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Let’s End the Big 4 or Bust Myth Once and For All. It’s recruiting season on campuses all across America; that special time of year when accounting students get a taste of what it’s like to be a five-star middle linebacker — minus the “hostesses,” envelopes stuffed with cash, and any semblance of athletic ability. For you soon-to-be graduates deciding on your first employer, however, recruiting season isn’t all fancy meals and Printable Golf Scorecards free pens. It’s stressful, dammit; and generally speaking, the greatest source of Kitchen For Resume 33 For consternation is whether the accounting industry boils down to “Big 4 or Bust.” While I’d love to tell you this distinction is Printable Golf - Print Golf overblown, it’s simply not true. Because despite what I’ve been told by It Professional, a long line of sympathetic yet clearly disappointed women, size really does matter. So with that in mind, should you be eliminating all but four options from your job search? Well, if you go to the Big 4, you’re likely to make a little more money and Printable Golf - Print Scorecard work a few more hours, so there’s that. The rest of the decision will come down to what kind of person you are.

Perception Dictates Reality. My first job was with Arthur Andersen, my second with PwC. I’ve now been with WithumSmith+Brown for ten years, which is nearly double the time I spent at my first two stops combined. Yet whenever I’m asked to provide my professional bio, I always manage to It Professional Resume Resume shoehorn my experience with the Printable Golf Scorecards Big 5 4 into Amazing Staff For Resume the first two sentences. Why? Because it matters. Right or wrong, the general consensus is while not all of the people at the Big 4 are the brightest in the industry, all of the brightest people in the industry are at the Big 4. Signing on with a KPMG or DT will bring you a level of gravitas that, try as they might, the firms outside the Big 4 simply can’t match.

And as I’ve experienced, even after you’re long gone, the years you spent with the Big 4 will afford you instant credibility, even if, like me, you spent the majority of those days hoarding Cliff Bars from the Printable Golf - Print Scorecard breakroom and plotting the murder of your senior manager. Is the perception of the Big 4 as the Report Online Download best of the best fair? Of course not. Printable Scorecards Scorecard? A lot of It Professional Resume Format that perception was created by the big firms beating everyone over Scorecards - Print Golf, the head with just how great they are. A freestyle rap battle has less obnoxious arrogance and self-congratulation than the Services~~element58.jpg standard Big 4 recruiting pitch. Deserved or not, ultimately, perception dictates reality. There’s a reason the majority of CFO and Scorecards tax director positions require Big 4 experience; the Format Resume Format perception is that only those who’ve tested their mettle with the big boys are prepared to handle those roles. That’s not to say that opting for a smaller firm will eventually disqualify you from all but the hottest and noisiest jobs. But the reality is, without the Big 4 on your resume, you may find that some doors are much harder to Printable - Print Scorecard open. Maybe you don’t want to Amazing For Resume be a CFO or a tax director. Maybe your primary concern is finding a job where you can learn as much as possible during your formative years while you figure out Golf - Print Golf, if public accounting is for Report Format Ppt Video Online you.

And maybe you prefer to Golf learn via hands-on direction and a lot of personal one-on-one time with your supervisors. Accounting Cover Letter & Writing | Resume? If that’s the case, going to a smaller firm is likely a better fit for you. As I wrote above, there is an abundance of smart people in Printable Scorecards - Print Golf the Big 4. The problem, however, is that at the giant firms, the people who are best positioned to teach you what you need to be successful - the managers — are the least likely to Military Resume have the time to Printable - Print Scorecard do it. When you’re a manager in the Big 4, it means that you are the point person for Format Resume Format a long list of clients, responsible for - Print Scorecard the detailed review work that partners are too expensive and staff too stupid to do, and you’re supposed to bear the burden of developing the next generation. It’s the Sample Evaluation Forms Free In Word, most exhausting activity one can engage in, outside of - Print soccer. Something’s got to give, and Entry-Level Accounting Cover & Writing Tips because managers are under constant scrutiny as to whether they belong on Golf Scorecards Scorecard the partner track, it’s sure as hell not going to be client service or placating the decision makers. Staff Job Description Your? It’s going to Golf Scorecards - Print Scorecard be the development of the manager’s underlings: i.e., you. At a smaller firm, while managers have the same responsibilities as their Big 4 counterparts, competition to make partner isn’t quite as fierce as it is in the large firms. Job Description For Resume? In addition, because smaller firms tend to lack the formalized training programs for staff (more on Printable Golf Scorecards Golf that next), greater emphasis is placed on the managers to develop their staff and seniors. Services~~element58.jpg? As a result, managers at a regional or local firm should have considerably more time to hold your hand.

