Disadvantages of the US Health Care System and Comparison With Universal Healthcare Other Countries

Table of contents

Introduction

The US healthcare system greatly differs from that of other leading countries. Industrial countries like Canada or Britain are seen as successful with their universal or national healthcare systems which makes health care accessible for all, funded by either the government or the people.

The US healthcare, meanwhile, has a combination of public and private systems like private insurance to help individuals pay for care, while the government has laws and acts in place to support the population, publically. These public versus private systems lead to disparities in care quality, especially in different social and economic groups. A majority of scientists and research shows the US lacks a key aspect of healthcare that separates us from others; unity.

Lack of a Universal System

The current healthcare system in the US is either described as hybrid of public and private systems or as a fractured system. The fractured definition would mean there is no balance and little regulation of standards or cost across the system. Dr. Kurt C Stange (2009), professor of Health at Case-Western and editor of the Annals of Family Medicine, writes about how much of a problem this fragmentation really is. “This unbalance, this brokenness, is at the root of the more obvious healthcare crises of unsustainable cost increases, poor quality, and inequality. Fragmentation is at the heart of the ineffectiveness of our increasingly frantic efforts to nurture improvement” (Stange, 2009, pp. 100-103).

He accredits the socio economic issues present today to the lack of a universal system. Others blame the fragmentation simply on the need for an update to the system. Reviews to the current laws and acts in place, such as the Affordable Care Act (ACA), show even with these helpful updates, the US system is still uneffective. (Dzau, McClellan, & McGinnis, 2017, pp.1461-1470) The time is accounting for the problems worsening according to Dzau et al., and current laws and acts by the state are proving ineffective to the solution, and occasionally burdening.

Social Economic & Inequality Care Issues

The ACA proved to be vital in evening socio economic disparities. It gave Medicaid access to low-income earners and had a correlating increase in diversity measured in state populations of states that were most affected by the ACA. The solution had limited because it only provided easier and cheaper healthcare access to who were deemed as low income earners and they still had to pay especially with the providers still showing signs of inequality.

The healthcare was still not free, and the ACA showed near zero improvement in higher-earners, and college graduates. (Griffith, Evans, & Bor, 2017) Griffith et al. (2017), go on to say that though improvements were made, the US’s issues were greater than those of other nations, which a majority of use a universal healthcare system. Reports from Corey Abramson (2015), PhD candidate from UC Berkeley showed research pointing towards perceived discrimination in the system. “9.7% of African Americans, 8.1% of Native Americans and 7.5% of Hipics believed that they would have received better medical care if they were a different race, while only 2.3% of whites reported the same” (Abramson, 2015, pp. 615-621). While the evidence doesn’t point directly to discrimination, it shows there are still issues of race in the system.

Compared to other countries, the US is spending far more money on healthcare, though Americans use “few hospital admissions and physician visits, but are greater users of expensive technologies” (Squires & Anderson, 2015). The difference of a low number of wellness visits compared to a high number of expensive machinery can lead to question if the system is spending the money appropriately.

Conclusion

The US healthcare system is evidently less effective than other systems of developed and industrialized countries. The more effective solution would be converting to a universal system but that would entail a complete teardown and objective analysis, which is incredibly time consuming. Another option, is slowly evaluating all aspects, starting with the perceptually most dire and finding the easiest solution, ideally through law or act reform. The system currently needs improvements to better care for and lessen the cost of American healthcare.

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Suggestions Canada health care

This essay will discuss the budget constraint model to understand the consumer behaviors towards health care and the Issue of adverse selection will also be analyzed, followed by the production of health care and the role f the government in the production of health care. This essay will conclude with suggestion of the lessons that policy makers in Canada can learn. Any of the economic models that exist must have assumptions; assumptions must be fulfilled to assert constancy.

In the standard budget constraint model, there are three assumptions: (1) consumers are rational and have perfect information about quantity, pricing and the key players in healthcare, (2) there Is no uncertainty about the future, and (3) Important decisions are made as If the future Is known with certainty. Consumers can choose any affordable combination of healthcare and other odds. Among these bundles, consumer has a set of preference which provided different levels of satisfaction. The budget constraint model states that the demand for medical services is derived from the demand for health care and how the consumer produces health.

Consumers do not purchase health. Indeed, they medical care inputs. An example of the Indian health market supports this model. India has a universal health care system of which government covers most medical services provided, similar to Canada. In India, many of the healthcare consumers are not able to produce health. Their ability to produce health is reduced by the poor vying conditions and living style. Patina in India is a slum; it is characterized with poverty, which encompasses low levels of health and income. People in this town are suffering in poverty and disease.

Patina has been hit by the epidemics and develops symptoms that are attributed to tuberculosis due to poor sanitation and ventilation. They repeatedly require medical care. However, public-health system lacks the medical resources, leaving poor people at risk. This has forced consumer to switch to the private healthcare, but they cannot afford it. These poor people are often the cities, caught between lousy care and unaffordable care (Specter, 2010). Consumers have limited budget and, hence, healthcare production is restricted by their budget, so they have to look for the best affordable bundle of goods to meet their needs.

Under lousy universal health care system, consumers are very much constrained in their choices. Policy makers must understand the budget constraints that the consumer faces. To formulate successful policies, policy makers must also consider the bundles that the consumer is permitted and regulate the private healthcare services to reasonable price (Specter, 2010). Government should also devote sufficient resources to improve the quality of care in the public sector and raise the level of nutrition and the standard of living of its people to reduce healthcare costs.

Similar policies could also apply in Canada to improve our public healthcare system. Private companies that offer health insurance often encounter adverse selection. This phenomenon can be explained by asymmetric information when insurance attracts higher than average utilizes than an actual fair premium suggest. Clients purchasing insurance know their actual expenditures whereas the insurance many only knows the distribution of expected expenditures. In this market, the higher health risks tend to drive out the lower health risk people until no market is left; this is known as the Lemons Principle.

