Nurse Staffing Essays

Nurse Staffing Essays Nurse Staffing Essay Nurse Staffing Essay Abstract Two major forms of staffing guidelines will be discussed, nurse-to-patient ratio and staffing by acuity. This paper will discuss the history of each staffing form. It will point out the benefits and negative features of both practices, describe how hospitals deal with staffing and discuss the states that have laws requiring certain guidelines be followed. Nurse Staffing: Does One Size Fit All? What is the one conversation that usually gets heated when talking to nurses? Bring up the subject of staffing levels on their unit. As a nurse assistant, staff nurse, charge nurse or nursing administrator, inadequate staffing creates tension and stress. When staffing is inadequate patient safety, infection rates, patient satisfaction and staff satisfaction are only a few of the areas affected. Many hospital administrators and lawmakers want to make patient care a numbers game. The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to create a staffing plan that defines staffing effectiveness as the skill mix, competence, and effectiveness related to the services needed. (Morgan, 2004) When it comes to staffing, one size does not always fit all. Patients are individuals with individual needs and one patient with a certain diagnosis can take much less attention and time from the nurse than a patient of the same age with the same diagnosis. For good nurses the main goals during their shift is giving exception patient care and providing a safe environment. â€Å"The notion of high-quality care in hospitals is essential to public safety isn’t new. In 1751 Benjamin Franklin founded America’s first hospital-Pennsylvania Hospital-and commented that patients ultimately suffer and die without sound nursing care. † (Clarke, 2003) Nursing leaders are under tremendous pressure to lower costs while improving quality. (Carter, 2004) It is often found that hospitals during low census times or times of budget cuts will try to let ancillary staff go and assign their duties to the nurse caring for the patient. Nurses can replace several other positions in a healthcare setting but no other position can replace the nurse. Nursing is not only a highly trained individual but someone who is called to be compassionate, caring and dedicated individual. There are many reasons why staffing by acuity or nurse-to-patient ratios should not be mandated by lawmakers. Direct care nurses should be involved in staffing decision. Outcomes are better when nurses have control of their workload. (Anonymous, 2005) Adequate staffing must be priority for anyone involved in healthcare and there are pros and cons to both staffing by acuity and nurse-to-patient ratios. With our aging population and the increased age of the baby boomer generation nurses are going to increase in demand. Healthcare is changing so quickly and this also affects the shortage. The average acuity of patients has increased over the last decade while the nursing shortage continues. Nurse-to-patient ratios are supposed to draw people into the filed but there is a shortage of educators at present time as well. Many colleges have long waiting list for nursing programs, yet many nurses only stay in the field for a short time after graduating. Many universities turn away good candidates to nursing programs due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. (Allen, 2008) We as a nation must come to a conclusion to deal with the nursing shortage. Too many lawmakers are paying attention to the staffing formats suggested above and not doing anything to fix the nursing shortage. Whether by acuity or ratios, for each nurse to take fewer patients we will definitely need more nurses. Staffing by acuity is a format used to decide how many nursing hours are needed for certain diagnosis or types of patients. Typically areas within a healthcare facility where patients are less ill such as rehabilitation and medical-surgical units, nurses can care for as many as seven patients at a time. Their acuity score is much lower than a patient in the intensive care unit or a step-down unit. Healthcare systems that utilize staffing by acuity are looking at the safe number of certain levels of patients that one nurse can care for. The down side to staffing by acuity is that many feel administration will influence numbers to maintain a high