When Do I Need a Business Lawyer for My Small Business?
Among the countless worries for entrepreneurs who are starting or are already running a small business is the question of whether they need a business lawyer. The perception is that attorneys charge high rates and many small businesses don’t have much, if any, extra capital with which to pay lawyers. As a result, most small business owners only hire an attorney experienced with business matters when confronted with a serious legal problem (e.g. you’re sued by a customer). However, legal help is a cost of doing business that often saves you money and helps your business in the long run.
While you certainly don’t need an attorney for every step of running your business, an ounce of prevention is worth a pound of the cure. This article will explain when you can cover legal issues on your own or with minimal attorney assistance and when you will definitely need a business lawyer.
Issues You Can Handle on Your Own
There are certain matters that are fairly straightforward and/or not unduly difficult to learn and therefore do not require the services of an attorney who charges at least $200 per hour. There are enough expenses associated with running a business, why not save yourself a load of money and do it yourself if you can?
The following is a list of some tasks that business owners should consider taking on themselves (with the aid of self-help resources, online and in print):
- Writing a business plan
- Researching and picking a name for your business (previously trademarked business names can be researched online)
- Reserving a domain name for your website
- Creating a legal partnership agreement, limited liability company (LLC) operating agreement, or shareholder’s agreement (see Choosing a Legal Structure )
- Applying for an employer identification number (EIN), which you will need for employee tax purposes
- Applying for any licenses and permits the business requires
- Interviewing and hiring employees (there are federal and state antidiscrimination laws which regulate the hiring of employees)
- Submitting necessary IRS forms
- Documenting LLC meetings
- Hiring independent contractors and contracting with vendors
- Creating contracts for use with customers or clients
- Creating a buy-sell agreement with partners
- Updating any partnership, LLC, or shareholder’s agreements under which you are currently operating
- Handling audits initiated by the IRS
The above is not an exhaustive list of legal tasks which small business owners can do on their own. It should be stated that if your business is well-funded or you feel that you need the assistance of an attorney, you can always retain a lawyer to help you with everything listed above.
Issues Where You Will Need a Business Lawyer
Most of the issues outlined above can be handled by any intelligent business owner (if you can run a business, you can certainly fill out IRS forms or fill in boilerplate business forms). There are times, however, when a business faces issues that are too complex, too time consuming, or fraught with liability issues. At that point,the wisest move is to retain a business lawyer.
A few examples include:
- Former, current, or prospective employees suing on the grounds of discrimination in hiring, firing, or hostile work environment
- Local, state, or federal government entities filing complaints or investigating your business for violation of any laws.
- You want to make a special allocation of profits and losses or you want to contribute appreciated property to your partnership or LLC agreement
- An environmental issue arises and your business is involved (even if your business didn’t cause the environmental problem, you may be penalized)
- Negotiating for the sale or your company or for the acquisition of another company or its assets
An Ounce of Prevention
While you certainly need to retain an attorney for the serious issues above, your emphasis should be placed on preventing such occurrences in the first place. Prevention does not necessarily involve hiring an attorney, though consulting with one wouldn’t hurt. By the time you or your business is sued, the preventable damage has been done and the only question that remains is how much you’ll be paying in attorney’s fees, court fees, and damages.
For example, by the time a prospective employee files a lawsuit claiming gender discrimination based in part upon questions posed at the job interview, all you can do is hire an attorney to defend the lawsuit. If, on the other hand, you had done your own research on anti-discrimination laws, or you had consulted an attorney beforehand, you would have known not to inquire as to whether the applicant was pregnant or planned on becoming pregnant. The small effort at the beginning of the process would save you an enormous headache later.
To prevent unnecessary attorney costs at the inception of your business as well as tremendous costs after a lawsuit has been filed, you might consider a consultation arrangement with an attorney. Such an arrangement would entail you doing most of the legwork of research and the attorney providing legal review or guidance.
For example, you might use self help and online sources to create a contract with a vendor and ask an attorney to simply review and offer suggestions. Or from the previous example, you might research types of questions to ask during an interview and then send the list to an attorney for his or her approval. This way, you prevent the potential headache later and the cost to you is minimal because you’ve already done most of the work and the attorney simply reviews the document.
Find the Right Attorney for Your Business Needs
You won’t need a lawyer for each and every legal issue that comes up in your business. But when you do, it’s good to know where to find the right one. Check FindLaw’s legal directory for a business and commercial law attorney near you.
What Does a Medical Assistant Do?