This is inefficient since insurance company is not able to sufficiently pool its risks. In the U. S, congress passed the Genetic information Nondiscrimination act. This act prohibits insurance company from using genetic information to determine rates (Coursework, 2010). Genetic testing provides the insurance company with pre-existing conditions, which gives insurer incentive to deny coverage or set a higher premium. This bill was unanimously supported by congress such that insurer cannot charge higher premiums based on pre-existing conditions.

The main idea of this bill is to protect the community from exploitation by insurance companies, which lead to community rating. At this time, private insurers cannot rely on medical underwriting. However, this act turns the insurance companies into oppression. The only factors they will be allowed to take into account in determining rates will be age, region, and whether or not someone smokes. While the government supports the community rating and universal access, it conflicts with its insistence of that the healthcare reform is dependent on private insurance companies (Coursework, 2010).

Yet, the fact is that healthcare system could do Just fine without an insurance system with community rating. Medicare is a and people with disabilities. It may be true to say that private sectors are better in terms of managing costs and providing services, but Medicare’s spending on healthcare over the past decade has risen more slowly than that of private sectors (Coursework, 2010). Economists all agreed that Medicare is a successful program, but that it needs efficiency improvements to be sustainable in the future (Walker, 2010). Canada can imitate from the success of Medicare in the US.

Medicare in Canada is framed by the Canada Health Act; it is designed to ensure that all residents have reasonable access to medical services, on a prepaid basis. Using our existing insurance system, policy makers should expand the government-run health care regardless of risks. Instead of replacing private insurance companies, it would be more sensible to turn them into public utilities. Netherlands and Switzerland have adopted this proposal, which turns out with reasonably good results. Government has a very large role to play in the production of health services.

Production of health services is the relationship between health and the health inputs that are needed to produce health. The Case in most developed countries is that the government plays a significant role in health production (Coursework, 2010). The government provides health care which is either paid with taxes it collects or subsidy that are given to individuals. The government provides other inputs such as controlling pollution and legislation to regulate health safety. The government also carries out health promotion. This is done by promoting healthy lifestyles such as exercise and also raising awareness about diseases.

The government also puts regulation on excessive consumption of harmful substances. All this defines the role the government is supposed to play in the provision of healthcare. In conclusion, policymakers in Canada can learn from the lessons discussed. Starting with the example of the Indian health market, policy makers should consider budget constraints particularly for the poor people to devote sufficient resources into public health care to improve the laity and regulate the private health care system with reasonable prices.

Government could also raise the level of nutrition and the standard of living of its people to reduce healthcare costs. Secondly, from the US example, it is proven that the healthcare reform does not depend on private insurance companies. Medicare in Canada should also be expanded and private insurer can be turned into public utilities. Finally, though the Canadian government provides medical care, it is important for them to promote health as well. Provision of medical care must go hand in hand with the promotion of health as the case with other developed entries.

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Motivation of Nurses in Healthcare

Nurses and the healthcare industry are having to deal with stressed and De-motivated employees, and never before has levels of Job satisfaction, stress and burnout been so high among nurses In the healthcare industry (Graham, 2006) . The aim of this Annotated Bibliography is to examine the motivation of nurses in healthcare, and specifically to find and study the different motivational theories which Improve levels of motivation among nurses.

As stated by (Wham and Ogle, 2007) the question of how to improve the level of motivation in the healthcare industry is perceived to be at the heart of the contemporary health care management debate. The study builds to show that motivation Is multidimensional and complex needing clearer definitions, If searchers and practitioners are wanting to influence behaviors to motivate others. Similarly, (Hugh, 1995) had the same conclusion that motivating staff to Improve Involves many Interlinking factors. Hugh, 1995) goes on to show that through training and continuing education a team’s confidence and capability are enhanced creating an environment which is essential to maintaining momentum of continuous Increases In staff motivation and enthusiasm for improvement. Likewise, (Lee, 2000) suggests that motivation Is gained by empowering nurses to become role models, to mentor and motivate others. Which in turn enhances employees’ motivation and professional development. The two articles (Wick.

DOSS and Northman, 2009) and (Young. Albert, Apaches and Meyer, 2007) are similar in there approach by both identifying incentives to motivate employees. Both articles indicate a breakdown exists between nurse management and nurse practitioners with management not actively listening to nurse who express job stress and dissatisfaction. Both articles suggest flexible work schedules to improve levels of job satisfaction and individualized work incentives. Reference Externally, V. , and Satellite, E. 007) Improving motivation among health care workers in private health care organizations- a perspective of nursing 1 OF 7 personnel, Baltic Journal AT Management, 2(2), 213-224 Alma/ Purpose 10 explore ten experiences of nursing personnel, in terms of their motivation and satisfaction. To identify areas for sustainable improvement to the health care services they provide. Article Type Research Article( quantitative) and brief literature review Method Sample 237 registered nurse practitioners and 30 nurse executive with a 97% returning quota of questionnaires.

Data Collection 2 week response time to return survey. 9 close ended questions divided into 11 evaluation parts. Data Analysis: in order to identify barriers to motivation 99 questions were divided into 11 parts based on: Social-psychological competencies Clinical expertise competencies Educational competencies Managerial administration competencies Activity environment Communication and collaboration Responsibility Results and encouragement Autonomy Self realization Activity purposefulness.

Each question had two elements or responses to them either reflecting the external or internal motivators of each situation. A score was arranged between the responses Findings Findings were presented individually in 11 parts. Interestingly nurse practitioners and executives both believe personnel empowerment and motivation comes from continuing development and evaluation of personnel problems. Both didn’t foresee that the development of teamwork competencies and structuring of activity of scope of practice as affective ways of motivation.

