Thursday, October 10, 2019
Life Insurance
.. TABLE OF CONTENTS STRATEGIC MARKETING PLAN DEFINES SALES SUCCESS IN TWO LEADING LIFE INSURANCE COMPANY Target companies: AVIVA Life Insurance Pvt Ltd. 1] Executive summary: The research is to be conduct how each company has performed in sales and the improve effectiveness of selling process. Research objectives and aims are to compare the performance of the AVIVA and HDFCSLI. As this research studying based on the Indian market, the research is proceeding in Bangalore, which is one of the main city in India. Research mythology is proceeding under collecting data of the current status of the both company and from the people to know the brand awareness and the purchasing behaviour when buying life insurance policies. THE BACKGROUND OF THE INDUSTRY Companies rating can be identified as follows:- A++,A+ are superior companies. A or A- good companies B. is growing company C- means position is not good. D is below the standard (minimum). E rate is company is taking the help from the state to run the business. LITERATURE VIEW Sales management and customer satisfaction: Influence of Advertising on Sales: This is a very important fact in life insurance industry as, their most of sales advertising by the salespersons. Draw back of a company can be happen due to the lack of communication and the problems in communicating with the consumers. Influence of Sales promotions on sales Sales promotions has taken an increasing share of the marketing budget, at the expense of advertising,because promotion can achieve a measurable increase in short term sales , which advertising cannot. There is a tension between the short term effects of promotion and the long term effects of advertising. This results in confusion in marketing community. How ever, there is a desirable effect on sales market from promotions. The main intention to promote sales is to attract the customers attention. Doing promotions in life insurance industry is can be following To extend the user base To reward and retaining existing customers To introduce trail of new product and by cashing and on the establish brand To counter competitorââ¬â¢s offer To clear inventory To enhance brand value To survive under the high pressure of competition, companies tend to do more and more creativity on their sales promotions by adding promotion tools. Promotions tools which can be use in life insurance industry are, Games and contests Lucky draw Gifts Attractive offers for the policies RESEACH PROBLEM: *STUDY AIMS AND OBJECTIVES*: To analyze the potential of Life Insurance in Investment Industry. To get the better understanding of various Life Insurance Product. To compare the performance of the AVIVA and HDFC To evaluate various need of customers for Life Insurance and their To study the brand awareness of the AVIVA and HDFCSLI The levels of trade support achieved, such as point of sales display. IMPORTANTS OF THE STUDIES RESEARCH DESIGN AND METHODOLOGY Research Design: Research Design that is followed in this report is sampling which is the most appropriate technique because Bangalore is a big city. The sample numbers were not overlapping in areas & then these selected with ultimate sample consisting of all units whole Bangalore 10 potential areas ere selected and are picked randomly from these area. Thus the total sample of 300 was taken and analyzed. Research Methodology: Research methodology is mainly concentrating following questions. Evaluating the sales and marketing methods, personnel sellings , telephone selling ,postal orders, etc , that each of the retailerââ¬â¢s used , as well as determining the effectiveness of these sales methods. Determining how effective these methods w ere in supporting and communicating each companyââ¬â¢s product and company image Determining who are the customer and potential customers in each company. This is to establish their perception of the company , as well as their attitudes to its image in comparison to those of its competitors. Determining the intermediaries in the market place This is to establish why these intermediaries selected the company and its services, rather than the services of its competitors. In addition, the research evaluated how the company image enhanced the over all sales processes , through all the company communications. Contact with head office, agents and inspectors , promotional material sent to intermediaries , and information on new products , proposal forms , company information, etc Determining the insurerââ¬â¢s own agents and sales force This was to determine whether those members of the sales team were communicating the right image and sales message effectively. In addition, this research is designed to determine whether their sales techniques and methods were ââ¬Ësynergisticââ¬â¢ with other aspects of the marketing mix, such as advertising and promotions All the findings are based on the survey research method. Data Collection Methods: 1. Primary Data: Questionnaire Detail analysis of data collected through questionnaire: To evaluate various need of customers for Life Insurance and their Purchase behaviour. To know the level of brand awareness of the company among the