number of patients per nurse. If all patients on a unit were a level eight then most acuity systems would call for three patients to one nurse but if all patients on a unit were all level ones then a nurse could be caring for as many as eight to ten patients. Acuity does not take every patient encounter into consideration. For instance a dementia patient may have a low acuity based on the nursing care since they usually do not have indwelling lines or invasive procedures. Although the same patient may require a high amount help with activities of daily living, decision making and education. (Walsh, 2003) Thus staffing by acuity can be a subjective form of nurse staffing. When done accurately, acuity based staffing can be very beneficial for the nursing staff. Illinois is one of many states that have implemented laws requiring hospitals to base staffing on acuity systems and then report compliance on a quarterly basis. Illinois Hospital Association supports acuity based staffing over nurse-to-patient ratios. (Anonymous. 2008) SB867 is a law in Illinois that requires hospitals to base staffing on a model that has been developed by a nursing care committee made up of at least 50% direct care nurses. (Anonymous. 2008) This assures the bedside nurse a significant voice in the staffing process. It allows nurses to base their staffing on the work they perform. The model should include levels of care and examples that fit you patient population. At times, nurses will under staff themselves by simply not giving their patients credit for their true acuity level. This law and practice demonstrates hospital’s commitment to their direct nurse staff. Acuity based staffing is believed to take all facts into the picture. Nurses should be trained to develop and use their acuity tool to best describe the patients they are caring for, thus supporting the need for additional staff. Nurse-to-patient ratios are a concept that mandates a certain number of patients for each nurse to care for. Depending on the types of patients being cared for this number can differ. California has a law requiring nurse-to-patient ratios be following in hospitals. This law was signed in 1999 but was unable to be implemented for another four years. California state guidelines say that medical-surgical patients are one to five and in the intensive care units ratios are one to one. Illinois also has a law up for approval, HB0485 that would mandate ratios. â€Å"Establishing a minimum,  specific and numerical ratio implies that there is a scientific basis for determining the number of nurses to patients above which good outcomes patients can be guaranteed. † ( Flowers, 2009) This law would put even more stringent regulations on hospitals. California has seen many issues related to the ratios law. Ratios can cause longer transfer times for patients, increased ER bypass and postponed elective surgeries. California has experienced 12 hospital closures and downsizing of services since ratios was implemented. Patients are not all alike, their needs are individually different. Nursing units are different and ratios do not take into account the nurse’s level of experience or the physical layout of the facility. Many times hospitals will attempt to meet ratio laws by terminating such positions as nurse assistants and environmental services workers. So in reality nurses may only have four patients to care for but they are responsible for total care of those patients. The other strategy hospitals have used to meet ratio guidelines is to replace registered nurses with licensed practical nurses and have only one register nurse on each shift as a charge nurse. Under California law, nurses are considered registered or licensed practical nurses. HB0485 prohibits this by stating the nurse ratio can only be made up from registered nurses. Supporters of nurse-to-patient ratios believe that these types of laws will recruit more individuals into the field and retain our current nurses. According to CNA President Deborah Burger, the ratio law is a mafor reason why more nurses are coming into California and why RN’s are staying at the bedside. (Anonymous, 2005) The working conditions are believed to be better when a nurse has fewer patients. The environment is considered safer when more nurses are available to care for the patients. Nurses feel they will have more time for direct patient care and