Medical assistants are healthcare professionals who help run the offices of physicians and healthcare providers by performing daily administrative and clinical tasks. Specific duties vary depending on geographic location, the size of the practice, and the practitioner s specialty area. In smaller practices medical assistants generally have a wider range of responsibilities, performing administrative and clinical duties independently. Those working in larger healthcare facilities usually specialize in a particular area, and are supervised by a department administrator.
Medical assistants have many administrative responsibilities, and are often the first point of contact for patients entering a medical facility. They may be responsible for greeting patients, answering phones, scheduling appointments, organizing patient medical records, filling out insurance forms, bookkeeping, and billing.
The clinical duties of a medical assistant vary according to state law, but can include preparing patients for examination, recording medical histories, assisting the physician during the exam by drawing blood, removing sutures, changing dressings, and taking electrocardiograms. Medical assistants are often responsible for explaining treatment procedures to patients, and giving instructions about medication and special diets. Further duties may include preparing laboratory specimens, discarding contaminated supplies, and sterilizing medical instruments. Some facilities allow medical assistants to refill prescriptions.
Duties a Medical Assistant Cannot Undertake
As medical assistants do not need to be licensed, the clinical duties they can and cannot perform are dictated by state law. In general, they are not allowed to provide medical treatment independently or perform invasive medical procedures or other tasks that require a license, and must work under the direct supervision of a physician in relation to clinical tasks. More specific information about state laws can be found on the American Association of Medical Assistants website .
The Difference Between Medical Assistants and Physician s Assistants
Although they may perform routine clinical duties, medical assistants are not physician assistants – the two are often confused. Physician assistants, commonly referred to as PAs, examine, diagnose, and treat patients under the supervision of a physician or surgeon. They have more clinical responsibilities than medical assistants and fewer administrative duties. PAs work directly with other members of a healthcare team to examine and treat patients; order laboratory tests such as X-rays; prescribe medications; treat minor injuries that require suturing, splitting, or casting; and independently make diagnoses. In some clinics, they may also be responsible for managerial duties such as ordering medical equipment and even supervising medical assistants.
The specific duties of medical assistants vary with office size, location, and specialty. In smaller practices medical assistants usually have greater responsibilities and are known as generalists, performing both administrative and clinical tasks. Those working in larger practices may specialize in either clinical or administrative tasks.
- Administrative medical assistants handle the clerical duties within a medical practice. They maintain and file patients medical records, fill out insurance paperwork, arrange for hospital admissions and laboratory services, and handle bookkeeping and billing. They also handle communicative tasks such as greeting patients, answering telephones, scheduling appointments, and handling correspondence.
- Clinical medical assistants have a range of clinical responsibilities that are determined by state law. They may record medical histories and vital signs, prepare patients for examinations by explaining treatment procedures, and assist physicians during the examinations. If directly instructed by a physician, they may also prepare and administer medications, approve medication refills, draw blood, prepare patients for screenings such as X-rays, perform electrocardiograms, and remove sutures. They may also perform laboratory tests, discard contaminated supplies, and sterilize medical equipment.
What Type of Person Would Do Well in This Career?
Medical assistants should enjoy helping others and have excellent communication and interpersonal skills. They must often work with patients who are experiencing discomfort and pain, so patience and empathy are essential. They should be able to help patients feel at ease, and explain procedures and instructions clearly. As physicians schedules tend to be over-booked, medical assistants are expected to educate patients, making sure that they understand their diagnosis, and can follow the instructions of their physicians. Medical assistants should be comfortable multitasking, for the job is demanding and requires the ability to handle more than one task at a given time.
Find My Mobile #find #my #mobile,smartphone #lost #tracking,lost #smartphone #locator,samsung #galaxy #lost #phone #finder,samsung
Find My Mobile
Management service for personal information on device
If you lose your device, then Find My Mobile lets you minimise the possibility of your personal information becoming public by using the Lock my device and Wipe my device functions. In addition, you can locate your lost device by using the Locate my device function.
Find My Mobile
Find My Mobile
Where is my device? The Find My Mobile feature helps you find the current location of your device.
Lock my device
Lock my device
Lock your device remotely to prevent it from being used by others and to minimise the risk of personal information theft. You can also set a message to be displayed on the screen of your locked device and set a phone number that can be dialled even when the device is locked.
Ring my device
Ring my device
The Ring my device feature sounds the default ringtone of your device at its maximum volume for 1 minute, regardless of any sound or vibration settings. By sounding the ringtone, you can get people’s attention around your lost device, increasing the chances of your device being found.