Consumers. Limitations of the study As this research is focussed on limited group and a limited area space it is not enough to study the production success of the world wide company. Sales rofit can be different according to the area , culture and people. As it is not possible to cover the whole india and also whole Bangalore, results could be limited. Richard M SwILSON , Colin Gilligan with David pearson (1992) David jobber, Geoff Lancaster ââ¬â 7thedition ââ¬Ëââ¬â¢ selling &sales managementââ¬â¢Ã¢â¬â¢ Carl McDaniel , Roger Gates (1999) ââ¬Ëââ¬â¢ marketing researchââ¬â¢Ã¢â¬â¢ Robin Birn (1992) ââ¬Ëââ¬â¢The effective use of marketing research (1992) David jobber ââ¬Ëââ¬â¢ selling & sales s trategy ââ¬Ëââ¬â¢ Gorden wills (1974) ââ¬Ëââ¬â¢ strategic issues in marketing ââ¬Ëââ¬â¢ Colin Mclver (1984) ââ¬Ëââ¬â¢case study in marketingââ¬â¢Ã¢â¬â¢ Journal of marketing (2009) volume 25 Cunliff bolling (1969) ââ¬Ëââ¬â¢sales managementââ¬â¢Ã¢â¬â¢ Giep Franzen (1999) ââ¬Ëââ¬â¢Brand & Advertisingââ¬â¢Ã¢â¬â¢ William G. Zikmund (2003) ââ¬Ëââ¬â¢ Exploring marketing research Bill Donaldson (1998) ââ¬Ëââ¬â¢ sales managementââ¬â¢Ã¢â¬â¢ Martin lindstrom (2005) ââ¬Ëââ¬â¢ Brand senseââ¬â¢Ã¢â¬â¢ Bill Donaldson (1988) ââ¬Ëââ¬â¢ sales managementââ¬â¢Ã¢â¬â¢ Terence A. Shimp ââ¬Ëââ¬â¢ Advertising and promotionââ¬â¢Ã¢â¬â¢ www. AVIVA. co. in www. hdfcsli. co. in Google search
Wednesday, October 9, 2019
Challenges Using the AQHR Reseac Paradigm at an Outpatient VA Menral Essay
Challenges Using the AQHR Reseac Paradigm at an Outpatient VA Menral Health - Essay Example (WHO, 2007).Other benefits are; reduced stigma, better access to health care since the patient will be treated for co-morbid conditions such as Hiv /Aids , cancer and diabetes. Using this model enhances easier communication with practitioners and better follow-up of mental health disorders. Integrating of mental health care in primary care systems ensures early detection and prevention of mental health disorders (WHO, 2007). There are a number of challenges in using ARHQ recommendations. Time availability is a major challenge and it leads to overworking of the health care workers due to diverse health care programs. Increasing the number of health care providers can help in solving this challenge. The primary health care providers can also feel uncomfortable when dealing with mental disorders. Reluctance when working with mental disorders is also expected (WHO, 2007). Absence of a good referral system between primary health care and secondary care institutions is another challenge as it reduces the effectiveness of mental health care offered at primary care level (WHO, 2007).Another challenge is organization barriers which include lack of administrative support and appreciation of such research paradigm (Cook and Grant, 2002). Therefore, implementing of this research paradigm may be prevented by bad administrative policies. Organizational barriers are in the form of resistance to change and addition of new responsibilities. Lack of enough infrastructure and staff is another challenge and strengthening of the existing health care institutions can help in solving this challenge. This will involve enabling primary health care centers to offer mental health care services. More medical staff should be trained and recruited to increase competence and quality of services offered, Training of human resource ensures easy identification and treatment of mental disorders. However, this requires more resources which may not be available. Lack of sufficient funding is a
Tuesday, October 8, 2019
Operations Management Definition Essay Example | Topics and Well Written Essays - 2000 words
Operations Management Definition - Essay Example According to Westland (n.d., pp. 1), project is defined as to perform certain activities for the completion or execution of work which is planned to get delivered within a specific time. Projects have specific characteristics. For example, they are unique i.e. every project is different from the other. Another example is that there is certain amount of money in which they have to be completed in a specific time. Operations:According to Shim and Siegel (1999, pp.2), operations can be defined as the labor undertaken for making goods and services available. They have to be completed in time set by the customer and the manufacturer.Project and Operations ManagementAccording to Shim and Siegel (1999, pp.2), project and operations management is the management of all the processes or in other words, activities which are associated to the manufacturing of goods and services. According to Westland (n.d., pp.1), the project can be completed with the help of certain apparatus and dexterity. Wit h the help of talented people and good management project can be completed with success. With the help of dexterity, cleverness and skill the risks associated with in a project can be reduced. Experienced people are hired in management for this purpose. The tools or apparatus used to complete a project related to building a house may include pens, gauges, nails, wood, budgeting, CAD software and checklists etc. Methods or processes used for completing a project are divided in different and small tasks.