fully evaluate the patient’s needs. Individuals, who support both staffing by acuity and ratios, believe that research is needed to support both ideas. I feel that acuity is the most accurate way to determine safe ratios. At Union County Hospital, where I work, we use our acuity tool to establish a level for each patient. This is nursing staff’s first indicator of needed staffing levels. We also use ratios to staff. Once the acuity is finished the charge nurses takes the acuity of the patients, level of experience of the oncoming shift and also our staffing matrix into consideration and staffs the next shift appropriately. I did a simple study recently and based on our staffing matrix that the charge nurse can take up to three patients and each additional staff nurse should not routinely take over six patients, we met the staffing matrix 84% of the time. Of that 84%, only 12% of the time did the acuity call for different staffing levels and most of that was that the acuity actually called for less staff. We are a for-profit hospital and as a manager I have to validate our staffing to the CFO on a weekly basis. I asked the nurses to accurately and honestly complete the acuity, keep our matrix in their mind, and make the best decision for the patients. I also ask that if there are any circumstances that influenced their decision they should leave note of this on the daily staffing sheet. I think that acuity and ratios complement each other when used together, but one size does not fit all in nurse staffing models. Lawmakers and hospital administrators should not be making these decisions for nurses, the bedside nurse should be able to make an individualized staffing plan for each shift based on the patients on the unit. References Allen, L. (2008). The Nursing Shortage Continues As Faculty Shortage Grows. Nursing Economics, 26(1), 35-41. Retrieved March 1, 2009, from ProQuest Education Journals database. Anonymous (2005). Schwarenegger flexes muscles on nurses. Australian Nursing Journal, 12(7), 29. Retrieved March 1, 2009, from ProQuest Education Journals database. Anonymous (2005). Ratios: Savior or villain? Australian Nursing Journal, 13(1), 15. Retrieved March 1, 2009, from ProQuest Education Journals database. Anonymous (2008). Keep Contacting You State Representative To Oppose Nurse Staffing Ratio. Illinois Hospital Associations Position Paper. Retreived Febuary 24, 2009, from ihatoday. com/issues/workforce/hb392. html Carter, M. (2004). The ABC’s of staffing decisions. Nursing Management, 35(6), 16. Retrieved March 1, 2009, from ProQuest Education Journals database. Clarke, S. (2003). Patient safety series, part 2 of 2: Balancing staffing and safety. Nursing Management, 34(6), 44-48. Retrieved March 1, 2009, from ProQuest Education Journals database. Flowers, M. (2009). Nursing Care and Quality Improvement Act HB0485. 96th Illinois General Assembly. Retreived Febuary 24, 2009, from ilga. gov/legislation/96/HB/09600HB0485. htm. Morgan, S Tobin, P. (2004). Managing the Nursing Workforce. Nursing Management. Chicago, 35, 4-6. Retrieved March 1, 2009, from ProQuest Education Journals database. Walsh, E. (2003). Get Real With Workload Measurement. Nursing Management. Chicago, 34(2), 38-42. Retrieved March 1, 2009, from ProQuest Education Journals database.

Chemistry Nobel Prize Winners (1901 to Present)

Chemistry Nobel Prize Winners (1901 to Present) Alfred Nobel was a Swedish chemist and the inventor of dynamite. Nobel recognized the destructive power of dynamite, but hoped that such power would lead to an end to warfare. However, dynamite was quickly exploited to develop newer, more deadly weapons. Not wanting to be remembered as the merchant of death, an epitaph given him by a French newspaper in a mistaken obituary, Nobel wrote his will such that it would establish prizes in physics, chemistry, physiology or medicine, literature, and peace to those who, during the preceding year, shall have conferred the greatest benefit on mankind. A sixth category, economics, was added in 1969. It took some time to implement Nobels wishes. The first Nobel prize was awarded in 1901, which was five years after Alfred Nobels death. Note that the Nobel prize can only be won by individuals, there can be no more than three winners in a given year, and money is split equally between multiple winners. Each winner gets a gold medal, a sum of money, and