The Call logs feature allows you to check the recent calls to and from your device for the last week. By using Call logs, you can check whether you missed any calls or whether someone made a call you didn’t know about.
*Message logs aren’t currently supported.
Wipe my device
Wipe my device
Use the Wipe my device feature to protect your information as a last resort. This feature wipes all data saved on the device’s internal memory, external memory, and SIM card. It also deletes all the data saved on your device and resets the device to its factory settings.
*Find My Mobile is not available after wiping and resetting your device.
Unlock my screen
Unlock my screen
Forgot your PIN, password, or lock pattern? The Unlock my screen feature allows you to remove the Lock Screen settings of your device remotely.
*For certain models, this feature can be used to cancel the Lock my device feature.
SIM change alert
SIM change alert
If the SIM card from your lost device is changed, there is a high risk of personal information theft. Find My Mobile notifies the owner when the device’s SIM card has been changed. Also, a text message that your SIM card has been changed is sent to the number set for the Lock my device feature.
*Certain features may not be supported, depending on the model and region.
Register a personal guardian
Register a personal guardian
Register a family member or friend as a guardian in case of an emergency. The guardian can activate Emergency mode on your device, which enables the device to be easily located.
Emergency mode to save battery power
Emergency mode to save battery power
You can use Emergency mode to reduce the power consumption of your device and prolong the battery life. If the device that you have been registered as a guardian for must remain active for an extended period of time, activate Emergency mode on that device. Emergency mode will reduce the screen brightness and disable most of the apps and functions on the target device, extending the battery life.
The images of devices shown on the introduction page may differ for each country. The features described above may slightly differ depending on the country, mobile provider, or software version.
*Message logs aren’t currently supported.
*Find My Mobile is not available after wiping and resetting your device.
*For certain models, this feature can be used to cancel the Lock my device feature.
*Certain features may not be supported, depending on the model and region.
Do Electronic Medical Record Systems Inflate Medicare Reimbursements? by Kartik K # #ssrn, #do
Do Electronic Medical Record Systems Inflate Medicare Reimbursements?
Temple University – Department of Management Information Systems; Temple University – Department of Strategic Management
Date Written: January 8, 2016
Electronic Medical Record (EMR) systems allow physicians to seamlessly enter information in patient records compared to traditional paper-based records, potentially leading to higher quality and efficiency of patient care. On the other hand, the ease of capturing information into electronic medical records can be deliberately used by hospitals to inflate their reimbursement requests from Medicare by overstating the complexity of patients’ diagnoses (termed “upcoding”). A particular EMR module that can facilitate upcoding is the Computerized Physician Order Entry (CPOE) system, which provides physicians auto-populated default templates and allows them to copy and paste data from previous patients’ records. Accordingly, CPOE systems were alleged to allow physicians to report sicker patients and more intensive care. Concerns for upcoding have been widespread, and they led to a Recovery Audit Program by the Centers of Medicare and Medicaid Services (CMS) to combat the false (up)coding of patients. In this study, we examine the relationship between the adoption of CPOE systems and the case mix index (“CMI”) (aggregate complexity of all patients’ diagnoses) that hospitals report to Medicare. We find that, on average, the adoption of CPOE systems is associated with an increase in the case mix reported by hospitals, and our estimates correspond to a $300 million increase in inflated Medicare reimbursements per year. The increase in the case mix index after the adoption of CPOE systems is significantly higher among for-profit hospitals. By leveraging the staggered implementation of the Recovery Audit Program as a quasi-natural experiment, we find that the Recovery Audit Program attenuates the role of CPOE systems in inflating the case mix that hospitals report to Medicare, thus helping to combat upcoding. Interestingly, auditors who developed the capability to identify the use of default templates and cloned information are able to reinforce the effect of the Recovery Audit Program on combating upcoding. Implications for theory, practice, public policy, and society toward preventing inflated Medicare reimbursements from taxpayers’ dollars after the introduction of EMR systems are discussed.
Keywords: Health IT, Electronic Medical Record Systems, Upcoding
JEL Classification: L21; M21
Suggested Citation: Suggested Citation
Ganju, Kartik K. and Atasoy, Hilal and Pavlou, Paul A. Do Electronic Medical Record Systems Inflate Medicare Reimbursements? (January 8, 2016). Fox School of Business Research Paper No. 16-008. Available at SSRN: https://ssrn.com/abstract=2712758 or http://dx.doi.org/10.2139/ssrn.2712758
6 Tips to Get Approved for a Home Mortgage Loan, how do you get
6 Tips to Get Approved for a Home Mortgage Loan
Some people don t know the first thing about getting a mortgage loan. They hear reports of dropping interest rates and lower home prices and hastily decide to jump into home ownership. But the process of getting a home loan differs from getting a car loan or renting an apartment, and applicants who don t recognize these key differences are often disappointed when a lender denies their mortgage loan application.