Sunday, October 6, 2019
Wirless22 Essay Example | Topics and Well Written Essays - 500 words
Wirless22 - Essay Example Even though I spend most of my time at home, whenever I go out for recreation, I make it a point not to take my cell phone along. Right now I need to carry two phones: even though I do not like phones, this is the only way I can make my life easier. One phone is used for business and family only, whereas the other is for friends, school and other acquaintances. The second phone is usually turned off, unless I want to go out, and even then I mostly turn it on just to check the voice mail to check if I have any appointments (with a doctor or at school, for instance). The only times I have used text messaging is to check my bank account balance by texting at the number the bank gave to me. Even when I receive a text message to which I have to reply, I do not text back. I prefer calling up people rather than sending them text messages. The Bluetooth feature on phones is something that I do appreciate, because it enables me to connect my cell phone with my computer or other devices and transfer data easily. However, I do not believe that cell phones are a necessity. Even in emergency cases I think I can manage very well without a cell phone. I consider cell phones and email to be the worst invention of the last century. For me, cell phones are a luxury, a luxury we can very well do without. Currently, I have T-mobile and AirVoice as service providers for my two cell phones. T-mobile is expensive when compared with AirVoice: I pay 70 dollars for T-mobile and 40 dollars for AirVoice per month. On both these service providers I pay by minute along with the contract. AirVoice offers me unlimited text messaging, both domestic and international, which I do not use at all. I use prepaid plans on both; T-mobile carries the unused minutes to the next month, however AirVoice does not provide this service, the minutes end with the month, whether you have used them or not. Both AirVoice and T-mobile, being 3G, are
Saturday, October 5, 2019
Hotel Chocolat Essay Example | Topics and Well Written Essays - 4000 words
Hotel Chocolat - Essay Example Then the company started expanding in its domestic land and opened almost 43 stores in the UK and 23 stores inside John Lewis outlets. Hotel Chocolat mainly aims at making fresh chocolates which are way more adventurous in terms of taste. It produces chocolates using less sugar and more of cocoa, very different from the chocolates made by other companies. It follows originality and ethics in its services (Hotel Chocolat, 2010). In order to learn cocoa plantation the company decided to work with the local communities of Ghana. After achieving success in the production of chocolates, the company started many new projects. The company opened a restaurant called Boucan at its cocoa estate located in Saint Lucia. After its expansion in the domestic land, the company is now aiming at internationalisation. For this, the company needs an internationalisation strategy. According to Tyndall, Cameron and Taggart (1990), companies should achieve control over the business operation of both international and foreign market in order to achieve their strategic objectives. The next section of the study will discuss strategic options for the chosen company. In the first part it will be shown how the company will move towards diversification of products in the niche market and also show its internationalisation strategy, by using strategy clock and Ansoffââ¬â¢s matrix. In the second part, using suitability, feasibility and acceptability analysis model an analysis will be done to see whether or not the strategic options selected for the company in the first part is justified. In the third part, recommendation is to be provided, which is based on the directions and methods of strategic development which is appropriate for the organisation for the next 3 to 5 years. Finally, a conclusion will be drawn on the entire project. At first it has to be decided, which strategy out of the three strategies of
Friday, October 4, 2019
Research Proposal PowerPoint Presentation Example | Topics and Well Written Essays - 1250 words
Research Proposal - PowerPoint Presentation Example A nurse practitioner is a qualified nurse who has additional education and specialization in some particular area. In the USA, NPs must have a masterââ¬â¢s degree minimum and 500 to 1,000 hours of training; the education of NPs is guided by the American Association of Colleges of Nursing (Rough, 2009). Traditionally, NPs work as doctor supplements providing services which extend services provided by GPs. Now more and more NPs start working as doctor substitutes, having rights to independently provide a wide range of services, usually provided by GPs. The aim of such shift of the NPs role mainly is to address current GPs shortage and to reduce cost of health care services (Dierick-van Daele et al., 2008). The doctor-nurse substitution is much debated in professional literature and in the press; a number of important problems related to permissibility, practicability and efficiency of this innovation have been studied during the last decade. This document presents a proposal for a p iece of research which is aimed to explore the differences between patientsââ¬â¢ satisfaction with services provided by NPs in comparison with patientsââ¬â¢ satisfaction with services provided by GPs in primary care. In addition, we intend to explore factors influencing on the differences in patientsââ¬â¢ satisfaction. We hope that our study will promote an effective process of NPsââ¬â¢ and GPsââ¬â¢ skill mix and substitution and make a contribution in positive changes in the US health system at a whole. Problem Statement