a diploma. Here is the list of the Nobel laureates in Chemistry: Nobel Prize in Chemistry Year Laureate Country Research 1901 Jacobus H. vant Hoff Netherlands Discovered laws of chemical dynamics and osmotic pressure in solutions 1902 Emil Hermann Fischer Germany Synthetic studies of sugar and purine groups 1903 Svante A. Arrhenius Sweden Theory of electrolytic dissociation 1904 Sir William Ramsay Great Britain Discovered the noble gases 1905 Adolf von Baeyer Germany Organic dyes and hydroaromatic compounds 1906 Henri Moissan France Studied and isolated the element fluorine 1907 Eduard Buchner Germany Biochemical studies, discovered fermentation without cells 1908 Sir Ernest Rutherford Great Britain Decay of the elements, chemistry of radioactive substances 1909 Wilhelm Ostwald Germany Catalysis, chemical equilibria, and reaction rates 1910 Otto Wallach Germany Alicyclic compounds 1911 Marie Curie Poland-France Discovered radium and polonium 1912 Victor GrignardPaul Sabatier FranceFrance Grignards reagentHydrogenation of organic compounds in the presence of finely divided metals 1913 Alfred Werner Switzerland Bonding relations of atoms in molecules (inorganic chemistry) 1914 Theodore W. Richards United States Determined atomic weights 1915 Richard M. Willsttter Germany Investigated plant pigments, particularly chlorophyll 1916 The prize money was allocated to the Special Fund of this prize section 1917 The prize money was allocated to the Special Fund of this prize section 1918 Fritz Haber Germany Synthesized ammonia from its elements 1919 The prize money was allocated to the Special Fund of this prize section 1920 Walther H. Nernst Germany Studies on thermodynamics 1921 Frederick Soddy Great Britain Chemistry of radioactive substances, occurrence and nature of the isotopes 1922 Francis William Aston Great Britain Discovered several isotopes, mass spectrograph 1923 Fritz Pregl Austria Microanalysis of organic compounds 1924 The prize money was allocated to the Special Fund of this prize section 1925 Richard A. Zsigmondy Germany, Austria Colloid chemistry (ultramicroscope) 1926 Theodor Svedberg Sweden Disperse systems (ultracentrifuge) 1927 Heinrich O. Wieland Germany Constitution of bile acids 1928 Adolf Otto Reinhold Windaus Germany Study of sterols and their relation with vitamins (vitamin D) 1929 Sir Arthur HardenHans von Euler-Chelpin Great BritainSweden, Germany Studied fermentation of sugars and enzymes 1930 Hans Fischer Germany Studied blood and plant pigments, synthesized hemin 1931 Friedrich BergiusKarl Bosch GermanyGermany Developed chemical high-pressure processes 1932 Irving Langmuir United States Surface chemistry 1933 The prize money was with 1/3 allocated to the Main Fund and with 2/3 to the Special Fund of this prize section. 1934 Harold Clayton Urey United States Discovery of heavy hydrogen (deuterium) 1935 Frederic Joliot-CurieIrne Joliot-Curie FranceFrance Syntheses of new radioactive elements (artificial radioactivity) 1936 Peter J. W. Debye Netherlands, Germany Studied dipole moments and the diffraction of X rays and electron beams by gases 1937 Walter N. HaworthPaul Karrer Great BritainSwitzerland Studied carbohydrates and vitamin CStudied carotenoids and flavins and vitamins A and B2 1938 Richard Kuhn Germany Studied carotenoids and vitamins 1939 Adolf F. J. ButenandtLavoslav Stjepan Ruika GermanySwitzerland Studies on sexual hormonesStudied polymethylenes and higher terpenes 1940 The prize money was with 1/3 allocated to the Main Fund and with 2/3 to the Special Fund of this prize section 1941 The prize money was with 1/3 allocated to the Main Fund and with 2/3 to the Special Fund of this prize section. 1942 The prize money was with 1/3 allocated to the Main Fund and with 2/3 to the Special Fund of this prize section. 