrying costs. In addition to the interest on the working capital tied up, there are the costs of storage space, stores staff, handling, deterioration, loss through damage or pilferage, obsolescence (particularly important in retail clothing and electronics), and insurance.


Ø Opportunity costs. Stock is normally unproductive capital. Carrying it restricts other investments you could have made with the same money.


Ø Stock-out costs. In retailing, if an item is out of stock it could mean a sale is lost. In manufacturing, for the want of a spare part for a machine tool, production could be halted. A shortage of a raw material could mean using a more expensive substitute.


The costs above suggest trade-offs between the factors. A few large orders mean low purchase costs but high stock costs; many small orders mean low stock costs but high purchase costs. High buffer stocks mean low stock-out costs but high stock carrying costs. Firms need to strike the right balance between these various factors.


i. Out-of-stock situations


Operations mostly depend on stock. Raw materials shortage in manufacturing means halting production, rescheduling to make something that has raw materials or quick action to secure alternative supply.


Obviously average inventory for a stock item is represented by half the stock. A replenishment delivery is received (Q) and is added to any remaining stock. In an out of stock situation some of it may indeed be allocated already to outstanding (waiting) orders. The stock is now issued to jobs and orders and steadily depletes.


A personal computer assembly line that runs out of memory chips must stop; if a Wimbledon runs out of strawberries might perhaps change to peaches. If a paper supplier is hit by strike action urgent approaches will be made to other suppliers.


If finished goods are out of stock, or raw materials or consumables shortage affects the customer (sorry, the soup is off today) then customers may go off elsewhere, orders may be cancelled. Loss of goodwill means that competitors develop a relationship with your customer. All stock outs involve costs.


ii. Costs of Inventory


Costs are tied up in the inventory itself and in ordering and carrying the stock.


Ø Holding costs


· Expressed as a % of stock value and may be 15-0 % per annum.


o Cost of capital tied up in inventory (the opportunity cost of money).


o Storage costs space, equipment, warehouse and stores staff, services etc often 5-10 % of stock value per annum.


o Stock losses/wastage (legitimate or otherwise). Theft, accidental damage, stock exceeding its shelf life, and stock obsolescence and write-offs. How much depends upon the goods (perishables, rust, aging designs) but the write-off level will usually be greater than zero.


Ø Acquisition/ordering costs


Costs arise from ordering/acquiring goods regardless of the actual value of the goods. In both making to stock and making to order, stock acquisition costs are incurred. Replenishment and purchasing administration paid for. It may take a skilled operator an hour to set up equipment for a new order or scheduled batch. Material may be wasted in the set up process. On completion of the job, equipment must be cleaned and tools put away. The inventory associated set-up costs include labour, material wastage, associated loss of production time collecting or waiting for stores, paperwork and administration. The set-up cost may easily be $45-75 irrespective of the order or batch size.


The purchasing order processing costs include receiving the goods, delivery for large or small orders and invoice processing. Precise costs per ordered unit are often elusive, but the staff and overhead costs are significant. In actual terms £40 may be incurred to initiate and process one purchase order.


Ad hoc purchasing must be compared with long-term contracts involving regular deliveries perhaps with just-in-time supply or amounts that the operation can call off from a supply agreement over, say, a quarter. There are costs in


o Researching and negotiating the supply contract (requires a expenses of its own given the specialist nature. A whole team may be involved with travel and hotel costs)


o Processing each consignment (packaging, bill of lading, insurance, transport planning etc).


iii. Economic order quantity (EOQ)


We could buy-in, or make for stock either a few large orders or frequent small orders for a given usage. Few big orders involve low acquisition and high holding costs. Conversely many small orders result in low holding and high acquisition costs.


Purchasing an economic order quantity (a.k.a. economic batch quantity, economic lot size or EOQ) seeks to reconcile ordering and holding costs to obtain an optimum order size.


Therefore Total cost = Ch + Co


These relationships can be seen in the graphic representation of EOQ.


The EOQ is found at the lowest point on the total cost curve. Here the order size optimises the cost of stockholding with the cost of acquisition. The equation is


iv. Inventory Control Systems


It is important to understand systems of inventory management. As demand and lead times vary we can order fixed quantities of stock at variable times or order variable quantities at fixed times. Each has implications for safety stock, operational responsiveness, the level of risk involved given variable demand and supply and security. Many factories will use a two-bin replenishment system. Stock records systems; computerised more often than not today, provide move detailed control over stock levels, issues and receipts. They are essential to stores management. The data content and flows of such systems are needed by just-in-time methods. It must be aware also that the records say we have 5 in the warehouse but only three can be found and one of these is damaged.


Ø Pareto (ABC) Analysis


Pareto analysis (a.k.a. ABC analysis or 80/0 rule) can be used to classify stock groups. Stock items are ranked in descending order of usage value, and plotted on a cumulative frequency curve. it is common to find that 0% of items account for 80 % of usage value, the next 0% has 15% of value. The final 50% have 5% of value.


ABC or Pareto analysis points the way to where control efforts are best directed. Judgment is needed on critical inventory items or security matters that Pareto analysis in itself does not reveal.


Ø Safety stock and service levels


We may run out of stock because of a re-supply delay or higher than anticipated usage. If we can predict demand then we merely place EOQ orders on time.


But firms risk a stock-out with unpredictable demand, usage and resupply. So introducing a safety or buffer stock reduces the risks of variable demand/lead time.


Ø Lead-time


o The time between replenishment need arising and new deliveries being ready for use. It includes e.g. time to detect then authorise replenishment


o Establish supplier contact and complete admin/paperwork


o Obtain, produce and have the goods delivered


o Goods inwards/receiving and quality checking time


Ø Service Levels


Rather than guarantee 100% stock availability for any foreseeable need, inventory managers would normally agree a inventory service level (% probability of stock availability to meet demand). This mediates the estimated costs of stock-outs with the cost of carrying a safety reserve. If demand and lead times are normally distributed, the safety stock formula is


§ Safety stock levels


Calculating safety stocks requires understanding of demand and lead-time. Assuming that these are normally distributed then


Safety stock = (L Dv+D Lv)


L = mean lead time, D = mean demand (in the lead time) Lvar = variance of lead time, Dvar = variance of demand and


For a safety stock level in a service agreement, an Sdev (standard deviation) value of 1.6 gives 5% stock availability and . gives %.


The controllable aspects of lead-time should be investigated. It is seldom normally distributed and improved control over the length and variability of lead-time will reduce the need to maintain safety stocks.


d. Receiving, Inspection and Storing


Deliveries can usually be anticipated because of shipment notices, delivery dates on requisitions, or other notifications, and preparations should consequently be made to receive the material. Receiving personnel should be ready to inspect the material, storerooms should be ready to receive the material, and the necessary arrangements for working parties should be made well in advance so that once the anticipated material arrives, it maybe stored immediately to prevent temperature fluctuations. Such fluctuations will reduce the quality and storage life of the materials.


Ø Receiving


Many manufacturers lack clear documentation of receipt of shipments. This can cause problems when the business has to prove that there was a shortage in shipment or that the shipment does not meet quality specifications, or when other problems exist.


Upon receiving purchased goods or even services from a supplier, it is important that the shipment is checked to make sure that the correct quantity and quality was received. A receiving report should immediately be completed which indicates


o The date the material was received or service was performed


o Whether the delivery was on time


o The quantity of material received and whether any discrepancies exist when compared with the packing slip


o Whether the quality of the material meets specifications


o The names of the personnel who performed these checks


This receiving report can be of great help to the bookkeeper in maintaining accurate records, and when paying the bills.


Ø Inspection


It is important, upon receiving a shipment, to make sure that the material meets quality specifications. If it is of great importance that no defects in quality exist, you will probably want to run a quality check on each item of the entire shipment.


If, in your manufacturing process, you are able to detect defective materials, and it is clear that the problem lies with the supplier, then the incoming quality check can be limited to assuring that there is no massive quality problem which would disrupt your production.


In some cases, however, defective material could pass through manufacturing operations unnoticed, or a problem in production could be the fault of your people. In such situations, it is wise to conduct a quality check of materials, upon receiving the shipment.


However, since checking items against design specifications can be quite time consuming and expensive, it is rarely necessary to run a quality check on all items received.