The tendency to hire nurse practitioners as a substitute for doctors has intensified during last years. Rough (2009, para.4) cites the American Academy of Nurse Practitioners (AANP), which estimated that from 2004 to 2009 the number of NPs in the United States has increased by about 40 per cent, amounting to 125,000. Dierick-van Daele et al. (2008) consider four main reasons of the current demand for NPs: ââ¬Å"(1) to overcome a shortage of doctors in particular settings; (2) to improve the quality of care; (3) to advance the career of nurses; and (4) to lower health care costs by employing the ââ¬Ëlowest cost providerââ¬â¢Ã¢â¬ (p.481). Many experts agree that todayââ¬â¢s nurses may work well not only as doctor supplements, but also as doctor substitutes, in particular in primary care. According to the recent research, from 25% to 70% of GPââ¬â¢s work might be successfully fulfilled by nurses (Laurant, Reeves, Hermens, Braspenning, Grol and Sibbald, 2007). This includes a wide range of activity from diagnosing, testing and prescribing medication to health promotion and routine management of chronic diseases. In several countries and the US states the shift in NPsââ¬â¢ status is supported by legislation, allowing NPs to work independently in various health care fields, including such specific ones as family practice, psychiatry, women health, pediatrics etc. However, there is a certain controversy in the medic al community, as some experts argue about significant risks related to the independent work of NPs in primary care, such as misdiagnosis or inappropriate treatment. For example, the American Academy of Nurse Practitioners and the American Medical Association hold the opinion that NPs should work only in collaboration with GPs (Rough, 2009). Young
Thursday, October 3, 2019
Nurses floating to different specialized areas Essay Example for Free
Nurses floating to different specialized areas Essay Abstract: Floating is a staffing strategy that is seen as a solution to the general problem of nursing shortage. Floating involves utilizing nurses to work in different specialized units. Floating has its advantages in that it gives nurses an opportunity for overall professional development and relieves them from additional responsibilities such as delegating and staffing. Float nurses stick to patient care. However, as they have to work in units for which they are not sufficiently educated or trained, they find themselves inadequate in providing quality patient care. Moreover, it affects their overall sense of connectedness with their patients, their peers, and their specialty department. Thus, floating of nurses is considered by many as a threat to both nurses and patients. However, more recently, it has been found that the float nurse can be trained to meet varied needs of specialized units. This is made all the more easier when the float nurse undergoes training for a cluster of closely related specialty units. Resource teams are float pools where specialty of the nurse is recognized and training is provided as per needs by the management. Introduction: Nursing shortage is one of the major issues facing the healthcare sector of the United States. This is attributed mainly due to lack of enthusiasm amongst the youngsters today for pursuing nursing as a career option and secondly due to the rising population. To counter the increasing demands of nursing, the concept of floating has been introduced in many hospitals and clinical settings. Floating is a very recent phenomenon in nursing introduced mainly due to problems such as staffing shortages and fluctuating census (Dziuba-Ellis, 2006). Nurses are in general trained to work in particular specialties. But working in different specialized units requires them to undergo cross-training. This causes stress to the nurses and they lose their efficiency and confidence of attending to critically ill patients in specialized departments. In fact, when nurses are floated to different specialized units, both the nurses and the patients suffer. While the nurses find themselves inadequately trained to work in certain specialized units, patients face the danger of negligent or faulty treatment. Suitable analysis of issues involved in floating of nurses to different specialized units shows that this is highly risky both from the viewpoint of nurses and the viewpoint of patients. This problem is particularly relevant in todayââ¬â¢s context as the concept of having a float pool of nurses is touted as a solution to the overwhelming national problem of nursing shortage. This paper focuses on the issue of floating of nurses to various specialized units in the United States ââ¬â the reasons for floating, impact of such floating on nurses, impact of floating on patients and how to adapt this concept to the situation of nursing shortage. This paper will not cover alternate solutions to nursing shortage. The floating of professional nurses to unfamiliar practice settings should be avoided as it leads to unsafe practice situations and if at all floating is found to be totally essential, it must be ensured that it is allowed only in emergency situations when an increased demand for nurses with general basic skills is expected. Literature Review: The research report titled Nursing Resource Team: An Innovative Approach to Staffing by Baumann et al (June 2005) contrasts the traditional float pools with resource teams and after detailed analysis of the case study of the Nursing Resource Team at Hamilton Health Sciences from September 2002 until June 2004, concludes that resource teams as an innovative staffing strategy creates opportunities for full-time work, and provide nurses with opportunities for professional development. According to Baumann et al, floating