Educating yourself is key, and there are a number of ways to avoid this heartache and disappointment when applying for a mortgage loan.
Getting Your Mortgage Loan Approved
Buying a house is already stressful, and being ill-prepared heightens the anxiety. Why put yourself through this? Learn how to think like a lender and educate yourself on the best ways to get your mortgage loan approved:
1. Know Your Credit Score
It literally takes a few minutes to pull your credit report and order your credit score. But surprisingly, some future home buyers never review their scores and credit history before submitting a home loan application, assuming that their scores are high enough to qualify. And many never consider the possibility of identity theft. However, a low credit score and credit fraud can stop a mortgage application dead in its tracks.
Credit scores and credit activity have a major impact on mortgage approvals. According to the Home Loan Learning Center, a large percentage of lenders require a minimum credit score of 680 (620 for FHA mortgage loans) and if your score falls below 680, lenders can deny your request for a conventional mortgage loan.
In addition to higher credit score requirements, several missed payments, frequent lateness, and other derogatory credit information can stop mortgage approvals. Pay your bills on time, lower your debts, and stay on top of your credit report. Cleaning up your credit history beforehand and fixing errors on your credit report are key to keeping up a good credit score.
2. Save Your Cash
Requirements for getting a mortgage loan often change, and if you are considering applying for a home loan in the near future, be ready to cough up the cash. Walking into a lender s office with zero cash is a quick way to get your home loan application rejected. Mortgage lenders are cautious: Whereas they once approved zero-down mortgage loans, they now require a down payment.
Down payment minimums vary and depend on various factors, such as the type of loan and the lender. Each lender establishes its own criteria for down payments, but on average, you ll need at least a 3.5% down payment. Aim for a higher down payment if you have the means. A 20% down payment not only knocks down your mortgage balance, it also alleviates private mortgage insurance or PMI. Lenders attach this extra insurance to properties without 20% equity, and paying PMI increases the monthly mortgage payment. Get rid of PMI payments and you can enjoy lower, more affordable mortgage payments.
However, down payments aren t the only expense you must worry about. Getting a mortgage also involves closing costs, home inspections, home appraisals, title searches, credit report fees, application fees, and other expenses. Closing costs are roughly 3% to 5% of the mortgage balance paid to your lender before you can seal the deal.
3. Stay at Your Job
I know someone who quit working seven days before she and her husband were to close on their mortgage loan. I have no idea why, and unfortunately, it didn t turn out well for them. They weren t able to close on their new home and they lost out on a great deal.
Sticking with your employer while going through the home buying process is crucial. Any changes to your employment or income status can stop or greatly delay the mortgage process.
Lenders approve your home loan based on the information provided in your application. Taking a lower-paying job or quitting your job to become self-employed throws a wrench in the plans, and lenders must reevaluate your finances to see if you still qualify for the loan.
4. Pay Down Debt and Avoid New Debt
You don t need a zero balance on your credit cards to qualify for a mortgage loan. However, the less you owe your creditors, the better. Your debts determine if you can get a mortgage, as well as how much you can acquire from a lender. Lenders evaluate your debt-to-income ratio before approving the mortgage. If you have a high debt ratio because you re carrying a lot of credit card debt , the lender can turn down your request or offer a lower mortgage. This is because your entire monthly debt payments including the mortgage shouldn t exceed 36% of your gross monthly income. However, paying down your consumer debt before completing an application lowers your debt-to-income ratio and can help you acquire a better mortgage rate.
But even if you re approved for a mortgage with consumer debt, it s important to avoid new debt while going through the mortgage process. Lenders re-check your credit before closing, and if your credit report reveals additional or new debts, this can stop the mortgage closing.
As a rule, avoid any major purchases until after you ve closed on the mortgage loan. This can include financing a new car, purchasing home appliances with your credit card, or cosigning someone s loan.
5. Get Pre-Approved for a Mortgage
Getting pre-approved for a mortgage loan before looking at houses is emotionally and financially responsible. On one hand, you know what you can spend before bidding on properties. And on the other hand, you avoid falling in love with a house that you can t afford.
