Racism in the Chesapeake Area Essays -- Chesapeake Area Racism Racist

Racism in the Chesapeake Area The Chesapeake area in the seventeenth century was a unique community that was almost absent of racism. In this community, at this time, property was the central and primary definition of one’s place in society. The color of one’s skin was not a fundamental factor in being a well respected and valued member of the community. Virginia’s Eastern Shore represented a very small fellowship of people that were not typical of the Southern ideals during this time period and gave free blacks owning property a great deal of respect and merit usually equal to that of any white man around. Racism, as a generalization, was a common and mostly unified way of thinking in the Southern states for a very long time and was in its prime during the seventeenth and eighteenth centuries. The first importation of slaves into Virginia was in late August of 1619 and was only briefly recorded by one colonist, John Rolfe. He recorded them as â€Å"20. and odd Negroes† and from this the black population slowly grew to about three hundred by the mid-century. One must understand that the attitudes towards the blacks that came to Virginia were not inevitable. This is a very important point to note when understanding how the free blacks came to be they way they were in Northampton, Virginia. It is not specifically known how Anthony Johnson came to own his â€Å"modest estate† or how he ended up in Northampton. Historians believe that his former master, Rirchard Bennett,...

Act 1 :: essays research papers

In any play, the opening act is essential to the purpose of outlining the main themes and characters of the piece. It also reveals the plot and the mood of the play to the audience. Act I of Hamlet is very successful in outlining these aspects and yet is also successful in highlighting the atmosphere of the play and in doing so, suggesting aspects of the play as a whole. Shakespeare communicates this using a variety of dramatic techniques and I will also be outlining these in this essay.One of the most important aspects that is revealed in this act is that of the themes of the play. There are various themes that are suggested but I will comment on those that I consider most important; those of conflict and appearance versus reality. The theme of conflict is one that is emphasised from the start of the Act. The setting which Shakespeare starts the play is dark, desolate and "bitter cold". This aids with the atmosphere of tension as it emphasises the atmosphere that is being communicated; one of tension which in turn suggests conflict. The theme is also established at an early point as even the second line of the play regards a conflict, as Bernado is forced to "Stand, and unfold yourself". From this point onwards the atmosphere of conflict is highlighted by the constant use of military language, "Let us assail your ears...host of heaven". Yet it is also highlighted by other subtle aspects of the Act, the ghost's military apparel and the ongoing conflict between Hamlet and Claudius, "A little more than kin, and less than kind". In my opinion, the need for this conflict to be communicated early in the play was essential as, it is the major theme of the text; Hamlet's inner struggle id the epitome of the conflict in the play and it is this that is the central theme of the play.

Conventional Machining vs Non-Conventional Machining

lConventional Machining VS Non-Conventional Machining Conventional machining usually involves changing the shape of a workpiece using an implement made of a harder material. Using conventional methods to machine hard metals and alloys means increased demand of time and energy and therefore increases in costs; in some cases conventional machining may not be feasible. Conventional machining also costs in terms of tool wear and in loss of quality in the product owing to induced residual stresses during manufacture.With ever increasing demand for manufactured goods of hard alloys and metals, such as Inconel 718 or titanium, more interest has gravitated to non-conventional machining methods. Conventional machining can be defined as a process using mechanical (motion) energy. Non-conventional machining utilises other forms of energy. The three main forms of energy used in non-conventional machining processes are as follows : †¢ †¢ †¢ Thermal energy Chemical energy Electrical energy One example of machining using thermal energy is laser. Thermal methods have many advantages over conventional machining, but there are a few of disadvantages. Inconel 718, titanium and other hard metals and alloys have a very high melting point. Using thermal methods will require high energy input for these materials. Concentrating heat onto any material greatly affects its microstructure and will normally cause cracking, which may not be desirable. Safety requirements for thermal methods, especially laser, are demanding in terms of time and cost. Machining large areas or many surfaces at the same time using thermal methods is not normally possible. †¢ †¢ †¢ The methods using electrical energy are electrodischarge machining (EDM) and nodic machining (AM), which are similar in practice. EDM, often refered to as spark erosion, uses pulsed voltage to remove material from a workpiece and a non-conductive medium to clear the debris. Because the medium is electrica lly inert the tool is a direct reverse of the workpiece and no complicated tool design criteria are required. But the shock of spark erosion can affect the microstructure on the surface of the workpiece. Also, EDM has a lower material removal rate than AM. The chemicals used in AM are non-toxic and the energy required is less than other nonconventional machining processes.It has no effect on the microstructure of the workpiece. The electrolyte can even be common sea water, enabling AM to be used in a sub-sea capacity. The hardness and thermal resistivity of the workpiece material do not matter therefore hard metals and alloys can be machined using tools made from softer materials. The only disadvantage is that tool design is a little more complex than that of EDM, but software is being developed to make this easier. The controllability, environmental versatility, speed, safety and absence of change in workpiece microstructure make AM a competitive manufacturing process.

Airfield lighting

Decennial sensors detect movements of aircraft and there vehicles on the ground. The signals from individual lights and sensors are communicated via FALL and are comprehensively visualized for the operators in the tower through an ALAS. FALL enables the controllers to optimize the use of the entire airfield lighting system: through flexible control of each segment of the runway, taxiway and apron circuits, every component and individual lamp is exactly controllable.As such, FALL provides excellent tools to perform control of aircraft ground movements: taxiway routing, Stoppard control, runway incursion detection are now available for the operators in the tower. Safety of air traffic movements and number of slots per day are significantly increased with this modern and reliable control system. Using the power supply series circuit for reliable and high-speed communication between substation and individual lamps, FALL detects and supervises the actual status of each lamp and provides c omplete detailed information to the operational control station.FALL continuously monitors all lamps controlled via the system and identifies a lamp failure immediately, indicating the exact position of the failed lamp. As a result, the need for regular visual inspections is reduced and overall maintenance performance can be improved. In order to prevent collisions on the reside movement area, CIAO prescribes the implementation of an (Advanced) Surface Movement Guidance and Control System) – (A)SMOCKS is a modern control and monitoring system for the guidance of aircraft on the ground.The solutions offered by Siemens Intelligent Traffic Systems Airfield meet all legal and operational requirements in this field of application. Thanks to sophisticated navigational aids for air traffic control, aircraft can take off and land under almost all weather conditions. However, when traffic on the ground is lowed down, high-volume airborne operations are put in Jeopardy: Visibility cond itions of less than mm generally delay aircraft ground movements and reduce the total capacity of the airport.SUMS identifies each aircraft, provides continuous surveillance and monitoring of taxiing traffic; determines conflict-free taxiway routes automatically and uses visual signals to guide aircraft and vehicles reliably. And in case of route deviations, it warns pilots or drivers immediately. The comprehensive SMOCKS control and monitoring functionality provides controllers with tools to enhance airport safety, efficiency and availability – under all visibility conditions.Tower ALAS Airfield Lighting Control and Monitoring Systems Airfield Lighting Control Systems (ALAS) allow air traffic controllers (TACT) to monitor and operate a range of lighting functions from the control tower, at the same time providing them with valuable feedback on the performance status of system lighting equipment. Surface Movement Guidance and Control System CIAO has specified the provision of (advanced) surface movement guidance and control systems (A-)SMOCKS to avoid collisions on the ground. Siemens/DAB is doing its part to help airports to fulfill these requirements.In the late asses the problems of transition from the new precision radio instrument approach aids to the final, visual approach at night or in reduced visibility much exercised civil aviation. Various high-intensity approach lighting systems were developed to ease the transition from instrument to visual flight. In 1949 three competing systems – a British one (the Calvert system), a French one (a form of displaced Calvert system) and an American one (the Slope Line system) were presented to CIAO. Because each system had its supporters among the CIAO members, CIAO ended up recommending that any of the three systems could be adopted.Independently, and before the CIAO decision, DACCA engineers had also been studying the problem of approach lighting and had concluded that the British ‘Calvert' s ystem was superior. A trial installation was installed on Session's Runway 08 toward the end of 1951. This trial proved successful and the system was commissioned for operational use in 1953. The following information about the Calvert cross bar lighting system is based on an article High Intensity Approach Lighting by S W Hart (DACCA Sectional Airways Engineer) which appeared in the Civil Aviation Joanna, the Dacca house publication, Volvo 1, No 3, March 1951.In 1946 Mr. E S Calvert of the Royal Aircraft Establishment, Breakthrough, was requested by a UK Ministry of Civil Aviation Airfield Lighting Committee to investigate the problem of approach lighting and establish the general principles involved. Calvert tackled the problem by attempting to ascertain the visual and mental processes by which a pilot lands an aircraft. He then developed a theoretical model by which different lighting systems could be compared, and tested his theoretical results using simulation.Culvert's line of