1943 Georg de Hevesy Hungary Application of isotopes as indicators in the investigation of chemical processes 1944 Otto Hahn Germany Discovered nuclear fission of atoms 1945 Artturi Ilmari Virtanen Finland Discoveries in the area of agricultural and food chemistry, method of preservation of fodder 1946 James B. Sumner John H. Northrop Wendell M. Stanley United StatesUnited StatesUnited States Prepared enzymes and virus proteins in pure formCrystallizability of enzymes 1947 Sir Robert Robinson Great Britain Studied alkaloids 1948 Arne W. K. Tiselius Sweden Analysis using electrophoresis and adsorption, discoveries concerning serum proteins 1949 William F. Giauque United States Contributions to chemical thermodynamics, properties at extremely low temperatures (adiabatic demagnetization) 1950 Kurt AlderOtto P. H. Diels GermanyGermany Developed diene synthesis 1951 Edwin M. McMillanGlenn T. Seaborg United StatesUnited States Discoveries in the chemistry of transuranium elements 1952 Archer J. P. MartinRichard L. M. Synge Great BritainGreat Britain Invented distribution chromatography 1953 Hermann Staudinger Germany Discoveries in the area of macromolecular chemistry 1954 Linus C. Pauling United States Studied the nature of the chemical bond (molecular structure of proteins) 1955 Vincent du Vigneaud United States Synthesized a polypeptide hormone 1956 Sir Cyril Norman HinshelwoodNikolai N. Semenov Great BritainSoviet Union Mechanisms of chemical reactions 1957 Sir Alexander R. Todd Great Britain Studied nucleotides and their coenzymes 1958 Frederick Sanger Great Britain Structure of proteins, especially insulin 1959 Jaroslav Heyrovsk Czech Republic Polarography 1960 Willard F. Libby United States Application of carbon 14 for age determinations (radiocarbon dating) 1961 Melvin Calvin United States Studied the assimilation of carbonic acid by plants (photosynthesis) 1962 John C. KendrewMax F. Perutz Great BritainGreat Britain, Austria Studied the structures of globulin proteins 1963 Giulio NattaKarl Ziegler ItalyGermany Chemistry and technology of high polymers 1964 Dorothy Mary Crowfoot Hodgkin Great Britain Structure determination of biologically important substances by means of X rays 1965 Robert B. Woodward United States Syntheses of natural products 1966 Robert S. Mulliken United States Studied chemical bonds and the electron structure of molecules using the orbital method 1967 Manfred EigenRonald G. W. NorrishGeorge Porter GermanyGreat BritainGreat Britain Investigated extremely fast chemical reactions 1968 Lars Onsager United States, Norway Studied the thermodynamics of irreversible processes 1969 Derek H. R. BartonOdd Hassel Great BritainNorway Development of the concept of conformation 1970 Luis F. Leloir Argentina Discovery of sugar nucleotides and their role in the biosynthesis of carbohydrates 1971 Gerhard Herzberg Canada Electron structure and geometry of molecules, particularly of free radicals (molecular spectroscopy) 1972 Christian B. AnfinsenStanford MooreWilliam H. Stein United StatesUnited StatesUnited States Studied ribonuclease (Anfinsen)Studied the active center of ribonuclease (Moore Stein) 1973 Ernst Otto FischerGeoffrey Wilkinson GermanyGreat Britain Chemistry of metal-organic sandwich compounds 1974 Paul J. Flory United States Physical chemistry of macromolecules 1975 John CornforthVladimir Prelog Australia - Great BritainYugoslavia - Switzerland Stereochemistry of enzyme catalysis reactionsStudied the stereochemistry of organic molecules and reactions 1976 William N. Lipscomb United States Structure of boranes 1977 Ilya Prigogine Belgium Contributions to the thermodynamics of irreversible processes, particularly to the theory of dissipative structures 1978 Peter Mitchell Great Britain Studied biological energy transfer, development of the chemiosmotic theory 1979 Herbert C. BrownGeorg Wittig United StatesGermany Development of (organic) boron and phosphorous compounds 1980 Paul BergWalter GilbertFrederick Sanger United StatesUnited StatesGreat Britain Studied the biochemistry of nucleic acids, particularly hybrid DNA (technology of gene surgery) (Berg)Determined base sequences in nucleic acids (Gilbert Sanger) 1981 Kenichi FukuiRoald Hoffmann JapanUnited States Theories on the progress of chemical reactions (frontier orbital theory) 1982 Aaron Klug South Africa Developed crystallographic methods for the elucidation of biologically important nucleic acid protein complexes 1983 Henry Taube Canada Reaction mechanisms of electron transfer, especially with metal complexes 1984 Robert Bruce Merrifield United States Method for the preparation of peptides and proteins 1985 Herbert A. HauptmanJerome Karle United StatesUnited States Developed direct methods for the determination of crystal structures 1986 Dudley R. HerschbachYuan T. LeeJohn C. Polanyi United StatesUnited StatesCanada Dynamics of chemical elementary processes 1987 Donald James CramCharles J. PedersenJean-Marie Lehn United StatesUnited