The pre-approval process is fairly simple: Contact a mortgage lender, submit your financial and personal information, and wait for a response. Pre-approvals include everything from how much you can afford, to the interest rate you ll pay on the loan. The lender prints a pre-approval letter for your records, and funds are available as soon as a seller accepts your bid. Though it s not always that simple, it can be.
6. Know What You Can Afford
I know from personal experience that lenders do pre-approve applicants for more than they can afford. After receiving a pre-approval letter from our lender, my husband and I wondered whether they had read the right tax returns. We appreciated the lender s generosity, but ultimately decided on a home that fit comfortably within our budget.
Don t let lenders dictate how much you should spend on a mortgage loan. Lenders determine pre-approval amounts based on your income and credit report, and they don t factor in how much you spend on daycare, insurance, groceries, or fuel. Rather than purchase a more expensive house because the lender says you can, be smart and keep your housing expense within your means.
If you don t meet the qualifications for a mortgage loan, don t get discouraged. Instead, let it be motivation to improve your credit and finances. Many people have risen above credit problems, bankruptcy, foreclosure, and repossession specifically in order to purchase their first house. Just be sure to implement a realistic plan and stick to it.
How long did it take you to realize your dream of home ownership? If you re currently working toward this goal, what steps have you taken?
Stocks Basics: What Causes Stock Prices To Change, how to do stock trading.#How #to
Stocks Basics: Trading Stocks and Order Types
- Stocks Basics: Introduction
- Stocks Basics: What Are Stocks?
- Stocks Basics: Different Types Of Stocks
- Stocks Basics: How Stocks Trade
- Stocks Basics: Trading Stocks and Order Types
- Stocks Basics: Bulls, Bears & Market Sentiment
- Stocks Basics: How to Read A Stock Table/Quote
- Stocks Basics: Valuing Stocks
- Stocks Basics: Conclusion
In this section, we discuss the practical matter of going about buying and selling shares of stock. Individuals typically buy and sell shares by using a licensed brokerage firm or broker who makes the actual trade. Historically, stockbrokers were hired only by wealthy individuals and families, but today a wide range of brokerages exist for all price ranges. So-called “full-service” brokers offer a suite of research, opinion, and expert advice and can offer a personal relationship between the broker and the client. For more budget conscious clients, discount brokerages exist that offer a much more bare-bones service offering, in some cases simply executing purchases and sales. Over the past two decades, electronic trading has grown significantly, with many online brokerages offering both research and opinion as well as trades at low prices, some asking as little as $5 or less per trade in commission. (See also: Picking Your First Broker.)
Regardless of the type of brokerage used, the mechanics of buying or selling shares is fairly uniform. First, a stock quote is obtained. In the early days of stock exchanges, price information was transmitted via tickertape – a long ribbon of paper that printed basic data via telegraph wire. That is why today we still refer to stock quotes as the ticker.
A stock quote carries a lot of information including the current bid and offer (sometimes called the ask) prices as well as the last price that traded. The bid is the highest price that somebody in the market is willing to pay at a given time, while the offer is the lowest price that somebody is willing to sell. If you are interested in buying shares, you will make a bid, and if you want to sell an offer. When the price of a bid and offer coincide, a trade is effected.
In addition to this price information, data on trading volume (number of shares traded) is often included. Stock quotes obtained online are often real-time quotes that confer second-by-second details, and online quotes also often include charts and interactive tools. Stocks are quoted by their ticker symbol, represented by between one and four capital letters, which are often loosely representative of the company name. For example the ticker symbol for Microsoft Corp. is MSFT, Caterpillar Inc. is CAT, and Apple Inc. is AAPL.
Market Orders and Limit Orders
Next, the type of trade has to be determined. A market order is simply an order that instructs the broker (or online trading platform) to buy or sell shares at the best available price. If you wanted to buy 100 shares of AAPL at market, and the quote shows: Bid: $139.80 (100), Offer: $140.00 (50), Last: $139.95 (250). This tells us that the last trade was 250 shares at $139.50 and it indicates 50 shares are offered at $140.00. Suppose another 200 are offered at $140.05. Your market order would buy the 50 shares at $140.00 and then purchase 50 more at the next best price at $140.05.