reasoning led him to the conclusion that to provide smooth transition room instrument to visual flying without optical illusions, and to provide sensitive and natural indications which could easily be interpreted by the average pilot, the approach lighting pattern should consist of a centre line of light with horizontal bars basic elements – a line of lights leading to the runway threshold, and horizontal lights to define the attitude of the aircraft. Calvert placed much stress on roll guidance compared with the Americans who, up to that time, had completely neglected it.He was the first to realism that it was easy to confuse lateral displacement with angle of ann.. The Calvert system does not indicate a defined glide path, but the widths of the horizon bars are such that, if a pilot maintains a glide that will take him to the correct touch down point, each bar will appear to be the same width as the previous one as it disappears under the nose of the aircraft. Distance is i ndicated by using single lights in the centre line to indicate 1000 Ft or less from the threshold, double lights for 1000-2000 Ft and triple lights for 2000-3000 Ft.It is interesting to note that the basic form of the Calvert cross bar lighting system still forms the basis for high- intensity approach lighting systems today. Diagrams above: With horizon bars the pilot can see if he is on an even keel (left) or banked right wing down to turn on to the centre line (right). Below: A modified form of the basic High Intensity Approach Lighting system is used on some capital city precision approach (ILLS) runways, in this case on Melbourne/Utilitarian's Runway 27.The main difference is the larger array of lights Just prior to the threshold. Runway Edge Lights are used to outline the edges of runways during periods of darkness or restricted visibility conditions. These light systems are classified according to the intensity they are capable of producing: High Intensity Runway Lights (HIRE) Medium Intensity Runway Lights (MARL) Low Intensity Runway Lights (LIRA) The HIRE and MARL systems have variable intensity controls, whereas the Liars normally have one intensity setting.Runway Edge Lights are white, except on instrument runways where yellow replaces white on the last 2,000 feet or half the runway length, whichever is less, to form a caution zone for landings. The lights marking the ends of the runway emit red light toward the runway to indicate the end of runway to a departing aircraft and emit green outward from the runway end to indicate the threshold to landing aircraft. Lighting (ARC) or Pilot Activated Lighting (PAL), is a technical system by which aircraft pilots can control the lighting of an airport or airfield's, approach lights, runway edge lights, and taxiways via radio.PC systems are most common at non- towered or little-used airfields where it is not economical to light the runways all night every night nor to maintain staff to turn the runway lightin g on and off as needed. PC enables pilots to control the lighting only when they require it, thereby saving electricity and reducing light pollution. If the airfield supports PC, the pilot test the radio to the ARC frequency for the airport, which is often, but not always, the same as the UNISOM/ACTA frequency (e. . Smiths Falls-Montague Airport hosts separate Unisom and ARC frequencies). The systems are then typically operated by performing a series of clicks with the radio microphone talk button. PC systems most often have three settings: Low intensity: Three clicks within seven seconds Medium intensity: Five clicks within seven seconds High intensity: Seven clicks within seven seconds When the lighting system is activated, a 15-minute countdown starts, after which the sights turn off.While the lights are still active, whenever a lighting command is issued, whether it changes the lighting intensity or not, the 15-minute countdown is reset. At some airfields, special lights may bli nk for ten seconds to warn pilots before the lights shut off. When using PC, it is very highly recommended that aircraft on final approach to the airfield issue a fresh lighting command even if the lights are already on (especially if the lights were activated by another aircraft). This is so that the lighting does not go off by surprise at a critical moment (such as when crossing he runway threshold).The Visual Approach Slope Indicator (VASS) is a system of lights on the side of an airport runway that provides visual descent guidance information during the approach to a runway. These lights may be visible from up to eight kilometers (five miles) during the day and up to 32 kilometers (20 miles) or more at night. Contents [hide] 1 Types 1. 1 Standard VASS 1. 2 API (Precision Approach Path Indicator) 1. 3 PASS' (Pulsating Visual Approach Slope Indicator) 1. 4 Trio-colored VASS 2 Mnemonics 3 Reference 4 See also 5 External links [edit] Types Standard Visual Approach Slope IndicatorBas ic visual approach slope indicators consist of two sets of lights. One set marks the start of the runway, while the other is set up some seven meters (twenty feet) along the runway. Each set of lights is designed so that the lights appear as either white or red, depending on the angle at which the lights are viewed. When the pilot is approaching the lights at the proper angle, meaning he is on the glide slope, the first set of lights appears white and the second set appears red.When both sets appear white, he is flying too high, and when both appear red he is flying too low. This is the cost common type of visual approach slope indicator system. [edit] API (Precision Approach Path Indicator) Main article: Precision Approach Path Indicator Precision Approach Path Indicator consist of four sets of lights in a line perpendicular to the runway, usually mounted to the left side of the runway. These have a similar purpose to basic visual approach slope indicators, but the additional light s serve to show the pilot how far off the glide slope the aircraft is.When the lights show White- White-Red-Red the aircraft is on the correct glide slope for landing, usually 3. 00. Three red lights (White-Red-Red-Red) indicate that the aircraft is slightly below glide slope (2. 80), while four red lights (Red-Red-Red-Red) indicate that the aircraft is significantly below glide slope (3. 50). Most large airports utilize this system. Although most airports use a API based on a 3. 00 glide slope, some airports may use a glide slope as great as 4. 50 in order to have proper obstruction clearance. Edit] PASS' (Pulsating Visual Approach Slope Indicator) This is a single light next to the runway. The signal format is solid white when established on the proper descent profile, and solid red when below the proper scent profile. An actively pulsing red or white light when well above or well below allows the pilot to determine his position in the signal format and what corrective action is n eeded to return to the proper descent profile. [edit] Trio-colored VASS This is a single light that appears amber above the glide slope, green on the glide slope and red below it.It is rarely used, partly because pilots who are unfamiliar with them have been known to misinterpret the lights, causing them to ‘correct' in the wrong direction. [edit] Mnemonics Older Visual Approach Slope Indicator Pilots often use mnemonics to help them remember basic information. In English, the following are common: Red over white, you're all right. White over white, you're out of sight. Alternative: White over white, you'll fly all night. Alternative: White over white, you're high as a kite. Alternative: White over white, you remain in flight. Red over red, you're dead.Alternative: Red over red, watch your head. Also Red red you're dead Red and white you're alright White and white you're as high as a kite Runway End Identifier Lights (REEL) are installed at many airports to provide rapid and p ositive identification of the approach end of a particular runway. The system consists of a pair of synchronized flashing lights located laterally on each side of the runway threshold. Reels may be either unidirectional or unidirectional facing the approach area. They are effective for: Identification of a runway surrounded by a preponderance of other lighting.Identification of a runway which lacks contrast with surrounding terrain. Identification of a runway during reduced visibility. An approach lighting system, or ALLS, is a lighting system installed on the approach end of an airport runway and consists of a series of lighters, strobe lights, or a ambition of the two that extends outward from the runway end. ALLS usually serves a runway that has an instrument approach procedure (PAP) associated with it and allows the pilot to visually identify the runway environment once he or she has arrived at a prescribed point on an approach.The runway lighting is controlled by the air traffi c control tower. At uncontrolled airports, Pilot Controlled Lighting may be installed which can be switched on by the pilot via radio. In both cases, the brightness of the lights can be adjusted for day and night operations. A key ingredient of all Approach Lighting Systems in the US is the Decision Bar. The Decision Bar is always located 1000†² from the threshold, and it serves as a visible horizon to ease the transition from instrument flight to visual flight.It also is situated such that at Decision Altitude, the Decision Bar is Just appearing to pass under the cowling of the plane. Approach Light Systems are designed such that they allow the pilot to quickly and positively identify visibility distances in Instrument meteorological conditions. For example, if the aircraft is at the Middle Marker, and the Middle Marker is located 3600†² from the threshold, the Decision Bar is 2600†² ahead. If the reoccurred calls for at least 1/2 statute mile flight visibility (roug hly 2600†²), spotting the Decision Bar at the marker would indicate enough flight visibility to continue the procedure.In addition, the shorter bars before and after the Decision Bar are spaced either 100†² or 200†² apart depending on the ALLS type. The number of short bars the pilot can see can be used to determine flight visibility. Approaches with lower minimums use the more precision 100†² spacing systems for more accurate identification of visibility. Several ALLS configurations are recognized by the International Civil Aviation Organization (CIAO); however, non-standard ALLS

Strategic Human Resource Management: a Paradigm Shift for Achieving

