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Miami And New York City - 947 Words

Miami and New York City are cities located at complete opposite sides of the United States. Miami, the city where sunshine, palm trees, and beautiful beaches are the norm, is located in the southern part of Florida. Meanwhile, New York City, famously referred to as the city that never sleeps, is located right in the heart of New York. Both, have numerous compelling similarities, as well as many distinguished differences that give each their own distinct identity. Whether it’s their weather, cultural diversity, their exquisite cuisine, or what they each have to offer, both, are recognized as prominent hotspots which result in their heavy load of tourism annually. Weather is one of the most notable differences between Miami and New York City. Throughout the year, Miamians enjoy warm, sunny days in which the temperature rarely drops below 90 degrees. While the breezy, cool nights remain around the 70 to 80 degree mark. Winter is viewed as part of a fable, and Christmas time consist of lying on the beach, soaking in the radiant sun. Everyday feels as though it is vacation. Conversely, New York City experiences significant differences in temperature. During the summer, New York City’s weather mirrors that of Miami’s warm climate. However, the weather during the winter is a whole another story. The days and nights consist of freezing temperatures, which at times, can even fall into the negatives. The heavy snowfalls create a thick blanket of snow which covers the whole city,Show MoreRelatedUnderstanding The True Value Of Something911 Words   |  4 Pagesseeking, which is in the ballpark of 6 to 8 times its $800 million EBIDTA. Real Estate 89th and 90th floors of One57, the high-end apartment tower overlooking Central Park at 157 W. 57th St New York City rent and apartment prices are fair because they can be justified from the bottom’s up. 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Financial Performance of Coles & Woolworths-Samples for Students

Question: Discuss about the Financial Performance of Coles Limited and Woolworths Limited. Answer: Introduction Coles Limited is one of the largest retail sector companies in Australia. The market capitalization of Coles Limited is larger to that of Woolworths Limited. Both Coles Limited and Woolworths Limited exhibit strong financial health (Wesfarmers.com.au. 2017). One of the study measures that the ability of these companies is to absorb shock to its operations that need to find out what went wrong at a ready or functional stage. In addition, companies with strong economic heath score mainly tend to have a healthy balance sheet as well as regular earnings that underpins by strong operating cash flow (Woolworthslimited.com.au. 2017). In the given patter, it is noted that both the business display high levels of total liabilities as compared to total tangible assets. Companies that exhibit a high total tangible assets ratio are considered to be more vulnerable to fiscal difficulties as an increase in borrowings that limit the skill for absorbing impact in the incident of the recession in tra ding activities (Wong and Yeung 2014). Analysis Annual reports in conformity with conceptual framework and AASB standard requirements Coles is a retail based company that strictly adheres with the AASB and conceptual framework (Wesfarmers.com.au. 2017). They properly follow the approaches that are mention in the Exposure Draft itself. This company follows the Exposure Draft requirements as presented in the financial statements and analyzed in the business systems and reports. Coles Limited accepts invitation and participates in IASB outreach programs such as recent lease projects (Weygandt, Kimmel and Kieso 2015). On the other hand, Woolworths Limited is a company that provides opportunity to the investors where they discuss the matter as mentioned in the initial comment letter (Woolworthslimited.com.au. 2017). In that way, the comment letters actually deals with property leases in accordance to future rental standard. The business believes in treating all leases as financial alternatives that pertains to attainment of financial realism. This business follows IAS 17 for on-balance sheet identification of leases that is used specifically for secretarial action. It is all about looking at the economic aspect like continuing supply preparations and repair agreement (Weil, Schipper and Francis 2013). Conceptual framework amendment including Prudence for addressing discrepancy in Corporate Reporting Both Prudence and reliability in conceptual structure explain the concept after addressing the disparities that are mentioned in the corporate reporting likewise. There are several options that help in addressing the disparities and looking at the accountability options as well as presenting the financial statements in a fair way (Van Deventer, Imai and Mesler 2013). Companies need to apply strategies that best suit or align with the financial statement as it will improve the level of understanding by the financial users. It is noted that there are disparities in the financial statement that need proper attention after accounting issues and fair representation of financial statements. These need to be present by abiding with the rules of AASB Standards and IASB through IFRS (Wesfarmers.com.au. 2017). To explain the concept of Prudence in detail, it is important to gain proper or reliable financial information that will help the potential financial users at the time of decision-making process (Woolworthslimited.com.au. 2017). In that way, Prudence in financial statements means presenting the financial statement in fair manner in relation to a given company. It is important that the financial declaration represents a true and fair view of monetary position and even the operational aspects for the companies for given point of time. It majorly relates with the corporate reporting as well as governance for companies (Robson, Young and Power 2017). Comparing and contrasting figures from the annual reports of Coles and Woolworths Limited Coles Limited enjoys net profit of 6.1% after excluding net asset sales. To that, the pre-tax earnings for the company arrive at $167 billion (Wesfarmers.com.au. 2017). Coles Limited occupies the topmost position in the retail sector and their supermarkets has enjoys profit percentage as a whole. On the contrary, Woolworths Limited enjoys