A market order does not guarantee the price you will get, but it does guarantee that you will get the number of shares that you want, in this case 100. When an order is completed, it is said to be filled. A market order is most often used in cases where the buyer or seller is most concerned with filling the size of the order and not concerned with the price. A limit order specifies the price at which you want to trade. For example, you may specify that you want to buy AAPL for $140.00 but no more, in which case you would buy the 50 shares offered at $140.00 and then wait for some other seller to come down to your price. Until that happens, the new quote would be Bid: $140.00 (50), Offer: $140.05 (200), Last: $140.00 (50).
A limit order can also be designated all-or-none (AON), meaning that you won’t agree to buy your shares unless you can get all 100 that you want. If the original limit order in this example were AON, you would not buy the 50 that are offered until another 50 came along. Limit orders are used by those who are primarily concerned with the price they want to receive, but they are not guaranteed that the size of their order will be filled. Price versus getting filled on the size of your order are the primary trade-offs between market and limit orders.
Stop orders are contingent on a certain price level being attained to activate the trade. With a stop order, your trade will be executed only when the security you want to buy or sell reaches a particular price (the stop price). Once the stock has reached this price, a stop order essentially becomes a market order and is filled. For instance, if you own stock ABC, which currently trades at $20, and you place a stop order to sell it at $15, your order will only be filled once stock ABC drops below $15. Also known as a stop-loss order, this allows you to limit your losses.
This type of order can also be used to guarantee profits. For example, assume that you bought stock XYZ at $10 per share and now the stock is trading at $20 per share. Placing a stop order at $15 will guarantee profits of approximately $5 per share, depending on how quickly the market order can be filled. Stop orders are particularly advantageous to investors who are unable to monitor their stocks for a period of time, and brokerages may even set these stop orders for no charge.
One disadvantage of the stop order is that the order is not guaranteed to be filled at the preferred price the investor states. Once the stop order has been triggered, it turns into a market order, which is filled at the best possible price. This price may be lower than the price specified by the stop order. Moreover, investors must be conscientious about where they set a stop order. It may be unfavorable if it is activated by a short-term fluctuation in the stock’s price. For example, if stock ABC is relatively volatile and fluctuates by 15% on a weekly basis, a stop-loss set at 10% below the current price may result in the order being triggered at an inopportune or premature time.
Other Kinds of Orders
Orders may also be tagged with instructions regarding how long an order is good for. An immediate-or-cancel (IOC) order is cancelled if the order isn’t executed right away. This is typically used in conjunction with a limit order. When an IOC order is combined with an AON order, it is designated fill-or-kill (FOK). A day order is a limit or stop order that is cancelled at the end of the trading day, and will not be active the next morning. A good-til-canceled (GTC) order is active until the instruction is given to cancel it, and may remain active for many days at a time or longer.
Margin Trading and Short Selling
In addition to the mechanics described above, many brokerages offer margin trading, allowing their customers to borrow money to buy shares in excess of the amount of cash in their account. Margin also allows for short selling, which is where a market participant borrows shares they do not own in order to sell them with the hope of buying them back in the future at a lower price. A short seller is betting that the price of a stock will go down, rather than up.
In addition to using a brokerage, there are two less common ways to own shares: dividend reinvestment plans (DRIPs) and direct investment plans (DIPs). DIPs are plans by which individual companies, for a minimal cost, allow shareholders to purchase stock directly from the company. DRIPs are where the dividends paid by shares are automatically used to purchase more of those shares (including fractions of a share).
Nurses do not wake up each morning intent on delivering poor care, what skills
Nurses do not wake up each morning intent on delivering poor care.
Today marks the end of Christina Patterson’s investigation into the worrying state of British nursing. Throughout the week, readers’ responses have been extraordinary – ranging from moving first-hand testimonies to thought-provoking suggestions for change
- Friday 13 April 2012 23:00 BST
Poor care is due to systemic failings, not the nurses
When people discuss their experiences of poor care, there is little one can say in defence, it’s their experience and no one else’s. I can’t deny for one moment that poor care happens. Every single instance is tragic and utterly unacceptable. However, when a problem is alleged to be systemic, as Christina Patterson appears to argue, one must look at the system and not simply the individuals at fault.
Despite political rhetoric to the contrary, deep budget cuts are being made right across the NHS. Tens of thousands of jobs are being stripped from the front line, and when nurses leave or retire, they aren’t being replaced. What does this mean for the team working on an older people’s ward that used to be staffed with five nurses, and now has to cope with three? It means that the 20 or so patients on the ward cannot physically get the attention they all need, that those who need help at mealtimes may not get it and that, despite the best intentions, standards slip.