International Bulletin of Business Administration ISSN: 1451-243X Issue 7 (2010)  © EuroJournals, Inc. 2010 http://www. eurojournals. com Strategic Human Resource Management (SHRM): A Paradigm Shift for Achieving Sustained Competitive Advantage in Organization Benjamin James Inyang Department of Business Management, University of Calabar P. M. B. 1115 Calabar, Nigeria E-mail: benji1955. [email  protected] co. uk Tel: +234 8033773403 Abstract The human resource of an organization offered the potential synergy for sustained competitive advantage, when properly deployed, maintained and utilized.From the onset, the traditional HRM, the formal system for managing people in organization, concerned itself essentially with transactional and administrative support services. The emergence of SHRM, concerned with the relationship between HRM and strategic management of the organization, was a paradigm shift. The strategic business partner model emphasized the proper integration or fit of HR practices with the business strategies of the organization, to generate a competitive advantage.To perform successfully, the roles of business partner and change agent under SHRM, the HR practitioner must be highly knowledgeable, multiskilled and acquire core competencies like business knowledge, strategic visioning and global operating skills, credibility and integrity, internal consulting skills, among others. Keywords: Strategic human resource management, human resource management, competitive advantage, fit, integration, business strategy, strategic business partner. 1. IntroductionAn organization requires the utilization of a complex array of resources to grow, survive and achieve the ultimate mission or objectives that informed its existence or creation. The mobilization and deployment of these resources – human, financial and material – in the right resource-mix, gives the organization leverage toward the desired end. Of these resources, the human resource is t he most potent and central, contributing significantly to corporate bottom line and competitiveness.The organization therefore gains sustained competitive advantage through people, the organization workforce. Competitive advantage is simply defined as anything that gives an organization an edge over the competitors in its market. According to Porter (1985), the unique talents among employees, including flexibility, innovation, superior performance, high productivity and personal customer service are ways employees provide a critical ingredient in developing a firm’s competitive position.Similarly, Chiavenato (2001) notes that employees are purveyors of activities and knowledge whose most important contributions in the organization are their intelligence and individual talents. There is a 23 growing consensus that effective management of human capital is critical to an organization’s success (Barney & Wright, 1998; Jackson, Hitt & DeNisi, 2003; Akhtar, Ding & Ge, 2008). Managing the human resources in the organization is the traditional responsibility of the personnel manager, a precursor to human resource management (HRM).Some scholars however equate HRM with personnel management, concerned with providing staff support in the organization (e. g. Guest, 1989). Other scholars consider HRM as a natural development of personnel management practices in the face of changing economic and business environment (Armstrong, 1989 & 2004; and Fajana, 2002). The people-management discipline is undergoing continuous metamorphosis, with the recent emergence of strategic human resource management (SHRM) in organization and management literature.In a recent review covering 30 years, Lengnick-Hall, Lengnick-Hall, Andrade & Drake (2009) present an evolutionary and chronological perspective on the development of SHRM. The authors identify the following seven themes which influenced the development of the field of SHRM: (1) explaining contingency perspective and fit, (2) shifting from a focus on managing people to creating strategic contributions, (3) elaborating HR system components and structure, (4) expanding the scope of SHRM, (5) achieving HR implementation and execution, (6) measuring outcomes of SHRM, and (7) evaluating methodological issues.SHRM is evolving as a new approach to the management of people, and specifically focusing on integrating the human capital to business strategy to enhance organizational competitiveness. According to Aswathappa (2004:39), â€Å"the advent of SHRM has brought forward the issues of linkages between the employer-employee relationships and wider organizational strategies and corporate objectives†. â€Å"The field of strategic human resources management has enjoyed a remarkable ascendancy during the past two decades, as both an academic literature and focus on management practice† (Becker & Huselid, 2006:898).The transition from the older HR practice with focus on staff matter to a subject of re-birth which focuses on linking people as organizational asset with the business strategy of the firm (Niehaus, 1995) means that the HR professional is performing a new and more challenging responsibility that requires new competencies and skills. He has to think outside the traditional organizational box of HR – and develop a radically different approach to manage the human capital and create a fit between HR architecture and business strategy formulation and implementation in the firm.The HR architecture, according to (Becker & Huselid, 2006:899) â€Å"is composed of the systems, practices, competencies, and employee performance behaviors that reflect the development and management of the firm’s strategic human capital†. This paper discusses the emergence of SHRM as a paradigm shift and the pertinent issues raised or implied in this transition. It further presents the resource-based view (RBV) of integrating SHRM with business strategy.The organizational im plications of the strategic business partner model for corporate competitiveness, and the strategic skills and core competencies required of the HR practitioner are finally discussed. 2. Literature Review: Traditional HRM versus SHRM In their seminal thesis on the development of HR function, Jamrog & Overholt (2004:1) declare that â€Å"over the past 100 years the HRM professional has been continuously evolving and changing, adding more and different responsibilities†.The authors’ account shows that the HRM function has evolved through many stages, from the medieval time through the industrial revolution, the scientific management, the human relations movement, etc. , to the present strategic business partner model. For most of its history, HR has mainly focused on the administrative aspects of HRM, except recently, with the strident call for HRM to become a strategic business partner (Ulrich, 1997; Brockbank 1999; Lawler III & Mohrman, 2000; and Lawler III & Mohrman, 2003). 24Some scholars therefore, are wont to differentiate between the traditional HRM and SHRM. Traditional HRM is transactional in nature, concerned essentially with providing administrative support in terms of staffing, recruitment, compensation and benefits (Rowden, 1999; and Wei, 2006). Ulrich (1997) argues that the HR function has been an administrative function headed by personnel whose roles are essentially focused on cost control and administrative activities. Managing people is therefore the responsibility of HR manager.HRM is then a â€Å"formal system for the management of people within the organization† (Bateman & Zeithaml, 1993:346). For Inyang (2001:8), HRM is simply â€Å"organization’s activities, which are directed at attracting, developing and maintaining an effective workforce†. The many transactional or administrative activities involved in managing the human resources of an organization – training and development, staff motivation, compensation, staff commitment, quality performance, etc. are meant to be carried out effectively to influence the achievement of corporate objectives (Inynag, 2008a).The paradigm shift from the administrative aspects of HRM led to the emergence of SHRM as a new generation of value-added core responsibility or function of HRM. The emphasis of SHRM is that of a strategic business partner. It now supports the company’s competitive advantage by providing high quality people and by helping business managers strategically plan the functions of the human capital within the organizations (Rowden, 1999). SHRM strongly beliefs that critical organizational capabilities or performance behaviors are sine qua non, for the attainment of a particular business strategy or goal.Unlike the traditional HRM which covers a wide range of employment practices, including recruitment, selection, performance appraisal, training and development and administration of compensation and benefits, SHRM refl ects a more flexible arrangement and utilization of human resources to achieve organizational goals, and accordingly helps organizations gain competitive advantage (Wei, 2006). For Becker & Huselid (2006:899) the traditional HRM differs from SHRM in two important ways: â€Å"First, SHRM focuses on organizational performance rather than individual performance.Second, it also emphasizes the role of HR management systems as solutions to business problems (including positive and negative complementarities) rather than individual HR management practices in isolation†. This therefore reflects a shift of emphasis from operating efficiency of individual employees to managerial efficiency of the entire organization. The distinction presented in this review shows SHRM as a more systematic approach, which extends beyond the management of human capital and people – management activity to involve the integration of human factors to strategic business goals of the organization.The s trategic business partner focus of SHRM helps to add value to the organization – by contributing to the bottom line and competitive advantage. Despite its current popularity among academics and HR professionals, SHRM is still experiencing problems of status identity and precise definition (McMahan, Virick & Wright, 1999: 101). Dyer & Kochan (1994) note the problem of status identity as affecting the development of a systematic theory of SHRM.Even the definitions of SHRM vary in emphasis among scholars: Wright & McMahan (1992); and Lundy (1994) emphasize the elements of HR planning; Hendry & Petigrew (1990, 1992) stress the management of organizational change; Watson (1986) defines it as coordination mechanism of the organization; Beer (1984), Guest (1987), Dyer & Holders (1988), Lengnick-Hall & Lengnick-Hall (1990); Schuler, Dowling & De Cieri (1993), Truss & Gratton (1994); Ulrich (1997), Boxall (1999); Brand & Bax (2002) highlight HR policies as a tool for business strategy .Despite the differences in definition, a common thread that is emerging in the literature is that which stresses the relationship between business strategy and HR practices as the core of SHRM. What has also emerged from the literature is the broad agreement of the basic function of SHRM, which is concerned with designing and implementing a set of internally consistent policies and practices that ensure the human capital of an organization contributes to the achievement of its business objectives (Schuler & MacMillan, 1984), Baird & Meshoulam, 1988; Jackson & Schuler, 1995).On his part, Armstrong (2004:105) states that SHRM is essentially â€Å"concerned with the relationship between human resource management and strategic management of the firm†. Following from this, he defines 25 SHRM as â€Å"the overall direction the organization wishes to pursue in order to achieve its goals through people† (p. 105). SHRM is a strategic approach to manage human resource of an org anization. It concerns all organizational ctivities which affect the behavior of individuals in their effort to formulate and implement planned strategies that will help organization achieve the business objectives. According to the Gomez-Mejia, Balking, & Cardy (1995), SHRM implies a managerial orientation that ensures that human resources are employed in a manner conducive to the achievement of organizational goals and missions. SHRM must give careful consideration to the organizational import of all human resource decisions and to their links with the external environment and the organization’s competitive strategy (Beaumont, 1993).In their own contribution, Boxall & Purcell (2003) argue that SHRM is concerned with explaining how HRM influences organizational performance. It is obvious from this point that SHRM is based on the principles incorporating, the concept of strategy. Therefore, if HRM is a coherent approach to the management of people, then SHRM implies that this approach is done on a planned way that integrates organizational goals with policies and action sequences (CIPD, 2007). 