Hospital

Our goal is to inspire, engage and develop our people to unleash full potential as individuals and as an organization. The organizational components of the hospital are its governing board, administration, the nursing staff and other key personnel. Each group has primary responsibilities specific to the nature of their function. However, each group share common Interests with others and must work cooperatively on issues such as long range planning, budgeting, capital equipment acquisition, facilities design, maintenance, and quality assurance.

According to Giuliani (2004) decentralization is a structure that would promote better-informed decision-making, ensure effective articulation. Additionally, decentralization encourages self-sustainability and enable greater of understanding of local needs as well as better use of local resources and growth potentials for improving productivity and increased quality of care.

Being cognizant of how Select Medicals’ decentralized structure functions will help to formulate effective strategies for improvement. There are crucial responsibilities In the organizing of Select Specialty. The Governing Board represents corporate leadership and ownership. The Governing Board address legal and regulatory manliness, Investments and business procedures, allowably Insurance, gulden and directing the organization, and establishing its policies and for charting its future course.

Of crucial importance is the need for the governing board to ensure that specific organizational goals and philosophies are identified so that all parties have a clear understanding of why the institution exists and what goals everyone should be working toward. The Administrator is responsible for the implementation of the Board’s policy in the daily operations of the hospital. While the board is primarily unconcerned with whether the hospital will do well, the administrator is responsible for how it will be achieved.

Typically the administrator focuses on hiring, organizing and supervising personnel and staff, designing and implementing proper policies and procedures, and allocating resources efficiently. The nursing staff and other key staff are responsible for caring out the interventions prescribed by the physician according to polices and procedures designed by the Governing Board. The staff team approach works to identify all of the patient’s medical conditions, devise he administrator is the liaison between the Governing Board and the rest of the organization.

The identification and knowledge of Selects structure and functionality will assist in developing a strategic plan that will be in align with the vision, mission and objectives of the organization. Please feel free to contact me. Best regards, Michelle Frank References Giuliani, V. S. (2004). Decentralization of Health Care: Understanding the Relationship Between Values, Social Interaction and Health Policy. Conference Papers American Sociological Association, 1 . Dot: as_proceeding_35637. PDF

Here is evidence to show us ad to give us an idea of Titus salts values and beliefs. For example the church, the institute, the mill, the houses, the street names, the hospital and the almshouses. When I look the church that Titus Salt Built I can see that it is a replica of the Italian church, and that it is the main and central feature of Saltaire I can also see that it is opposite the mills, which meant that the workers could go to it everyday a think about the importance of religion.

Inside I can see the beautiful di??cor which included gold, marble-paste (scagliliola) pillars, decorated brickwork ring of 6 bells, glass lanterns which used to be powered by gas but now are powered but electricity due to health and safety (Source 2). The church itself cost i??16 000 to build it. This shows us that Titus Salt’s beliefs were that religion is valuable to him and his new town. He wanted to have a caring instinct and followed strict morals. Also if you were a regular member of the church for example went every day then you could get a promotion at the mills.

The limitations of the church today portray how impressive it still is in the town. The church is still beautiful and it shine through. Also we can still see Titus Salt’s vision clearly even though some parts of the building have faded or have been in need of repair. It is still possible to see the original design. For example the balcony that Titus Salt and his family used to sit in is now boarded up. Even though the balcony was there Salt chose not to sit up on the balcony but to sit with his workers which shows his true values of not being an elitist. The Institute is another example of Salt’s values and beliefs.

Looking at the Institute I can see that it is symmetrical and is made from very expensive stone . I didn’t get a chance to look inside. Looking just at the outside I can see that there are a lot of windows, and from research I also found out that there was a swimming bath, library and a reading room. Lectures, band, horticultural society and sewing classes were also provided. The school today is sill and educational establishment. This Institute shows us that Titus Salt believed that children should have an education that’s why children had to attend school half time.

There is also a tower with a bell. At the top point of the Institute there are engraved alpaca’s and a bird with stars and leaves around it . Also opposite the Institute is the a model of a town hall with lions outside it with Titus Salt’s initials engraved in them. Here there are also activities that take part. Overall I believe that Titus Salt believed in good education. Today the Institute is a collage and is used for Saltaire’s festivals and dance classes. another example of Titus Salts values and beliefs the mill.

Just from looking at the outside I can see what Titus Salt believed in. The first thing that I see are a lot of Big windows which would let in a lot of light . This shows that he cared about his workers. Also the mill is very symmetrical and based on the Osborne house. The bricks that have been used again are very expensive and neo classical style. There is also a very tall chimney, but it has now been lowered due to health and safety issues. The height of the chimney meant that the pollution was released away from the town and meant that the town was not polluted .

The location of the mill itself was originally in the country side away from the pollution of Bradford. This was because Salt believed that the pollution was causing the people heath problems, which showed that Titus Salt valued and believed that people should have better health. The mill is near the canal and River Aire which meant that the workers could have a fresh and clean supply of water constantly as well as being able to clean the wool before being spun. The inside of the mill doesn’t give us much evidence of what Titus Salt’s values and beliefs were.

The mill had now been transformed into an art gallery and also has shops selling art tools such as paint . There is also a Cafi?? and a shop with clothes and accessories. The other part of the mill has now been converted into apartments. When I am inside the mill, the only thing I can see that meant that Titus Salt valued his workers are the big windows, as they let in a lot of light. As I look at the houses I can see that they are big and that they are made from expensive stone . Each house had its own running water, toilet and garden The houses are not back-to-back which was very unusual during this time period.

The housed are built right next to the mill which meant that people didn’t have very far to walk to go to work. There were also arches where people threw their rubbish. This showed that Titus Salt believed is cleanliness and valued the health and living conditions of the town and its people. Today the houses are still in very good conditions and people still live in them. When I look around I can see that the street names are after members of the Family . This shows us that Titus valued his family and believed that they should remember them and him long after he has died.