The nurses of this country do not wake up each morning intent on delivering poor care – it just doesn’t happen. What does happen is that systemic failings bring about individual cases of poor care. We need to openly discuss the factors that are currently making a nurse’s life very difficult indeed.
Chief executive general secretary, Royal College of Nursing
No wonder so many Brits come to work in Canada
After 30 years as a nurse, nothing surprises me and I know there will always be bad nurses, although happily at the hospital I work they are the exception. Part of the problem is the abysmal wages in the UK. When I saw the pay scale I understood why so many British nurses emigrate to Canada to work. The wages are appalling given the intensity and difficulty of the work and the educational requirements.
I’ve had only superb care: is it because I live in a rural area?
I have been treated for two years for breast cancer by my local NHS Trust, and I have had superb care from all staff: oncologists, MacMillan nurses, nurses on the breast ward, radiotherapy centre and associated services such as X-ray, my GP, transport by ambulance or volunteer drivers, counselling, and appointment clerks.
So why is my experience so different from that reported? I believe it is because I am being treated in a rural area – Cumbria, with relatively small hospitals and clinics – not in a pressurised urban area where care is delivered via huge institutions. I don’t want a Big Society, I want a Small Society, where people – professionals and patients – can foster genuine relationships in a caring environment.
Let’s build on what’s good I will be retiring from the profession at the end of April after 42 years as a nurse . It has been my privilege to have worked with nurses who are committed and compassionate, putting patient care at the heart of their decision-making. Please let’s look at what’s good about the profession and build upon that, instead of assuming that we all need to develop a new “culture of compassion”.
Missing managers and cliques of self-serving staff
Some practitioners have all the qualifications anyone could ask for, but lack any empathy. Some are even vindictive, as I can attest. In the vast majority of my contact with hospitals, the person in charge is never seen and does not supervise in any way. The main observation I have, though, is that most of the poor staff exhibit massively childish behaviour. My question is why these people are ever offered training in the first place, as they have no ability to deal with themselves let alone vulnerable patients. They form nasty, gossipy little self-serving cliques, and woe betide anyone who tries to enforce professional standards. I observe that hospital managers are paid handsomely. What for?
A missed opportunity Christina Patterson’s excellent series highlights the disaster of the abolition of State Enrolled Nurses. The NHS now relies on thousands of healthcare assistants to care for NHS patients under registered nurse supervision.
Many healthcare assistants do a great job but there is no uniform training. A healthcare assistant dismissed for poor standards in an NHS hospital one day, can turn up working in a private nursing home the next.
In the Lords, in debate on the Health and Social Care Bill, Labour Peers strongly supported the statutory regulation of healthcare assistants. This was voted down by Coalition Peers. A great pity and a real missed opportunity to boost standards.
Lord Philip Hunt
Shadow Deputy Leader, House of Lords
Care and practical skills must count for more than NVQs As a recently retired Charge Nurse, and having worked in the caring profession since the 1970s, I believe I can offer a perspective on the “crisis in British nursing” today.
When applying for a position within this field, I was able to say that I wanted the job because I enjoyed working with others, and actually wanted to help people, see their situations, and improve their recovery. More recently, individuals with career aspirations in the nursing sector are encouraged to place emphasis on the NVQ’s or diplomas that they have, since managers and senior staff are primarily interested in what career paths the interviewee is pursuing.
I used to be an “enrolled nurse”, known in the profession as “the practical nurse”. Sadly, it seems that such skills are no longer valued in nursing. The culture needs to change again.
Atomised care is a disaster Christina Patterson’s series of articles this week illuminate a vital aspect of healthcare but it is a mistake to view healthcare and its problems in this compartmentalised way.
Healthcare is, or should be, an intimate commingling of disciplines and not an incoherent assemblage of entities, structures and processes. Atomised private healthcare is the perfect image of a disaster – clinically, practically, financially and ethically.
Unless and until we have a government truly committed to the welfare of the patients, the decline will continue. This excludes all three conventional parties who are united in their ambition to destroy the NHS.
“A lot of nurses are scared to think outside the box”
“Nurses do care. When the press is constantly having a go, it does knock your spirits; everybody gets tarred with the same brush. I’ve seen bad care, but give a fair hearing to the remarkable things that are going on around the country. Knocking the NHS won’t make it better. I’ve come across a lot of nurses who were scared to think outside the box. They were worried that if they did something off the wall, someone would clamp down on them. We need to get nurses fired up, get them to connect with patients more closely and thank them when they do a good job.”