net profit that amounts to $60.8 billion (Woolworthslimited.com.au. 2017). The company eventually raises ways for the normalized earnings that deals with categories such as food, petrol and liquor. The liquor sale generates revenue at 4.6% that is worth $7.4 billion. As far as hotels are concerned, it delivers $1.47 billion for given period of time. On comparison, it is noted that Coles Limited has shaded Woolworths Limited from the investment perspective in current financial years (Wesfarmers.com.au. 2017). It is in accordance to Stock Doctor Database where Coles Limited generates total return after dealing with the capital gains and adding up dividends that arrives at a percentage of 15.8 for previous months. Coles Limited, in a way actually delivers 20% starting from 1 year to 5 years of time span. On the other hand, Woolworths Limited generates revenue at 6.8% for 12-month returns for specific financial years. In that way, Coles Limited slumps at 23% and direct with the losses that are less than 2% on yearly basis (Miller and Shawver 2016). Identification of disclosures of Coles and Woolworths Limited The operating revenue of Coles Limited for the year 2016 rose by 3.7% to $62.4 billion that is drive by solid assistance from the supermarkets (Wesfarmers.com.au. 2017). Furthermore, in the headline growth, there need improvement to gain operational efficiency that denotes an augment in the earnings before interest and tax margin from 5.8% to 6.1% when it is compared to past consequent period. While looking at the margin improvements, it is observed that core operating segments of the company improves over the supply chain as well as get access to efficient management of working capital at the same time. In that way, earnings per share arrives at 16.8% as well as return on assets improved by 7.9% to 8.7% that reveals an increase in prepared competence (Wesfarmers.com.au. 2017). Woolworths Limited, on the other hand, operating revenue declines by 0.14% to $60.87 billion because of petrol sales, hotel revenues as well as poor general merchandise that contribute to decrease in its headline result (Woolworthslimited.com.au. 2017). The net profit after tax of the company increased by 0.10% to $2.45 billion after normalizing the impacts of alteration costs as well as idleness expenses In addition, the expenses eventually do not translate into getting asses to positive EPS growth that declines at 0.15% because of the shareholder base. As far as asset utilization is concerned, return on asset declines down from 14.52% to 13.79% that shows decrease in operational efficiency (Macve 2015). The management teams for both the companies practically failed to supply the market with quantitative direction for the year 2016. Hence, the qualitative expectations could have been easily gleaned from supervision shareholder performance. At Coles Limited, the supermarket business aims at maintaining its relative outperformance after comparing it with the major peers. In that way, further investment can be done by lowering the prices that is expected and that can drive or look into the customer transactions as well as sales density and basket size. Improvement is needed at the store network of Coles Limited and online platform as it provides the backdrop especially for increased customer interaction. It give a sense of optimism while looking at Coles Limited as the company maintains a degree of prudence for the Industrial and Resources business that displays mixed presentation for the year 2016 (Wesfarmers.com.au. 2017). Woolworths Limited, on the other hand, the outlook of the company remains more clouded. It is the management of the company that shows margins in the Australian, food, liquor and petrol division will actually gets negatively affected by the reinvestment into price as well as customer service with the investments of being most viable in the financial year 2016 (Woolworthslimited.com.au. 2017). Coles Limited is trading in price earnings ratio of 16.5 times as compared to its industry average of 15.8 times. In that way, it makes the investors to be ready to pay for a trade that is higher on escalation forecast (Wesfarmers.com.au. 2017). On the contrary, Woolworths Limited is trading on price earnings ratio of 13.7 times. In this way, the reduction to the business explains the expectations of the market for lower future growth as margin compression from price deflation as well as increasing costs that forecasts to guide future working perspectives (Hoyle, Schaefer and Doupnik 2015). Both Coles Limited and Woolworths Limited had maintained stable dividends that benefit the income-oriented investors by rendering reliable above-market yields (Woolworthslimited.com.au. 2017). Both the companies has the ability to retain high levels of dividends distributions in the near future where Coles Limited earning constancy prompts to suggest as a Star Income Stock (Beatty and Liao 2014). Coles Limited announced a final dividend payment that is fully franked and brought as full-year ordinary dividend at 5.3% on the past corresponding year (Wesfarmers.com.au. 2017). It helps in translating to a grossed dividend yield of 7.3% that shows Coles Limited as attractive investments especially for the income-oriented investors. It is therefore believed that the level of distribution remains sustainable as it gives solid earnings as well as robust cash flows in the most appropriate way. Woolworths Limited, on the other hand, declares a final fully franked dividend that brings about total distribution for 2016 from the past corresponding period (Woolworthslimited.com.au. 2017). It mainly highlights an above market yield of 8% where the lower expected earning help in translating into volatile cash flows. It mainly hampers the ability for paying reliable above-market distributions. The sale and leaseback will help Woolworths Limited for dealing with the cash as it translates to higher rental costs in the year 2016 and puts more pressure on cash flow. The low share price as well as high yield of Woolworths Limited indicates a dividend trap for unsuspecting investors (Hoskin, Fizzell and Cherry 2014). On comparing both the companies based on last 12 months, Coles Limited delivers 10.56% loss and Woolworths Limited faced 29.92 losses after excluding the dividends. For a period of three years, Coles Limited outperforms Woolworths Limited that delivers 12.80% and 13.70% (Drury 2013) Information gathered from Annual