MANAGING STRESS

 Madeline Mears, RN, is nurse manager of emergency services and critical care units at two corporately owned suburban hospitals. The corporation recently purchased three not-for-profit hospitals located in the urban center of the metropolitan area. Madeline and several other nurse managers at the suburban hospitals have been informed by the vice president for patient care services that they will now be responsible for managing the same service lines at the newly acquired hospitals. Managers at the urban hospitals will move into charge nurse roles on their respective units. Madeline has the challenge of effectively and efficiently managing emergency services and critical care units at five separate facilities, all located within a 60-mile metropolitan radius. Her past experience in merging the management responsibilities at the two suburban hospitals will be extremely useful as she works to transition the new hospitals into the health care system. Madeline anticipates that staff at the hospitals will be concerned over the changes in ownership and management. Some staff may be fearful of the unknown and worried about their jobs, while others may be excited at the opportunity for increased pay and job mobility in the health care system. Former managers at the hospitals may be angry about their demotion. Human resources representatives have indicated that they will offer former managers the opportunity to apply for open management positions in the health care system. Myriad reactions among the staff members are expected as well as the potential for increased stress. Madeline and the other nurse managers meet and develop a transition plan. The transition plan defines the tasks, time frames, and expectations for merging the patient care units. Additionally, the plan helps decrease the stress Madeline and her fellow managers experience by organizing and delineating roles and responsibilities. Consistency in implementing change will help decrease stress among the staff at the urban hospitals. Each manager is committed to meeting with staff on each unit to address questions, concerns, and morale issues. Madeline plans to schedule a lunch meeting with each former manager to discuss the unit’s strengths and weaknesses as well as her goals for the unit. Three months into the transition, Madeline’s units have had low turnover, and staff members report they are satisfied with the new management structure. In particular, staff nurses enthusiastically have accepted the clinical ladder promotion program and evidencebased practice implementation. Two of the former managers have moved into management roles in the health care system. The transition has been stressful, but Madeline has enjoyed the opportunity to stretch her leadership skills.

Manager’s Checklist

The nurse manager is responsible for:

● Recognizing the impact of stress, both positive and negative, on themselves and their staff

 ● Utilizing personal and professional strategies to identify stressors and develop a plan to manage stress

● Communicating openly and honestly with employees who are stressed in their work environment

 ● Using creative solutions to address stress so employees are able to effectively perform their jobs

● Assessing the effectiveness of solutions and adjust as necessary

A city is planning the installation of a new water treatment plant to supply a growing population. There will be only one rapid mix tank basin and then the flow will be evenly split between two flocculator trains, each with three basins consisting of equal volumes for each stage. All basins will be square in the plan profile. The required water depth for all basins is 4.0 m. Determine the correct basin volumes in basin dimensions (in ), tank equivalent diameter (inm), required water power in W), required input power (in W), impeller diameter (use table below, in m) and rotational speed (in rpm). Be sure to check standard values for basin dimensions. The following parameters apply: Q= 11,500 m’/d Rapid mix HRT Total flocculation time = 30 min with tapered flocculation at G = 70·50. 30sec. Water temperature = 5°C Impeller depth = l/3 of water depth (ie, 2/3 of the tank is above impeller) * 2 min at G = 600/sec . The rapid mix basin will use radial flow impellers; the flocculator will use axial flow impellers (same size in each basin) Motor transfer efficiency * 75% Impeller T Im Diameter (m) Power Radial Axial 0.8 0.8 2.0 0.31

Break-Even Analysis—Organized Crime The organized crime boss and perfume king Butch (Stinky) Rose has daily overheads (bribes to corrupt officials, motel photographers, wages for hit men, explosives, and so on) amounting to $20,000 per day. On the other hand, he has a substantial income from his counterfeit perfume racket He buys imitation French perfume (Chanel No= 225) at $20 per gram, pays an additional $30 per 100 grams for transportation, and sells it via his street thugs for $600 per gram. Specify Stinky’s profit function, P(x), where x is the quantity (in grams) of perfume he buys and sells, and use your answer to calculate how much perfume should pass through his hands per day in order that he break even.

Below is the new Supply and Demand graph (Graph 2.b.) that illustrates the equilibrium price and quantity of Brazilian Coffee beans.

Graph 2.b. – Brazilian Supply(S), Brazilian Demand (DB) and combined Brazilian and Canadian (D) for Brazilian Coffee Beans $5.00 DB $4.00 $3.50 $3.00 Price $2.50 $2.00 $1.50 $1.00 $0.50 $0.00 Da

A) From the supply schedule and the combined Canadian and Brazilian demand schedule, what will be the new price at which Brazilian coffee growers can sell Brazilian Coffee beans?

B) With the Brazilian coffee growers selling to both the Canadians and the Brazilians, what price will be paid by Brazilian consumers?

C) With the Brazilian coffee growers selling to both the Canadians and the Brazilians, what will be the quantity consumed by Brazilian consumers?