is not a new practice. Nursing shortages that existed between 1974 and 1979 lead to innovative staffing solutions and floating was one of them. However, floating came to be known as resource team in 1981 when the term was first used in an article to describe the creation and organization of a float pool (Baumann et al, 2005). Earlier, float pools or resource teams were used across Canada and the US to save expenditure, counter the shortage of nurses, fluctuations in patient census, acuity, volume, and care demands. Baumann et al point out that use of float pools/resource teams is often viewed as a staffing strategy ââ¬â one that facilitates flexible manipulation of staff. Today, float pools are more of a recruitment and retention strategy and this is proved by a study conducted by Crimlisk (Crimlisk et al, 2002). Contrary to this finding, however, experts in Canada suggest float staff do not serve retention purposes. According to Baumann et al, the NRT approach is different from the float pool in that it recognizes nursing expertise. In the case of float pools, a nurse is regarded as a generic worked who is able to work with different patient groups and utilize many skill sets. Further, the literature indicates that float nurses may be deployed as either assistive or replacement staff. According to a study by organizational development specialist Suzanne C. Luongo, titled ââ¬Å"Connectedness as a Motivator for Nurse Retention at the Bedsideâ⬠(2004). It has been found that floating is a disruption to connectedness to patients and families, connectedness to peers and connectedness to administration of the institution. This study was based on group interviews of staff nurses who have been at the bedside for a minimum of 5 years and have received high evaluations. While the first study focused on defining the concept of floating and explaining how it is applied in the nursing context, the second study raises the warning that float nurses may not enjoy their job because the job takes away the connection that a nurse needs to develop with the patients, the peers, and to the administration. When nurses are shifted through various specialized units, they cannot follow up on patients continuously; they cannot form stable friendships among other nurses and will not form any attachment to any specialized unit (Luongo, 2004). Crimlisk et al (2002) in their study titled ââ¬Å"New graduate RNs in a float pool: An inner-city hospital experienceâ⬠focus on the view of nurse managers and nurse educators that fresh graduate RNs cannot be included in a float pool. They prefer to have experienced nurses with multiple skills. However, the authors say that new graduate RNs are highly motivated, ready-to-learn, educationally prepared and intellectually stimulated though they do not have much clinical experience. The authors present a program for training new graduate RNs to practice nursing in a float pool. It has been proved that the program resulted in a 96% retention rate Boston Medical Center Nursing Division (Crimlisk et al, 2002). Moreover, the program offered the medical surgical units a strong clinical support float nurse, nursing managers a staffing solution in times of need, and the new graduate RN a broad range of clinical experiences making them more valuable members of the healthcare team. According to Crimlisk et al, this training model can be replicated in other institutions. Thus, this study gives a positive approach to the inevitable staffing solution of having a float pool of nurses. Crimlisk concludes that fresh graduate nurses who do not have the experience needed to become a float nurse should be trained specially to become more flexible and versatile (Crimlisk et al, 2002). Thus, this study holds that floating of nurses to specialized departments does not necessarily need only experienced nurses. With training, even newly graduated RNs can handle various specialized services in nursing. The article titled Full-Time or Part-Time Work in Nursing: Preferences, Tradeoffs and choices by Jennifer Blythe et al (2005), reviews historical trends in full-time and part time work in the general workforce and among nurses in particular. The study was conducted at three teaching hospitals in Ontario with more than 400 beds and included 10 focus groups of RNs and RPNs. Fourteen additional interviews were conducted with hospital administrators who were knowledgeable about nursing work arrangements. According to this paper human resources managers in all hospitals agreed that investment in full time staff saved ââ¬Å"costs, provided better coverage, higher commitment, lower turnover and more continuity of car and more stable relationships in nursing and multidisciplinary teamsâ⬠(Blythe et al, 2005). To increase full time jobs, the paper reports that one hospital offered a float pool of full time nurses in critical care, maternal-child and medical surgical areas. This float pool was part of a training strategy to help novice nurses to progress from medical surgical settings to specialist areas with shortages. However, it was found that these floating jobs appealed only to nurses with particular needs. The first study indicated that float nurses could be absorbed as assistive or replacement staff. According to the second study float nurses suffer due to lack of connectedness whereas the third study showed that float nurses could be trained to acquire new skills. But despite such training and absorption, this study takes a neutral stand that only some nurses can enjoy the experiences that come through float jobs depending on their needs. While the lack of connectedness and lack of training are cited to be discouraging factors in floating nurses, this study brings in a third angle ââ¬â that of needs of