When I look at the hospital I can see it is built of very expensive bricks . Although the hospital is no longer used as a hospital I can see that Titus Salt valued his workers because he built them a hospital. Today the hospital has converted into flat, so I can’t see what it like then. Opposite are the almshouses. They are wall made from expensive stone and haver a beautiful garden at the front . If you or your children misbehaved you lost everything, your house, job and pension. Children could start working at the age of 10 so they were well trained. Today these houses are still lived in by pensioners.

Beginning in the home, a woman’s role is socially constructed from an early age. A woman’s role models are traditionally her parents and many women naturally follow in their mothers footsteps. However, this can often work In reverse and women of whose mothers stayed at home In a domestic care role then go on to carve careers for themselves. Although these days women do have careers they are still socially seen as the homemaker regardless of this.

A woman’s domestic role is often run alongside other work and a great number of women choose careers which are care eased. The sexual division of labor is at the heart of gender inequality, which is underpinned by the patriarchal family structure where the man Is the highest authority and sole provider and there Is a rolled dolls of tasks and responsibilities, all of which have been regulated by social norms that have become constructed and ingrained over time. Florence Nightingale was a great influence in creating the nursing/caring role.

She acknowledged that a great number of women naturally progressed into care roles and so she introduced the role of a nurse yet it was not a consider profession at this point Medical stations in the Crimean war were poorly staffed with awful medical and sanitary conditions. This was reported by the media In Britain. Florence Nightingale, one of 38 voluntary nurses traveled to Turkey to help relieve the situation. Nightingale worked towards improvements in sanitation, nutrition, and activity for the patients of the hospitals.

Death rates were reduced dramatically with the introduction of such measures. Nightingale kept meticulous records of the number of deaths, and the causes of deaths, so that on her return to Great Britain she could Justify the need for Improving conditions In hospitals. Criticisms of Florence Nightingale have been that she created a female occupation, excluding males based around her view that women were naturally caring and naturally gifted at looking after people.

This only emphasized ‘female virtues’ especially in the media as they made this her main point even though there was much more to her than Just this point. As a result of what she did the beliefs of the male professionals were further supported. Those beliefs being that women are innate males in the workforce and the nursing role was stereotyped as a role which only women performed bringing with It the stereotype which we still hold today. Even now, with many more men taking on the role of the nurse we seem to find this unusual and sometimes quite a surprise.

During this time the education system excluded women from the ability to gain scientific knowledge and the medical profession denied access to women who actually had managed to gain education. After Florence Nightingale, Ethel Bedford Fenwick (who is she) said that by 1901 , although we had moved on from the workhouses there was still no professional nurses in Britain and campaigned for a nationally recognized training system to create an actual nursing ‘profession’ This era was such named the era of the ministering angel’ She worked to elevate nursing from the time of Florence Nightingale.

During much of the 20th Century there was little progress with the imbalance of male to female care professions, even with the introduction of the INS women still made up the majority of the workforce in the INS with the male professions making up the majority of top rank Jobs, such as surgeons and insulates, much higher paid, recognized and respected professions. Domestic service of all kinds was the single largest employer of women (40 per cent of female occupations stated in the census of 1851 in provincial cities and 50 per cent in London).

The textile and clothing sectors came a close second (http:// www. BBC. Co. UK/history/British/Victorians/women’s_work_OLL . SHTML) A greater number of women than men choose Job roles in the care industry. Ann Oakley refers to this as being the influence of gender oscillation and the women’s domestic role in the home throughout history. This fact adds to the divide between men and women in the health and social care sector with statistics showing that in 2010 for an example, women made up 74% of the workforce in the INS and men only 26%.

Even the most educated women earn less than men, women generally receive a lower return on their education and against women is reflected in pay irrespective of educational level. In 2009 the BAM report was released, highlighting the inequality in male and female salaries within the health care industry. An average gap of El 5,245 between men and women in the same reversions. “Our results show that men and women with identical experience and expertise are paid differently – which suggests evidence of discrimination” (BAM 2009) It seems women are discriminated against due to her weakness in her ability to move.

In the orientation process I would Inform them of our hospital’s fantastic mentoring program. How we promote confidence, learning and professional growth. I would explain that we adapted the culture from Johns-Hopkins Hospital in Baltimore, which has been ranked the top 25 hospitals, “Best Hospitals” for twenty- one consecutive years. I would stress on utilizing the hospital’s tuition reimbursement and the quarterly professional development classes.

How we believe in the staff so much that we provide free medical care for the employee and family members within our hospital. The hospital offer discounted rates for the on-site dry cleaners and discounts for entertainment. I would help them and prevent burnout by providing discounts to local restaurants [business and hosting annual employee appreciation dinners. I would have monthly raffles that would give the winner a day off with pay. The hospital would have surprise pep rallies that would consist of balloons and clowns.

By offering these incentives the hospital will give the newly hired nurses the culture and values of the hospital environment. 2. Hospital staff has to endure with fast-paced, long shifts, stressful environment hat are constantly pushed to limitations. (Evangelic, Kankakee, & Matheson) By creating a trusting, and open communication that support the staff in a hospital environment will help reduce and manage their stress levels. Having management and departmental leaders display the desired behavior they would like to have the employees demonstrate on the Job and off the Job.