3. SHRM and Business Strategy Fit or IntegrationThe new business context, which is characterized by increasing globalization, greater organizational complexity, market competitiveness and cutting-edge information communication technology, is prompting organization executives to take more interest in the deployment and utilization of their human resources. The HR function is therefore playing a far more strategic role in the business or corporate strategic planning process in the organization. The emergence of SHRM is increasingly adding more value to the organization. Thus, SHRM is based on HRM principles, which integrate the concept of business strategy.Strategy here refers to â€Å"the pattern of organizational moves and managerial techniques or approaches used to attain organization objectives and to pursue the organization’s mission† (Inyang, 200 4:20). Strategy is also considered as â€Å"the process by which the basic mission and objectives of the organization are set, and the process by which the organization uses its resources to achieve these objectives† (Tichy, Fombrun, & Devanna, 1982:47). Organizations must choose and follow the diverse approaches in order to achieve success or gain competitive advantage.Scholarly advocacy as already noted has consistently emphasized the need for HRM to become a strategic business partner. That means that SHRM has to be integrated with business strategy. This is also the issue of fit. Integration or fit refers to the involvement of SHRM in the formulation and implementation of organizational strategies and the alignment of SHRM with the strategic needs of an organization (e. g. Buyens & De Vos 1999; Schuler & Jackson, 1999). To become strategic business partner means that the HR managers should participate in strategic decision-making alongside other senior managers in the org anization.This, according to Ulrich (1997), would provide greater opportunity to align HR goals, strategies, philosophies and practices with corporate objectives and the implementation of business strategies. The involvement of HR managers would be to become members of senior or top management in the organization (Budhwar, 2000; Teo, 2000). Membership at this level in the organizational hierarchy offers opportunity for SHRM to represent its concerns and influence the direction of business strategy from the onset of the decision making process.This involvement from the crafting stage of strategy decision-making will enhance commitment on the part of the HR managers during implementation stage of such business strategy. Inyang (2008b) argues for the co-optation of the HR manager to business policy formulation as a business partner, to help drive policy implementation to success and attain competitive advantage. There is research evidence that integration tends to result in enhanced co mpetence, congruence and cost effectiveness (Black & Boal, 1994; Teece, Pisano & Shuen, 1997). 6 There is increasing attention being focused on SHRM discourse about congruence or fit† or integration between HR practice and business strategy (Baird & Meshoulam, 1988; Wright & McMahan, 1992; and Wei, 2006). The underlying assertion in the fit analyses is that the employment of effective HR practices and the design of an HR system compatible with the firm strategy are sine qua non for the successful implementation of the organization’s business strategies (Lengnick-Hall & Lengnick-Hall, 1988).Fit is therefore a fundamental feature of SHRM, which connotes the utilization of human resources to enhance the attainment of organizational goals. According to Wright & McMahan (1992:298), fit means â€Å"†¦ the pattern of planned human resource deployment and activities to enable a firm to achieve its goal†. Scholars of SHRM identify two kinds of fit: horizontal fit and vertical fit. Horizontal fit refers to the congruence among various HRM practices (Baird & Meshoulam, 1998), and vertical fit refers to the alignment of HRM practice with strategic management process of the firm (Schuler & Jackson, 1987).Generally, vertical fit or integration is necessary to provide congruence between business and human resource strategy so that the latter supports the accomplishment of the former, and helps to define it. Horizontal fit or integration with other aspects of the HR strategy is required so that its different elements fit together. The aim is to achieve a coherent approach to managing human resources, in a manner in which the various practices are mutually supportive.Both types of fit contribute significantly to the competitiveness of an organization and it is important for organization to arrange a variety of HR practices in a systematic way. According to Pfeffer (1994), a set of properly arranged HR practices can have a positive impact on a firm perf ormance when they are properly implemented. Creating a proper fit or integration is the key issue in SHRM and it is this congruence in organization’s HR practices that impact on the bottom line. Figure 1 below illustrates these concepts and their impact on the organization.Figure 1: Two Types of Fit Vertical: (Alignment of HR practices with business strategy) SHRM Integration/Fit Horizontal: (Congruence among HR practices) †¢ †¢ †¢ Bottom Line Competitiveness Performance SHRM is essentially about integration – integrating HR practices with the business strategy of the organization. Both the vertical and horizontal fits create the congruence between business strategy and human resource policies which jointly enhance the attainment of bottom line, competitiveness and performance.Thus SHRM helps the organization to achieve strategic fit with its market environment. One of the key policy goals of SHRM according to Guest (1989) is to ensure that HR is integra ted into strategic planning so that HRM policies cohere both across policy areas and across hierarchies and HRM practices are used by line managers as part of their everyday work. Walker (1992) points out that the HR strategies are functional strategies like marketing, production or IT strategies, but they are different in the sense that they are intertwined with all other strategies in the organization.Managing the human resource is a very unique function in the organization, and the human capital provides the 27 resources for implementing all business strategies. Therefore, HR planning should be an integral part of all other strategy formulations in the organization. 4. SHRM and the Resource Based View (RBV) of the Firm The RBV of the firm is based on the ideas of Penrose (1959), who sees the firm as â€Å"an administrative organization and a collection of productive resources†. A firm that obtains and develops the human resource can achieve competitive advantage (Hamel & P rahalad (1989).Other researchers have similarly advocated the need to align HR systems with the firm’s strategy to create competitive advantage (Barney, 1986, 1991; and Wright & McMahan, 1992). The underlying assumption of the RBV of the firm is resource heterogeneity. This means that the resources that different firms own are unlikely to be identical. Accordingly, these resources owned by the firm that help it achieve sustained competitive advantage must meet four requirements. The resources must be (i) valuable, (2) rare, (3) inimitable, and (4) non-substitutable.This follows therefore that if the resources a firm employs cannot be easily imitated by another firm or substituted by similar resources another firm employs the firm can easily take advantage of this to gain competitiveness not simultaneously pursued by other firms. Snell, Youndt & Wright (1996) argue that human resources meet these four requirements. Others have equally shown that the linkage of organizational r esources and firm strategy cannot be easily identified and imitated by other firms due to the social complexity and causal ambiguity (Barney, 1991, Boxall, 1998).Thus, the integration of human resource practices and policies with the appropriate strategy can generate a sustained competitive advantage for the firm (Wei, 2006). The firm’s HR policies, practices and strategies are a unique blend of process, procedures, personalities, styles, capabilities and organizational culture, which are difficult to imitate. As Purcell, Kinnie, Hutchinson, Rayton & Swart (2003) point out, the values and HR policies of an organization constitute important non-imitable resources, as long as they are enacted and implemented effectively.One of the most important factors of competitive advantage is the ability to differentiate what a business supplies to its customers from what is supplied by its competitors. Purcell et al (2003) maintain that such differentiation can be achieved by having HR st rategies, policies and practices which ensure that: 1. The firm has higher quality people than its competitors. 2. The unique intellectual capital possessed by the business is developed and nurtured. 3. Organizational learning is encouraged, and 4.Organizational specific values and a culture exist that ‘bind the organization together [and] give it focus’. The RBV of the firm is concerned with developing strategic capacity, making adequate investment in the organization’s human capital to add more value to the firm. According to Armstrong (2004:108), the aim of RBV â€Å"is to improve resource capability – achieving strategic fit between resources and opportunities, and obtaining added value from the effective deployment of resources†.It is generally acknowledged that the human resource is an organizational asset, and when it is adequately trained and effectively deployed can contribute immensely to the bottom line. Aligning the HR systems with busin ess strategy is therefore a sine qua non for organizational competitiveness. Business strategies designed to achieve organizational objectives are not likely to succeed when HRM is not involved in both strategy formulation and implementation. Organizations must create the conducive environment for integrating HRM with business strategy since the HR supplies the energies for driving organization strategies.Wei (2006) notes that the HR system and practices are crucial in facilitating the achievement of business strategy through the management of people. Several studies have shown that a firm’s HR creates value in the organization in different ways. The impact of SHRM on organizational performance is quite obvious. SHRM has positive effect on business performance (Martell & Carrol, 1995); SHRM can help an organization to allocate its human 28 resources more effectively, promote operating efficiency, and encourage creativity and innovation (Dyer, 1983; Walker, 1980); it enables t he firm ope more effectively with the challenges of environmental change (Cook & Ferris, 1986; Tichy & Barnett, 1985); encourages a more proactive management style, transmits organizational goals clearly and motivates greater involvement by line managers in HRM concerns (Gomez-Mejia, Balking & Cardy, 1995); enhances organizational morale, financial performance, and overall organizational performance (Huang, 1998; Anderson, Cooper & Zhu, 2007); brings about commitment, customer satisfaction and innovation (Pfeffer, 1994; Chew & Chong, 1999; Bowen, Galang & Pillai, 2000; Wright & Kehoe, 2008); enhances market value per employee (Becker & Huselid, 1998); creates value for customers and stakeholders (Ramlall, 2006); and brings about return on equity (Delery & Doty, 1996).Garavan (2007:11) sees strategic human resource development as contributing â€Å"to the creation of firm-specific knowledge and skill when it is aligned with the strategic goals of the organization†. Increased p roductivity has also been noted in small enterprises that align or integrate their formal and informal HR practices and strategies with the business strategies of the organization (Singh & Vohra, 2005). 