report and conducting a comparison between Coles Limited and Woolworths Limited Financial Health Both Coles Limited and Woolworths Limited exhibit strong financial health. Both the companies actually shows narration of strong operational cash flows that counteract some of the balance sheet risk as increased liquidity allows for better liability for funding future capital expenditure as well as debt repayments. Both the companies are ranked strong in terms of financial health as well as display healthy productivity and cash flow ratios at the same time (Wesfarmers.com.au. 2017). Management assessment Coles Limited is the winner over Woolworths Limited because of financial performance of Coles Limited for the year 2016. Coles Limited had achieved healthy revenue growth. Woolworths Limited, on the other hand, achieved a result in line with administration leadership as well as modest earnings development in core food, petrol segment and liquor that was considered as offset by earnings that declines in general merchandisers and hotels and future losses for home development (Edwards 2013). Outlook and forecast Coles Limited wins over Woolworths Limited as Coles Limited experiences robust results from the sale of supermarkets that offset the weaker performances from industrial as well as resources. Woolworths Limited, on the other hand, the company faces management issues and deficit of the supermarkets and home development segment as it weight on short-term performance where the prospects of the company are likely to be constraint for the year 2016. Share price value Woolworths Limited wins over Coles Limited. The company is perceived to be underdog as well as optimistic structural changes may ensure when a new CEO is appointed. In addition, price discount is applicable that provide a chance for those who are willing to back a turnaround (Wesfarmers.com.au. 2017). Total Returns From dividend-yield perspective, Coles Limited wins over Woolworths Limited. Coles trumps Woolworths Limited by providing the shareholder with higher dividend yield as well as capital returns on specific scenario. Coles Limited leads from a total return standpoint in and across all periods that underscores the best investors that quality to staple earnings growth as well as sound capital organization (Gassen 2014). Taxation Coles Limited follows incentives metrics policies while Woolworths Limited follows redesigning of increased level of transparency. shareholders should invest in Coles and Woolworths Limited Both Coles Limited and Woolworths Limited are supermarket giants and faces tough competition from each other. It is not important to discuss that where should investment done, it is for Coles Limited or Woolworths Limited. On analysis, it is noted that Wesfarmers Limited is preferred by the customers when it comes to consumer staples. From price-to-value perspective, Woolworths Limited presents larger upside potential. On the contrary, Coles Limited indicates better historical working performance as well as dividend yield and returns to shareholders. It is believed that Coles Limited has the skill to convey higher earnings growth that would maintain its better dividend yield in relation to Woolworths Limited in the near future irrespective of any challenge faced in the business (Horton 2017) Conclusion Entire study highlights the facts and information about the retail sector companies based in Australia such as Coles Limited and Woolworths Limited. Comparison had been done at each section starting from financial performance, share price valuation, total revenues and management assessment. To each of the evaluation, proper recommendation had been made regarding which company proves to be best in the near future. The study even highlights about whether both Coles Limited and Woolworths Limited adheres by AASB Standards and Conceptual framework. Information had been gathered from annual reports of Coles Limited and Woolworths Limited for the year 2016 that is relevant, reliable and valid. Reference List Beatty, A. and Liao, S., 2014. Financial accounting in the banking industry: A review of the empirical literature.Journal of Accounting and Economics,58(2), pp.339-383. Drury, C.M., 2013.Management and cost accounting. Springer. Edwards, J.R., 2013.A History of Financial Accounting (RLE Accounting)(Vol. 29). Routledge. Gassen, J., 2014. Causal inference in empirical archival financial accounting research.Accounting, Organizations and Society,39(7), pp.535-544. Horton, J., 2017.Advanced Financial Accounting and Reporting: Theory, Practice and Evidence. Routledge. Hoskin, R.E., Fizzell, M.R. and Cherry, D.C., 2014.Financial Accounting: a user perspective. Wiley Global Education. Hoyle, J.B., Schaefer, T. and Doupnik, T., 2015.Advanced accounting. McGraw Hill. Macve, R., 2015.A Conceptual Framework for Financial Accounting and Reporting: Vision, Tool, Or Threat?. Routledge. Miller, W.F. and Shawver, T.J., 2016. The Potential Impact of Education on Whistleblowing Behavior: Benefits of an Intervention in Advanced Financial Accounting.Journal of Business Ethics Education,13, pp.67-90. Robson, K., Young, J. and Power, M., 2017. Themed Section on Financial Accounting as Social and Organizational Practice: Exploring the work of financial reporting.Accounting, Organizations and Society,56, pp.35-37. Van Deventer, D.R., Imai, K. and Mesler, M., 2013.Advanced financial risk management: tools and techniques for integrated credit risk and interest rate risk management. John Wiley Sons. Weil, R.L., Schipper, K. and Francis, J., 2013.Financial accounting: an introduction to concepts, methods and uses. Cengage Learning. Wesfarmers.com.au. 2017.Reports. [online] Available at: https://www.wesfarmers.com.au/investor-centre/company-performance-news/reports [Accessed 14 Aug. 2017]. Weygandt, J.J., Kimmel, P.D. and Kieso, D.E., 2015.Financial Managerial Accounting. John Wiley Sons. Wong, S.T. and Yeung, C.S., 2014.Advanced Financial Accounting. Pearson Education Asia Limited. Woolworthslimited.com.au. 2017.Reports - Woolworths Limited. [online] Available at: https://www.woolworthslimited.com.au/page/Invest_In_Us/Reports/Reports [Accessed 14 Aug. 2017]

Staffing Nursing and Health Care free essay sample