Or prefer to be left alone? If, however, you hate dealing with people (like me!) and Printable - Print Scorecard prefer to learn without one-on-one interaction (like me!) then the bigger you go, the better off you’ll be. Because say what you want about the Big 4, but they have wonderful, formalized training programs. At AA, we would get shuttled off to St. Charles for Amazing Kitchen Staff Job Description Your a week to Golf Scorecards - Print Golf learn oodles of tax law.

At PwC, we had similar, intensive training weeks that were designed specifically for our experience level. And just recently, a former co-worker of mine went to work at EY, and when he asked for some reading material about the niche he would be working within, EY sent him two three-hundred page manuals on the matter, both authored by EY experts. Resume Format Resume? That ain’t happening at a 40-person firm. So if your preferred method of learning has more to do with reading quietly and less to - Print do with a senior’s coffee breath, head to the Big 4. Protect yourself from yourself. If there’s one recurring theme throughout your twenties, it’s shitty decision making. Trust me when I say that neither your Instagram photos nor your carefully placed tattoo would indicate that you should be trusted with any decision of import.

And this makes going straight to the Big 4 a dicey proposition. Because if you head off to PwC or DT, they’re going to ask you to commit to either audit or tax, despite the rather seemingly important fact that you don’t know anything about Services~~element58.jpg, either. Yeah, you can eventually switch if you change your mind, but let’s be honest, if you don’t pull the chute on Golf - Print Golf Scorecard your first choice within the first six months, you’re not going to Business Evaluation - 9+ Documents Pdf want to Golf Golf deal with starting all over again much beyond that. Generally speaking, however, a smaller firm will allow you to dabble in Services~~element58.jpg both audit and tax for several years before eventually choosing a focus. Based on Golf Scorecards Golf Scorecard my conversations with the For Resume 33 For Your young staff at WS+B, this is the primary reason they landed at a regional firm; to get a feel for where they may find an Printable Golf Scorecard area of interest within public accounting, rather than being asked to jump in with both feet to untested waters. So if you have lingering doubts about your area of interest, going smaller is your best bet.

If you’re certain that you’ll be involved with tax return prep in some capacity, however, consider whether you would prefer to see the light of Resume Addendum day in winter or summer. At smaller firms, getting a return done before the original due date is Printable Golf - Print Golf Scorecard a badge of honor, so for reasons I can’t comprehend, these firms will typically work you into submission from January through April rather than just file a piece of paper that, you knowbuys you an extra six months. To the contrary, the April 15th tax season in the Big 4 is an Business Evaluation Forms - 9+ Free In Word, afterthought; nearly everything gets extended, which means that while your winter shouldn’t be too stressful, you might find yourself spending Labor Day weekend in the office while your small-firm counterparts are lounging oceanside. I’m a firm believer that everyone should get to feel like a Big Fucking Deal at some point in their life. To throw on a nice suit and eat at Scorecards Golf Scorecard a fancy restaurant and Military Resume Addendum wash it all down with a private box at the Knicks game, without spending a dime of your own money. And nobody does luxury like the Big 4. When I was with AA in Denver, people would routinely grab you during the middle of the day to go check out a couple of innings of the Rockies game from the firm’s club seats. Every Friday, some partner would open a tab during happy hour to bid farewell to the latest defect. Printable Golf? Post-project celebration dinners required tips that with four digits.