5. The Roles of SHRM Professional The HR professional has more challenging roles to perform under SHRM – the emergent business partner model. Unlike the traditional HRM, which is transactional in nature and is concerned with administrative activities, SHRM is a value-added core responsibility that aligns the HR system, policies and practices with business strategy to gain sustained competitive advantage for the firm.In performing the new challenging roles, the HR professional must think outside the traditional organizational box of HRM and develop a more systematic and radically different approach to manage the human element to effectively support the firm’s business strategy formulation and implementation. For successful implementation of the business partner role, the HR manager needs to understand the company’s business direction and its competitive position in the market place. Apart from this, to become a successful strategic partner, the HR manager must have competencies that have to do with the business issues involved in strategy and strategy development, and ability to contribute to organizational design and change management (Lawler, III and Mohrman, 2003).The HR function, according to Rowden (1999) must change from a staff function that delivers prepackaged HR services to a service that helps managers create customized strategic plans to influence the effectiveness of company performance. The HR manager can play an important role in the formulation of strategy and providing the human resource required to support various strategies and strategic initiatives in the organization. He provides the leadership role in developing the human capital and the necessary capabilities to enact the strategy and drive the implementation and chang e management processes to success (Lawler III & Mohrman, 2003). Good human capital management is a prerequisite for successful execution of business strategies.According to Ulrich (1998), the modern HR professional must perform four complementary roles. The first role, administrative excellence, is important because it is an immediate way of contributing to the overall efficiency of the organization. As administration expert, he must rethink how work is done throughout the organization. The second role HR professionals must realize is that of employee champion. The HR manager must play the crucial role of employee advocate. He should be the employee’s voice in management discussion, offer employee opportunities for personal and professional growth; and provide resources that employees need to meet the demands put on them.The new role might also involve suggesting, that employees be given more control over their own work schedules. This is the issue of employee empowerment. Tw o additional roles the modern HR professional must realize are those of strategic partner and change agent. Being a strategic partner calls for an on going evaluation of the alignment between current HR practices and the business objectives of the firm, and a continuing effort to design policies and practices that maximize this alignment. HR practitioner should be held responsible for defining an 29 organizational architecture – that is, identifying the organization’s way of doing business.Such framework as looking at the organizational components – strategy, structure, rewards, processes, people, style and shared values may be adopted. This new knowledge will allow HR to add value to the executive team with confidence. Being a change agent the HR manager must play a key role in implementing and managing organization change, assessing potential, sources of resistance to change, and collaborating with line managers to overcome these barriers. The HR professionalà ¢â‚¬â„¢s role as a change agent is to replace resistance with resolve, planning with results and fear of change with excitement about its possibilities. These last two roles – strategic partner and change agent – are of particular interest to us because they represent the emerging strategic dimension of HR function SHRM.In addition to the above roles the HR practitioner needs to be a model and take on the specific role of integrating people strategies with business strategies in a way that advances the bottom line. Metzler (1998) adds that: the HR manager must play an active and guiding role in enabling the organization to choose its human resources well, invest in these people, support that growth and respect their needs, while fostering innovations needed to achieve the strategic business objectives. The HR professional operating under the SHRM system must chart roles that include early and active involvement in key strategic business choices. He must become the part ner of decision makers in the organization, and sharing accountability for organizing and performing work.He must carry out effective monitoring to see that everyone in the organization, and at every organizational hierarchy, stay focused on share strategic priorities. He must challenge old ways and constantly promote innovation to enhance corporate performance and the firm’s competitiveness. 6. Requisite Strategic Skill Development and Competencies To function as a strategic business partner and successfully execute the new critical and challenging responsibilities, to bring about the bottom line, the HR professional needs to possess the relevant strategic skills or core competencies. Ismail & Long (2009: 118) define competency in general term â€Å"as a personnel related concept referring to a set of behavioral dimensions of one’s effective performance work†.Inyang (2009:65) considers competencies as constituting â€Å"a cluster of related knowledge, attitude s, and skills, which an individual acquires and uses together, to produce outstanding performance in any given area of responsibility†. A lack of certain competencies may affect the HR professional in the performance of the strategic role in the organization (Aitchison, 2007). Zigarelli (1997) identifies seven strategic skills that can help the manager develop effective strategic plans to handle the emerging challenges in the organization: 1. Global operating skills: These skills enable him to understand the issues of globalization and how to do business with individuals of diverse background or nationalities. 2.Business and financial savvy: He needs to understand financial reports, business goals, and possess the business acumen necessary to understand and support the function. 3. Strategic visioning, critical thinking and problem solving skills: As a strategic business partner, he needs the skills to take the lead in contributing to strategy, vision, and critical thinking to gain credibility for the HR function. 4. Ability to use information technology: The HR professional must be well grounded in information communication technology (ICT) and leverage this for business results. ICT is the engine that drives the modern organizations to business success and offers them sustained competitive advantage. 5.Deep HR knowledge: He needs to be well grounded in the theoretical and practical fundamentals of HR to adequately articulate HR practices. He needs to invest more time and resources for training and development. 30 6. Change management skills: He needs these skills to move the organization to new and more efficient ways of doing business. He needs to show commitment to change management in the organization. 7. Organizational effectiveness skills: These skills enable him to diagnose the effectiveness of the organization as accurately as possible to portray the current and future state of the organization. He can then monitor and correct inefficiencies. Ye ung, Wolcock & Sullivan (1996) identify the following core competencies that effective HR professionals should develop: 1.Business knowledge: Capacity to understand competitive issues impacting the business (e. g. , market, products, technology, processes) and to understand how business can create profit and value. 2. Customer orientation: Ability to viewing issues from the perspective of customers. 3. Effective communication: The ability to provide both verbal and written information clearly, consistently and persuasively. 4. Credibility and integrity: To walk what you talk, act with integrity in all business transactions and honor personal commitments. 5. Systemic perspective: The ability to view problems and issues in the context of the bigger picture and understand the inter-relationships among sub-components. 6.Negotiation and conflict resolution skills: The capacity to reach agreements and consensus in spite of different goals and priorities. Similarly, Ismail & Long (2009) ex amine six competencies – business knowledge, strategic contributions, HR delivery, personal credibility, HR technology and internal consultation, which HR professional needs to possess in order to function in his strategic partnership role and to excel in the current competitive environment. These competencies are based on Human Resource Competency Study (HRCS) under the initiative of the University of Michigan in the year 2003 (Brockbank & Ulrich, 2003), except internal consultation.The HR practitioner must acquire consulting skills which constitute a combination of diagnostic and behavioral skills that enable the professional, who is in support function in the organization to collaborate with the line managers to develop strategic solutions to business performance problems. As an internal consultant therefore, the HR manager is in a better position to contribute significantly to the functioning of other departments, solving problems, and delivering enhanced performance (Ism ail & Long, 2009). The rapidly changing global business environment calls for high knowledgeablity on the part of the human resource managers, to function effectively as strategic business partners. According to Inyang (2008a: 61), â€Å"Human resources practitioners need to broaden their horizons, seek more knowledge and information to manage the intellectual capital effectively.This requires people who are multi-skilled, self-responsible, visionary and able to learn, to handle, to lead the organization to success†. The HR practitioner is also expected to develop a new mindset, as he becomes a strategic partner. In fact, to be a strategic partner, â€Å"the HR function must go beyond delivering services, maintaining records, and auditing. It needs to spend time being a member of the management team, doing strategic HR planning and making contributions to organizational design, strategy development, and strategic change† (Lawler III & Mohrman, 2003:4). 