The management and departmental leaders set clear expectation of hospital staff. Hospitals could keep an effective mentoring program that employees could rely on for providing confidence, learning, and professional growth. 3. Exhibit 2. Intervention Points to Influence Culture Change. The cycle of the points are; Behavior, Justification of behavior, Cultural Communications, Hiring and colonization of members who fit in with the culture (Culture), and Removal of members who deviate from the culture. Evangelic, Kankakee, & Matheson, Exhibit 2. 6 Intervention Points to Influence Cultural Change) A company that I was previously employed with had poor communication problems with the staff. During a restructuring process the facility manager was fired. A manager from the Greensboro, NC faculty relocated to the Memphis, TN faculty. He Implemented shift dieting that started at the beginning of every shift. The meeting would inform the He would have a weekly meeting with his managers and supervisor for them to inform him of any problems.

He would advise us of any information that we would have to convey back to the employees. He took away dress down Fridays for office staff, supervisors and departmental managers. He wanted to give a professional environment to the hourly employees at all times. The multiple communications and the dress code he created in the organization changed the behavior of the employees and the supervising staff. I believe it was successful in creating a desired culture.

An analysis of Patton-Fuller Community Hospital Network systems James doglas CMGT/554 December 19, 2011 Carol Eichling An analysis of Patton-Fuller Community Hospital Network systems Patton – Fuller community hospital’s network system consist of two major parts, the first part is the executive part that connects the hospitals executive management, human resources department, operations, IT and data center, etc. , the first network is connected using a 1000base-T Gigabyte network connection that uses a typical Cat6 cabling (Apollo Group Inc. 2008), the second major part of the network connects the departments of radiology, operating room, wards, ICU’s, etc. using a 1000base F fiber optic based connection, this connection is a gigabyte connection too and the both parts of the connections are connected to the network bridge switch that is acting as a core switch. Observing the network structured layout (Apollo Group Inc. , 2008) reveals that the deployment decisions were made depending on the physical distances between the nods in each major network part.

In the first part, it was obvious that the nods where in one physical place and the distances between them is not more than three hundred meters, this assumption were made depending on the fact that the 1000Base T network cannot be efficient more than the distance mentioned above. Where the second major part is in physical locations that more in distance than the executive network, this was based on the assumption the multi-core fiber network can be distanced up to two to three kilometers.

The network logical operations are all based around the IT data center (Apollo Group Inc. , 2008) since it contains the major servers and the NAS (Network Attached Storage) (About. com, 2011), it’s also included the internet gateway router that allows access to the Internet. Furthermore any access to the network from the external resources will be routed through the RAS (Remote Access Server).

Depending on the current topologies readings, several recommendations are necessary to be done in order to keep the network efficiently operational, especially that some parts of the network are mission critical and it is very important to address the issues of availability and reliability. In nowadays network it is very efficient network structure practice to separate the network nods into groups, this will ensure efficiency in interconnection and data transmission, and furthermore it is also one of the famous security practices that will prevent networks in internal structure to access each other.

This can be achieved through using VLAN (virtual LAN) practice (Cisco, 2002), that separates the network nods into groups, each group will be related only to that group nods, this can be done on the switch level (layer 2), and all the VLANs can be interacted with each other through the core switch (layer 3) which provides routing along with switching. This practice can reduce the load on the internal networks through reducing the broadcast messages to that VLAN member’s level, though freeing some bandwidth capacity to more important transmissions.

Another important recommendation is necessary in data center, this will be the separation of the internet server from the internal network, and access it only using remote access methods in case access is needed, this will insure that there are no method of access the internal network only through the RAS server which forces authentication mechanisms to allow any external connection.

It is obvious too that the current server array and the both data centers in the hospital’s network are missing one very important component, and that is the backup system, it is very important to include a backup server to the network to insure data replication is available in case of accidental data corruption or deletion, furthermore take a data snapshots in logical periods of time keeping them physically in another geographical place will be a very likely practice in case of catastrophic data loss.

One of the very good utilities of the hospitals network is the availability of the wireless access on the ward level, this will insure instant connectivity to the hospitals network from the small mobile devices such as laptops or other Wi-Fi based medical devices such as the new cardiograph devices which shares data with the database servers through wireless connection. These wireless devices depending on the diagram specifications are in 5 gigahertz frequency which are not compatible with every laptop computer, a recommendation to replace them with 2. gigahertz frequency devices are more efficient in order to allow laptops to access the network. A special attention is needed in the security of these wireless access points by connecting them to a server like RAS server to authenticate the personnel accessing the network wirelessly before allowing the devices to use the network. This is very important practice to prevent a destructive intrusion into the network. The conclusion

Patton – Fuller hospital’s network has the potential of a successfully designed network with some adjustments to the network configuration is essentially needed to insure availability and reliability. Adding backup system is also an important necessity to prevent data loss, and applying security policies and authentication mechanizes are also essential to ensure continuous network security and performance. References About. com. (2011). Introduction to NAS. Retrieved from http://compnetworking. about. om/od/itinformationtechnology/l/aa070101a. htm Apollo Group Inc.. (2008). Patton – Fuller IT Data Center Diagram. Retrieved from https://ecampus. phoenix. edu/secure/aapd/CIST/VOP/Healthcare/PFCH/IT/ITDC. htm Apollo Group Inc.. (2008). Patton – Fuller Logical Network Diagram. Retrieved from https://ecampus. phoenix. edu/secure/aapd/CIST/VOP/Healthcare/PFCH/IT/ITLogNet. htm Cisco. (2002). VLAN Security Practice. Retrieved from http://www. cisco. com/warp/public/cc/pd/si/casi/ca6000/prodlit/vlnwp_wp. pdf

A Healthy Work Environment: Essential in Providing Quality Health Care Kimberly Lett DeVry University ENGL135: Advanced Composition Fall term 2010 A Healthy Work Environment: Essential in Providing Quality Health Care The delivery of healthcare has evolved and changed over the years and with the advances in science and technology, the ability to provide safe, quality care to all patients has been impacted by the changes.