Nyeri general hospital was started in the early 1930s as a military hospital. its is now a provincial hospital owned by the ministry of health. its located in central pronvice ,nyeri county . its one of the major hospitals serving the population of nyeri county. it consists of various departments such as out patient ,medical –surgical , orthopaedic ,intensive care unit ,maternity and gynaecology ,paediatrics , psychiatric ward ,eye clinic ,ENT clinic ,thetere ,laboratory ,pharmacy and radiological departments. it offers various services ranging from curative ,preventive ,promotive ,rehabilitative and supportive services . the hospital comprises of different healthcare workers that collaborate with each other to offer quality care to the patient . the hospital is not only a referral centre for the critical cases but also acts as a medical training for both diploma nurses and clinical officers . Hospital vision A referral centre of excellence offering comprehensive healthcare services Hospital mission To improve the health and welfare of population ion the region by offering affordable ,equitable and accessible health care services through the provision of specialized ,quality health care ,medical training and research. We will write a custom essay sample on Staffing: Nursing and Health Care or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Problem statement Introduction Nurses play a very important and vital role in most health systems, and their contribution is recognised as essential to meeting developmental goals and delivering safe and effective care. One difficulty in making an accurate global estimate of numbers of nurses . The nursing shortage is a global challenge, affecting each and every country in the world. With this shortage, patients are suffering because the healthcare workforce is not prepared to deal with their health needs. Each country have several factors such as aging nursing workforce and low employment,contributing to nursing shortage which ultimately cause a decrease in the quality of health care provided to the patient. A nursing shortage is not just an organizational challenge it has a major negative impact on health care Failure to deal with a nursing shortage will lead to failure to maintain or improve health care There has been an increase need for more registered nurses in hospitals due to rising acuity of patients and shorter lengths of stay. The safety and quality of patient care is directly related to the size and experience of the nursing workforce therefore insufficient number of nurses will not only affect patient care and safety but also the nurses themselves become overwhelmed, distressed, and dissatisfied. High patient-to-nurse ratios have been shown to lead to frustration and work burnout, which is linked to higher turnover. inadequate number of nurses has been linked with poor patient outcomes. some studies have been carried out and has demonstrated that the shortage of registered nurses, in combination with an increased workload, poses a potential threat to the quality of care. Increase in the number of nurses was associated with a reduction in hospital-related mortality and failure to rescue as well as reduced length of stays. In the past ,hospitals received help from both voluntary and employed staff. This success did not last for long since it was periodically interrupted by short-term shortages, especially shortages of nurses. recently the hospitals find themselves facing both immediate and long-term shortages of personnel therefore it will be more severe and have a longer duration than has been previously experienced. For sustained change and assurance of an adequate supply of nurses, solutions must be developed in several areas: education, healthcare deliver systems, policy and regulations, and image. This shortage is not solely nursings issue and requires a collaborative effort among nursing leaders in practice and education, health care executives, government, and the media According to the country-level policy perspective, a nurse staffing shortage is usually defined and measured in relation to that country’s own historical staffing levels, resources and estimates of demand for health services. WHO concluded that the shortage crisis has the potential will worsen in the future . It noted that demand for service providers will escalate markedly in all countries – both developed and undeveloped. Literature review Staffing is an important function of management which mostly deal with the recruitment, selction orientation ,induction and promotion of employees at the work place . Components of staffing Staffing pattern-itrefers to how many people of job classification should be on duty per each unit ,per shift ,per day. Staffing plan-it indicates how many people of what job classification mustbe hired to deliver on the staffing pattern. Staffing patterns are built on 2 assumptions Each given unit wil continue to admit the same type of patients in the same numbers for the total period in which staffing pattern is in effect. The patients needs is averaged out per unit on a daily basis . If staffing fails it leads to alteration in patient acquity levels ,actual patient day ,assignment systems ,nursing care goals and nursing care delivery. staffing is measured in one of two basic ways: Nursing hours per patient per day because payroll processing requires this information. They exclude paid time off for illness, vacation, or continuing education The nurse to patient ratio Variables affecting nursing staffing patterns Nursing organisationla factors-patient care objactives Determined level of patient care Nursing divisional departments Patients factors Variety of patient conditions Acuity Lengh of stay Patient age ,general health ststus and the number Staff factors Job description Educational level Experience Work ethics and groups Health care organisational factors Support services Personnel p[olicoes Financial resources Staffing patterns According to WHO -There is no absolute norm regarding the right ratio of physicians or nurses to population. This depends on (1) demand factors, e. g. demographic and epidemiological trends, service use patterns and macro-economic conditions; (2) supply factors, such as labour market trends, funds to pay salaries, health professions education capacity, licensing and other entry barriers; (3) factors affecting productivity, e. g. technology, financial incentives, staff mix, and management flexibility in resource deployment, and (4) priority allocated to prevention, treatment and rehabilitation in national health policies.  