31 7. Conclusion The traditional HRM practices, which are concerned with the management of people in an organization, have contributed significantly to organization bottom line.HRM offers traditional and administrative support services in the organization, in terms of staffing, recruitment, training and development, compensation and benefits. It generally concerned itself with attracting, developing and maintaining effective workforce. The emergence of SHRM as a paradigm shift generated more value-added core responsibility, and emphasized the need to integrate HR practices with business strategy. SHRM is a strategic business partner model, which strongly beliefs that critical organizational capabilities or performance behaviors are necessary for the attainment of a particular business strategy or goal. SHRM is a more radical and systematic approach to the management of human capital, placing more emphasis on organizational performance rather than individual performance.It is this approach that help s to create a fit or congruence or integration of HR practices with business strategies that enables the organization to achieve sustained competitive advantage. The RBV of the firm highlights the strategic position of the human capital, as an organizational asset, that contributes significantly to the overall performance of the organization, when adequate investment is made on the human resources. The HR practices must be properly aligned with the strategic goals of the organization. To function as a strategic business partner and a change agent, to successfully handle the emerging challenges of SHRM, the HR practitioner must possess the requisite strategic skills and core competencies.The skills and competencies required include among others, being highly knowledgeable about business and its environment, developing a strategic vision, global operating skills, understanding and applying the ICT regime, organizational effectiveness skills, change management skills and ability to und erstand and manage conflict as well as possess internal consulting skills. References [1] [2] [3] Aitchison, D. (2007). â€Å"HR transformation: Myth or reality†. HROA Europe and sharedpertise forums in association with TPI. Survey Report January 2007. Akhtar, S. , Ding, D. Z . & Ge, G. (2008). â€Å"Strategic HRM practices and their impacts on company performance in Chinese enterprises†.Human Resource Management, 47(1), 15-32 Anderson, K. K. , Cooper, B. K. & Zhu, CJ. 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Physician and Nursing Shortages Essay

Healthcare reforms including Obama Care, formally named the Patient Protection and Affordable Care Act greatly impacts physicians and nursing shortages. There are several provisions which could direct impact physicians and nurses through incentives for potential recruitment, grants, training and retention. Through potential initiatives, the act may indirect effects that may question or present new reimbursement alternatives and models of health care delivery options. Healthcare reforms will allow millions of additional working as well as no working Americans to obtain healthcare coverage and this may challenge and highly impact physicians and nurses workforces across the United States. Many healthcare facilities have already reported high vacancy rates for technicians, pharmacists, maintenance staff, housekeeping staff and radiology technicians and laboratory technologists. Today, fair percentage of the American population, roughly 20%, lack proper access to needed primary care becau se there is an ongoing shortage of physicians. Some doctors, almost 30% are declining to accept new patients whom are insured with Medicaid. The changing demographics of the United States today and perverse reimbursements are direct impacts from the physician shortage. The looming physician and nursing shortages will inevitably hinder the health care system that is already being tax as well as alter the way patients and their physicians interact because the doctor-to-patient ratio will continue to be raised which will hurt patient outcomes. All workers within the healthcare arena play a vital part in making the healthcare system successful. Physicians and nursing shortages definitely create problems for every department and for all other workers within their system. Worldwide shortages that the United States are currently experiencing may create dangerous and unacceptable care to patients. Shortages additional enable work environments that do the foster retention of highly experienced and  qualified healthcare professionals, resulting in high turnover and revolving worker pool. Physicians and nursing shortages present c hallenges that do not help the workforce in healthcare organizations worldwide. These challenges include inadequate incentives which may attract students to join the profession, understaffing in various medical professions, as well as inadequate training facilities, and primary care being undervalued. Obama Care relies on primary care providers to coordinate care in the hopes of lowering costs and improving outcomes. â€Å"If the population growth, aging and demand for care created by the newly insured, it is estimated that by 2025, the U.S. will face a shortage of 30,000 primary care physicians, nearly 5,000 of which are attributable to the expansion of insurance under Obama Care.† (Howard, 2013) The health care system involves a network that is a combination of hospitals, employers, insurers, physicians, patients and various other stakeholders. A significant change impacting one component will reshape the entire system. Stakeholders are greatly concerned because the qualities of health care as well as the cost of care. Health care reforms will need to a ddress changes that are missing in policy outlines which should make primary health care more rewarding and appealing to potential new nursing and physician staff and which will also help to maintain the nursing and physicians that are already practicing. Additional the current supply of primary health care physicians will continue to fall behind the increasing patient demands. This will also result in stakeholders presented with the problems of increasing shortfall during the next decade within the primary care physicians. The availability of primary care is consistently and positively targeted to continued improvement with patient outcomes, raising health costs, lower utilization of health and reduced mortality rates. The Affordable Care Act set forth millions of dollars to address the problems and concerns that are associated with existing physicians shortages. The Affordable Care Act also has provisions that are aimed to improve the education, ongoing training as well as to help with the recruitment of nursing, physicians, doctors as well as other health care personnel. In addition, there are provisions in place that help to increase workforces’ cultural competency, enhance faculty training of healthcare professionals, and diversity. The provisions also play a vital role because of the fact they are put into place to examine innovative  reimbursement and care delivery models that highlight primary care services value and offer in improvement in the patient care coordination. On an average, primary physician groups may see about four or five patients within an hour, probably about one patient every fifteen minutes. Because of increase productivity and cost restraints and pressures, this number could increase dramatically. This trend, unfortunately, will be matching the burden of physicians declining incomes and job market. A lessor number of physicians earn what physicians earned many years ago. Primary health has been affected more as compared to services rendered. Additionally, the shift to a bundled fee for performance from the fee for service reimbursement system for force solo practicing physicians and small group practices into forming or partnering into larger practices. Physicians and nursing staff are not surprised by many of the findings. The Doctors Company, the largest physician-owned medical malpractice insurer in the nation in 2012, released results from a survey in which more than 5,000 physicians participated in across the nation commented on the future of health care reform. A result of the survey concluded that 60% of the respondents concluded that the pressures of trying to increase patient numbers will probably have a negative effect on the level of care physicians whom have the opportunity to provide services. The study concluded that 51% of the physicians thought that their ability to successfully keep positive relationships with their patients and grow patient relationships would be negatively affected. Lastly, the study concluded that out of 10 physicians, nine are disillusioned by the concerns with the shortages so that several of the physicians actively discourage family and friends from pursuing careers in medicine. Unfortunately, this is a shocking reality of what many of us already know, and statistics presented from the study would be even higher if the exact survey questionnaire was conducted today. While the many projected newly insured patients that will enter the health care system may obtain their insurance coverage through available st ate ran exchanges, many new patients may still find themselves unable to afford potential discounted policies. This will cause many to look for coverage from Medicaid out of urgency and because they may feel as though they have no choice. Primary care physician payments have been reduced in the past and we can look for them to be continually reduced maybe even more in the future. Many  physicians are unhappy with the fact that they may owe over 160,000 when they finish medical school. Many potential physicians do not find this attractive because many will have salaries that are likely to be less than the cost of their education. Many physicians in this case will find it more attractive and enticing to become specials which again will attribute to the physicians and nursing shortages. Physician assistants and nurse practitioners may have to step up in fill in. Physician assistants are qualified personnel that have been license and qualified to provide needed preventive care options. Physician assistants have an important role in the management of chronic disease prevention and management, administering blood sugars testing and interpreting blood sugar levels. When physicians have only a short time, less than 10 minutes or so to see a patient, sometimes they encounter issues which may leave no choice but to pass responsibilities to their , who are able, to practice with the supervision of the physician in most states. â€Å"Under the proposals, issued with a view to impending physician shortages, it would be easier for hospitals to use advanced practice nurse practitioners and physician assistants in lieu of higher-paid physicians.