Instead, spot checks on quality can be made on a small representative portion of the shipment. The reasoning behind spot checks is that if some of the material is defective, then you should have a fairly good chance of finding some defects if you sample items at random. Thus, you might pick some material from different places in the shipment. In the case of several packages, you might select a few pieces from the top of one package, from the bottom of another one, from the sides of a third one, etc., and run quality checks on this material instead of on the whole shipment.


Ø Store


There are many activities under stores including identification, stores counting (stock taking), stores accounting, materials handling, classification of materials, etc.


e. Materials Handling


Within a node - a warehouse, a plant, a retail store - goods have to be moved between incoming transport, storage, processes, and outgoing transport. The spectrum of available systems ranges from one person with strong arms through the supermarket trolley (in its way a revolutionary technology) to fully automated systems incorporating robot order picking and automated guided vehicles (AGVs). Most handling systems, and the packaging adopted by suppliers, are geared to supplier-warehouse-process transactions. In fact increasing numbers of businesses are moving towards JIT deliveries once supplier quality is sorted out, incoming goods can go directly into the process, without inspection or spending any time in a store.


This can have important implications for handling and packing - for instance, shrink-wrapped pallet loads of small parts are unlikely to suit JIT deliveries where the processes are based on assembly stations. A smaller load unit, with no unpacking needed, might be the right answer, at the price of higher-cost machinery to unload from the suppliers truck into robot carts. Bar-coding gives instant recognition of individual items to stock management systems - and to production systems.


Analysing the effectiveness of the existing handling systems involves assessing their cost and appropriateness to the rest of the firm's operations. It also means knowing something about the characteristics of different systems. The key factors for assessing a materials handling technology are


§ The physical characteristics of loads


§ The number of loads to be moved


§ The distance to be moved


§ Speed of movement required.


f. Transportation


Transportation provides access to natural resources and promotes trade, allowing a nation to accumulate wealth and power. Transportation is usually classified by the medium in which the movement occurs, such as by land, air, water, or pipeline. Within each of the first three media, many different methods are used to move people and goods from place to place. Pipelines are used mainly to transport liquids or gases over long distances.


g. Value Analysis/Value Engineering


The terms value analysis/value engineering originated in the early days of development of the techniques. The first approach was rather than reduce costs, to increase values. Hence the need to analyses value. Value Analysis is currently used to describe the application of the techniques to existing products or services. Value Engineering is used when the techniques are applied to projected products or services. Value Analysis/Value Engineering can be applied with equal success to any other cost generating areas.


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Tuesday, September 3, 2019

Mary Shelly Frankenstein Chunk Writing

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Mary Shelly uses the effects of isolation and alienation throughout the novel Frankenstein.


Throughout the novel Mary Shelly depicts the loneliness and deslatude through each of the characters. An example of isolation illustrated in the novel is when Felix and a group of people were at home playing music, and all of a sudden someone at the door is knocking. "The lady was dressed in a dark suit and covered with a thick black veil" (101). The veil that the lady wore represented isolation and alienation because it blocked off her face from the rest of the world. The darkness of the veil symbolized alienation because she did not want the light to hit her face. This also symbolizes dark versus light. The light is more open and carefree yet dark is more secluded and more mysterious.


All through the novel Victor is much supported by his father and his fianc�, but he lacks the caring toward his family to tell them what his plan is or what he is planning on doing. He forgets his responsibilities and alienates himself from his own father and furthermore is future wife. Unfortunately his family will soon find out what he is working on. "He little you know about me if such a wretch as me felt pride" (156). He isolates from himself from the rest of the outside world because he is too prideful of his great masterpiece. He does not consider his families' support in his greatest work therefore causing a big problem at the end. Victor alienating his only loved ones causes him to make a big mistake, creating the monster. When the monster is alive dead is shined upon his fianc� as well as his father. Alienation and isolation plays a major part throughout the novel creating a cause and effect situation for many of the characters.


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Rosa parks

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Report on Rosa Parks


Rosa parks was born on February 4th 11 in Tuskegee Alabama. At the age of 11 she enrolled in Montgomery industrial school for girls. Later on she then worked as a seamstress in Montgomery. Did you know that Rosa parks has been called the "mother of civil rights movement" and one of the most important citizens of the 0th century. In the early 150's the bus in Montgomery were segregated which means that the black people had to sit at the back of the bus and the white people got to sit at the front. (Personally I like sitting at the back of the bus but if I had to sit there because I was of different color then I would be mad because its wrong to contain people like that.) Any way if you were sitting on the bus and you were black then you had to give up your seat to a white man if there was none left. And well Rosa Parks had had a hard day at work. And her feet were killing her so she sat quietly on the bus. And there was a white man that had came onto the bus and decided he wanted her seat. Well she said that she did not want to give up her seat. Because she had had a hard day at work so she needed the seat more. And besides why should she have to give her seat up to a white man who was capable of standing or taking another seat. She said she would have gladly given up her seat for an elderly lady or a child. But she was mad with the way that the white race was treating them. So she stood up and refused to so on that day of on December 1st of 155 she was taken to jail for refusing to give up her seat to a white man on a bus. She then started a boycott in all of Montgomery and surrounding areas. This further helped the black to be treated better. I think that it impacted on Canadian's because we listened to the news and stories and read about it in our homes and schools etc. and we realized that it was so horrible. So we maybe tried to not be so prejudice.


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Friday, August 30, 2019

Nurse Retention

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I. Introduction


II. Situation Analysis


A. Industry Review


B. Company HistoryCheap custom writing service can write essays on Nurse Retention


III. Marketing


A. Marketing History


B. Current Marketing Plan


1. Product, Price & Place


. Promotion


C. Target Market


D. Statement of the Problem


E. Marketing Objective


IV. IMC Objective


V. Copy Platform


A. Basic Problem


B. Target Market


C. Major Selling Idea


D. Creative Strategy Statement


1. Campaign Theme


. Campaign Slogan


. Appeal


4. Execution Technique


E. Support Information and Requirements


VI. Creative Work Magazine Ads, TV Storyboard, Radio Ads, etc.


VII. Media Plan (See figure 10- in Belch)


A. Select Broad Media Classes


B. Select Media Within Classes


C. Develop a Media Schedule


VIII. Media Use Decisions


Everyone must have one broadcast, one print and one other major category, as a minimum.


A. Broadcast


1. Television


a. Vehicle Selection (VS)


b. Creative Work (CW)


. Radio


a. VS


b. CW


B. Print


1. Magazines


a. VS


b. CW


. Newspapers


a. VS


b. CW


C. Direct


1. Programs


. CW


D. Internet


1. Program


. CW


E. Sales Promotions


1. Programs


. CW


F. Personal Selling


1. Program


. Presentation Outline


G. Publicity & Public Relations


1. Program


. CW


H. Others, Promotional Products, Transit Advertising, Product Placement, Outdoor, Trade Shows, etc.


1. Programs


. CW


IX. Conclusions


X. Ethical and Environment impact statement


XI. Bibliography


XII. Appendix


According to a July 00 report by the Health Resources an Services Administration, 0 states were estimated to have shortages of registered nurses in the year 000. The shortage is projected to intensify with 44 states plus the District of Columbia expected to have RN shortages by the year 00. (Cox)


The solution lies in redefining recruitment and retention. Hospitals should develop techniques that can be sustained- building interest and image, developing scholarship programs, and cultivating a positive workplace culture and sense of community. These efforts are only successful with bridge building among all stakeholders, including CEOs, CFOs, nurse executive, nursing schools, and physicians. To encourage this collaboration HFMA brought together five experts to offer their perspectives on both problem and possible solutions. (Cox)


Hospitals should tap into this trend with retention and recruiting efforts.


Going to take time to tell the story about health care as a profession and the security of employment found in the healthcare profession.


(People moving into the technology sector�people were moving to those career paths without realizing that technology might not continue its rapid growth. Heath care, on the other hand, has been around for many decades.


Nursing shortage was brought about by an aging workforce,-- average age of a nurse falling between 40 and 4 years of age nationally, and by unresolved or unaddressed workplace issues.


Nurses are leaving the bedside and hospital setting to work in other areas, such as pharmaceutical sales, outpatient health care altogether. Until something is done to make nursing more attractive to both men and women, we will continue to see a problem.