nurses. Only nurses with particular needs would like floating to different specialized units. According to the study by Hugonnet et al (2004) titled ââ¬Å"Nursing resources: a major determinant of nosocomial infection? â⬠there is growing concern that changes in nurse workforce and hospital-restructuring interventions negatively impact on patient outcomes. The review focuses on the association between understaffing and health-care-associated infections. Previous studies have shown that overcrowding, understaffing or a misbalance between workload and resources are important determinants of nosocomial infections and cross-transmission of microorganisms. Importantly, not only the number of staff but also the level of their training affects outcomes. The evidence that cost-driven downsizing and changes in staffing patterns causes harm to patients cannot be ignored, and should not be considered as an inevitable outcome (Hugonnet et al, 2004). The fact that ââ¬Ëlevel of trainingââ¬â¢ affects outcomes is a major finding as float nurses often suffer from inadequate skills. In this study it has been found that such inadequacy can lead to nosocomial infections and cross-transmission of microorganisms (Hugonnet, 2004). Thus it is indirectly implied that floating of nurses can lead to such infections and cross transmission of microorganisms. This study brings out a scientific drawback in the floating of nurses ââ¬â one that could be detrimental physically to both nurses and the patients. This finding is further strengthened by the finding of Stone et al (2004) who point out that nursing shortage is managed by many health care facilities by expanded use of nonpermanent staff, such as float pool and agency nurses. Overwork and fatigue among these nurses have been associated with medication errors and falls, increased deaths, and spread of infection among patients and health care workers (Stone et al, 2004). Issue Analysis: RNs at many health care institutions have traditionally been required to float to other units as a solution to the issue of staffing shortage. Staffing practices, like floating, cross-training and the use of larger float pools are highly debated with focus on quality patient care and less stressful environment at work for nurses. Studies show that nurses naturally want to use the expertise theyve gained over the years on their own specialized units. But if they must work in a different area, or even if they choose to work on different units, they want the appropriate orientation to provide competent, safe care. According to Christine Kane-Urrabazo, MSN, RN, in Said another way: our obligation to float, floating is a viable solution to the issue of nursing shortage. She says that the though floating is opposed on the basis of many arguments, they are not justifiable when weighted against the consequences of not floating (Kane-Urrabazo, 2006). The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), requires all accredited organizations to ensure that ââ¬Å"â⬠¦all staff providing patient care and services on behalf of the organization are properly oriented to their jobs and the work environment before providing care, treatment, and servicesâ⬠(JCAHO, 2004, p. 5). This means, regardless of the settings, it is important for professional nurses to maintain clinical competence. According to the American Nurses Association (ANA, 2005), it is recommended that there should be a systematic plan for the cross-training of staff expected to float to ensure competence (2005). ââ¬Å"The Psychological Stresses of Intensive Care Unit Nursingâ⬠by Hay and Oken focuses on floating in the ICU that provides complex nursing care (1972). The float nurse in the ICU is exposed to traumatic events such as death and dying, posing threats of object loss and personal failure. The nurse in the ICU needs to be familiar in handling many kinds of complex technical equipments and make correct measurements. The nurse in the ICU should be capable of making observations about her patients condition, to interpret subtle changes and use judgment to take appropriate action. Moreover, the nurse must maintain detailed records. Because of this and the nature of her tasks, temporarily floating in nurses from elsewhere when staff is short can be dangerous when the specialized unit concerned is the ICU (Hay and Oken, 1972). Kelly Herbig, RN-OCN, Rockford Memorial Hospital, Rockford, in her article titled ââ¬Å"The highs of floatingâ⬠in Nursing Spectrum says that she enjoys a lot of benefits as a float nurse. She points out that as a float nurse, she needs to focus only on patient care and need not deal with issues of staffing, delegating, and other charge-nurse responsibilities. Kelly Herbig says: ââ¬Å"Floating to different departments and units affords me the chance to meet and work with a wide variety of staff and physiciansâ⬠¦.. Talking to them about their experiences and viewpoints has helped me broaden my own views and given me a new perspective on nursingâ⬠(Herbig, 2004). Best of all she says that as a float staff, she is often viewed positively as ââ¬Å"the help, the relief, the answer to the problem of short staffingâ⬠. On the contrary we have the case of Jackie. Badzek et al (1998) in her research article titled Administrative ethics and confidentiality privacy issues cites the case of Jackie. As a float nurse, Jackie found her work very stressful. She had to rotate between many units and patients. Each day she worked on a different unit with different co-workers. She developed few friendships or collegial relationships. She was often dispensing medications and treatments she found unfamiliar. When she attempted to ask questions, she found she approached gruff busy attending doctors and young uninformed house staff. Feeling