Conclusions The article concluded that with an increase demand for higher productivity, a changing health care systems and managed health care activity restrictions staff motivation is affected, with higher Job dissatisfaction and increased burnout rates. The research concluded that social factors influenced motivators: Motivation decreases when nurses aren’t empowered and not autonomous in activity. Motivation increases when nurses collaborate with physicians by parity. Results showed no difference between nurse practitioners and executives.

Strengths Clearly written and articulated The authors is neutral in undertaking research and the viewpoints between nurse practitioners Ana nurse executives. I en autonomous plants toner areas AT research needed. The validity of the research paper can’t be questioned and is therefore a useful reference in future studies. Weaknesses The quality of nursing cannot be assessed in terms of performance referenced criteria, but only in terms of personal qualities displayed in that performance. The characteristics of the provided sample limited the results. Reference Hugh, K. 1995) Motivating staff through teamwork: process review and data display. Health management Journal. 21(4), 32-35. Aim/purpose identify interlinking factors to motivate staff, in terms of total quality management and team work in a healthcare setting. Article type Critique Approach Examines claims there are four interconnecting intervention factors which are essential to motivating staff are: Understanding the psychology of excellence in teams Establishing cross-functional quality improvement teams Understanding and reviewing processes of care and service Using data display to motivate.

The article also uses psychology to understand total quality management and seeks to show how through teamwork staff become empowered in numbers and motivated. The author attempts to involve six issues which attempts to be a key determinate of staff motivation levels: Awareness of the employee trail Awareness of psychological issues Managing the existing culture of staff Increasing quality improvement attitudes in staff Integration of human resource management into operational teamwork Keeping jargon too minimum. Conclusion Describes four major factors which have practical implications, to motivate staff.

The author points out that training and continuing education enhances team’s confidence and capability, and that these factors are essential to maintain momentum and increase staff motivation and enthusiasm for improvement. Strengths The strength of the paper is it is descriptive in nature, and provides the deader with numerous way to improve motivation of employees. Weaknesses The weakness of the paper is it use limited sources back up it claims. The author also appears to be bias in his approach drawing on his own experiences or opinions rather then using evidence based practice.

Reference Wick, K. , Dols, J. , and Northman, S. (2000)What nurses want: the nurse incentives project. Nursing economics Journal. 27(3), 169-201. Aim/purpose To explore the relationship between specific factors, which can be managed or changed to improve motivation and Job satisfaction. The authors aims to show that nurse Job distraction, physician interactions, policies or autonomy are all related to staff motivation. Article type Research Method An anonymous survey involving 22 hospital systems and 5,176 Runs was circulated. Only 1 ,559 of the anonymous surveys were analyses.

This study was designed to allow predictive modeling of a set of independent variables, by including incentives and disincentives, in relation to what causes nurses to be dissatisfied and unmotivated in their Jobs. An online survey was also conducted over a 3 month period using the hospitals intranet, staff were made aware of the online survey through use of flyers. The data collected from both surveys, were analyses using the perceived stress scale. This scale isn’t specifically for nurses and therefore isn’t clinical oriented. The scale is a simple 10 item scale, involves respondents to respond from a range of “never” to “very often. The ASS score ranged from 10 to 50. The data used was then compared the mean age of nurses involved and the ethnicity. Findings The article shows that the mean age of nurses involved in the survey is 42. 24 years, with 88. 5% of respondents being female. The ethic breakdown was 5. 3% African American, 6. % Asian, 70. 3% Caucasian, 16. 4% Hipic, and 1. 3% listed other or no response. Conclusion The results were compared with the levels of staff dissatisfaction and stress showing a direct correlation between increased stress results in De-motivated staff and higher levels of Job dissatisfaction.

The levels of dissatisfaction and De-motivation was also comparatively different between the generations, as well as the incentives which staff through the survey identified as means of improving motivation levels. The article recommends that to improve levels of motivation management needs to revive flexible benefits to help create a cohesive work environment. By regarding the role of incentives in designing an environment where benefits and perks will be seen as incentives to perform tasks promptly and thrive in the current nursing workplace.

Strengths The strength of this paper is it draws information from a variety of sources increasing the reliability of the document. The data collected is presented statistically and clearly. By using a variety of methods it increases the validity of the paper. Weaknesses A low response rate of 30% could serve as a attention source of bias as some groups or hospitals maybe under-represented. Rather then present ways to improve motivation and levels of dissatisfaction, the article shows that levels of dissatisfaction and motivation are low. With high levels of staff indicating that they are unmotivated and stressed in there Jobs.

Reference Lee, L. (2000) Motivation, mentoring and empowerment. The nursing management Journal. 1 (12) 25-27. Aim/purpose To define motivation, and to show that through empowerment and mentoring staff become more motivated to perform. Article type Meta-analysis of literature Approach The author uses the evidence presented by 7 well known nursing journals to define motivation as “that which impels or compels movement or action. ” I en paper contributed to ten area Dye suggesting Tour stages to Deescalate motivation, mentoring and empowerment: Input: motivate employees.

Process: mentoring to channel motivation to reach goals. Output: completed goals creates empowerment. Feedback: empowered nurse has greater self-esteem and competence. The article is based on nursing practice to improve quality of care and enhance understanding of the nurse leaders role in motivation, mentoring and empowerment. The article suggests taking a test to identify how one can implement motivation, mentoring and empowerment to encourage higher achievement, to identify characteristics of a successful mentor/protog relationship, and differentiate the stages of motivation, mentoring and empowerment.

Conclusion The article shows how mentoring and empowerment of nurses gives nurses freedom to be creativity and to turn ideas into action. The article shows how current literature suggests that a creative climate in which employees can perform, become motivated in their work and are able to motivate themselves and others. The author states that motivation, mentoring and empowerment aren’t separate identities. The author shows how motivation and empowerment fuel mentoring. And that through mentoring protogs become empowered, which enhances professional development and motivation.