Hospitals facing battle to reclaim the heart of nursing and maintain levels of care for their patients. Nurses say that hospitals must improve the environment of care. Doing so will no doubt require that models of care are redesigned to focus nurses on direct patient care and use other support staff to fulfill the duties that take nurses from the bedside.


Staffing shortage affect the financial outlook of a healthcare organization. Can case the organ to look to traveling nurse as a solution to the shortage issue, and that can cost the organization up to three times more for that staffing resource.


Staffing shortages can reduce the number of beds that are available, resulting in emergency- department overcrowding due to the unavailability of beds. Also, hospitals may choose to close beds to avoid the substantial financial impact of using contract staff.


staffing shortages can also be associated with low staff satisfaction, turnover, and low patient satisfaction, thus whether patients return to your organization.


Hospitals are learning that retention is as important== perhaps more important=-- than recruitment. The cost of turnover is tremendous in financial terms, and then there is the issue of the morale of remaining staff.


it's imperative that they hire the right person for the right job and ensure that the individual is a fit for the organization. Hospitals need to take time to review their mission and core values with the applicant during the interview process. The applicant needs to know what is important to the organization's success.


hospitals also should make every attempt to avoid implementing compensation programs that are too costly over time to continue. Wages and benefits should be market competitive.


Advocacy is also important. Hospital leaders should make sure that state legislators in their area are educated about how the community is being affected by workforce shortages and how the legislators can help.


Providing on-site education is very important for recruitment, as well as retention.


Hospitals should involve staff in decisions that affect their work environment, helping ensure the organization is meeting their needs.


Today, nurses need the greater challenges of a career that provides personal satisfaction for the long term. Therefore, recruitment and retention go hand in hand.


Hospitals and health systems are focusing their efforts on retention and employee satisfaction because they are recognizing that internal scorecards reflecting employee satisfaction are as important as measure of financial viability. Involving nurses in professional development and patient care issues is extremely important. Hospitals have developed shared governance models to bring nursing staff to the table in making decisions that will affect their daily lives, such as developing staffing models, redesigning patient care models, recruiting and interviewing nurse candidates, ad defining equipment needs.


Nurse managers have been challenged to provide alternatives to traditional 8, 10, and 1-hour scheduling. Providing for associates to work full time at higher pay in lieu of benefits and integrating flexible scheduling are important ways to meet changing needs and expectations of associates. There has recently been, and will continue to be, a more proactive focus on nursing. Prioritization will be based on each region's need.


President Bush has signed the nurse Reinvestment Act, which will provide for scholarships, a loan repayment program, public-service announcements to promote nursing as a career, and many other programs to support nursing.


The right mentality is, "I want to be able to make some decisions." One hospital chief nursing officer went directly to the nursing staff to solve the problem. Together, they came up with a protocol, assigning mandatory overtime only as a last resort. Nurses made extra efforts to avoid the mandatory overtime by first looking for volunteers and ten working through the protocol. As a result, mandatory overtime was reduced, and nurses gained some control over their scheduling.


Today's nursing workforce wants to have some choices and be able to make decisions.


Keep the lines of communication open. Share financial data with staff; let them understand the financial challenges.


Focus as much on retention as on recruitment. It is important to keep your current staff engaged and satisfied by creating a positive work environment for your nurses. Use surveys to determine their needs, and be willing to respond with the changes they desire, such as self-governance models, sufficient support staff, adequate equipment, ongoing staff development, and other resources.


Don't ignore the needs of your nursing leadership team. these are the people who will help maintain your nursing workforce. Be sure to offer them opportunities for education, professional development, and mentoring so they are well equipped to help you with the challenges of the future.


Create an attractive environment to retain the nurses within the organization. Hospitals might look at furthering efforts toward work flexibility, and they might look at eliminating mandatory overtime in healthcare, the needs of patients cause wide fluctuations in census and acuity causing sharp spikes in demand for nurses. Can you picture a nurse leaving to go home in the middle of a surgery?


The pieces of the puzzle between nursing and finance must link because staff retention reduces turnover, which reduces labor costs associated with recruitment, orientation, and education. As all the dots connect, you should have happier associates and enhanced satisfaction among physicians and patients.


Misallocation of RN staffing on one sift can mean short staffing on another, resulting in lower morale, diminished patient care, and erosion of nursing supply. Finance and nursing should collaborate to measure the use of nursing staff (RNs, LPNs, nursing assistants) on a daily, shift-by-shift basis. A simple spreadsheet of days, evenings, and nights collect minimal data and disclose how well the staffing model is being used, where utilization is not appropriate, and where nurse managers can focus.


Calculating highly variable components such as overtime will ensure that there are no surprises at month's end. Staffing grids, average wage rates, and budget targets should be combined to create a monitoring tool that provides useful, actionable information. Shift-to-shift knowledge about variances from the staffing model supports decision-making about vital nursing resources. The simple spreadsheet becomes a management tool that reflects variance in staffing hours, rates, overtime utilization, and skill mix.


There needs to be good working relationship with nursing, and that starts with good communication.


One solution to complicated CFO-nurse manager relations is to allow the nurses to have more authority and influence on interdepartmental relations, as seen with the relatively new role of nursing financial officer. This person interacts heavily with the financial staff and is responsible for monitoring the budget, nursing position control, the float pool, and nursing interns. Giving the nursing division the final work on the top three candidates of the nursing financial officer position ensures a positive working relationship between the departments, and it adds some accountability. (Cox)


Industry experts say that by 00, this country could have 800,000 fewer nurses than it needs.


We've even begun to understand, as studies from the University of Pennsylvania and other places suggest that there is a direct connection between the ratios of nurses to patients and mortality rates. The fewer nurses, the higher the rate.


Good new is that more students are interested in nursing. A 00 Harris poll found that 6 percent of 18- to 4- year- olds have discussed a nursing career for themselves or a friend. Nursing school applications in man places have soared. Baccalaureate nursing school enrollments, according to the American Association of Colleges of Nursing, rose 8 percent last year. In February, Congress approved $0 million for nurse education programs that include scholarships and continuing- education grants for practicing nurses.


Geriatric training for nurses also needs to be expanded. More than half of all hospital patients are over 65, and their umbers are expected to rise during the next 0 years.


The American Nurses Credentialing Center, raises nursing care standards, as well as improves the recruitment and retention of nurses.


Nurses are an essential element of our health care system. Research consistently shows that nurses increase the cost effectiveness and quality of care and improve the efficacy of a wide range of interventions, from heart surgeries to depression treatments.


Qualified people are answering our nation's call for more nurses. Let's do what we can not to lose them. (Fagin and Rieder)


Welcome Susan MacMillan, Senior Vice President, Chief Nursing Officer, comes form Cap Gemini Ernst and Young, where, for nine years, she served as a consultant understanding and developing best practice models of Nursing throughout the country.


Our recruitment and retention initiatives are well underway and coincide with the launching of our nursing marketing campign "exceptional Care Extraordinary Nurses."


Care Delivery Model


Launching nurse "quality council" that will include nurses from al units focusing on patient care issues such as skin care, falls, teaching, etc.


Clinical subcommittee for physician-nurse issues (generated at the unit liaison meetings) will continue quarterly.


Medical-Surgical areas are conducting team building sessions and role classification for nurses and technicians. Expectations to meet patient care needs and workloads are being redefined.


Recruitment and Retention


Implemented "new" approach to compensation with focus on our experienced nurses.


New "marketing" campaign to attract nurses includes a logo, brochures, slide show and commercial. Focus on highlighting what Mercy has to offer and attracting experienced nurses.


MHA (Maryland Hospital Association) nurse retention survey completed. Results and action plans will be shared with staff during April and May. Major areas for focus included compensation, use of agency staff and meeting role expectations.


(The Morning Report)


HR 4654 IH


107th CONGRESS


d Session


H. R. 4654


To amend the Public Health Service Act to provide programs to improve nurse retention, the nursing workplace, and the quality of care.


IN THE HOUSE OF REPRESENTATIVES


MAY , 00


Mrs. MCCARTHY of New York (for herself and Mrs. BONO) introduced the following bill; which was referred to the Committee on Energy and Commerce


A BILL


To amend the Public Health Service Act to provide programs to improve nurse retention, the nursing workplace, and the quality of care.


Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,


SECTION 1. SHORT TITLE.


This Act may be cited as the 'Nurse Retention and Quality of Care Act of 00.


SEC. . FINDINGS.


Congress finds the following


(1) The current nurse workforce is aging, and the average age of practicing registered nurses is 4. years, representing an increase of 5. years since 18. This means that the nursing workforce is aging at twice the rate of other occupations in the United States, and the enrollment in nursing programs has decreased in the past 5 years. Many hospitals around the country are reporting vacancy rates for nursing positions.


() Studies have shown a correlation between higher nurse staffing levels and reduction in adverse patient outcomes, including risk of infection, shock, upper gastrointestinal bleeding, and increased length of stay.


() Retention problems are contributing to the nursing shortage problem. According to a 001 survey, 50 percent of nurses say they have recently considered leaving the nursing profession for reasons other than retirement.


(4) A majority of those individuals who are considering leaving nursing express a low level of overall job satisfaction, and their lack of participation in decisionmaking is a major factor contributing to dissatisfaction.


(5) Magnet hospitals are hospitals that have reorganized care to be more participatory, collaborative, and patient-centered and as a result are able to attract more nurses.


(6) Even in times of nursing shortages, magnet hospitals enjoy low turnover. The average length of employment for registered nurses in magnet hospitals is 8.5 years, which is twice the length of employment in hospitals generally, and magnet hospital nurses consistently report greater job satisfaction than other nurses.


(7) Magnet hospitals report lower mortality rates, higher patient satisfaction, and greater cost-efficiency, with patients experiencing shorter stays in hospitals and intensive care units.


SEC. . AMENDMENT.


Title VIII of the Public Health Service Act (4 U.S.C. 6 et seq.) is amended by adding at the end the following


'PART H--INITIATIVES TO IMPROVE NURSE RETENTION, THE NURSING WORKPLACE, AND THE QUALITY OF CARE


'SEC. 851. DEVELOPING MODELS AND BEST PRACTICES IN NURSING CARE.


'(a) PROGRAM AUTHORIZED- From amounts appropriated under section 85, the Secretary shall award grants to eligible entities to enable the eligible entities to carry out demonstrations of models and best practices in nursing care for the purpose of developing innovative strategies or approaches for retention of professional nurses.


'(b) DEFINITIONS- In this section


'(1) ELIGIBLE ENTITY- The term 'eligible entity means a health care facility, or any partnership or coalition containing a health care facility and a collegiate, associate degree, or diploma school of nursing.


'() HEALTH CARE FACILITY- The term 'health care facility means a hospital, clinic, skilled nursing facility, long-term care facility, home health care agency, federally qualified health center, rural health clinic, public health clinic, nurse managed health center, or any other entity as designated by the Secretary.


'(c) PRIORITY- In awarding grants under this section (other than awarding grant extensions under subsection (e)()), the Secretary shall give priority to applicants that have not yet been designated as a magnet hospital by the American Nurses Credentialing Center.


'(d) DISTRIBUTION OF GRANTS- Grants awarded under this section shall be distributed among a variety of geographic regions, and among a range of different types and sizes of facilities, including facilities located in rural, urban, and suburban areas.


'(e) DURATION OF GRANTS-


'(1) THREE-YEAR GRANTS- A grant awarded under this section shall be awarded for a period of not greater than years.


'() GRANT EXTENSIONS- A grant awarded under this section may be extended if the grantee demonstrates that--


'(A) as determined by the Secretary based on the factors described in paragraph (), the grantee has significantly improved the quality of its workplace for nurses and has enhanced patient care; or


'(B) after the original award of the grant, the grantee was designated as a magnet hospital by the American Nurses Credentialing Center.


'() PREFERENCE- In awarding grant extensions under this subsection, the Secretary shall give preference to entities that have--


'(A) significantly increased retention rates for professional nurses;


'(B) significantly reduced rates of workplace injuries for professional nurses; and


'(C) significantly reduced rates of nursing-sensitive adverse patient outcomes.


'(4) MAXIMUM DURATION OF GRANTS- The total maximum duration of a grant under this section shall not be greater than 6 years.


'(f) USE OF FUNDS- An eligible entity that receives a grant under subsection (a) shall use funds received under the grant to carry out demonstrations of models and best practices in nursing care for the purpose of--


'(1) promoting retention and satisfaction of professional nurses;


'() promoting collaboration and communication among health care professionals;


'() promoting nurse involvement in organizational and clinical decisionmaking processes;


'(4) organizing care to enhance the satisfaction of professional nurses, improve the nursing workplace environment, and promote the quality of nursing care;


'(5) promoting opportunities for professional nurses to pursue education, career advancement, and organizational recognition;


'(6) promoting high quality of patient care--


'(A) by enhancing institutional measurement of quality outcomes, including identification and measurement of nursing-sensitive patient outcomes;


'(B) by basing the development of policies, procedures, guidelines, and organizational systems on research findings and patient outcomes measurement, including nursing-sensitive patient outcomes measurement; and


'(C) by involving professional nurses in developing and implementing ways to measure and improve the quality of care;


'(7) promoting a balanced work-life environment; and


'(8) offering such other activities as may be determined by the Secretary to enhance the workplace environment for professional nurses.


'(g) APPLICATION-


'(1) IN GENERAL- An eligible entity desiring a grant under subsection (a) shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require.


'() CONTENTS- An application submitted under paragraph (1) shall--


'(A) include a description of the project proposed to be carried out with grant funds;


'(B) demonstrate the eligible entitys commitment to the project through a statement describing--


'(i) the involvement of high-level executive management, trustees, nurse leadership, and medical staff in designing, implementing, and overseeing the project;


'(ii) the designation of key personnel and management structures to design, implement, and oversee the project;


'(iii) any actions that the eligible entity has already taken that contribute to developing innovative models and approaches for retention of professional nurses; and


'(iv) the eligible entitys funding or any evidence of other contributions and commitment for the project, along with information on overall project budget and funding resources; and


'(C) include information regarding the retention rate and occurrence of workplace injuries to nurses at the entity applying for such grant and any other information as the Secretary may reasonably require.


'SEC. 85. SURVEY AND EVALUATION.


'The Secretary, in consultation with the Agency for Healthcare Research and Quality and the Health Resources and Services Administration shall--


'(1) conduct an annual survey of the projects carried out under section 851 and provide to Congress the results of such survey beginning not later than years after the date of enactment of the Nurse Retention and Quality of Care Act of 00; and


'() develop and provide to Congress, not later than December 0, 007, a final report that--


'(A) evaluates the projects funded by grants under section 851; and


'(B) includes findings about best practices and the impact on patients and staff of employing participatory, collaborative, and patient-centered models of nursing care.


'SEC. 85. AUTHORIZATION OF APPROPRIATIONS.


'(a) GRANTS- There is authorized to be appropriated to carry out section 851, $0,000,000 for the period of fiscal years 00 through 007.


'(b) SURVEY AND EVALUATION- There is authorized to be appropriated to carry out section 85, $,500,000 for the period of fiscal years 00 through


The HeartMath Report


A journal devoted to developments in how thoughts and emotions affect our health, performance and relationships. Major categories include


• education


• emotional intelligence


• healthcare


• heart health


• heart rate variability • mind/body medicine


• positive psychology


• organizational performance


• stress research


If youd like to post comments to the articles, youll need to register - see the Register link in the upper left corner of the screen. If you have any comments, questions, or items to suggest, email the editor at tom@heartmath.com.


Delnor Hospital increases patient satisfaction, employee retention with HeartMath


Diane Ball, R.N., had just about reached her breaking point. I was at a point where I was starting to second-guess my nursing career and position, she says. Familiar reasons like burnout, information overload, changes in technology, time pressures and family issues were starting to take their toll.


Posted on Nov 1, 0 | 100 pm


[0] comments | link


Study Looks at Nurse Workloads


Nurses are getting older and there are fewer of them, leaving patients and hospitals in serious trouble as a work shortage reaches a crisis level in American hospitals.


Nursing advocates warn the staffing situation in hospitals is getting worse and a study published Tuesday in the Journal of the American Medical Association finds the higher the patient-to-nurse ratio in a hospital, the greater the likelihood of patients dying or suffering life-threatening complications from surgery.