trapped, Jackie began to divert narcotics (Badzek et al, 1998). This case highlights the plight of the float nurse without specific training and also offers a glimpse to the stress levels of an untrained float nurse. Many states have laws that indicate that itââ¬â¢s considered negligent or unprofessional for a nurse to offer or perform services for which she is not qualified by education, training, or experience. Therefore, accepting floating assignments for which the nurse is not qualified can jeopardize his or her career. There can be lawsuits and also disciplinary action by the state board of nursing. Disciplinary action can include license limitation, suspension, or revocation, and possibly mandatory continuing education (Gobis, 2001). In the study titled ââ¬Å"When terror is routine: how Israeli nurses cope with multi-casualty terrorâ⬠, authors Riba and Reches report on the case of Israeli nurses working in hospitals and looking after emergency care in times of terror attacks (Riba and Reches, 2002). Based on qualitative analysis of the data collected from focus group discussions involving 60 nurses and analysis of problems faced by them, the authors make a few recommendations in the context of floating. Riba and Riches recommend that post-basic courses in emergency medicine and trauma should be expanded to include emergency room logistics, stress management techniques, and debriefing strategies. Moreover, for nurses floating into emergency care from other departments, they suggest that an annual workshop should be held that includes drills for emergency care. They also suggest that the ER charge nurse should be provided training in leadership and group dynamics. Thus we find that the training that should be insisted for float nurses should be related to the specialized units for which they are chosen to work. This finding is also in accordance with the conclusion of the research report titled Nursing Resource Team: An Innovative Approach to Staffing by Baumann et al (June 2005). Indicators that can be used to measure success of these specially trained staff would be based on measuring retention in clinical settings where such trained float personnel are used. Susan Trossman, RN in her article titled ââ¬Å"Staffing smart: A difficult propositionâ⬠says that cross-training to several units will make a nurse end up being an expert at little things and lose in-depth specialty advantage. Kim Armstrong, RNC, has worked at Tacoma General Hospital in Washington for 20 years. She agrees that cross-training gives RNs a greater range of skills. But, she says, It also dilutes skills. She clearly points out that floating nurses to various units and making them accept assignments for which they are educationally unprepared are putting their patients and their livelihood at risk. A nurse at the Elms College hearing illustrates this point. I was recently floated to Hematology/Oncology unit and had 8 patients. Six patients were on research protocols, each with 6 to 10 medications that I had to deliver. I didnt know any of these drugs. Many nurses do not even know their deficits (Nursing Report, 2001). In this context, it must be noted that there is a direct relationship to the skill of nurses and the number of nurses to patient outcomes (Nursing Report, 2001). All the above arguments indicate to only one clear solution. In a country that is facing nursing shortage, it would be unreasonable to say that floating should be totally banned. As numerous studies have shown, what is needed is adequate training of staff for various specialties. This argument is further stressed by Ruth Shumaker, RN, CNOR, and president of the Association of Operating Room Nurses, Inc. : The valuable nurse in the next millennium is the one who can do more who has the knowledge base to function as a specialist but also as a generalist working in multiple areasâ⬠(Trossman, 1999). Recommendations: While it is understood that float nurses need special training and education, one should remember that such skills imparted through short term programs tend to be forgotten if not used constantly. Hence they need regular scheduled workshops. Some recommendations to remember while choosing to have a float pool of nurses are (NYSNA, 2005): â⬠¢ Nurses should not be floated to unfamiliar practice settings. â⬠¢ If floating is deemed necessary, it should only be permitted in emergency situations that call for general nursing care. â⬠¢ The RN should be able to self-evaluate and ask for further knowledge or training as her job needs. She should be granted the right to refuse assignments for which she is neither qualified nor trained. â⬠¢ The charge nurse/supervisor should take the responsibility of allotting a particular float nurse to a particular specialized unit. If possible, she should assign a regular staff member of the specialized unit to guide and instruct the new float nurse. â⬠¢ The healthcare facility should be able to perform needs assessment on a continuous process and provide inter department training as per needs. By monitoring trends in nursing indicators such as turnover, satisfaction, work-related illnesses and injury, overtime, etc. , they should also evaluate and maintain the quality of the nurseââ¬â¢s work life. Conclusion: Further research should be conducted as to the type of skills a float nurse is expected to perform in her various specialized units. It has been proved that resource teams that are an improvised float pool are ideal to counter the problem of nursing shortage. In resource teams, nurses work in their area of clinical expertise and preference, developing ââ¬Å"in-depth knowledge of particular clinical populations. â⬠Sometimes, nurses may be assigned as generalists and specialists from the float