With the rising healthcare costs and decrease in reimbursement for care provided, organizations must look for ways of cost containment to maintain viability for the future. Fabre (2005) noted that administrators are struggling to maintain financial stability and retain competent nurses during these difficult financial times. Organizations are being evaluated and reimbursed based on their patient care outcomes; as such the nurse’s role is critical in helping to identify potential safety risks to patients and the prevention of medical errors. As hospitals have responded to financial pressure from Medicare, managed care , and other private payers, registered nurses have become increasingly dissatisfied with the working conditions in hospitals” (Fabre, 2005, p. 20). One of the many challenges in healthcare today, is the need for organizations to recognize and facilitate the improvement of the work environment. The need for competent, qualified nurses in any organization is imperative for providing safe, quality care to the clients. For this reason the critical role that nurses have in providing patient safety should not be underestimated.

The Institute of Medicine (2004) reported “ research is now beginning to document what physicians, patients, other healthcare providers, and nurses themselves have long known: how well we are cared for by nurses affects our health, and sometimes can be a matter of life or death” (p. 2). The importance of a healthy work environment has been recognized as a key component in maximizing organizational performance, contributing to a decrease in the nursing shortage within an organization and is vital in providing quality care to the clients they serve.

The growing concern for the nursing shortage continues to be a major issue affecting the profession and attention is being given to the stressful nature of the work environment. Several national surveys were completed in 2002 and 2004, identifying reasons for the ongoing nursing shortage, one of the major concerns centered on the work environment (Florida Center of Nursing, 2006). Organizations are looking at ways of restructuring the work environment, enabling staff nurses the opportunity to participate in decisions that impact their ability to practice.

McDonald, Tullai-McGuinness, Madigan, and Shively (2010) remarked that workplaces that have a supportive work environment have noted success in recruitment and retention of their work force, citing an increase in job satisfaction and improved patient outcomes. With nurses making up the largest percentage of professionals working in a hospital setting, organizations now recognize the importance of the nurses’ role and measures to improve the workplace are being developed.

Lowe (2002) noted “ diagnosing the extent of work environment problems in healthcare is the first step in designing strategies to improve the quality of healthcare workplaces” (p. 49). Hospitals looking to improve on the work environment must first have an understanding of the nurses’ perception of their workplace environment. Kramer and Schmalenberg (2008) noted “the perspective of clinical nurses at the front line as to what constitutes a healthy work environment is essential if interventions to improve practice environments in hospitals are to be implemented” (p. 57).

Once an organization is able to identify distinctive characteristics that have an impact on staff and their environment, they are then able to proceed in developing strategies to improve the work culture. All members of the healthcare team, including staff, management, and administrators, must be committed to the development of a healthy work environment as well as sustaining the culture through modeled behavior. Practical techniques to assist in the development of staff friendly cultures are clearly identified, with long term strategies implemented rather than short term fixes, for all members of the organization.

To help facilitate and guide organizations, professional groups have designed several programs available for their use in fostering a healthy work environment (Florida Center of Nursing, 2006). The American Nurses Credentialing Center (ACNN) sponsors the Magnet Recognition Program, which focuses on the development of nursing practices and evaluates the environment where nursing is practiced. This program is well recognized by organizations throughout the country, as the Magnet Journey and is considered to be one of the highest achievements that organizations can obtain (Broom, & Tilbury, 2007).

Organizations that strive to achieve the Magnet designation, acknowledge the link between a healthy work environment and the development of an organization of nursing excellence. Hospitals utilizing the Magnet concept demonstrate the following characteristics; (a) authentic leadership, (b) skilled communication, (c) effective decision making, (d) quality patient care processes, (e) collaboration and teamwork among all healthcare workers, (f) professional growth and accountability, (g) clinically competent staff and (h) adequate staffing levels (Shirey, 2006).

All the above components are essential and linked to the effectiveness of a quality work culture. An online survey of clinical nurses, conducted by the AACN, were asked to identify factors that had an impact on their satisfaction with nursing as well as potential reasons that might cause them to leave the profession ( Ulrich et al. , 2006). Leadership style was identified as a key component affecting nurses’ satisfaction with their job. Nursing leadership is a crucial element to the work environment of nurses, as it is the leaders who can bring about positive changes to the environment (Florida Center of Nursing, 2006).

The importance of effective leadership from all levels of management in any organization is essential in developing and promoting collaboration with their employees. A manager’s ability to foster leadership growth, and recognize the importance and expertise of the nursing staff will have a major advantage in retention of competent nurses in their units. In essence, leaders who can motivate and provide opportunities for their staff, and demonstrate a high level of role model behavior, have higher levels of staff participation and commitment to the organization.

Authentic leadership is characterized as one that establishes relationships which are based on trust, respect, and can be considered genuine and believable (Shirey, 2006). Leaders that demonstrate excellent management styles are participatory, coaching and mentoring, they encourage and value staff members and support staff involvement in decision making that has an impact on their work environment (Tomey, 2008). The importance of effective leadership, with staff and management working together, is noted by their ability to create a shared vision for the organization through collaboration and continuous improvement of the work environment.

Shirey (2006) noted “authentic leadership was described as the glue needed to hold together a healthy work environment” (p. 256). Another influential factor in the workplace is skilled communication among all levels of the healthcare team. Key components when utilizing one’s communication skills include verbal and nonverbal interactions and enhanced listening skills, all are vital in ensuring effective communication. Because communication happens continuously in the workplace between employees, managers and customers, it plays a vital role in the development of healthy relationships.