Article More...


Posted on Oct , 0 | 111 pm


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US nursing shortage a national security concern


The nursing shortage that is sweeping through the USA is already at a level that has been upgraded from a health crisis to a national security concern, according to report issued by the Institute for Public Policy and Social Research and Institute for Health Care Studies at Michigan State University.


Article More...


Posted on Sep 14, 0 | 4 pm


[0] comments | link


Hospitals are being revitalized with HeartMath


While some hospitals are playing bidding wars for registered nurses, other hospitals are evaluating how they can increase employee retention and reinvent their reputation for being a high-quality health care organization. Delnor-Community Hospital, outside Chicago, is such a hospital. They've re-invented their hospital by making their employees and patients their top priority and as a result they've realized $800,000 in annualized savings due to their first-year turnover reduction. Measurables from staff retention to staff satisfaction and patient satisfaction have dramatically improved for Delnor over the past two years.


Article


Posted on Sep 10, 0 | 17 pm


[0] comments | link


The Patient Has Turned the Corner


The patient is nursing. There are signs of nascent recovery. This is a good time to review those signs and to focus on the problems that remain and could still doom the patient. But there is reason for hope.


Article


Posted on Sep 06, 0 | 557 pm


[0] comments | link


Predicting Nursing Turnover


The nursing shortage problem has continued to devastate labor budgets all around the world. While there are many theories as to why hospitals and other medical providers cannot maintain an appropriate level of staff nurses, the overall demand for nurses will continue to grow. Yet the supply of competent nurses will not ascend to the predicted levels needed to replace the accelerated attrition within the field.


Posted on Jun 05, 0 | 600 pm


[0] comments | link


Retain, recycle, replenish, and recruit


It must be about the same where you live. The newspapers, news magazines, radio, and television news report almost daily on some aspect of the current nursing crisis, or on its sequelae in the world of healthcare delivery. Thats the good news. We need to keep this situation in the public focus.


Posted on Mar 1, 0 | 1001 pm


[0] comments | link


Where Have All the Nurses Gone?


When it comes to recruiting nurses to staff long-term care facilities in Genesis ElderCares Chesapeake region, Deborah Rowe, M.S., R.N., Ph.R., is using tactics shes never considered before


Contentment


Magnet hospitals tend to attract and retain nurses


UC Davis Medical Center nurse with patient.


Youve read the article. Now tell us what you think.


For more information


Magnet Nursing Services Recognition Program


Cedars-Sinai Medical Center


Hackensack University Medical Center


UC Davis Medical Center


By Todd Stein


May 11, 000


When actor Judd Hirsch sang the praises of nurses on a New York radio station late last year, it had an astounding effect on the profession.


We got calls from nurses all over New York saying, 'My God, it was so inspiring,' said Toni Fiore, MSN, RN, chief nursing officer at Hackensack (N.J.) University Medical Center. It showed that people really do care about nursing.


Hirsch, who was paid for his services, announced Hackensack's receipt of magnet hospital status from the American Nurses Credentialing Center (ANCC), an honor that so far only 17 hospitals and one long-term care facility can claim. The award certifies that a hospital meets 14 standards of nursing care, which the credentialing center credits with fostering a pro-nurse workplace. The standards seem to make it easier for a hospital to attract and retain nurses.


The Washington-based, nonprofit arm of the American Nurses Association evaluates nurses' status, freedom to make emergency care interventions without fear of punishment, collaborative efforts to improve patient care with physicians and administrators, and the ratio of nurses to patients.


Magnet recognition is the one award that exists in the nursing profession that recognizes that an institution provides outstanding quality care and service, and is the best place to work for nurses, said Linda Burnes Bolton, DrPH, RN, FAAN, chief nursing officer at Cedars-Sinai Medical Center in Los Angeles, which in January became only the second California hospital to earn magnet status. It's a great feeling.


Cedars-Sinai Medical Center staff with the magnet hospital award, Linda Burnes Bolton, DrPH, is second from left. Photo courtesy of Cedars-Sinai Medical Center


It also is a great promotional tool. Magnet hospitals tend to flaunt their status to draw patients, win grants, beat their competition, and recruit nurses. Hackensack Medical Center splashed its certification on roadside billboards, and Cedars-Sinai handed out free phone cards to its 1,00 nurses at the magnet award ceremony, telling them to call their friends and tell them you work at a magnet hospital, Burnes Bolton said.


In an era of chronic nurse shortages and rampant job burnout, it is understandable why hospitals would go to such lengths to advertise their virtues to nurses. But is the magnet award more than a gimmick?


Definitely, said Linda H. Aiken, PhD, RN, FAAN, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania in Philadelphia, and a recognized nurse-practice researcher. Magnet status is the most positive idea around in this era of re-engineering nursing, she said.


Aiken was the lead author of a recent study that found nurses at the credentialing center's 17 magnet hospitals had higher levels of job satisfaction and lower burnout rates, and gave the quality of care provided at their hospitals higher ratings than did nurses at other top hospitals in the country.


The study, published in the March issue of the American Journal of Nursing, compared nurses' written evaluations of their jobs at ANCC-designated hospitals to those from nurses in 41 hospitals studied in 180-8 by the American Academy of Nursing�what the academy then called magnet hospitals for their high quality of care and their ability to attract and retain nurses.


Aiken and her colleagues are nearing completion of a much broader study of 700 hospitals in the United States, Canada, England and Germany that will research whether hospitals with magnet-like qualities actually produce better care. Our preliminary research to date suggests that the answer to that question is 'yes,' Aiken said. Nursing is the single most important factor in a hospital's ability to save the life of a patient who develops a serious complication.


Aiken estimated that as many as 0 percent of American hospitals could qualify for magnet status under the credentialing center's guidelines. That only 17 have done so reflects more on the center's internal process than on the quality of U.S. hospitals. The center offered magnet certification only as a pilot program in 15, and opened the process to all hospitals just two years ago.


Many hospitals are still not aware of the award. But word is spreading fast. The ANCCreports that 6 hospitals have paid the $500 magnet application fee and are in the early stages of certification.


UC Davis Medical Center


Many hospitals haven't bothered with the magnet program because they're looking for quick solutions to the nursing shortage, such as sign-on bonuses and bringing in travel and registry nurses, said Carol Robinson, MPA, RN, associate director of patient care services at the only other magnet-designated hospital in California, the University of California, Davis, Medical Center in Sacramento. They don't really think about the core reasons that people don't want to come or don't stay.


While the UC Davis center had promoted magnet-like nursing values and programs for years, Robinson said the credentialing center's lengthy certification process encouraged the staff to listen more carefully to floor nurses when making care decisions.


It has really heightened our sense that nurses should be making those decisions from the bedside, she said. Now, every time we make a decision from the perspective of clinical care, we ask'What is it that the staff nurses would want us to do?'


And for our staff, it's a recognition that what they do is of the highest quality, which is a message I think they should hear as often as possible.


FACTS ABOUT AMERICAN NURSES CREDENTIALING CENTER MAGNET RECOGNITION PROGRAM


Program Overview


The Magnet Recognition Program was developed by the American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association (ANA), in 14 to recognize health care organizations that provide the very best in nursing care and support professional nursing practice. The program also provides a vehicle for the dissemination of successful practices and strategies among nursing systems.


The Magnet Recognition Program is based on quality indicators and standards of nursing practice as defined in the ANAs Scope and Standards for Nurse Administrators (16) and as identified as forces of magnetism in research undertaken by the American Academy of Nursing in the early 180s. Recognizing quality patient care and nursing excellence, the Magnet Recognition Program provides consumers with the ultimate benchmark to measure the quality of care they can expect to receive.


To obtain Magnet status, health care organizations must apply to the ANCC, submit documentation that demonstrates their compliance with standards in the ANAs Scope and Standards for Nurse Administrators, and undergo an onsite evaluation to verify the information in the documentation submitted and to assess the presence of the forces of magnetism within the organization. Magnet status is awarded for a four-year period, after which the organization must reapply.