†(Pear, 2011) Because these change, hospitals could benefit by seeing savings which would be immediate. Legislation within several states at this time is seeking to extend the physician assistant’s autonomy by enabling the assistance to independently practice without of physicians, but under certain guidelines and protocol s. Many Americans may find this legislation to be filled with controversy, but many may feel that the legislation is needed to increase productivity of physician assistants, nurse practitioners and primary-care physicians whom will ultimately have responsibilities because of the growing shortages. Doctor-patient relationship will definitely change because of the shortages. In the past, patients were granted appointment times that could last up to 60 minutes, these days are gone because patients are rushed out because of people waiting to be seen in addition. This doesn’t mean service will go down or the quality of medical care will not be like it was. Even though many people have doubts and are not optimistic, I feel the quality of medical care and health service will improve. Research also indicates the quality of patient care will improve performance measurements will prove this in the future. The Patient Protection and Affordable Care Act will impose  changes that may be dis ruptive in the delivery of primary care. The act allows expansion of primary care access to physicians, millions of new patients, and policymakers will be faced with increase pressure to resolve primary care practitioner’s shortages. Even though controversy surrounds the Affordable Care Act enactment, the government should do more to drive motivation among physicians, nurses and professional medical associations. They can also embrace medical societies that may offer strategy initiatives suggestions that will help to meet the nation’s primary care needs. Physicians have experience some success to this date with embracing the changes to primary care, such as supporting laws that allows primary care practice to be perform by non-physician practitioners including assistants and nurse practitioners. Some physicians have realized that they may benefit from the integration of primary care practice from population health needs. Many physicians have realized that the environment now created is beneficial, it helps the m. Many physicians have chosen to stop being against non-physician practitioners and are welcoming them to work with them. Physicians can also offer problem solving and physicians should take initiatives to foster policies and develop solutions which addresses primary care shortages. Initiatives can involve no more opposition of non-physician practitioners with primary care providers (in the past medical organizations as well as physicians did show opposition to this). Additionally, physicians should embrace changes with the delivery of primary health care including the shifting of some responsibilities to the practitioners. Lastly, because of the Affordable Care Act focuses with prevention and wellness, physicians should realize that opportunities exist to the integration of the primary care practice with population health. Many Americans will have coverage with the expansion of health insurance coverage. With the nation’s continued growth and new covered Americans the drive the demand for primary care to levels will definitely exceed existing capacity levels. The millions of newly insured Americans who may not had access to primary care will definitely be looking for primary care now with the enactment of the act. Because of this, there will more than likely be disruptive and unwelcome changes in the delivery of primary care. Important ethical issues are presented with health care reform. The recently 2010 enacted Patient Protection and Affordable Care Act have  ignited ethical debates over some minor and major controversial topics. Why do many feel as though reform within the health care system such a controversial issue? Politicians seek to gain advantages over their worthy opponents which fuel the policy debate. Differences which are important to us all, with values and moral beliefs are the underlying issues of political differences. To help comprehend the moral paramete rs of debate within health care reform, it may be beneficial to start by analyzing the primary goals of the nation’s health care system. Individuals and as the society want and have high expectations with our health care system. The United States health care system has been shaped by fundamental desires and goals. The American people will accept nothing less those exceptional, high levels of quality care which provides excellent health benefits. Americans expects the United States to continue being the frontiers of medicine and expects the United States to continue improving the quality of health care. The American people also want and welcome having a freedom of choice which means they make their own decisions about their care. These decisions can include deciding where to receive care, if and when they do, what kind of care they get, and from which health care provider in which they seek care. Basically, Americans including myself would like to maintain our on control over our health care needs, choices and providers. We also want affordability with healthcare, we don’t want to spend all our hard earned money on health care costs and not have enough money to cover our other needs. In addition, most Americans feel as though our fellow Americans can share in the costs of providing health care benefits to us all and Americans Americans as well as the government wants to make sure that medical care costs are controlled. This is an important attribute of the cost of medical care and it’s a vital element of the health care reform enactment. Extending care access to everyone without appropriate cost control measures will be unsustainable. â€Å"The number of emergency room visits continues to rise at a rate greater than that of population growth, exemplified by an increase in emergency room visit rates from 352.8 to 390.5 per 1000 persons from 1997-2007.† (Tang, 2010) Today, the United States spends the most on health care per capita, more than any other country. Americans generally would prefer cost containment that does not reduce quality or services. Cost containment approaches are not design to interfere with the  value of health care. The PPACA have address cost containment strategies which include patient care that is accountable, patient-centered medical homes, and programs to reduce patients being readmitted and patients acquiring new conditions while admitted as well as bundled payments. The Patient Protection and Affordable Care Act have some provisions that may be negative for doctors, however in some instances patients can suffer more. However examining the positives, On a positive side, provisions as well programs can help many of us. The Affordable Care Act seeks to provide additional access to coverage, lowering health care spending and improving the quality of health care delivered services. Initiatives of the ACA aid health care organizations; doctors and providers work together to coordinate health care of patient’s beneficiaries to ensure the quality of health care continues to improve while spending and costs are lowered. Many of the elderly have begun receiving the benefits of the provisions of the law. Some of these benefits include lower payments and preventive service care. They also are seeing the benefits of Medicare prescriptions at lower drug cost. The Affordable Care Act is helping seniors by allowing annual wellness visits and preventive services in which they have no upfront or out of pocket costs, offering coverage to individuals that may have pre-existing conditions and it allows for no one to be denied coverage because of pre-existing condition and huge savings on prescription drug costs. Though the health reform law includes measurement which may address the presented and growing shortage, other provisions in the law most likely will raise the demand of primary care. For example, the law is expected to extend coverage to millions of uninsured people by 2019, which will definitely increase the demand for primary care services. â€Å"The PPACA coverage expansions are predicted to increas e the shortage of primary care physicians from approximately 25,000 to 45,000 by 2020.† (Carrier, 2012) There are several measurements that can be implemented to help improve access to primary care providers and services. Because the U.S. has a high percentage of Americans without adequate healthcare a Mobile Health Clinic or a Nursed Managed Centers can be used to attract a lot of people such as the homeless people who do not have the means to be able to go to the doctor (Whelan, et al, 2010). This will allow them to be able to see a doctor and get the proper medical attention they need to have healthier lives. One possible  approach to alleviating pressures on the primary care workforce is greater use of nurse practitioners, which could both increase the number of primary care providers and potentially free up physicians to care for more complex patients. Improving access to primary care services and having more effective public health measures are critical to ensuring that individuals have access to high-quality services at the place and time that best meets their needs. Physician assistants can we be a part of the answer as well. They are well trained, have the clinical skills, with a high level knowledge base, and be a part of the solution. The skills they bring to the table can help address the impending avalanche of patients. Not only are they cost effective with overall labor costs less than a physician, but can take the stress off of a physician needing to see a certain amount of patients per day, as to keep the productive practice (Bahrych 2011). Finally, a scholarship program for students committed to providing primary care in communities with doctor shortages should be implemented; the program can allow open residency slots to be utilized in areas with shortages. Grants and incentives should be established. Also initiatives should be in place to forgive student loan debt. I would also make the following recommendations for improvements that will increase the availability of specialty care through tele-health, bringing specialists to primary care sites, and using physician assistants to deliver specialty services; and also expand the role of primary care providers, physicians and nurse practitioners to handle more specialized health issues through consultations and ongoing training. References: Howard, Paul. (2013, July). Get Obama Care While Supplies Last. Retrieved from http://www.usatoday.com/story/opinion/2013/07/11/obamacare-doctors-medicaid-primary-care-column/2510199/ Tang N, Stein J, Hsia RY et al: Trends and characteristics and US emergency department visits, 1997 – 2007. JAMA 2010; 304: 664-670 Pear, Robert. US Moves to Cut Back Regulations on Hospitals, October 2011. Retrieved from http://www.nytimes.com/2011/10/19/health/policy/19health.html?_r=0 Bahrych, Sharon. Let Physician Assistances be Part of the Primary Care Answer, December 2011, Retrieved from

Role of Ultrasound in the Early Detection of an Ectopic Pregnancy.