Fabre (2005) noted that nursing staff expect sincerity, trust and good communication from all levels of leadership within the organization. Communicating openly and honestly allows for individuals to deal with one another in a respectful manner, build trust and have an appreciation for each other. A healthy relationship among co-workers enhances the communication process, allowing collaboration and teamwork, which in turn leads to a decrease in medical errors and fosters a safe environment for patient care.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) remarked that the 80% of medication errors and 70% of sentinel events that occurred in delivery of patient care were directly related to ineffective communication among the care providers (Florida Center of Nursing, 2006). Interactions among nurses, physicians, patients and managers, all have a direct impact on the quality of care delivered. In order to provide optimal patient care, it becomes crucial for all members of the healthcare team to communicate effectively with one another.

Interpersonal relationships and collaborative teamwork among nurses, physicians and other members of the healthcare team are crucial to the delivery of quality care to the patients (Parsons, & Cornett, 2005). Another important aspect of a healthy work environment is one where nurses are supported and feel empowered to participate in decision making. Ulrich et al. (2006) reported the Institute of Medicine advocates for frontline staff to be involved and entrusted in the decision making and delivery of the patient care provided.

When nurses are given the opportunity to participate in clinical and organizational decisions and receive support for their efforts, it fosters personal accountability and autonomy for all staff involved. Empowerment of the nursing staff establishes the groundwork for a positive workplace with collaboration and meaningful communication, enabling professional development and growth within the organization (Parsons, & Cornett, 2005).

Organizations that promote staff involvement in the development of policies and procedures, fosters support for the nurses’ ability to use their critical thinking skills in determining what is the best plan of care for their patients. Nurses need to feel safe and secure in their work environment to be effective in utilizing their critical thinking skills. Kouzes (as cited by Fabre, 2005) remarked “the key to unleashing the organization’s potential to excel is putting that power in the hands of the people who perform the work (p. 7).

When staff members are engaged and feel valued as member of the team, a true sense of autonomy is present in their daily care of patients. Fabre (2005) remarked it is extremely important for nurses to be autonomous, allowing them the ability to make decisions about direct patient care in their daily practice. One such method for getting staff members involved is through the use of shared governance committees within their units. Direct care nurses participating on these councils, are involved with decision making regarding positive patient care models as well as nursing satisfaction and retention (Florida Center of Nursing, 2006).

Nurses working in positive work environments demonstrate mutual respect for one another, show consistent professional collaboration among all team members and function as high performance team members in their organizations. Vollers, Hill, Roberts, Dambaugh, and Brenner (2009) noted “nurses affect patients’ outcomes by their direct actions and their influence over the actions of other” (p. 24). It becomes easier for employees to recognize and accept the need for change, problem solve and decrease stress in their workplace. Another important aspect relating to nursing satisfaction is the importance of professional development.

Organizations that are recognized for their high standard of patient care acknowledge the importance of their nursing staff and provide opportunities for personal and professional growth. Successful organizations offer various learning avenues for their employees. Emphasis is placed on orientation for new staff members, in-service education, continuing education as well as formal education and career development (Tomey, 2008). Nurses recognize that continuing education and competency go hand and hand and is imperative for professional development as well as patient safety.

Individuals, who are given the opportunity to grow and develop their skills and abilities within an organization, will be happier and more productive at work. Another avenue of development for nursing is certification in their specialty. A certified nurse provides a level of expertise at the bedside when caring for his/her patients. Ulrich et al. (2006) noted the correlation between certified nurses and improved patient care; nurses were able to quickly identify the problem and intervene appropriately to the issue at hand.

Nurses who embrace the idea of lifelong learning are able to adjust to the ever changing needs in healthcare and are much more satisfied in their job roles. Personal and professional growth is valued in organizations, where managers are committed to providing time and resources for staff learning and educational opportunities (Institute of Medicine, 2004). A shift in management thinking, from controlling to guiding staff, becomes an important step for staff development which in turn improves quality of nursing care. A common concern that nurses have with their current work environment is one of inadequate staffing levels.

Hospitals that employ the concepts of magnet empower their nurses to make decisions about appropriate staffing levels. Management and staff nurses work together to build safe staffing strategies to meet the needs of the individual units. This collaboration between staff and management, builds trust, empowers the nursing staff and enables nurses to feel they have personal accountability for the success of their organization (Fabre, 2005). Organizations have struggled with trying to determine the number of nurses needed to provide safe, quality patient care and do so in a cost effective manner.

The Institute of Medicine (2004) remarked that experts have recognized that healthcare organizations need to be aware, that overemphasis on efficiency and productivity may have a negative impact on patient safety. With the added stress of providing care for sicker patients with fewer nurses at the bedside, less time is available for nurses to meet all the physical, mental and psychosocial needs of the patients. Morgan and Lynn (2009) remarked “being pressed for time and energy, nurses describe their work in terms of survival; the luxuries of meaningful care interactions with patients are forgone” (p. 07). Often nurses feel they have time to only perform the minimum amount of basic care; and patient education, basic comforting and advocating for the patient is omitted. The lack of resources in staffing as well as a poor working environment is extremely dissatisfying to the nursing staff and impacts patient outcomes. “Research indicates that nurse staffing has a definite and measurable impact on patient outcomes, medical errors, length of stay, nurse turnover, and organizational outcomes” (Florida Center of Nursing, 2006, p. 5).

There is no single action that guarantees a foolproof solution to patient safety during one’s hospitalization, but consideration of staffing levels has played a critical role in providing that safe care. Buchan and Aiken (2008) noted an association between higher nurse staffing ratios and a decrease in medical complications and patient mortality. Staff nurses recognize high risk situations and patient safety concerns, when understaffed they are often times unable to prevent these catastrophic incidents. Safety is a patient’s right and they deserve the nurse’s best efforts.

Fabre (2005) noted that the success of nurses as well the healthcare organization is dependent on a positive healthy work environment. Patient safety needs to be the most important goal for any organization. Culture does matters and a healthy work environment makes the difference in an organization’s performance. The importance of promoting health, through the use of wellness programs, as well as prevention of illness for employees in an organization should not be overlooked. Staff should be supported and encouraged to participate in their own health management.