Strengths The article in itself is motivation, encouraging researchers to become empowered and motivated and to think about think about other means to motivate others that haven’t been thought of before to contribute to this area of knowledge and research. Weaknesses The paper is limited and weakened by not using enough information from scholarly peered reviewed resources. , making very generalized statements. Reference Young, C. , Albert, N. , Apaches, S. , and Meyer, K. (2007) The ‘parent shift’ program: incentives for nurses, rewards for nursing teams.

Nursing Economics Journal. 25(6) 339-344. Aim/purpose To introduce the ‘parent shift’ program as innovative model of attracting, retaining and motivating nurses to return into the workforce. The study aims to show how the parent shift nurse program decreases stress, improves time efficiency of full time staff and also improves motivation of involved staff and those that work with them. Article type Research (quantitative) Method The prospective, descriptive, comparative survey research study was conducted in a 1000+ bed hospital.

The survey was anonymous and conducted over a 12 month period, and conducted on day one of commencement and 4 months after. This survey was also conducted in reference to the nursing management, who were given a salary survey wanly was contacted 4 months rater ten Implementation. I n data was summarized by mean and standard deviation. Nursing motivators were ranked on percentage and nursing management and URN roles responses were compared. Conclusion A brief literature review was conducted at the start of the article which found that in one study that those involved in the parent shift program that 98. % of respondents found the program extremely useful. And also found that in terms of nursing management it decreased overtime and burnout, and collaboration and team work was also enhanced among nurses. The literature review also stated that nurses motivation and retained in the workforce improved 41. 5% when the current employer accommodated their scheduling needs. In all areas it was found that nurse involved were less stressed, team work improved and URN cohesiveness improved. It was found that a supportive work environment, was created due to flexible working environment.

Strengths The study suggests other areas to be improved upon if research is undertaken in the same field again. (program affects on teamwork, interruptions, models of care implementation, ability to meet non-patient care responsibilities and the dynamics of specific roles and responsibilities could strengthen the program). Weaknesses Large sampling size resulted in a generalization of results. Only operated for a short time. Other staff members working along side those involved in the program weren’t revered.

And was identified as an important factor in continued program participation. The literature review which was conducted prior research was short and didn’t provide enough information. Conclusion This annotated bibliography highlighted many different opinions and studies related to motivating employees. The research into this topic supports the belief that employee motivation is related to empowerment, mentoring, continued education and autonomy within the workplace. Of the five articles in this annotated bibliography all come to the similar conclusion and finding .

They analyses and viewed a sufficient number of studies and theories in the area of motivating staff in the healthcare environment. It can be concluded that motivation increases when nurses collaborate with physicians, the nursing profession is respected and recognized as autonomous and valued by themselves and other healthcare professionals. After analysis of the sources of motivation among nurses as shown through the respective annotations, it is evident that management needs to listen to employees and recognize when motivation is an issue in their unit and the incentives needed to re-motivate staff.

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The Work Load And Necessity To Pay An Incentive For Nurses

They pick up the extra load that physicians pass along to them. Within Reenter Memorial Hospital one would understand why the work is becoming too physically demanding. Registered nurses (Runs) deliver and manage patient care. They teach them along with the public about the countless health conditions and supply guidance and emotional support to them and their families on how to care and treat themselves. Without the use of registered nurses a shift in performance feedback is sure to happen.

Back in the day, meaning 100 plus ears ago, women were responsible for nurturing and delivering care to children and those family members who were ill. It wasn’t until the 17th century that men became nurses and tended to the sick as well. However, in the 19th century the definition of nursing was stretched to not only tend to those who were sick and ill but also work under physicians to support them. In reference to hospitals across the U. S, there has always been a shortage of nurses, however they always seemed to work themselves out.

Meaning the hospitals would have a certain period of time when they weren’t so low on nurses. It wasn’t until 1998 that things seemed to get worse. The baby boomers were set to retire in 2008, but because of the recent recession they were forced to continue to work. In the years to come, the baby boomers will eventually began their retirement and need more medical care. Add on the amount of years they have been working plus the work load, the Job as a nurse really has taken a toll on the bodies. What the current healthcare industry doesn’t realize is that experienced nurses will be leaving the industry.

The reason behind the nursing shortage is that no one can precisely pin point causes. With the addition of managed care and other elements, these maybe the reasons for the nursing shortage. Reenter Memorial Hospital is Just one of many hospitals affected by this. Others may say it is because of the low pay paired with the heavy workload or the treatment they are getting from the other employees. Whichever way you may put it, the nursing profession is indeed declining and the healthcare industry is reaping the consequences.

Proposal Initially, the ultimate problem with Reenter Memorial Hospital is that there is a lack of nursing staff. To add on to the nursing staff problem, the nurses are being over irked, which has led to a lack of retention. In addition, recruiting new nurses for those who are retiring is becoming more difficult because of the shortage. No one wants to enter into a new employment expecting to be burnt out and over worked. Just like any other healthcare organization, Reenter Memorial Hospital requires nurses that are highly trained, effective and stable.

It is said that the nursing profession has a tremendous impact on how the healthcare industry operates. Within this proposal five other hospitals that have undergone the same situation as Reenter will be evaluated. It is very important for any healthcare organization to tackle the shortages of nurses. No particular hospital within Florida is suffering more then the others. James A. Haley VA Medical Center along with other nursing homes and home health agencies are being picky about who they want to work for them. This is what has caused them to have a nursing shortage. We did notice that all the employers that responded said that their difficult-to-fill positions required nurses with experience and advanced education,” Yore said (Peters-Smith, 2012). Not every nurse freshly out of college is going to have the experience that organizations want. Even though it is up to the employers to offer them a chance, have declined. Another reason why the VA Center’s nurses are at a shortage is because of poor working conditions and pay. Some people often think that the military has so many assets, but they are Just like any other organization.