pool or resource team. It has been found that training is better possible when nurses are assigned to clinical clusters with certain patient populations. Examples of clustered units include critical care and emergency departments, adult medical-surgical, and pediatrics. However, nurses may also be sent to areas such as medical-surgical for which it is assumed only generic skills are required. The following general points should be remembered while implementing float pool nursing as a staffing strategy: Innovations should be introduced in a phased manner; it is important to have consistent leadership during the implementation phase; Orientation and interpretative sessions must be planned and roles of float nurses should be charted in detail; Evaluation should be done on a continual basis. With respect to the float pool of nurses, it must be ensured that their number is large enough so that there is no overtime. Care should be taken to ensure that clinical clusters include relatively narrow and related skill sets and areas of expertise. To make floating of nurses to different specialty units, a viable solution to the problems of nursing shortage and quality care, it is important that the top management, the nurse in charge and the float nurse all work in synchronization towards providing respect and support for development of float nurses as specialists with patient-specific expertise and experience. When individual nurses are deployed only to those areas for which they possess the requisite skills, there is mutual benefit for the nurses as well as for the patients to whom they offer their valuable services. Bibliography: American Nurses Association (2005). Utilization guide for the ANA ââ¬Å"Principles for nurse staffingâ⬠. Silver Spring, MD: Author Joint Commission on Accreditation of Healthcare Organizations. (2004). Systems analysis. Ensure that your float staff and contracted staff are providing safe care. Joint Commission Perspectives on Patient Safety, 4(7), 5-6. New York State Nurses Association. (2005). NYSNA position statements, RN staffing effectiveness and nursing shortage. Latham, NY: Author. http://www. nysna. org/programs/nai/practice/positions/floating. htm Kane-Urrabazo, Christine (2006). Said Another Way: Our Obligation to Float. Nursing Forum. Volume 41, Issue 2, Page 95. April 2006. http://www. blackwell-synergy. com/doi/abs/10. 1111/j. 1744-6198. 2006. 00043. x Luongo et al (2004). Connectedness as a Motivator for Nurse Retention at the Bedside. July 24, 2004. Nurse Retention. http://stti. confex. com/stti/inrc15/techprogram/paper_17745. htm Hugonnet et al (2004). Nursing resources: a major determinant of nosocomial infection? Current Opinion in Infectious Diseases. 17(4):329-333, August 2004. Copyright Lippincott Williams Wilkins, Inc. http://www. co-infectiousdiseases. com/pt/re/coinfdis/abstract. 00001432-200408000-00009. htm;jsessionid=FDkbKKGyZ54nPbDSzyJwhhhBs1b8hS866nCYvc8Lxqp2qV1zHRp5! 2082300909! -949856145! 8091! -1 Crimlisk et al (2002). New graduate RNs in a float pool. An inner-city hospital experience. Journal of Nursing Administration. April 2002. 32(4):211-7. http://www. ncbi. nlm. nih. gov/entrez/query. fcgi? db=pubmedcmd=Retrievedopt=AbstractPluslist_uids=11984257itool=iconabstrquery_hl=6itool=pubmed_docsum Crimlisk et al (2002). New Graduate RNs in a Float Pool: An Inner-city Hospital Experience. Journal of Nursing Administration. 32(4):211-217, April 2002. http://www. jonajournal. com/pt/re/jona/abstract. 00005110-200204000-00010. htm;jsessionid=FDmP1gHbHHxZW8Rvmffskj9WcBrHyqH9WYdGTLq0ftDVdJyt8141! 2082300909! -949856145! 8091! -1 Dziuba-Ellis, Jennifer (2006). Float Pools and Resource Teams: A Review of the Literature. Journal of Nursing Care Quality. 21(4):352-359, October/December 2006. http://www. jncqjournal. com/pt/re/jncq/abstract. 00001786-200610000-00013. htm;jsessionid=FDmJkWq3P7J4btG4yWyy9L1CdkfnTw61myy60RB4WYG5RFRJ32wy! 2082300909! -949856145! 8091! -1 Badzek et al (1998). Administrative Ethics and Confidentiality Privacy Issues. Online Journal of Issues in Nursing. December 31, 1998. Available at http://www. nursingworld. org/ojin/topic8/topic8_2. htm Stone et al (2004). Nurses working conditions: Implications for infectious disease. November 2004. Emerging Infectious Diseases 10(11), pp. 1984-1989. http://www. ahrq. gov/RESEARCH/dec04/1204RA4. htm Herbig, Kelly (2004). The Highs of Floating. Nursing Spectrum. http://nsweb. nursingspectrum. com/cfforms/GuestLecture/HighsOfFloating. cfm Gobis, Linda (2001). The Perils of Floating: When nurses are directed to work outside their areas of expertise. The American Journal of Nursing. September 2001. Volume 101, Issue 9. http://www. nursingworld. org/AJN/2001/sept/Wrights. htm Riba and Reches (2002). When terror is routine: how Israeli nurses cope with multi-casualty terror. Online Journal of Issues in Nursing. Vol. #7 No. #3, Manuscript 5. Available: http://www. nursingworld. org/ojin/topic19/tpc19_5. htm Trossman, Susan (1999). Staffing smart: A difficult proposition. American Nurse. Nursing World. 1999. http://nursingworld. org/tan/99janfeb/float. htm. Nursing Report (2001). Report of the Legislative Special Commission on Nursing and Nursing Practice. May 2001. http://www. mass. gov/legis/reports/nursingreport. htm Blythe et al (2005). Full-Time or Part-Time Work in Nursing: Preferences, Tradeoffs and choices. Healthcare Quarterly Vol. 8 No. 3. 2005. Pages 69-77. www. nhsru. com/documents/Full-time%20or%20part-time%20work%20in%20nursing%202005. pdf Hay, Donald and Oken, Donald (1972). The Psychological Stresses of Intensive Care Unit Nursing. Psychosomatic Medicine. Volume 34, No. 2. March/April 1972. www. psychosomaticmedicine. org/cgi/reprint/34/2/109. pdf.
Subscribe to:
Posts (Atom)