Burton (2008) remarked “it is intuitively obvious that unhealthy, stressed employees will cost a company something in terms of absenteeism and decreased productivity” (p. 3). A positive work environment fosters healthy lifestyles, behaviors and enables individuals to develop coping skills to deal with stress on a daily basis. The financial benefits versus the cost of creating a healthy work environment can be cost neutral. Many of the magnet concepts, if developed in the workplace, are done with no direct costs to the hospitals.

Changes in leadership styles, supportive and respectful behavior towards staff and empowering nurses in the decision making does not cost the organization money (Burton, 2008). All these factors will have a significant impact on the work environment; improving the physical and mental wellbeing of staff members. Patients trust and recommend hospitals because of the nursing care they receive. Fabre (2005) noted an important reminder to hospitals; patients tell their family, friends and neighbors about the care, good or bad, they received while a patient in their organization.

Excellent patient care coupled with patient satisfaction is what attracts people to an organization. Healthcare organizations that demonstrate and promote healthy work environments will become the employer of choice in their communities. Burton (2008) noted that administrators of an organization cannot argue the fact that their reputation is extremely important in the community in relation to the success of their facility. Patients do notice the difference and when hospitals are able to recruit and retain the best nurses in the community; this nursing excellence has the ability to drive the success of the organization.

Whether an organization chooses to seek Magnet designation or not, the concepts can still be utilized in any organization towards the development of a healthy work environment. It is important that organizations recognize the need for development of strategies that foster a healthy work environment, where staff are valued and acknowledged for their contributions and have a desire to work in their facilities. The association between a healthy work environment and the health and wellbeing of the nursing staff correlates to the impact on the quality of care provided to the patients they serve.

It is evident that the continuity of patient care, recruitment and retention of competent nursing staff and organizational viability are all greatly impacted by the nurses’ work environment. Maintaining a healthy workplace remains a challenge in healthcare and must be seen as an ongoing process. Healthcare organizations that are able to develop and sustain quality workplaces will be able to meet the demands of healthcare in the future by retaining competent nursing staff and meeting the health needs of their communities. . References Broom, C. , & Tilbury, M. S. (2007).

Magnet Status: A journey, not a destination. Journal of Nursing Care Quality, 22(2), 113-118 Buchan, J. , & Aiken, L. (2008). Solving nursing shortages: a common priority. Journal of Clinical Nursing, 17, 3262-3268. Burton, J. (2008). The business case for a healthy workplace. Retrieved January 24, 2011 from: http://www. iapa. ca/pdf/fd_business_case_healthy_workplace. pdf Fabre, J. (2005). Smart nursing: How to create a positive work environment that empowers and retains nurses. New York, New York: Springer Publishing Company, Inc. Florida Center of Nursing. (2006).

The value of a healthy work environment. 1-20. Retrieved January 28, 2011 from http://www. flcenterfornursing. org/files/healthworkenv. pdf Institute of Medicine of the Nation Academies. (2004). Keeping patients safe: Transforming the work environment. Washington, D. C. : The National Academies Press. Kramer, M. , & Schmalenberg, C. (2008). Confirmation of a healthy work environment. Critical Care Nurse, 28(2), 56-64. Lowe, G. S. (2002). High-Quality Healthcare Workplaces: A vision and action plan. Hospital Quarterly Summer, 49-56. McDonald, S. F. , Tullai-McGuinness, S. , Madigan, E.

A. , & Shively, M. (2010). Relationships between staff nurse involvement in organizational structures and perception of empowerment. Critical Care Nursing Quarterly, 33(2), 148-162. Morgan, J. C. , & Lynn, M. R. (2007). Satisfaction in nursing in the context of shortage. Journal of Nursing Management, 17, 401-410. References Parsons, M. L. , & Cornett, P. A. (2005). A healthy emergency department workplace; the staff describe it. Topics in Emergency Medicine, 27(3), 198-205. Shirey, M. R. (2006). Authentic leaders creating healthy work environments for nursing practice.

American Journal of Critical Care, 15(3), 256-267. Tomey, A. M. (2009). Nursing leadership and management effects work environments. Journal of Nursing Management, 17, 15-25. Ulrich, B. T. , Lavandero, R. , Hart, K. A. , Woods, D. , Leggett, J. , & Taylor, D. (2006). Critical care nurses’ work environments: a baseline status report. Critical Care Nurse, 26(5), 46-57. Vollers, D. , Hill, E. , Roberts, C. , Dambaugh, L. , & Brenner, Z. R. (2009). AACN’s healthy work environment standards and empowering nurse advancement system. Critical Care Nurse, 26(6), 20-27.

A Farewell to Arms Study Gulled Questions *Answer the following questions on a separate sheet of paper as completely as possible. Keep these questions/answers to use as notes in order to prepare for discussions, quizzes, and tests.