Since the VA overworked their nurses, some patients weren’t receiving the adequate care they needed. Army Staff SST. Alex Dillon said “his wound dressing wasn’t changed often enough nor would he get pain medication promptly’, due to the over worked and short staffed nurses (Peters-Smith, 2012). This s very similar to what Reenter Memorial Hospital is experiencing, the nurses are being over worked except for the inadequate care. What the VA did to solve their situation was become less picky and started hiring those recent graduates. As the current members grow older within the nursing profession, the need for skilled nurses increases.

Of the hospitals surveyed in Florida, 89 percent said they would hire straight out of school and 29 percent have nurse residency programs to continue their training after school (Peters-Smith, 2012). This has decreased the shortages of nurses within their facilities. The recent graduates may not have much experience, but they have to start somewhere. Wesley Medical Center of Wichita Falls, Kansas is also experiencing a shortage of nurses as well. After doing research, Wesley Medical Center came to the decision to pay nurses more. This helped retain more nurses while giving the baby boomers a chance to retire with no hassle for a while.

It gave the retiring nurses a chance to retire without looking back and thinking they let the business down, or the hospital has a shortage because of them. However this plan backfired. The nursing school of Wichita University housing the graduates who come to Wesley Medical Center for a job was deeply impacted when this pay raise occurred. When the nursing pay went up, the professors of WAS left. Since budget constraints at the university, nursing professionals realized they could make more money practicing than teaching nursing (Went, 2013).

One way to fix the problems at hand that included the hospital and college, the chief nursing officer of Wesley Medical Center suggested simulation training. What the simulation training does is allow students to practice on dummies to get the feel of how to treat patients. A new technology developed in recent years has created mannequins who can talk, interact with doctors and nurses, and graphically recreate many medical situations nurses and doctors in past history could only learn in clinic work or on the Job: how to save a person in cardiac arrest for example (Went, 2013).

With this simulation training the nurses at the college get hands on training while the staff of the hospital can see new prospects to choose from. In an effort to fill the nursing shortage, New Orleans hospitals are pooping up bonuses, helping new graduates repay student loans and recruiting workers from overseas (Grids, 2007). What Tour Infirmary located in New Orleans is doing is offering $12,000 for two years for those nurses who agree to work at their location and for those who continue to stay. They will get $6,000 the first year they work and another $6,000 the next year. One may think this is a bribe, but hey, business is business.

The leaders of any organization, especially those involved in the healthcare industry, have to do whatever they have to do to retain their current employees and to gain new ones. The incentives are boosting Tour’s costs but are still less than eying temp agencies or contract firms anywhere from $60 an hour to the high $ass for each nurse (Grids, 2007). This particular solution worked for Tour Infirmary; who’s to say it will work for others healthcare facilities to include Reenter Memorial Last, two healthcare facilities in South Carolina came to a solution to decrease nursing shortages.

Both Sconce Medical Center and Named Medical Center are not necessarily experiencing a shortage now, but they know they will later on down the line. The reason for this, like all other hospitals, is that the experienced nurses are retiring. Their solution to keeping the shortage down gives credit to Clemson and Trio- County Technical College. Both offer nursing degree programs that contribute to the nursing staff of the Medical Centers (Stated, 2009). Also it all depends on which particular area the Medical Center is located.

Both Sconce Medical Center and Named are located in upstate South Carolina where a number of nursing programs provide a ready supply of nurses. “That helps us to not see shortages other people around the state are seeing,” Jury said (Stated, 2009). This applies to all hospitals no matter what the state is. One would have to compare the facilities community-by- community rather than state-by-state. One hospital could be located in a rural area with a college that offers nursing programs, but the teachers are retiring so this could cause the hospital to have a nursing shortage (Hurst, 2010).

On the other hand, some teachers may not want to teach because the actual practice may offer more money. Some have even opted to working in teaching hospitals so they can tackle two birds with one stone, teach and work. The starting nurse practitioners can make $60,000 and up (Stated, 2009) depending on which area they work in whether it be caching or working within the profession. Furthermore, the resulting healthcare organizations have successfully implemented transformational changes that have brought them out of their dilemma of nursing shortages.

With these changes they have been able to not only retain experienced nurses but hire new inexperienced ones as well. Considering the five hospitals evaluated, the two solutions that are most viable to Referee Memorial Hospital would be to offer an incentive that motivates the nurses to stay or offer a simulation program with the colleges that house the respective nurses. These two solutions will work well for Referee because others healthcare facilities have shown great progress after implementing them. It is even possible for Referee Memorial Hospital to implement both solutions.

If Reenter Memorial Hospital were to implement the first solution, an incentive for their current and future nurses it would affect everyone. All the stakeholders to include patients, hospital administration, accounting, physicians, and other employers would either see the nursing getting paid extra as a good thing or bad thing. Before the nurses loud even started getting the incentive a devised plan would need to be taken to administration to see if they agree I. E a proposal on why they should be paid a little extra. The reason why administrations would be affected is because they are the true leaders of the hospital.

Before anything can happen they have to be notified. This way the administration would be able to compile the necessary paper work. The next step, or stakeholder involved would be accounting. Accounting would be affected because Reenter Memorial would need to know how much money within the budget they would be willing to give. In any case dealing with money both the administration along with accounting needs to be involved. Both the administration and accounting within Reenter Memorial influence decision-making, operational control and managerial planning. Both of these departments support one another.

If accounting is not able to get money from the budget, administration would not be able to approve the extra pay. As far as the physician, they are not impacted as much. This is because they grasp the concept that the workload is heavy upon the nurses and they realize the nurses do need to be paid a little more. The physicians get paid much ore to do less however, the patient’s lives are solely their responsibility. Overall the physicians are impacted less then the other stakeholders. Moreover, when the nurses receive an incentive, controversy will arise within Reenter.