one would expect that relatively high nurse staffing ratios to be associated with improved patient outcomes, and if this intuition is correct, these patient benefits should be a key consideration in the determination of nurse staffing levels. In most health care settings nurse staffing is measured according to the workload of each nurse, Most hospitals can easily report the average number of productive nursing hours per patient day because they keep data on nursing hours and patient days. However, many health care leaders and managers prefer to conceptualize workload as a nurse-to-patient ratio. Although the way this measure is stated implies that a single nurse has responsibility for a set group of patients, this might not be the case. Hospital nurse staffing is a matter of major concern because of the effects it can have on patient safety and quality of care therefore the hospital should ensure that there are sufficient numbers of qualified nursing staff to meet the nursing care needs of the patient. The nurse workforce consists of licensed nurses—registered nurses (RNs)- have obtained their education through three different routes: 3-year diploma programs, 2-year associate degree programs, and 4-year baccalaureate degree programs.  they assess patient needs, develop patient care plans, and administer medications and treatments. licensed practical nurses (LPNs)- receive training programs of about 18 months that emphasize technical nursing tasks. They carry out specified nursing duties under the direction of registered nurses . nurses aides (NAs)- are not usually l icensed but many acquire certified nurse aide or nursing assistant status after proving they have certain skills related to the requirements of particular positions. they typically carry out non-specialized duties and personal care activities. Both registered and licensed practical nurses are licensed by the State in which they are employed. all these nurses provide direct patient care. Registered nurse hours per patient day andtheir skill mix were positively related to intensity of patient care, hospital complexity, and the supply of RNs in the geographic area surrounding the hospital. Licenced pratical hours, and licensed skill mix were predicted less reliably but appear to be used as substitutes for RNs. Overtime hours increased in areas with a lower Registered nurses supply.turnover rates and the use of contract nurses were not affected by nurse supply. Shortage of nurses Nurses have varied educationand practice competencies which bring different skills to patient care, and they must be able to practice to the fullest potential of these capabilities therefore practice environments must recognize and reward these differences by defining nurses roles, and by utilizing and compensating nurses according to their different educational preparation and competencies. Historically shortage of nurses were shortterm but todays shortage is different because It is the beginning ofa long-term shortage. It reflects fundamental changes in the relative attractiveness of careers in hospitals, increased competition from non-hospital employers for caregivers and support personnel, and the aging and pending retirement of the old experienced nurses . Nowadays nursing shortage is evidenced by fewer people training to be nurses therefore there is a growing realization that the supply of appropriately prepared nurses is inadequate to meet the needs of a diverse population and that this shortfall will grow more serious in the near future. A nursing shortage is usually defined and measured in relation to a country? s historical staffing levels, resources and estimates of demand for healthcare services (Buchan Aiken, 2008). Thus, nursing shortages are not easily quantifiable, and they may be defined in terms of professional capacity standards shortage of nurses that are needed to provide quality services or from an economical perspective. Evolution of nurse shortage is due to the following Time over Money Employees today seek more personal time versus financial compensation. Professional versus Personal Role Employees want to be active both at work and at home, not choosing between the two. Rising Superclass of Employees As more employees opt for less stressful work/more personal time, a subgroup of employees, often characterized as more driven, are carrying the load of travel, relocation, and long hours Integration of Home and Work Employers are increasingly offering services to reduce the stress of managing professional and personal lives. These services include child and elder care, dry cleaning, housecleaning, on-site full service banking, and yard care. Gen X Entrepreneurs Employees in their twenties and thirties view the workplace differently, preferring greater autonomy and less bureaucracy. They are loyal to the work versus the employer. Thus, many are choosing independent work/freelancing, such as the temporary agencies in health care. Implications for Hospitals and Health Systems Due to the currently long term shortage of nurse staff The Strategic Planning Policy Committee believes there are seven major implications for hospitals and health systems, plus issues that hospitals, health systems, and associations should consider. Health care is generally about people caring for people. It depends upon appropriate numbers of motivated and well –trained heath care workers caregivers and support personnel. Hospitals leaders must increasingly recognize personnel as a strategic asset, different from, but as important as, adequate payment, capital acquisition, and market share. New technologies which allow staff to emphasize the care-giving and care-supporting functions of their positions are essential for hospitals to attract, develop, and retain employees. The workforce will only expand if hospitals attract staff from the economy generally. Concerted efforts are needed to increase the attractiveness of health careers relative to other employment options if the health care workforce shortage is to be corrected. New work arrangements require a broader perspective on employee relations to build loyalty and create a sense of stability. Some employers are looking to unionization and collective bargaining as a means of increasing their sense of stability. Educational systems need hospital involvement to help identify skills and capabilities in demand in the labor market. Important Issues for Consideration by Hospitals and Health Systems Health care executives need to adopt a long-term time strategy for workforce supply. To correct the