Benefits of Becoming a Magnet Designated Facility


Magnet Designation


• Is an important recognition of nurses worth


• Is a major factor in nursing recruitment and retention


• Is a competitive advantage


• Enhances nursing care


• Increases staff morale


• Attracts high quality physicians


• Reinforces positive collaborative relationships


• Creates a magnet culture


• Improves patient quality outcomes


Independently sponsored research projects suggest that Magnet facilities have positive outcomes for patients, nurses and workplaces. Specifically, patients experience lower mortality rates, shorter lengths of stay and increased satisfaction; nurses experience increased job satisfaction, increased perceptions of quality of care given and productivity, and increased RN mix; and workplaces have a lower incidence of needlestick injuries, increased RN retention and recruitment rates, and lower rates of nurse burnout.


For more information on the Magnet Recognition Program and for a list of Magnet facilities, go to www.nursingworld.org/ancc/magnet.htm or call (0) 651-76. (Press may call ANAs Communications Department at (0) 651-708).


The identification of magnet hospitals in the USA.


( A brief summary)


Dr Jenny Carryer


In the 180s the American Academy of Nursing (AAN) conducted a study of US hospitals to identify the organisational attributes of hospitals that were successful in recruiting and retaining nurses during a national nursing shortage. Six AAN fellows in each of 8 regions of the country were asked to select 6 to 10 hospitals according to the following criteria


1) Nurses consider the hospital a good place to practice nursing.


) The hospital has the ability to recruit and retain professional nurses, as evidenced by a relatively low turnover rate.


) The hospital is located in an area where it will have competition for staff from other institutions and agencies.


A total of 165 hospitals were nominated, 155 of which agreed to take part. Each hospital provided information on a range of nursing-related issues including nurse vacancy, turnover and absentee rates; the ratio of inexperienced to experienced nurses; use of supplementary staffing agencies; nurse staffing policies; educational preparation of nurses in leadership positions; and the predominant mode of nurse organisation on the units (primary, team, functional or other). Hospitals were then ranked and staff nurses and directors of the top 41 were interviewed. These 41 hospitals were awarded "magnet hospital" designation.


Key characteristics


The magnet hospitals shared certain organisational features that served to promote and sustain professional nursing practice. These features included


® a flat organisational structure (see following section);


® unit-based decision-making processes decision making was decentralised to the unit level, giving nurses on each unit as much discretion as possible for organising care and staffing in a manner most appropriate to the needs of their patients


® influential nursing executives the nurse executive was a formal member of the highest decision-making body in the hospital, which signified the high priority that hospital administrators placed on nursing


® investments in the education and expertise of nurses


® the administrative structures supported the nurses' decisions about patient care


® good communication existed between nurses and physicians


® very high patient satisfaction


® excellent RN to patient ratio


® a decrease in hospital acquired infections, falls/other injuries, and medication errors and related complications


® very low RN turnover rate


A sub-set of 16 of the originally identified magnet hospitals was followed throughout the 80s and early 0s. It was found that these hospitals not only maintained the "attributes of magnetism" but also continued to enhance their nursing practice environments to more closely approximate the "ideal" professional nursing practice model through the following strategies


® Moving towards all registered nurse (RN) staffing


® Increasing the RN-to-patient ratios


® Continuing to flatten organisational structures


® Implementing shared-governance initiatives


® Implementing RN salaried status as opposed to hourly wages


® Implementing flexible and varied nursing care delivery models designed to meet patient and staff needs throughout units within the organisations.


These hospitals continued to be distinguished for their quality patient care, nurse autonomy, education and striving for excellence.


Currently the American Nurses Credentialling Centre (ANCC) designates magnet status by way of the Magnet Recognition Program process that includes a rigorous self-assessment, documentation, site visit and review. Magnet status is awarded for a four-year term and The Magnet Award is the highest award a hospital can receive for outstanding achievement in nursing services that highlights a commitment to excellence. Measurement criteria is based on outstanding performance on the following fourteen standards as indicated in the Scope and Standards for Nurse Administrators document (16, Publication No. NS-5 available through American Nurses publishing at 1-800-67-0)


1. Assessment


. Diagnosis


. Identification of outcomes


4. Planning


5. Implementation


6. Evaluation


7. Quality of care and administrative practice


8. Performance appraisal


. Education


10. Collegiality


11. Ethics


1. Collaboration


1. Research


14. Resource utilisation


Nursing structure


A key characteristic of the original magnet hospitals was that nursing services were organised in a flat organisational structure with few supervisory personnel, rather that a pyramid structure composed of many layers.


The organisation of nursing in magnet hospitals has consistently demonstrated three distinct core features that are elements of a professional nursing practice model


® Professional autonomy over practice


® Nursing control over the practice environment, and


® Effective communication between nurses, physicians and administrators.


This enables nurses to use their knowledge to do for clients what they know should be done in a manner consistent with professional standards. This is key for providing high-quality and cost-effective patient care because


® RNs are the healthcare providers who perform round-the-clock patient surveillance


® They are physicians' primary source of information about changes in their patients


® Nurses often have to act in the absence of the physician when timely intervention is required


Thus nurses are positioned as the providers most likely to identify the early stages of complications and, in some cases, are the providers who are first in line to intervene. What is noteworthy about the professional practice models identified in magnet hospitals is that they may provide the organisational support that enables nurses to exercise their professional knowledge, judgement, and skill to initiate intervention to "rescue" patients from dire and costly consequences.


Patient outcomes demonstrated at magnet hospitals.


This was written prior to the recent release ( December 001) of outcome related information which has increased the recognition of links between RN staffing and patient outcomes.


The organisational characteristics that attract nurses to magnet hospitals have also been found to be consistently and significantly associated with better patient outcomes than those of matched non-magnet hospitals.


A study of mortality rates in Medicare patients compared magnet hospitals with 15 matched comparison hospitals controlling for hospital characteristics which had been previously suggested to influence patient mortality (such as ownership, teaching status, size, location, financial status, physician qualifications, technology index and emergency admissions). Results suggested that magnet hospitals had lower mortality rates than those in matched hospitals by approximately 5 per 1000 (4.6, 0.-.4 5% CI). As magnet hospitals differed from their matched controls on skill-mix, nursing staff differences were controlled in subsequent analyses but the mortality differences remained.


Another study investigated mortality rates in AIDS patients and found up to 60% lower mortality rates in scattered bed units in magnet hospitals when compared with similar units in non-magnet hospitals. Other outcomes measured demonstrated significantly higher levels of patient satisfaction, lower levels of staff burnout and fewer needle-stick injuries in nurses. In addition, research has shown that nurses working in magnet hospitals reported significantly higher levels of job satisfaction than their non-magnet colleagues reported and, specifically, report that their administrators were more supportive and placed a higher value on nursing.


While magnet hospitals have been shown to have higher nurse-to-patient ratios than other hospitals, the cost of more nurses was more than offset by significantly shorter lengths of stay and lower utilisation of ICU days.


According to a report by the Centre for Outcomes and Policy Research, Aiken, Sochalski and Silber have expanded the patient outcome measures beyond hospital mortality rates to include "failure-to-rescue", described as "a promising nurse-sensitive measure that captures the mortality rate among patients who experience serious inpatient complications". The measure has been shown to be inversely related to nurse staffing levels.


References


Aiken L. H., Havens, D. S., & Sloane, D. M. (000). The Magnet Nursing Services recognition Program, A comparison of two groups of magnet hospitals. American Journal of Nursing, 100(), 6-5.


Aiken, L. H., Smith, H. L., & Lake, E. T. (14). Lower medicare mortality among a set of hospitals known for good nursing care. Medical Care, (8), 771-787.


Havens, D. S., & Aiken, L. H. (1). Shaping systems to promote desired outcomes. The magnet hospital model. Journal of Nursing Administration, (), 14-0.


Center for Health Outcomes and Policy Research. University of Pennsylvania School of Nursing. www.nursing.upenn.edu/doctoral/research/center_for_health_outcomes_and_p.htm


www.hospitalhub.com/resources/career/magnete101/.


Sunday, March 5, 001


Respect for nurses drives success at St. Elizabeth


Good pay and chance for input result in low turnover


By Tim Bonfield


The Cincinnati Enquirer


Most Tristate hospitals have been struggling to hire nurses.


The problem is so severe that hospitals have diverted record numbers of life squads elsewhere five of the past six months.


Tracei Schack (right), a registered nurse, drops by to show her newborn to fellow nurses.