The other employees will feel as if they may need to get an incentive as well. Even though the patients are the main focus and keeping nurses keeps patients happy, the other employees will not see it that way. Within any organization when one person gets a raise other people will feel they need to get a raise as well. Reenter doesn’t have to explain the circumstance behind the choice. However, what they can do is let the other employee know that their hard word is not going unnoticed. As far as the patients, they will be affected in a positive way because more nurses will be around.

There will be more nurses, experienced and inexperienced, to go around. In regards to solution two, offering a simulation program would work well for both the incoming nursing and the experienced nurses. However, the stakeholders affected would be different from those of solution one. Medical simulation is a new method to facilitate skill training and assessment (Carroll & Messenger, 2008). The stakeholders impacted y solution two would be the nurses themselves, physicians, the government, the patients and the hospital. The nurses would have more hands on training.

The experienced nurses would be able to watch or facilitate a training session that would be Just for the nurses. The physicians would be able to Join is as well. Those nurses who would be put on a surgical team or a Code Blue team would be able to practice side by side. In the same way, a simulator can have a negative affect on the nurses as well. A major limitation of simulation is the fidelity; no matter how high the fidelity is, it is not real. It is often impossible to imitate actual physiological signs or symptoms.

For example, it is impossible to display crackles in the lung, when such a symptom would be important to the scenario (Carroll & Messenger, 2008). On another note the hospital would have to push out more money to compensate for the simulation training. Access to the simulator could also be limited at times. It often depends on whether or not instructors and operators are availability. Since Reenter Memorial has a nursing shortage, who’s to say the existing nurses will have time to teach. Also negative transfer may happen with the nurses.

This occurs when the students learn something wrong due to imperfect simulation (Carroll & Messenger, 2008). This could possibly bring upon lawsuit for the hospital if things are done incorrectly on the actual human patients. This usually happens when the instructors fail to constantly remind the students the difference between the training devices. Even though it may seem like a lot of negative affects for the hospital there are positive ones as well. Ultimately there is no direct risk to any patients. Simulations bring forth opportunities to practice events that involve critical tasks that the nurses may encounter with a real patient.

Additionally, team training is a positive affect and benefit with simulations. The scenarios that the team goes through will give not only the nurses but the physicians as well a better understanding. After the training is done a insightful debriefing of the scenarios is conducted to inform the team of what was done and what could have been done.. To sum it up, the best solution for Referee Memorial Hospital would be to pay the incentive. Reenter is already having problems retaining nurses, so why not pay them to stay. The hospital would save none from paying the temp agencies, and they would possible keep the nurses they have already.

Plenty people stay at least a year over their retirement Just so they can get a little extra cash added on. “Every organization is going to have some issues with the nursing shortage and have a hard time filling certain openings,” said Margaret Gibson, the manager of employment and employee relations at Mercy Hospital in Miami (Nard & Gorky, 2013). Any nursing facility would want to retain their experienced nurses. Just like any other healthcare facility, Reenter Memorial Hospital wants a devoted, dedicated workforce. Ultimately paying an incentive would, keep more. In conclusion, the issue of nursing shortages is an ongoing problem.

Not only is it happening within Reenter Memorial Hospital, but it is happening in other hospitals around the US as well. It is said that due to the baby boomers retirement and extensive workload, nurses are becoming harder to retain. Whether a healthcare facility decides to increase pay, give an incentive or implement simulation training scenarios, it is totally up to that facility to decide. The best choice when compared to others is for Reenter Memorial hospital to pay an incentive to their nurses. The solution is much cheaper then continuing to pay temp agencies and has a higher chance of solving their staff retention problem.

As far as the physically demanding workload, one cannot stop patients from enduring different problems that required different care.

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Health Care Utilization

According to “Keeping America Healthy” (2013), “Medicaid provides coverage for individuals according to poverty guidelines who are unable to afford health care insurance because of limited income” (Eligibility). John Q. Qualifies for Medicaid but lives in a rural community with no public transportation to travel to access his benefits due to provider office hours and the distance he must travel to the location. John does own have a car. John is predisposed to heart disease through heredity and has been diagnosed with high blood pressure. According to “What Is High Blood Pressure? 2011),” blood pressure is when blood is forced against the artery walls to disperse oxygen and turbines carried in the blood to the body. Blood pressure is measured by two numbers; Systolic the top number or the higher of the two is measured when the heart beats pushing the blood against the walls of the arteries. Diastolic is the measure when the heart is at rest between beats. The normal measure for normal is 120/80. Persons with a measuring of 140/90 or higher is a person with High Blood Pressure or HIP” (What happens in the body when blood pressure is high? ).

HIP can lead to Hypertensive heart disease (“Hypertensive Heart Disease”, 2013). Regular doctor visits and prescribed medications to control blood pressure can offset the nest of Hypertensive Heart disease in patients with high blood pressure. Regular physician visits are required to keep check on John’s condition (“What Is High Blood pressure? ” 2011). The problems with health care utilization for John is that he lives in a rural community with limited providers, the distance of travel to reach locations, time needed to schedule appointments, and office hours of the available physician locations will not provide him with reasonable access.

Many Medicaid participants are faced with this same set of problems and have to adjust their lives to gain access o healthcare. Medicaid programs have benefits available to help participants conquer many obstacles. Patients need to inquire and learn what benefits are available to help. Utilizing social programs available in the community, and accessing information on Medicaid websites help to inform members of what is available for help. Medicaid programs have established grants for rural health clinics; John needs to find out if a clinic exits in his area.

These clinics provide information about benefits and do health screenings. The clinic can be a place where John can go to get blood erasure checks to make sure he is in target range regularly without having to travel too physician’s location for blood pressure checks. Rural health clinics provide education to patients and can issue devices such as blood pressure monitoring equipment and train patients to utilize self-check methods between physician visits. Government medical programs do provide for education and training to use medical devices like blood pressure monitors used at home for patient self-monitoring.