shortage, they must assure that the hospital has the power to focus on workforce for the full education, recruitment, career development and retention of employees . Health care management teams need to recognize that the supply, development, and satisfaction of health care workers and supportive personnel is a critical success factor for the organization.. Hospital leadership generate innovative ideas that establish a competition at the work environment, including information technologies that reduce manual documentation and repetitive administrative task ,work schedules that provide more employee flexibility and work roles which emphasize professional competencies and contributions rather than those defined by bureaucracy, administrative procedures, and regulatory requirements. hospitals and health systems will have to create the capacity to develop the staff skills necessary for their survival.clinical and non-clinical education and career development programs upgrade skills and help personnel transition from one career to another it is one of the success factors for hospitals and health systems. Hospitals have always supported continuing education, especially for physicians and nurses. The emphasis on continuing education and career development opportunities needs to be extended across all occupational groups and deepened. Individua l hospitals and health systems may only be able to develop effective programs through collaboration with one another and/or through joint programs with colleges and universities. They should uyilse the new technology to enhance continued medical education. Hospitals need to consider innovations that encourage present staff to obtain additional training and enter new careers in order to facilitate career development, upward mobility, and increased employee tenure. Hospitals and health systems need to broaden their workforce initiatives to reach populations that have not usually been employed throughout health care. Regional initiatives that combine the efforts of multiple institutions are needed as well as individual hospital initiatives.since most of the nurses are women the majority are found only in the lower paying positions. Meeting the workforce challenge will require expanding the boarders of interested persons to reflect fully the diversity of the society. As society becomes more diverse and patients come from an increasing number of racial, ethnic, and national backgrounds, hospitals need to recruit a more diverse workforce that can readily understand, relate to, and communicate with their patient population. compensation strategies need to be reviewed and evaluated despite of the economic pressures faced by hospitals.\hospital works are quite demanding therefore these occupations often require advanced education and continuing training. Unless hospitals provide compensation that is comparable to positions with similar education and responsibility, some potential workers will seek other positions. some hospitals have provided large-numbers of employees with stock ownership as a means of attracting, retaining, and improving the productivity of their employees. As business increasingly uses stock to compensate employees, non-profit hospitals without the opportunity to provide stock options mustdevelop other benefits and compensation approaches to remain competitive. Hospitals and health systems, individually and collaboratively, need to consider establishing new relationships with school, colleges, and universities . while collaborating with these learning institutions then they will be able to increase exposure to hospital careers to the students . Factors contributing to shortage of nurses inadequate workforce planning and allocation mechanisms therefore creating a mismatch between education supply and service based funded demand. Inadequate financial resources which leads to undersupply of new staff. poor recruitment and retention of the nursing staff by the hospitalleading to Increasing demand At this same critical juncture there are large numbers of nurses retiring and are unable to recruit and educate enough nurses to replace them, the baby boomer generation is aging and requiring more healthcare, putting additional strain on an already overburdened healthcare system. ineffective use of available nursing resources through inappropriate skill mix and utilization. Fewer people choosing nursing as a profession. Nursing has traditionally been one of the few female professions. Today, women have more and better professional opportunities and fewer are choosing nursing. Retirement of baby boomer nurses. At the same time that fewer nurses are entering the profession, many are leaving due to retirement. . Nurses quitting the profession due to burnout is reaching epidemic proportions for the same reasons that it is difficult to attract new nurses to the profession. Nursing is exceedingly stressful, physically demanding and exhausting. poor incentive structures or appraisal systems which demotivate the nurses . inadequate career support concerning nursing . other contributing factors include the continued existence of gender-based discrimination in many countries and cultures with the perception that nursing is women’s work. persistence of lawsuits against health workers in many developed countries with nurses often taking the blame because they are the ones who mostly spend most of the time with the patient. Effects of nurse shortage The shortage of nursing staff s have several effects on patient care as wellas the healthcare sector;these include the heavy workload on hospital nurses. Nurses are experiencing higher workloads than ever before due to the following reasons- increased demand for nurses inadequate supply of nurses. reduced staffing and increased overtime reduction in patient length of stay. Studies show that a heavy nursing workload not only affects patient safety but also negatively affects nur sing job satisfaction and, as a result, contributes to high turnover . Quitting of job by the recently employed nurses due to job dissatisfaction and disappointment. Strategies to reduce nurse shortage in the hoaspital According to the ICN (2005) major reform needs to take place within five key areas for policy intervention to improve the global nursing shortage. The five key areas of reform are: 1) macroeconomic and health sector funding policies, 2) workforce policy and planning, including regulation, 3) positive practice environments