(Patrick Reddy photos)


| ZOOM |


One exception is the St. Elizabeth Medical Center group in Northern Kentucky.


Unlike their big competitors north of the Ohio River, St. Elizabeths three hospitals in Covington, Edgewood and Williamstown are not desperate for nurses. They are not facing financial crises. And they are not sending life squads someplace else every other day.


St. Elizabeth has been adding beds and services while other hospital groups have endured closings and deep cutbacks. Along the way, St. Elizabeth is quietly developing a reputation for low cost and high quality, especially in cardiac services.


"The key to all this has been the nurses," said Joe Gross, St. Elizabeth president and chief executive. "Our product is patient care, and the biggest raw material in that product is our nursing employees."


SURVEY HIGHLIGHTS


A survey for the Greater Cincinnati Health Council conducted in December and January measured job satisfaction views of 6 randomly selected hospital nurses


• 77 percent were somewhat or very satisfied with their jobs


• 5 percent said excessive patient-to-staff ratios or intensity of workload would be most likely to make nurses quit


• 5 percent would not recommend nursing as a career to friends and relatives


Of those who would not recommend nursing as a career, reasons included


• 5 percent citing inadequate pay and benefits


• 1 percent citing intensity of workload


• 0 percent citing lack of professional respect


When asked What one change would most increase their likelihood to stay on the job?


• 47 percent said provide adequate staffing


• 4 percent said increase pay and benefits


• 10 percent said professional respect and recognition


• 8 percent said improved communication and better management


Source Greater Cincinnati Health Council


ST. ELIZABETH


Founded 1861 in Covington.


Locations Covington, Edgewood, Williamstown.


Affiliations Catholic Healthcare Partners, Archdiocese of Covington.


Employment About ,00, making it Northern Kentuckys third-largest employer.


Patient volume More than ,000 inpatient admissions per year, ,000 emergency visits and 50,000 outpatient visits per year.


Awards June 000 HCIA-Sachs rated its heart services among the top 100 in the country; April 000 Healthgrades.com rated its cardiac program among the top percent nationwide, including five-star ratings in specific surgeries and treatment of heart attack; Fall 000 Data Advantage Corp. ranked it among the nations 100 lowest-cost providers for 0 of the 50 highest volume services provided by hospitals; April 1 St. Elizabeth featured in a front-page Wall Street Journal article; August 1 St. Elizabeth Medical Center named the nations 0th "Baby-Friendly" hospital by an affiliate of UNICEF.


No hospital, not even at St. Elizabeth, is having a rosy time. But its confrontation with economic troubles offers insight into issues facing hospitals today.


Among the signs of success at St. Elizabeth


• With a $5.6 million profit on operations, St. Elizabeth was the only big hospital group in the Tristate that made money in 000. It earned enough to give nurses a 6.5 percent raise this year and all employees a bonus averaging $500. Cincinnatis biggest hospital groups the Health Alliance of Greater Cincinnati, TriHealth and Mercy Health Partners have reported losses and closings in recent years. Mercy Hospital in Hamilton is the latest, expected to close by June 1.


• St. Elizabeth has about half the nurse vacancies other Tristate hospitals face. The average nurse has worked there more than 10 years.


• The hospital group hasnt gone on diversion at all in 001. Hospitals go on diversion when they are swamped, directing life squads to take all but the most unstable patients someplace else. Through February, Jewish Hospital declared 41 diversions; Christ Hospital, 6; Good Samaritan and Bethesda North, 15 each; and University Hospital, 1.


• St. Elizabeth has collected several industry awards since 1, including a ranking among the nations 100 lowest-cost hospitals and among the nations top 100 hospitals for cardiac care.


• St. Elizabeth has been adding services, including a new cancer wing in 000 and a womens health unit this year in Edgewood. It also recently tripled the size of its emergency department in Williamstown.


St. Elizabeth has spent years building a culture of respect for nurses, Mr. Gross said.


"At its best, nursing is no cakewalk," he said. "Its a demanding profession, emotionally and physically. We try to let nurses do what they like to do care for the patient and work with their families."


Other nurses in the Tristate notice.


"Nurses are staying there," said Cheryl Townsend, a nurse at University Hospital. "They seem to have a family atmosphere. They seem to have a close connection between the administration and the nurses that do the work."


St. Elizabeths treatment of nurses is uncommon, said Dr. Linda Aiken, an expert at the Center for Health Outcomes and Policy Research at the University of Pennsylvania.


Hospitals nationwide are failing to retain nurses, she said, because they no longer offer the pay, the involvement and the institutional support nurses expect. Hospitals are less able to compete for nurses with home-care services and doctors offices.


"There are plenty of nurses in the United States at the moment," Dr. Aiken said. "But they dont feel good or safe about the work theyre doing in hospitals.


"There are some hospitals out there, like St. Elizabeth, that are developing those conditions. But most hospitals are way, way, way behind in terms of modern approaches to managing their workplaces."


St. Elizabeth can afford to offer the highest average hourly pay for nurses in the region $0.8 per hour. And the hospital group involves nurses in many decisions, such as what supplies to buy and how to staff the units.


Perhaps most important, St. Elizabeth avoided two morale-bursting policies common among Cincinnati hospitals It does not pay large signing bonuses to new employees. And it does not hire temporary-agency nurses.


At some hospitals, as many as half the nurses in hard-to-fill shifts are temporary staff, Mr. Gross said.


Nurse Melanie Ingram and social worker Jim Bishop.


| ZOOM |


"Nurses dont like working with (agency) nurses that get higher pay than they do but dont know the hospital as well," Mr. Gross said. "They dont like seeing new co-workers getting bonuses they dont get."


St. Elizabeths willingness to close medical units rather than overburden nurses also breeds loyalty, said Jane Swaim, who left University Hospital five years ago to become vice president of nursing at St. Elizabeth.


"The administration truly supports nursing. Ive had (nursing staff) increases every year Ive been here," she said.


Melanie Ingram, 4, has been a nurse at St. Elizabeth since 1. She came to the hospital because it offered much higher pay than the hospital near her home in Milan, Ind. She stayed because she feels involved in how the hospital runs.


"I have a vested interest in seeing that things go well," Ms. Ingram said.


At other hospitals, temporary nurses often dont get involved in planning or solving problems, Ms. Ingram said.


St. Elizabeths location also has contributed to its growth during difficult times for health care.


A Rays of Hope pin means an employee contributes to the "Vision" program.


St. Elizabeth is 140 years old, and is Northern Kentuckys third-largest employer. The areas continuing influx of residents and businesses provides its hospitals with employees, volunteers and financial support.


The sense of pride at St. Elizabeth can be measured in hard dollars More than 75 percent of employees give part of their pay to the hospital groups "Vision" program, contributing $1.5 million for various hospital projects.


St. Elizabeth moved its main hospital from a limited-growth location, Covington, to a fast-growing suburb, Edgewood.


The greater demand has given the hospital greater leverage with health insurers.


In contrast, many of Cincinnatis biggest hospitals remain concentrated in older neighborhoods with shrinking populations. Until the mid-10s, the state blocked them from moving into growing suburbs.


St. Elizabeth also avoided the waves of hospital consolidations, which led to downsizings, closings and management reorganizations at Health Alliance, TriHealth and Mercy Health.


St. Elizabeth is not immune to the industrys ills. It still copes with tight reimbursement from insurers and a shrinking pool of nurses. The hospital group has vacant nursing jobs.


"Lots of days, I think I cant walk one more mile," Ms. Ingram said. "But the reasons I went into nursing are still there. I always wanted to fix things for other people."


socialist newsweekly published in the interests of working people


Vol. 64/No. 8 October , 000


Striking Washington nurses Treat us with respect


BY JANICE LYNN


WASHINGTON--A sea of picket signs reading RNs on Strike, filled the streets here outside the Washington Hospital Center September 0, as more than 1,00 nurses walked out. Some held handmade signs saying, We have a life, no more mandatory overtime. A number of passing cars and trucks honked their horns in support.


The issue is not money, but working conditions and quality of care for patients, explained Sharon Clark, who works in emergency surgery and has years at the hospital. Clark is local president of the D.C. Nurses Association. Our members can be told at the end of the shift, without prior notice, that they will have to stay another two to four hours. They dont care how that affects your family or that you need to be home for your kids after school, Clark said.