CASE STUDY: Role of Ultrasound in the early detection of an ectopic pregnancy. Introduction. Ectopic pregnancy is the fourth most common cause of maternal death in the United Kingdom, accounting for 80% of early pregnancy deaths (Lewis and Drife 2004). Furthermore, it is still the most common cause of maternal death in the 1st trimester of pregnancy (Condous G 2006) affecting 1:100 pregnancies (Ectopic Pregnancy Trust 2007). For this case study I will discuss the essence of scanning women who present in EPU’s with a positive pregnancy test and any symptoms of a possible ectopic pregnancy. CASE REPORT This is the case of 32yrs old primigravida referred to an early pregnancy unit by her GP with a history of irregular menstrual cycle, heavy bleeding for a week and a positive pregnancy test which she did 10days earlier. Conception was spontaneous. Her Gestational age by her LMP was 4weeks and 4days. A transvaginal ultra-sound was performed which identified the absence of an intrauterine gestation sac. The endometrial thickness was 2. 0mm, midline echo intact and thin and homogenous. The right ovary was visible and normal; the left ovary was visible and normal with a corpus luteum. An adnexal mass separate from the ovary was found adjacent to the left ovary (appendix 1). There was free fluid in the pouch of Douglas with was ground glass appearance which was consistent with haemoperitoneum and was tender to the left were the mass was situated (appendix 2). In view of the findings a left tubal ectopic was diagnosed. In keeping with the department protocol an urgent BHCG and progesterone was done whiles she was referred to the emergency team for further management. Result came back as BHCG 72 iu/l and progesterone 3. 00nmol/l.. She had a laparoscopic salpingectomy for a left tubal ectopic pregnancy. Histology of the product removed laparoscopically was positive of an ectopic, and a repeat BHCG was repeated after a week. The patient was started on antibiotics and recovered successfully. DISCUSSION An ectopic pregnancy is an extra uterine pregnancy. The most common site for implantation is the fallopian tube; however, the conceptus may implant in the ovaries, the cervix, or the abdomen (Drife J, Magowan B 2004). An ectopic pregnancy is a potentially life-threatening gynaecological emergency hat requires urgent intervention. With the above case her LMP indicated a pregnancy of less than 5weeks. She would have been considered outside the criteria of finding an ectopic pregnancy, and would have been considered a possible early miscarriage. With the patients history of irregular bleeding a decision was made to scan. An irregular period can mean that ovulation does not match her last menstrual cycle. All sexually active women of reproductive age who present with lower abdominal pain, with or without vaginal bleeding; an ectopic pregnancy must be excluded. When woman present in a clinic and has had a positive test either at home or at a GP practice it is an indication she is pregnant, and as mention by (Bisset, et al 2002) the role of ultrasound is to identify the site of the pregnancy, if an intrauterine pregnancy is not found then ectopic pregnancy should be considered. Likewise a study by (Haider et al 2006) found out that providing ultrasound as an initial assessment with suspected ectopic has improved clinical management. She should be scan to identify the site of the pregnancy; this was why the decision to scan these women in the department even before an HCG test is carried out. but with her history of irregular period a decision should be made to scan. (The Early Pregnancy RCOG guidelines 2006) confirms a BHCG below 100 iu/l and progesterone below 60iu/l should be treated as an ectopic. When the scan was done and an endometrium of 2mm was seen. The endometrium thickness and appearance can be can be deceptive and these findings can be interpreted as a non pregnant uterus The urine dipstick test for beta-hCG (urinary pregnancy test) carried out is a quick, easy, and sensitive test. It has a sensitivity of 99% at a urine beta-hCG level greater than 25 IU/L, If a woman has a negative urinary pregnancy test, this almost invariably means that she does not have an ectopic pregnancy. However a blood beta-HCG of 72 iu/l was a low level in keeping with guidelines and if this was done prior to the scan it would have been interpreted as a possible failing pregnancy. However, (Condous G, 2006) insists that if it is positive the woman should have a USS. As the vast majority of ectopic pregnancies are tubal, there is ongoing debate in regard to the best method to investigate and diagnosing (tubal) ectopic pregnancy. In Condous report it was recommended that a urine test be done but most patients would have had a test prior to their visit in the clinic. An ectopic pregnancy should be suspected in any woman of reproductive age with any symptom the above patient presented with; however these can be associated with symptoms of miscarriages or other non-pregnancy related etiology. Clinicians should be very suspicious of this symptom although patients can present with others. A recently published review by (Sawyer and Jurkovic 2007) found that the most accurate way to diagnosing an ectopic pregnancy is the use of a combination of ultrasonography, serum beta-hCG, and histology, either following laparoscopy or dilatation and curettage (D&C). These were all carried out in the purpose of diagnosing, confirming and ensuring a resolution to the problem. However, unlike ultrasonography, neither biochemistry nor histology is available immediately, and when presented with a pregnant woman with pain and/or vaginal bleeding, clinicians must urgently exclude an ectopic pregnancy. As such, the initial investigation should be ultrasonography. With the above patient the ultrasound identified fluid in the pouch of Douglas and haemoperitoneum which could have been a rupturing corpus luteal cyst could be the closest differential diagnosis; however the thick tubal ring and a solid corpus luteum seen in this case strongly favours ectopic gestation as the diagnosis (appendix 3). This case highlights an example of a situation in which an ectopic pregnancy was adequately diagnosed rather than of a complete miscarriage. Free fluid was noted, it was echogenic suggestive of haemoperitoneum. Colour. Doppler study reveals a highly vascular ‘ring of fire’ appearance surrounding the tubal ring, confirming that the cystic adnexal mass is an ectopic gestational sac. This appearance is due to a high velocity, low resistance, and trophoblastic flow through the feeding branch of the uterine artery on the affected tubal gestation site, which may aid in narrowing the differential, leading to early detection of the condition. It is usually seen as a variable sized mass, consisting of a hypoechoic centre and surrounded by a thick echogenic rim. This tubal ring can be used to distinguish an ectopic from a ruptured corpus luteum cyst, which is its closest differential. Separate studies by (Ash et al 2007) and (Vaisky et al 2007) demonstrated the value of transvaginal colour flow Doppler in aiding the diagnosis of cornual ectopics. REFERENCES Ash, A, Smith, A, Maxwell,. D (2007) Caesarian scar Pregnancy. British Journal of Obstetrics and Gynaecology. Volume 114:3:253-263 Bisset R. , Khan A, Thomas N (2002)-Differential Diagnosis on Obstetric and Gynaecological Ultrasound. Second Edition. Elsevier Science limited. London. Condous G. Ectopic pregnancy – risk factors and diagnosis. Aust FAM Physician. 2006; 35:854–857. Drife J, Magowan B, editors. Clinical Obstetrics and Gynaecology. London, United Kingdom: Saunders; 2004. pp. 169–171. Haider . Z, Condous. G, Khalid. A. , Kirk. , Bourne. T,. Van Calster. B (2006) Impact of the availability of sonography in The Acute Gynaecology Unit Lewis G. , Drife J, Why Mothers Die 2000–2002 – The Sixth Report of Confidential Enquiries into Maternal Deaths in the United Kingdom; London, United Kingdom: Royal College of Obstetricians and Gynaecologists; 2004. Royal College of Obstetrician and Gynaecologist (2006). Green Top Guidelines in Early Pregnancy loss (WWW) http://www. rcog. org. uk/resources/public/pdf/green top 25 management epl. pdf (April 5th 2007). Sawyer E, Jurkovic D. Ultrasonography in the diagnosis and management of abnormal early pregnancy. Clinical Obstet Gynecol. 2007; 50:31–54. Vasky, D. , Hamani Y. , Verstanig, A. , Yagel, S (2007)The use of 3D rendering, VCI-C,3d Power Doppler and B flow in the Evaluation of Interstitial Pregnancy with Arteriovenous malformation treated by selective Uterine Artery Embolization. Ultrasound in Obstetric and Gynaecology . Volume 29:3:352-355.