and organizational performance, 4) retention and recruitment, and 5) leadership Hospitals have developed both short-werm and long –term strategies to reduce the shortage of nurses.these strategies include development of a responsible action plans for delivering patient care in the face of staff shortages that address the following: Attracting and retaining qualified staff by addressing issues important to today’s workforce, including strengthening the patient/clinician/executive partnership, treating each other with respect, promoting continuous quality improvement, and providing fair compensation, flexible scheduling and professional development; Maintaining workloads and expectations that strive to alleviate and prevent burnout; Examining work stream processes to ensure staff is being deployed in an effective manner to meet patient needs; Creating systems for job assignments and backup coverage that ensure responsibilities are appropriately matched with qualifications; Being sensitive to the financial and nonfinancial consequences o f utilizing temporary personnel to fill vacancies; Responding to potential disasters that would significantly impact staff availability over sustained periods, requiring multilevel backup capacity; Conducting employee opinion surveys and exit interviews, using results to identify steps to improve job satisfaction; Identifying ways to engage employees to help define and address issues adversely affecting recruitment and retention objectives; Maintaining a diverse and culturally competent work force; Analyzing departments or units with high turnover rates to determine whether management shortcomings, working conditions, and/or other factors may be contributing to staff morale problems; Exploring, evaluating and implementing best practices from similar organizations that could be helpful in avoiding staff shortages; and Closing units or diverting patients if staff shortages become severe, to ensure that patient care is not compromised and high-quality care is maintained. Attracting new people to the profession- Although this has been the first and only strategy needed to correct past nursing shortages, it is not the first thing we need to do this time. We currently have more qualified applicants to nursing schools than we can educate. As we correct other problems, however, we will need to attract bright young people—and especially men—to the profession. Nursing must become as attractive a career option as other professions. Recruiting inactive nurses-. Inactive nurses are a neglected reservoir of educated, experienced professionals. Educating nursing educators- The lack of nursing educators is a huge problem in solving the nursing shortage. We must create incentives that will attract graduate-level nurses into education. That includes increasing educator salaries so that colleges can compete with other employers and subsidizing advanced education for nurses who commit to teaching for a period of time. Improving nursing’s image- There are two national media campaigns that focus on attracting people to the nursing profession. Both are educating people about the nursing profession and eliminating inaccurate stereotypes about nurses. These are an excellent first step toward improving nursing’s image. We must also improve salaries and benefits and allow nurses more control over what they do. increase recognition that human resources are a core, strategic resource of hospitals so that people may be aware that human resourse affect the care of a patient recruitment of new nurses and improving the retention of nurses tat the hospital will help reduce thatshortage design work patterns and employment practices attractive to today and tomorrows workforce while improving performance and productivity; encouraging promotion and performance appraisal at the work place-this will help in the retention of healthcareworkers at the hospital and therefore reduce the shortage . Case scena rio Nyeri provincial general hospital has a total number of 513 personnel against the establishement of 700. the hospital does not sufficient number of staff intwerms of number and requisite skills to meet the its service delivery . the hospital still continues to experience a shortage across all cadres . mostly the shortage of nurses ,surgeons and radiographers . The nursing staffing pattern in the hospital The nursing staffing patterns in the hospital include Senior nurse officers (SNOs)-most of them are the ward incharge who ensure that the wards are operating smoothly and they are concerned with the general management of the ward . Kenya registered community health nurse –(KRCHN) theses are nurses who have acquired their training in General Nursing, Midwifery and Community Health. The Nurses are empowered with proper knowledge, skills and attitudes to promote health, prevent illness, manage and rehabilitate the individual, the family and the community that may be afflicted by ill health. The duration of study is 3 1/2 Years. Kenya enrolled community health nurses –KECHN-are trained at certificate level in accordance with the Nurses Act Cap 257 of the laws of Kenya and the regulations thereto (or any other nurse whose training and qualifications are recognized and equated at certificate level by the Nursing Council of Kenya) and whose name shall appear in any of the Rolls maintained by the Nursing Council as required by the Act. Bachelor of science in nursing interns –they usually are trained to be nurse educators ,administrators or even researchers . the duration of study is 4 years The shortage of nurses at Nyeri PGH According to my case study I focused on the shortage of the nurses in the hospiotal – The shortages is diverse in that it ranges from shortage of nurse to the other health care workers in the hospital therefore limiting the care offered to the patients . The shortages of other staff are adversely impacting nurses who have the most continuous and closest relationship with patients and their families Without sufficient numbers and quality of nurses and other health careworkers it would be difficult to meet the health care needs of the people. The total number of nurses is 310 while the ideal number of nurses should be about 420 . the shortage that exists is of about 110 nurses . From my analysis here are the number of nursing staffs findings of Nyeri provicila genrral hospital Nurses Norms Available deficit KRCHN 153 110 43 KECHN 171 145 26 For the BSN –they were 15 in