They need to adjust the staffing, declared Greg Pelletier who works in the cardiovascular recovery room. Were tired of working 1-hour shifts every day. And we want to be treated with some dignity and respect, he added. There are times when you dont even get a lunch break. This was the first walkout since 178 when nurses struck for 1 days for union recognition.


Kiveyette Nelson, 1, just started working at Washington Hospitals Intensive Care Unit in August after graduating from Delaware State University. I came here in the midst of this, but I feel the nurse-patient ratio is very important for giving people safe care, Nelson said. If youre overloaded, stress and burnout sets in. On the picket line, many young nurses said this was their first job and their first strike.


Jeanette Walker works in neonatal care, and has 8 years at the hospital. Sometimes nurses have as many as eight patients to care for. This means youre making rounds from one patient to the next the entire shift, increasing the odds that something serious can happen to one of the patients while youre trying to complete the round, she said. Walker explained the turnover was very high because of the mandatory overtime and the lack of a decent benefits package, where not everyone has full medical coverage.


Linda Pope, a nurse at D.C. General Hospital, came to show her support for the strike at Washington Hospital. This fight and the fight to keep D.C. General Hospital open is part of the same thing, she said. If D.C. General closes, nurses here will face even more mandatory overtime and the quality of care will be badly affected. Iron workers, teachers, and others have joined the picket lines.


The hospital brought in replacements from an outfit called U.S. Nursing Corp., which specializes in strike-breaking. Along with the bosses they are trying to keep the hospital operating. Patients beware, management giving care, is one of the chants on the picket line. The employers have embarked on a media campaign to try to portray the nurses as overpaid and insensitive to patients needs. The nurses explain that they want a voice in setting hospital policies and that they are determined to hold out for their demands.


Sam Manuel, Socialist Workers candidate for D.C. Delegate to the House of Representatives, contributed to this article.


Respect Medical Services


Contact Patrice Foster, President


1718 Knights Road


Philadelphia, PA 1154


Phone 866-757-544


Email PFo10668@aol.com


http//www.respectmedicalservices.com


FOR IMMEDIATE RELEASE


NOW MORE THAN EVER, AMERICA NEEDS NURSES


In the wake of terrorist attacks, Americas nurse shortage is being strongly felt


Philadelphia, PA -- In a recent speech about the September 11th terrorist attacks, President George W. Bush stated that, the hour is coming when America will act, and you will make us proud. As our President and other government and military officials have clearly said, America will take military action to punish those involved in the tragedies of last month, which took thousands of American lives and injured hundreds of others.


Now more than ever, when America is staring war in the face, hospitals and other medical facilities need to be fully staffed with nurses and other qualified personnel. Our boys could be going to war any day now, says Patrice Foster, President of Respect Medical Services, and America is short on nurses as it is. Nursing schools, hospitals, and medical staffing firms need to join forces now, forming an alliance to care for those who will be injured.


Especially over the past few weeks, America has felt the immediate and potential need for nurses, as well as the shortage were currently suffering from. Especially back east, we have a lot of big cities from New York, to Philadelphia, to Atlanta, and as weve seen, these cities can be attractive targets for such attacks, says Foster.


One solution to the nursing shortage problem, in addition to heavy recruitment of nursing students, is for hospital administrations and medical staffing companies to work together to find, recruit, and handle the staffing issues of new nurses, says Foster.


If and when America goes to war, whether with Afghanistan or any other country, experts say were going to need more medical staff than we have right now to cope with the injuries. That includes recent graduates as well as those currently out in the field.


Our firm specializes in matching nurses with facilities and the associated staffing work, and I can tell you that firms like ours are a great resource that are extremely under-used. says Foster. Its a problem that can be solved, but we must be willing to start now and work together, for the good of our country.


For more information about finding or filling a nursing, physician, or mental health position, see http//www.RespectMedicalServices.com.


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Thursday, August 29, 2019

Instead of Banning Tobacco what can we do?

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There are many ways to stop people from using drugs such as tobacco instead of prohibition there are infinite possibilities that you can do to stop people from drinking or smoking. Whether we like it or not we can not stop everyone from drinking or smoking and that's the same as not being able to prevent what happens to innocent civilians like how a drunk driver can hit your child. Or you can't stop the effects of drugs like tobacco which influence you in a really bad way which leads to poor judgments. So you really have no control over someone else's life not to do drugs. Well, there are ways to help prevent it but it's really not anyone's choice if you can drink or smoke.


One way to help prevent people from wanting to take tobacco is to make laws that prohibit if you abuse the ability to take drugs too much. Well I think there is a law like that but if you make it worse like making a longer prison period or a larger payment fee it may work. Some people think there is nothing left for them in this life or they got nothing to lose if they do drugs so we should help those people out and try to force help upon them even though we can't.


I really think no matter what we do people will continue to smoke or take drugs because no matter what happens people still took drugs we banned many illegal drugs on the street. Even if there is a law or chance to get arrested people take that chance and risk it all for a couple minutes of pleasure people think drugs are the answer if all else didn't help so that is why they turn to drugs. So no matter what law we come up with or anything else we try to do to stop drugs there is no guarantee all of it will go away so no matter what drugs are here to stay. So have hope, maybe you can save one or two lives but not every ones. So one person can make all the difference for you so drugs are going to always be a problem no matter what anyone's opinion is.


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Wednesday, August 28, 2019

Eyes

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New eye tracking techniques improve realism of aircraft


simulators


A simulated flight environment for pilot training may soon Custom Essays on eyes


be made more realistic through the use of eye-tracking


technology developed by researchers at the University of


Torontos Institute of Biomedical Engineering (IMBE).


Many safety and cost benefits are obtained by training aircraft


pilots under simulated conditions, but to be effective the


simulation must be convicingly realistic. At present, the


training facilities use large domes and gimballed projectors, or


an array of video screens, to display computer-generated images.


But these installations are very expensive and image resolution


is low. Further, it would take an enormous amount of addi to


improve image quality significantly throughout the whole viewed


scene.


However, based on the visual properties of the eye, realism can


be obtained by providing a high-resolution area of interest


insert within a large, low-resolution field of view. If the


image-generating computer knows where the pilots fixation is,


it mage there.


The technology to make this possible was developed by a research


team headed by Professor Richard Frecker and Professor Moshe


Eizenman. The work was carried out in collaboration with CAE


Electronics Ltd. of Montreal with financial support from the


Natural Sciences and Engineering Research Council of Canada.


Their eye-tracker can record and analyze accurately up to 500 eye


positions per second. The system works by means of capturing and


processing the reflections of a low-level beam of invisible


infra-red light shone onto the eye.


Multi-element arrays capture the image of the eye and digitize


the information, which is then processed in real time by a fast,


dedicated signal processing unit. The difference in position


between the ligh tre of the pupil reveals the instantaneous


direction of gaze.


Developments by the IBME team have significantly increased the


speed of signal processing in addition to enhancing accuracy


of eye position estimates. Eizenman believes that these


improvements make our eye-tracker very effective in monitoring


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Tuesday, August 27, 2019

Is there a God

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some of us do believe in a higher being, others however, do not feel that a belief in a higher power is necessary. my personal opinion is that you can believe what you want, and if what you believe helps you live your life, then you shouldnt care about the others.


the story of creation states that a higher power, in this case, God, created the earth and its inhabitants in a time of seven days. this belief has been carried on for over two thousand years.


another story, a more scientific one, states that the universe and all of its inhabitants were created in a split second. a star exploded and formed masses of gravitational pull, which in turn, caused the planets to form and micro-oranisms to grow.


whichever theory you may choose to believe is totally a personal preference, but in my personal opinion, i would choose the story with the solid background. Order Custom Essay on Is there a God


to backup my belief in the theory, i will list some comparisons.


first, the story of creation does not include the making of the other planets, and the creation of other galaxies.the big bang theory states that billions of years were needed to get the planet ready enough to hold any life form.


second, the story of creation does not say anything about the existance of dinosaurs before the population of man. scientists have proven, through fossil records and carbon dating that the skelital remains of any dinosaur out date those of any early form of man.


lastly,even though the story of creation states that god created the earth, is does not state why he created it. the big bang theory is all chemical equations.


loopholes like those which i have explained are the key questions that ride on every non-belivers mind.


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