I’ll confess: while all this was going on, I felt like the Pope of Chillitown. And you know what? That’s OK. Military Addendum? Because for Printable Golf Golf the overwhelming majority of us, our college years were spent barely scraping together enough cash to keep the fridge stocked with Busch Light. To suddenly be thrust into a life of open bars and free filets is understandably intoxicating. But it won’t last. As unlikely as it may seem at 22, you’ll eventually meet someone, move in together and maybe make some babies. Before you know it, human nature sets in, and the lure of Report Format Chemistry Ii. - Download free drinks and box seats won’t seem nearly as enticing as Netflix and a good night’s sleep. And when that day comes, a good part of what attracted to you to the Big 4 will be lost forever, along with your youth, innocence, and stable blood pressure. But until that day comes, there’s no harm in Golf - Print relishing in the Patrick Bateman lifestyle, minus the axe murders. Go the Sample Business Evaluation Free Documents In Word, Pdf Big 4 and live it up.

Obviously, there are other things you’ve got to take into consideration: big city versus small town, the opportunity for niche services like MA or consulting at Printable Golf Scorecards the Big 4, and the potential for more work-life balance at a small firm (though I don’t necessarily see that to be the case). But keep an eye on the items discussed here, and Entry-Level Letter & Writing Tips you just might wind up happy with your first job. For a year or two. Then you’ll be ready to read this. Big 4 Choices choosing a firm Recruiting season Small firms Author Tony Nitti Posted on Printable Scorecard October 22, 2014 November 30, -0001 Categories Students Tags Big 4, Choices, choosing a firm, Recruiting season, Small firms. I’ve yet to be impressed with the work product I get from a small/local/national firm. Take that however you want. Tax return(s) filed by the deadline?

Audited F/S to Amazing Staff Job Description Your the bank? Their purpose has been served. Have you ever crossed paths with GT? If your company is in one of GT’s CHOSEN MARKETS, their professionals will dazzle you with their INSTINCT FOR GROWTH and create a DYNAMIC work-product. I work for Printable Scorecards - Print Golf Scorecard a large financial institution in Resume Addendum internal audit and while I did think of going big 4, I am very glad I did not. Printable Scorecards - Print? I chose this route because of my interest in the field of banking, work life balance (I still work over 50 hours most weeks but no crazy busy season), and the compensation package.

I get to work on interesting projects (interesting as accounting work is) and Amazing Job Description For Resume Your I’m gainiging experience that will help me down the Golf Scorecard road make internal/external career moves. Not knocking Big4 but there are other options out there to have a challenging and ultimately financially rewarding career in accounting. How cute. Evaluation Forms - 9+ Documents? As a senior auditor in the banking/capital markets group of a B4 firm, I rarely if ever hit anywhere close to the 50 hour mark outside of season – sounds like you either 1) got robbed, or 2) bought into Printable Golf Scorecards - Print Golf Scorecard the BS that we work ridiculous hours here. Despite the self-reported awful hours in audit, it usually simply isn’t the case so long as you have a competent manager with whom you can create an Evaluation In Word, Pdf adequate audit plan ahead of Golf Scorecards - Print Scorecard time, and who doesn’t expect useless face time. Those are some big if’s. I have only come across two of those managers in 3 years of public and Military Resume one of them was overruled by a dumb ass senior manager that felt face time was next to godliness.

I think you situation is the Scorecards Golf Scorecard exception not the rule. I’ll give you that, my friend. Entry-Level Accounting Cover Letter & Writing Companion? Sometimes it’s also luck of the draw on clients, since they want the facetime too, to feel like our fees are justified. I don’t know where you’re at but we worked a shit ton of hours even outside busy season at Golf KPMG in Chemistry Ii. - Ppt Video Online Download the Southwest. Especially if you get a client with a 6/30 or 9/30 year end.

Also left KPMG for Golf another Top 20 firm and I wasn’t going home before 7pm during “non-busy season” many many times. Now that I’m in industry I really only work late 3 days a month, and Services~~element58.jpg life is grand. TL:DR “While I’d love to tell you this distinction is overblown, it’s simply not true. Scorecards - Print Scorecard? Because despite what I’ve been told by a long line of Amazing Kitchen sympathetic yet clearly disappointed women, size really does matter.” If that’s the case then they should call ME Big12Veteran . Ouch… someone get me some cold water for that burn. What good is all that well-rounded experience and knowledge if you can’t use it to get a top position in Printable Golf - Print Golf Scorecard the big leagues of private industry?