StatesFrance Development of molecules with structurally specific interaction of high selectivity 1988 Johann DeisenhoferRobert HuberHartmut Michel GermanyGermanyGermany Determined the three-dimensional structure of a photosynthetic reaction center 1989 Thomas Robert CechSidney Altman United StatesUnited States Discovered the catalytic properties of ribonucleic acid (RNA) 1990 Elias James Corey United States Developed novel methods for the synthesis of complex natural compounds (retrosynthetic analysis) 1991 Richard R. Ernst Switzerland Developed high resolution nuclear magnetic resonance spectroscopy (NMR) 1992 Rudolph A. Marcus Canada - United States Theories of electron transfer 1993 Kary B. MullisMichael Smith United StatesGreat Britain - Canada Invention of the polymerase chain reaction (PCR)Development of site specific mutagenesis 1994 George A. Olah United States Carbocations 1995 Paul CrutzenMario MolinaF. Sherwood Rowland NetherlandsMexico - United StatesUnited States Work in atmospheric chemistry, particularly concerning the formation and decomposition of ozone 1996 Harold W. KrotoRobert F. Curl, Jr.Richard E. Smalley Great BritainUnited StatesUnited States Discovered fullerenes 1997 Paul Delos BoyerJohn E. WalkerJens C. Skou United StatesGreat BritainDenmark Elucidated the enzymatic mechanism underlying the synthesis of adenosine triphosphate (ATP)first discovery of an ion-transporting enzyme, Na+, K+-ATPase 1998 Walter KohnJohn A. Pople United StatesGreat Britain Development of the density-functional theory (Kohn)Development of computational methods in quantum chemistry (GAUSSIAN computer programs) (Pope) 1999 Ahmed H. Zewail Egypt - United States Studied the transition states of chemical reactions using femtosecond spectroscopy 2000 Alan J. HeegerAlan G. MacDiarmidHideki Shirakawa United StatesUnited StatesJapan Discovered and developed conductive polymers 2001 William S. KnowlesRyoji NoyoriKarl Barry Sharpless United StatesJapanUnited States Work on chirally catalysed hydrogenation reactions (Knowles Noyori)Work on chirally catalysed oxidation reactions (Sharpless) 2002 John Bennett FennJokichi TakamineKurt Wthrich United StatesJapanSwitzerland Developed soft desorption ionisation methods for mass spectrometric analyses of biological macromolecules (Fenn Tanaka)Developed nuclear magnetic resonance spectroscopy for determining the three-dimensional structure of biological macromolecules in solution (Wthrich) 2003 Peter AgreRoderick MacKinnon United StatesUnited States Discovered water channels for transport of water in cell membranesPerformed structural and mechanistic studies of ion channels in cells 2004 Aaron CiechanoverAvaram HershkoIrwin Rose IsraelIsraelUnited States Discovered and elucidated the process of ubiquitin-mediated protein degradation 2005 Yves ChauvinRobert H. GrubbsRichard R. Schrock FranceUnited StatesUnited States Developed the metathesis method of organic synthesis, allowing for advances in green chemistry 2006 Roger D. Kornberg United States for his studies of the molecular basis of eukaryotic transcription 2007 Gerhard Ertl Germany for his studies of chemical processes on solid surfaces 2008 Shimomura OsamuMartin ChalfieRoger Y. Tsien United States for the discovery and development of the green fluorescent protein, GFP 2009 Venkatraman RamakrishnanThomas A. SteitzAda E. Yonath United KingdomUnited StatesIsreal for studies of the structure and function of the ribosome 2010 Ei-ichi NegishiAkira SuzukiRichard Heck JapanJapanUnited States for the development of palladium-catalyzed cross coupling 2011 Daniel Shechtman Israel for the discovery of quasi-crystals 2012 Robert Lefkowitz and Brian Kobilka United States for studies of G-protein-coupled receptors 2013 Martin Karplus, Michael Levitt, Arieh Warshel United States for the development of multiscale models for complex chemical systems 2014 Eric Betzig, Stefan W. Hell, William E. Moerner (USA) United States, Germany, United States for the development of super-resolved fluorescence microscopy 2016 Jean-Pierre Sauvage, Sir J. Fraser Stoddart, Bernard L. Feringa France, United States, Netherlands for the design and synthesis of molecular machines 2017 Jacques Dubochet, Joachim Frank, Richard Henderson Switzerland, United States, United Kingdom for developing cryo-electron microscopy for the high-resolution structure determination of biomolecules in solution