BOOK I

1. What tone Is set in the opening chapters? Why Is this unexpected? The scene that Hemingway creates is peaceful and serene. However, the tone is depressing as fall turns into winter with rains and cholera plaguing the army. This is unexpected because the novel is about war and we do not see any action.
2. What are your Impressions of the narrator so far?
3. He seems rugged yet sensitive to the beauty of nature, articulate, inured to the dying that is part of the war, probably a reliable reporter of external events, but pretty close-lipped about his own feelings.
4. How/Why did the narrator get Involved In WWW? Why Is he In the Italian army?  He signed up to drive an ambulance in the Italian army, he tells the head nurse he was in Italy and spoke Italian.
5. What does the narrator’s initial attitude toward the war seem to be?  He seems objective and detached.
6. Describe the relationship between the Italian officers and the priest. What are their views concerning the Catholic Church? The priest is young and sincere, and the others tease him about his celibacy. The others poke fun at the church also.
7. Describe the priest’s native village of Brazil.  Brazil is green with hills and a castle yet more guns and new hospitals and Bruits on the street. Does he apologize to the priest? Milan, Florence, Rome, etc. He visits women. He apologizes to the priest for not visiting his hometown and family.
8. Who is Catherine Barley? How does the lieutenant meet her? A British V. A. D. – something like a nurse’s aid. She has been seeing Ronald and Ronald drags Let. Henry to meet his girl. Discuss the effect on Catherine of her fiance©’s death in the war. She held regret that they did not marry… There is sadness as she says “l could have given him that anyway’ she also said she was going to cut all of her hair off for him as she wanted to do something for him.
9. How does Let? Does Ronald react to Catering’s obvious preference for Henry? Was he sincere in his expressed intent to marry her? What does Ronald mean when he says, “Thank God I didn’t become involved with the British” (32)? (5-6) Ronald is indifferent to Catering’s attachment to Henry. He is not sincere in his intentions to marry Miss Barley.
10. Why does the lieutenant tell Catherine that he loves her? What is meant by the comment, “This was a game, like a bridge”. He says it because it is what she wants to hear- if they are to have a physical relationship- but he has no intention of falling in love.
11. How does the soldier with the hernia feel about the war? Why does the lieutenant tell him to “get a bump on your head”? What was the outcome? He doesn’t want to go to the line again; by getting “injured” in a way that doesn’t look like he did it on purpose, the soldier can -and does- get a ride to the hospital.
12. What is Henry’s attitude now toward the dangers of war? He recognizes them but feels that they have nothing to do with him- that he could not be killed.
13. Why does Ronald make the lieutenant chew coffee before going to see Catherine? To mask the smell of alcohol to say that she can’t see him that evening? How might this be a turning point for Henry? Lonely and hollow. He recognizes that he loves her and longs to be with her. 16. How and when does Henry get injured? What medical treatment does he receive? Henry gets injured during dinner when a mortar explodes near his bunker. Henry tests his wound cleaned at the dressing station and then transferred to the hospital.
14. Contrast the personalities of Ronald and the priest as revealed in their visits to Henry in the hospital. What does each of them do for Henry’s recovery/spirit?  Ronald – Free and fun. Likes to have fun, tease, drink, and women – talks about the medal of honor and brings Henry Cognac Priest – Talks more about feelings and what is on his mind (war, hometown, etc. ) – Brings mosquito net, vermouth, and English newspapers.
15. Why does the priest call Henry a patriot? Is this complimentary? Why or why not? The priest calls Henry a patriot because he is a foreigner fighting for Italy. Yes, it is complimentary because the priest respects Henry.
16. Discuss the priest’s view of love. Is the love affair between Henry and Catherine genuine according to the priest’s definition? The priest believes that when you love you are willing to sacrifice, do things, and serve. Love is like a religion to the priest. Henry and Catherine do have that sort of relationship. They meet together and seem to really like each other. Lovemaking might play a key role, but they seem to care for one another. Although the relationship is young.
17. Where is Henry to be taken when he is removed from the field hospital? Why are doctors anxious for him to leave? Who will be at the other hospital?  To Milan to the American Hospital. Doctors need the room because there are more injured coming. Catherine was transferred to the other hospital.
18. What is Henry’s arrival at the hospital like? How does Mrs… Does Walker try Henry’s patience? Would you say that he is overbearing… Or that she is over-sensitive? He isn’t expected and is left literally hanging- on the arms of the men supporting him- while she whines about having no room ready; he orders the porter to find him room and Mrs… Walker cries.
19. How do Miss Van Camped and Henry get along? Neither likes the other. She mistrusts him for being in the Italian army. He gets angry when she refuses to order wine for him.
20. Why do you think Miss Gage tells Henry that she doesn’t like Miss Barley? It is her humorous way of admitting some Jealousy- that Miss Barley is so attractive- and perhaps some Jealousy that Miss Barley leaves no room for Miss Gage with him
21. How does the barber act toward Henry? Why? Thinking the Let. Henry is Austrian, the barber acts hostile.
22. What does Henry see when he looks at his wound now? It looks repulsive- like hamburger meat- but he views it objectively, with detachment.
23. What is the surgeon’s advice for Henry? Why does he not like the advice?  The surgeon advises waiting six months before surgery, to allow the bullet to “encysted”.
24. Why does Henry decide to have Dry? Valentine’s go ahead with the operation? Let. Henry wants a major- not a captain- to do the operation, and he wants it done right away- which Valentine agrees is the way to go.
25. Why does Catherine tell Henry not to think about the two of them while he is under the anesthetic? She doesn’t want him to talk about their relationship in front of her colleagues.
26. Why do you think Catherine wants to know about Henry’s past loves? Why do you think he lies? Would Catherine think less of him if he told the truth? Because he thinks the truth would hurt her.
27. After Henry’s operation, Henry realizes that “Catherine was right. It did not make any difference who was on night duty. ” Why not? He is feeling too sick to care whether or not he sees Catherine that night.
28. How do Ferry and Catherine get along? Ferry and Henry? Why do Ferry and Henry have this type of relationship? The women are good friends; Ferry is protective of Catherine and suspicious of Let. Henry’s intentions.