Missing time from work can be a problem. Most employers have paid time off that employees can access and schedule for personal situations. John can have his physician provide documentation of his appointments to submit to his employer and arrangements can be made for an adjustment in hours or to come into work on additional days if possible. Other options to John may be to use vacation time or sick time to cover missed time at work when he has to visit the doctor. According to “Medicaid. Ova; Keeping America Healthy” (2013), “Medicaid benefits cover inpatient hospital care, outpatient hospital services, and rural clinic services. These services give John comprehensive coverage to help with chronic illnesses like high loot pressure. He also has available prescription coverage for medications to help manage his blood pressure. Preventive services and diagnostic screenings are available for early detection and prevention” (Benefits). Medicaid and Medicare also pays for transportation to and from medical appointments for patients covered through the government programs.

John can research and locate Passport certified transportation providers in his area to reach his medical provider of choice. The Affordable Health Care Act of 2010 gave states the option to expand Medicaid in their states with federal funding. It also provides more insurance options for lower income residents to other insurance plans that may be more accessible for member access to services and providers. Starting in 2014 the act also makes John eligible for insurance through other carriers even though he has a preexisting illness (“Gpo. Ova”, 2010). John may need to make lifestyle changes to accommodate his illness. Eating a healthy diet and reducing sodium intake would be the first changes to make. John’s diet should consist of heart healthy foods, like Broccoli and other dark green vegetables. By exercising and keeping weight under control at an ideal weight or his height and age he will decrease the chances of heart problems and promote self-healing by keeping blood pressure numbers from getting higher increasing risk of other related illnesses.

John and many Americans face the dilemma of access to quality healthcare. John has a chronic illness that may lead to other related illnesses and continuous access to healthcare is crucial to his remaining healthy and productive enough to continue working. The government provides financial coverage because of his eligibility status as beneath poverty level income. Although he has uncial assistance, he still has problems with appointment times and transportation. These obstacles are mutable, but his illness is a predisposed health condition that is immutable.

Educating himself in what is covered by government assisted health plans and obtaining the needed medical care access would help John’s situation. He must also be responsible for his own well-being. Adapting his life, eating healthy, and exercising will not only deter worse health but also improve his high blood pressure.

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The Professional Role Of A Nurse

THE PROFESSIONAL ROLE OF A NURSE, THE CORE VALUES AND THE ETHICAL HEALTH AND SOCIAL CARE PRACTICE. The outline of this essay will be in six parts, (1) an introduction, (2) the main body which will explore the role of a nurse, (3) conduct and the requirements for the effective delivery of care, (4) responsibilities and work of a nurse , (5) ethical, moral and social care dilemmas, and, (6) the important of team work including working under supervision. According to the NMC code of conduct, (2008) a Nurse must be able to deliver high quality and professional care to patients and clients.

Nursing qualities must include the following: good listening skills, good communication, and implementation plan of care, evaluating, and a good advocate. A nurse must be non judgemental, none discriminating, be patient and, ability to work as a good team worker. A Nurse’s role is to promote healing and be able to comfort the patient and family members. Good listening and communication skills are required in this role. These should include the ability to effectively communicate with other professionals in the carer environment and outside agencies.

They must be passionate about the delivery of carer to the patient. They should be concerned with the overall health and wellbeing of patients both physically and emotionally. NMC code of conduct also states that as a health care professional, you must be accountable for your practice, respect the patient’s privacy and treat them as individuals; therefore you must act to safeguard and promote the interest of clients. A healthcare professional must cultivate a friendly and a helpful relationship at all times in the practice environment.

Assertiveness and the use of positive body language are part of the core values underpinning good practice of a health care professional. They must have high self esteem and must be non judgemental. The work of the nurse has seen significant changes over the years. The professional role of a nurse has a higher status in today’s world as more of the duties that doctors used to perform have now been delegated to the nurse. The training of the modern nurse thus reflects the additional responsibility placed on them in the way they deliver care.

The role of a nurse must recognise and take into account the Ethical, social and cultural background of patients when delivering care. Most nurses have to deal with ethical and moral issues on a daily basis and have to provide care for all patients regardless of their own values and beliefs. They must also have self-awareness. A professional nurse must also be sensitive to the aged, and respecting their privacy and individuality in the care provision. In conclusion, this essay has looked at the role of the Nurse, core values and principles underpinning ethical health and social care practice REFRENCES;

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Decision Making in Healthcare Organization

Running Head: Decision Making in a Healthcare Organization 1 Decision Making in a Healthcare Organization Xavier Hunt MHA 601: Principles of Healthcare Administration Professor Jack Lazzare December 19, 2011 DECISION MAKING IN HEALTHCARE ORGANIZATION 2 In the health care profession a CEO will be asked to make a lot of difficult decisions. The CEO will not only have to make decisions that fit the ongoing vision of the healthcare facility he/she may work at they will also have to form stable relationships with their peers, media, and staff.

Decision making occurs in all organizations. The decision-making process begins with identifying a question, problem, or area needing improvement, or an operational issue. Problems, issues, questions, and operational challenges come to leaders and managers from many different people both within and outside the health organization (Pablo, 1996). To make the important decision that was given to us in the case study, I would use the garbage can model and its subsets to help me come to a conclusion. This decision involves a lot of people so the choice that will be made will affect all parties involved.

In this paper I will discuss how I would tackle this problem with the various tools of decision making through the readings that we have had. The Garbage Can Model How can the garbage can model help in this situation? The garbage can model was invented to expand the understanding of the organization. It addresses the problem that is going on at that time and accepts confusion as a reality. In the garbage can model loose coupling is required in an organization to understand decision making. The garbage can model has also been introduced as a possible method to understand how an organization learns (Tsang, 1997).