Jill Fraser, a nurse of 30 years and co-founder of Kissing It Better, a charity that aims to improve patient care
And, from the many comments posted at independent.co.uk and on Twitter:
@witchynicky: As a nurse who trained in the 1980s I weep for my profession. Yes, there was much that was overly formal and task-orientated but we took pride in our work. I worked hard and I loved my work. As a patient six years ago, the nurses were cold and uncaring.
Robert: As a junior doctor working across a number of busy general and specialist medical wards I have been struck by the sheer volume of paperwork which nurses are obliged to complete in order to ensure their ward meets its CQC (Care Quality Commission) targets. Which seems to be a bizarre way to improve care.
Musabah67: I am a highly qualified nurse who has worked both in public and private hospitals and I was shocked by the poor standard of care when I was suddenly admitted into my local NHS hospital. The experience described in this article is similar to the one I endured and my life was only saved by the fact that I was a nurse and I knew exactly what to do.
@MariannaNodale: The point is that for one dodgy nurse, there are also 10 brilliant ones on the ward who are impeccable in their care, are sympathetic of patients needs, have an eye for detail and don’t make any mistakes. Yet the 10 good apples don’t negate the bad one.
@ajgaskin: Patients are only too often ready to complain but fail to acknowledge the good treatment they have received.
Martin West: I have had two operations for cancer in the last year, at different hospitals in the UK. In the first, the nurses were surprisingly brusque, unfriendly and, at times, bullies – to an extent that shocked me. In the second, they were warm, kind, compassionate and friendly, and I left feeling genuinely cared for. Two hospitals, same NHS.
Special report: A crisis in nursing
#how do business loans work
How do business loans work?
To explain how business loans work, I think it’s best to first talk about the two main types of lenders to business owners: traditional banks (Chase, Wells Fargo, Bank of America) and online lenders (OnDeck, Lending Club, Funding Club).
Traditional bank loans can be your lowest-rate option, if you qualify. But bank loans are extremely hard to come by — 4 out of 5 business owners are turned away by banks. And bank loans often exclude certain industries, take far longer to process, and can only be used for limited purposes.
With online lenders, you have several different kinds of loans available. They have a quick turnaround, are available to more business owners, and have a wide variety of options.
Here are the main types of loans available and a quick explanation on how each works:
- SBA Loan: This loan is guaranteed by the Small Business Administration (government-guaranteed), a federal agency that helps foster entrepreneurship. The loan is generally longer term, and has a reasonable interest rate. You are lent money, which you repay over a set period of time.
- Traditional Term Loan: A term loan is similar to a traditional loan you would obtain from a bank. You are lent a set amount which you pay back over a set period of time.
- Equipment Financing: You are lent money for the purpose of purchasing equipment for your business. The equipment serves as collateral for the loan. It’s the like buying a car — you are lent money up front to buy the asset, then you pay back the value borrowed over time.
- Business Line of Credit: You are given access to a credit limit that you can draw from whenever you need the money. It gives you a cushion to tap into, and you only pay interest on funds drawn.
- Invoice Financing: Invoice financing allows you to sell your outstanding invoices to a lender, who will front you money in exchange. While you lose a portion of your potential profits, you are able to get cash immediately rather than waiting on your customers to pay.
- Short Term Business Loan: A term loan with a very quick payback period, as short as 3 months.
- Merchant Cash Advance: The lender gives you cash up front in exchange for a percent of daily credit card sales for a set future period.
If you want more info on how each type of loan works, we put together a comprehensive guide on our site: Which Business Loan is Best For You?
Hope this helps!
I work as a small business finance expert for Yellowstone Capital, a small business lender that has helped over 250,000 small business owners secure more than $500 million in funding for their businesses.
Banks look at many aspects of the company, as well as the business owner, before making a decision on whether to extend a line of credit.
Business: Revenue, profit, business plan, investors, outstanding loans
Owner: Credit history/score, outstanding debt, previous business history, personal referrals, current employment
You have to make sure that you have everything in order before you go in to apply for a loan, especially if your business is just getting off the ground.
Of course this leaves out the approval process, and where to go if you aren t able to secure a loan due to credit issues, but this covers at least how to choose the right bank if you go that route.
Here’s our own take on your question that might help shed a little more light on the topic:
Here’s the official Wikipedia entry on the subject:
Here’s a video that helps explain why small business loans can be so difficult to get approved for at traditional lending institutions like banks and credit unions:
If you have any more questions, please feel free to read any of our blog posts on the topic of small business loans.
Tony D. and the Yellowstone Team