A “great opportunity” that is “fast moving” Sounds like something Chipman would like to answer with DYNAMIC and GROWTH. “Big leagues of private industry”? Aren’t you the guy who always talks about B4 being your only job with no intentions of leaving? Talking about great exit opportunities when you don’t plan on taking them just adds another level to your douche-baggery. Amazing Job Description For Resume 33 For? As far as I can tell, the best thing about Printable Golf - Print Golf Scorecard, your life is Services~~element58.jpg posting on here like some kind of Golf - Print self appointed B4 guru. You got me. I’m so embarrassed.

Well the fact that you replied in 3 minutes kinda proves my point about Amazing Kitchen Your, your exciting life. In the literally thousands of comments I’ve left on this esteemed site, I don’t think I’ve said one time that I have an exciting life. But rock on, bro. You must have a really exciting life if it gets your rocks off to anonymously pick internet fights with another anonymous person on an accounting-related message board… Companies are probably lining up for your “profession judgment” with no audit manual!! Using your sample size example, there is a reason audit firms have audit manuals, and that’s for consistency across their engagements. How awful do you think it would be to be to explain to an inspection team where you tested 15 samples for this daily control but another team at your firm tested 50 for a similar daily control?

There are plenty of areas to exercise your judgment on Printable Golf Scorecard a B4 team, and Kitchen Job Description For Resume 33 For Your those are usually the Golf - Print areas that require judgment, such as estimates. Happily took an Accounting Letter & Writing Tips | Resume officer for a F200 company Rotational Program making 15% more than what Big 4 pays starting out around here. There’s more than one path to the top. That’s what, $7,500-$8,200 per year as starting pay? I’ve known plenty of people who did such 2 year programs: they rotate you and Printable Scorecard try and pigeon-hole you into one singular role…I’ve got plenty of Online Download friends who did that song and dance then decided it wasn’t for them and Printable Scorecards - Print Golf Scorecard weren’t able to get anything more than a senior accountant role anywhere else. Meanwhile there’s people I know who are leaving Big-4 with 4 years experience getting job offers in the $90k to $110k range. I’ll take that 45% – 50% pay increase after four years over that starting 15% and whatever marginal increase you get in that time period any day. Lots of Services~~element58.jpg people want to argue the merits / advantages of Big 4 experience. I’ll say this: it may not always help, but it sure as hell will never hurt either.

Those really good private industry positions just about require measurable Big-4 experience, and even if they don’t the people who have the final say certainly weigh Big-4 experience higher than just about any other. The intern rotation program trumps the Big4. Interns are preselected and Printable - Print Golf Scorecard trained from the Sample Business Evaluation Forms Pdf bottom up. If your rotation strands you in a senior accountant role, then you said no more than 2 times to Printable Golf - Print Scorecard a transfer. New Lab Report Format Chemistry Ii. - Ppt Video Online? Or you were given a thumbs down as an Printable Golf - Print Golf Scorecard intern. Interns that make it through the Military rotation program are always selected first from a list of new roles that open up on a specific career ladder. The Big4 is never on that list.

These interns represent the future face of the organization. They are trained to know the organization in a specific manner and the probability is that they will spend a majority of their career at - Print Scorecard the organization. “but it sure as hell will never hurt either.” I think this statement is It Professional Format Resume Format false. It hurts every season. having been a partner in a national firm and 3 regional firms; there is NO question of this: the big 4 and the mid-tier firms put firm first, client second. Golf Scorecards - Print? They need to do this because of Resume Format liability and Golf Scorecard the public market they serve.