In the case study the CEO is faced with a myriad of issues like for instance trying to keep the physicians, and adequate staff at the hospital not only that if they were to leave they have threatened to go to their rivals hospitals across the city. The CEO also has to deal with a possible DECISION MAKING IN HEALTHCARE ORGANIZATION 3 lawsuit because the nurse who possibly has HIV has been asked to leave the operating room to work somewhere else. Would this not spark a fire?

Could asking the nurse to leave no matter how they tried to butter the deal up still seem like covert discrimination? So the hospital is about to be hit by a media freight train if they cannot get this under control. The garbage can model allows for the CEO to handle these problems accordingly. “Garbage can decisions can occur in any organization but are more likely to be found in ‘organized anarchies’ where decisions are made under ambiguity and fluid involvement of participants. ” Garbage can models are attempts at finding logic and order in the mist of decision-making chaos.

Garbage, defined as sets of problems, solutions, energy, and participants, is dumped into a can as they are produced (streams of “garbage” in time) and when the can is full, a decision is made and removed from the scenario (Takahashi, 2002). The garbage can model depicts the chaotic nature of decision making. Temporal Order Temporal order is a component of the garbage can model. Temporal order replaces sequential order. Time is spatial in that a multitude of issues, problems, information flows, and sensing mechanisms can bombard decision makers in short or long time blocks.

How problems and information to resolve the problems arrives in time has relatively equal priority as the evaluation of their importance. Arrival time and sequence in the current context influences decision makers’ attention to the situation. “The process is thoroughly and generally sensitive to load. An increase in the number of problems, relative to the energy available to work on them, makes problems less likely to be solved, decision makers more likely to shift from one arena to another more frequently, and choices longer to make and less likely to resolve problems”

DECISION MAKING IN HEALTHCARE ORGANIZATION 4 (March, 1996). Individuals in the decision-making process, directly and indirectly, are interconnected and influence the context of the decision at hand. The amount of time that the CEO has to make his decision is limited he has to try to make an informed decision about a very sensitive issue that involves a lot of individuals. His decision also will take an effect on peoples family members that use the hospitals services. If he keeps the man will they still want to use the hospital? Or will they go to the cross cities rival hospital?

The CEOs problems increased when the media got involved. The CEO has to find a way to balance his time so no one issue become bigger than the other because if he does this something will be forgotten in the process. To combat these issues the CEO will have to be attentive. Attention demands influence decision making. Time and energy must be allocated to understand, evaluate, and formulate a problem, then synthesize relevant information, evaluate options, and finally choose an alternative to counter or terminate the problem. Individuals focus on some things and do not attend to others in the same space of time.

Corporate actions, outcomes, and responsiveness are the results of dynamic organizational processes, not heuristics of individual choice (Swanson 1996). Time and energy combine to form “attention. ” Attention is a dynamic concept that is highly dependent on load (that is the number of decisions that need to be made). Information to Media The information that is conveyed to the media is an important tool in this case study. The way that we receive news has dramatically changed in recent years with the addition of social DECISION MAKING IN HEALTHCARE ORGANIZATION 5 etworking sites. These sites allow us to get information much more quickly, and the way a decision is made and perceived can be misconstrued. Information richness is defined as the ability of information to change understanding within a time interval. The longer the time interval to exchange understanding, the less rich the information. Consequently, the less time required the more rich the information is to the communicators (sender and receiver). The media (such as email, the telephone, or face-to-face conversation) that carries information to intended audiences also has a richness associated with it.

A continuum of media richness has been established based on the medium’s capacity for immediate feedback, the number of cues and channels utilized personalization, and language variety. In decreasing media richness, the continuum of richness consists of: “1) face-to-face, 2) telephone, 3) personal documents such as letters, memos, and emails, 4) impersonal written documents, and 5) numeric documents. ” The richer the media, the better equivocality can be reduced; media low in richness is best used when communicating messages that are understood well and possess standard information (Draft, 1986).

Simply put, face-to-face interaction works best and bulletin board flyers work the worst in transferring meaning. Leaders and managers must consider what media with which to communicate to ensure the highest probability to transfer meaning to their intended audience. So as CEO he need to make sure that he communicate well with the media saying exactly what he means at all times. My final decision would be to not remove the nurse from the operating room because if he is singled out a lawsuit would ensue and it would be hard to say that he was not removed because it is suspected that he has HIV.

He cannot be asked if he has it or not because of HIPPA DECISION MAKING IN HEALTHCARE ORGANIZATION 6 laws prohibit this. As long as everyone followed hospitals protocols such as use of blunt tip sutures as approved by the surgeon, a hands free neutral zone large enough where sharps can be placed and not easily tipped over and the use of double gloves in the operating room if would be okay for everyone to work there. If these procedures were taken lightly whoever did not follow would be reprimanded because there is little room for error in this type of setting.

It has already been said that you treat everyone as if they are infected not just certain people. DECISION MAKING IN HEALTHCARE ORGANIZATION 7 References Daft RL, Lengel RH. Organizational information requirements, media richness, and structural design. Manage Sci. 1986;22(5):554–571. March JG, Weisinger-Baylon R. Ambiguity and Command: Organizational Perspectives on Military Decision Making. Marshfield, MA: Pitman Publishing; 1986. Pablo AL, Sitkin SB.

Acquisition decision-making processes: The central role of risk. Journal of Management. 1996;22(5):723–747. Swanson DL. Addressing a theoretical problem by reorienting the corporate social performance model. Acad Manage Rev. 1995;20 (1):43–65. Takahashi, N. A single garbage can model and the degree of anarchy in Japanese firms. Hum Relat. 2002;50(1):91–109. Tsang EWK. Organizational learning and the learning organization: A dichotomy between descriptive and prescriptive research. Hum Relat. 1997;50(1):73–90.

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