29. Why don’t Catherine and Let. Henry get married?  Catherine points out that if they were married, she would probably be sent away.
30. What are Catherine and Henry’s beliefs about religion?  She tells Let. Henry that he is her only religion; he seems to be pretty much of an atheist.
31. Who are the Meyers? Who else does Henry know in Milan and what do they do for a living?  They are a couple who like horseradish.
32. How can you tell that Catherine has deep-rooted fears? Why does she cry when it anis?  She says that she is afraid- that she images both of them dead in the rain.
33. Describe the horse races at San Sirs. What about them makes Catherine feel “unclean”?
34. What is Catering’s big news for Henry? How does Henry seem to feel when he finds out?  She is pregnant. He is worried but reassuring.
35. How long was Henry’s convalescent leave supposed to be? How did he lose it? A couple of weeks; he develops Jaundice and Miss Van Camped accuses him.
36. Before Henry leaves, he and Catherine go to the hotel. Why is she unhappy there? She feels like a where.
37. How does Henry end up on the floor of the train back to the front?  He pays a machine- gunner to hold it for him but gives up the seat when a captain protests. What is the change in mood Henry encounters in Georgia when he returns from the hospital? Why doesn’t it “feel like a homecoming”? Gloom is pervasive – and things have changed. He does not know the British ambulance driver, the major looks older, etc.
38. What does the major tell Henry about how things have been going while Henry was away? The major says it has been a bad summer and there are many sick; he is pessimistic bout the next year.
39. How does Ronald seem to be doing? How has he changed since Henry last saw him? While he still Jokes, he seems depressed about the war and worried because he believes he has syphilis.
40. Why does Henry tell Ronald he doesn’t want to drink too much? Let. Henry explains that he has had Jaundice.
41. How has the priest changed since Henry last saw him? What does he mean when he says, “Many people have realized the war this summer” on page 178? The priest is subdued, weary; he thinks that people are finally realizing the brutality and senselessness of war.
42. What does Henry think about Gin’s patriotism? He notices Gin’s criticism of his own country which is not in keeping with a patriotic mindset.
43. Why do the Italians plan to retreat? What is Henry’s role in the preparations? The order is given after the Germans break through to the north; Let. Henry is supposed to stay put and help clear out the hospital equipment and the wounded; not all the wounded can be evacuated.
44. Why do Henry and the others leave the main road? They are afraid of getting stuck if the column is stopped by a few dead horses or deserted trucks.
45. What happens to the sergeants when Henry asks them to help free the ambulance? Are Henry’s actions Justified? When the sergeants refuse to help get the ambulance out of the mud, Let. Henry shoots and injures one, whom Bone happily finishes off.
46. Pain and Ammo call themselves anarchists and socialists. What do they mean? An anarchist believes in voluntary association- the overthrow of the government control; socialist advocates giving ownership and control of land and capital to the community as a whole.
47. Why does Henry go across the bridge first? What does this show about his developing/changing character?  They all know that the bridge may be mined- but that one person alone probably would not detonate the explosives; he is pretty brave and feels responsible for the others.
48. Why is Henry so angry when he sees the German staff car and bicyclists?  It means that the Italians have not held back the Germans; he thinks the Italians should have blown up the bridge and set up machine gunners along the embankment.
49. Who gets killed by Henry’s group? How? Who actually shoots him? Why is Henry so upset about his death?  Ammo gets shot by frightened Italians. Let. Henry isn’t visibly upset, but admits that he.
50. How does Henry almost get killed? Why? How does he escape?  The Italian battle police are about to shoot him for leaving his regiment- and because they suspect he is a German- when he escapes by jumping into the river.
51. Why does Henry cut the stars from his sleeves? For “convenience”- so that he won’t be further harassed as an officer without his regiment
52. What does Henry think about as he lies in the train car? How does he feel about the war and his life at this point? How has his character change since the beginning of the novel?  He thinks about his lack of anger, his desire simply to wash his hands of the war, and bout the friends- Ronald, the priest, etc. – that he will never see again. He had been sure that the war would not kill him- now he knows it could. He is anxious to be with Catherine, while at the beginning he wanted no commitments.
53. What help does the proprietor of the bar in Milan offer Henry? Why does he Make this offer?  He offers him a safe place to stay and phony leave papers; having seen Let. Henry lump from the train, he has deduced that Henry is in trouble- and genuinely likes him.
54. What information does the porter and his wife give Henry? Why does Henry offer them money? Why do they refuse it? Catherine has gone to Stress; he pays them to keep quiet, but they refuse the money because they like him and want to help.
55. Who is Simmons? Where in the novel does he first appear? How does he help Henry? Henry met Simmons when he was a patient at the hospital in Milan and Simmons was taking voice lessons; Simmons gives him some civilian clothes.
56. Explain what Henry means when he says, “I had made a separate peace” on page 243. (34) the war, he just wants to be contentedly alone with Catherine somewhere.
57. How does Henry find Catherine once he gets to Stress? He asks the barman at the hotel whether he has seen two English girls; the barman finds out where Catherine and her friend are staying.
58. How does Helen Ferguson react to Henry’s appearance in Stress? Why?  She is angry and annoyed because she feels Henry has exploited Catherine; also, she is probably Jealous because he is taking away her companion.
59. Where does Henry plan to go to leave the war behind? Why? To Switzerland
60. Why does Henry feel like a criminal?  Because he has deserted from the Army
61. Who is Count Grief? Despite the age difference, how are he and Henry alike? A very old man Henry had met previously; as they play billiards, he reveals his belief that Italy will win the war- since younger nations usually do.
62. Why does Emilio, the barman, come to Henry’s room in the middle of the night?  To alert Let. Henry that there are plans to arrest Henry in the morning.
63. What escape plan do Emilio and Henry devise? Emilio gives Henry his rowboat and Henry and Catherine row to Switzerland.
64. What do Henry and Catherine decide to do as soon as they reach their destination? What immediately happens after they’re done? They go too cafe© and order a big breakfast. They are arrested but don’t seem afraid. They foresaw the arrest.
65. What excuse do Henry and Catherine give for their trip to Switzerland?