total bt the hospital did not indicate how many BSN they needed as for the senior nurse officers they were 41 in total .from the my calcuklation the average approximate number of nurses were in each ward were 12 . this number was too low as compared to the number of patients admitted in that ward. Gaps Gap Between Supply and Demand for Registered Nurses Shortage is the gap between the reality of current availability of nurses and the aspiration for some higher level of provision shortage . hospital require adequate healthcare workers not only in terms of number but also they shoulh have the appropriate skills needed so as to deliver quality care to the patient. shortages exists among all the health care workers but critical gaps exist in the nursing department.the number of nurses are inadequate to meet the patient need. this shortage is not only experienced in this hospital bt also in the other health care settings at different countries . the demand for nurses in the healthcare setting is high but the supply is low in that the number of nurses enrolled are not adequate enough to meet the patient needs. this gap is widening since most of the old nurses are nearing to retire but there are no enough new nurses to recruit inorder to replace them . this issue will have negative consequences on the nursing department therefore stsrategies nned to be put in place to deal with this issue before it gets worse in the near future .a gap between patient need and the nursing care available to meet patient needs. This gap occurs because patients now remain in the hospital only as long as they are acutely ill and clearly in need of nursing care. Once these very acute care needs are met, patients are discharged. Soon other patients, likely with even higher acuity needs, will be admitted to these beds previously occupied by the recently discharged patients. A greater proportion of beds will then be filled by patients with very high acuity needs. Unfortunately, hospitals have not kept up with the need to provide more nurses to care for this increased number of patients requiring higher acuity care. This gap has led to discussions regarding the quality and safety of hospital nursing care currently provided. The increasing intensity of care, due to a greater number of invasive procedures, more powerful medications, and a growing number of patients with chronic acute illness, has markedly increased the intensity of nursing care needed. Recommendation I would recommend for the following strategies to reduce the shortage of nurses at the hospital-developing a human resourse plan that will ensure that the hospital is adequately staffed with the appropriate skill mix to the level that is commensurate withj the existing human resourse capability need. Developing and implementing an intergrated performance management system to enhance improved and sustainable productivity. it will focus on the overall performance of the hospital to find out whether are any performance improvement. Deveopling a human resourse information system that is linked to a hospital –based health management information system to strengthen planning and decision making. Development of policies inorder to increase the recruitment and retention of young adults into the nursing profession. These strategies will come up with Strategies for recruitment of new nurses are needed for the long term . Another critical area for policy intervention  is to achieve effective skill mix-through clarity of roles and a better balance of registered nurses, physicians, other health professionals, and support workers. Nurses should also shape the impression that others have about the profession. –Nurse managers and leaders can be helpful by starting an organization al campaign to educate their staff about how to communicate in social and community settings so as to encourage people to join the nursing profession. Each nurse is the most important recruiter for an organization Healthcare mangement team including nurse leaders must learn new skills for valuing employees since Retention of nurses begins with how the organization does or does not value the staff. with these skills they will reduce the incidencs of shortages in the hospital. Education Developing career progression initiatives to: Move nursing graduates through graduate studies more rapidly; Identify the range of options available beyond the entry-level role such as faculty, researcher and administrator. Institute an education and practice system to promote more equitable compensation in the health care community based on a better understanding of the educational preparation required for different health care roles. Support health care employers to create and sustain staff development programs and lifelong learning for continued competence. Reach out to youth through counselors, youth organizations, schools and other outlets to promote recruitment of a younger, more diverse population of nursing students. Work Environment -Implement specific strategies to retain experienced nurses in the provision of direct patient care, such as: Introducing greater flexibility into work environment structure and scheduling programs; Rewarding experienced nurses for serving as mentors and/or preceptors for new registered nurses; Implementing appropriate salary and benefit programs. Create a partnership environment that advances the practice of nursing by: Establishing appropriate management structures within the health care system; Ensuring adequate nurse staffing and Providing nurses with sufficient autonomy over their practice in all settings. Redesign work to enable an aging workforce to remain active in direct care roles. Use of Technology, Research and Data Collection Investigate the potential for using technological advances to enhance the capacity of a reduced nursing workforce. Promote consistent data collection at the national, state and local level to account for variations at each level to enable appropriate workforce planning for registered nurses. Conclusion In conclusion, nursing shortage is a global problem and each country is facwe with such a problem . the nursing shortages in each country are different but ultimately they have similar effects on health care systems in each country. it is viewed as a problem which undermines health system effectiveness and requires immediate solutions.. These shortage interfere with the delivery of quality care to the patient. shortage of nurses interfere