Forget being entrepreneurial. Online Download? it is ALL ABOUT risk management and Golf process, process, process. Regional firms will put the Military client in the center. Very entrepreneurial, whilst still adhering to - Print Golf Scorecard standards. Salary and/or draw at the partner level? Likely higher in the big firms, but at what personal cost? If you like work/life balance and It Professional Resume Professional Resume can live on Printable Golf Scorecards - Print $600k annually, and up to $750k, then the New Lab Report Chemistry Ii. - Ppt Video Online well run, regional firm of size (200 or more professionals) is the only way to go, long term. It is all about Printable Golf Scorecards - Print Golf Scorecard, what you want and who you are. You form your “professional career DNA” in your twenties going into your thirties. Accounting Cover & Writing? Your choice. No surprise, my experience as a partner in a national firmed sucked. Care to talk actual partner income levels between the regional and Printable Scorecards Golf national firm?

Being this would first hand knowledge, although as rare as a unicorn on this board, it might add more to your thoughts above. And I also came to Services~~element58.jpg the conclusion that you were actually a partner , based solely on the comment “If you like work/life balance and Printable Golf Scorecard can live on $600k annually……”. I can only speak as someone looking in from private industry: My company’s controller and Entry-Level another director are Big 4 alums with their CPA licenses. They got in the door for my company pretty easily because of their Big 4 credentials and having the license. Golf Scorecard? The CPA from a Big 4 does not guarantee the job offer, but it does open the doors for you to make the Business Evaluation Forms In Word, sales pitch. The caveat is we do not have anyone from the Big 4 without the CPA license. Are they from the same firm? And how long did they stay?

I notice that they don’t stay long in the same position if they are not sitting in a top dog role. But when they do get a top dog role, then it is almost impossible to get them to transfer. Printable Golf Golf Scorecard? (F500) They came from different firms. They are into their 3rd and 1st year, respectively. “say what you want about the Sample Business Evaluation In Word, Big 4, but they have wonderful, formalized training programs.” That’s a myth. The training is Golf Scorecard done by seniors and managers reading slides to a roomful of staff.

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Hey, I know we still have 6 hours of work to do this evening, but let’s take an hour and lean some technical accounting. That doesn’t happen – training is the place where you learn this. Nonsense. A manager who won’t make time to teach technical accounting to staff on the job is saving one hour and Golf Scorecards Golf losing 16 hours down the line when he has to clean up the stuff they would have gotten right if he’d bothered to teach them. Everyone knows the purpose of training programs is to travel to a different city for a week or two every year, party ballz, shirk client responsibilities, and try to Report Chemistry Ppt Video phone it in from 9-5 during training that week while running up a giant tab that would make MITT ROMNEY blush at the weekly happy hour and/or nightly dinners, all the while dreaming up bullshit to pitch to your s/o about why you can’t answer their phone calls each night (hint: it includes getting f-ed up each night and regretting your choices in the morning). Golf Scorecards - Print Golf Scorecard? Good times… I for It Professional Resume one am glad to find out Printable Golf Scorecards Scorecard, I did my new-hire training the right way. If you don’t go B4 you should just end your life. Or work at New Lab Chemistry Ii. - Ppt Video Starbucks.

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Government Recycling and Conservation: Statistics and Golf Scorecards information. Should mothers stay home with their children? Do long distance relationships work? How can divorce be prevented? Is divorce something that kids can recover from? Are teenage marriages a good idea? Should teenagers that get pregnant keep their children? How can you get out of the friend zone? How can you know you are in an abusive relationship? Why do people stay in abusive relationships?

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This is a great resource. I've just entered into college, and Staff Job Description Your didn't know where to begin writing my first argumentative essay. Thanks so much - voted up :) Do you know or have you written of anything to Printable Golf - Print Golf Scorecard do with the Military Resume Addendum, argumentative essay of should smoking be banned because I have to do essays with research and I need some reliable sites. Virginia Kearney 3 weeks ago from Printable Golf Scorecards Scorecard United States. Hi Aashi! I'm glad that younger students are finding my work too.

Although I now teach college students, I started my career teaching in your grade for several years. I will have to put together some topics for primary grade students. Until then, you might want to look at my High School Topics, which have many ideas which are good for your age too. I am in primary school in grade 6 and I want some good topics for primary students. Good job making this page. Services~~element58.jpg? I don't know what to do at first. I was clueless and was browsing for answers but none of Printable Scorecards - Print Golf, them made sense except for this.

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It has helped me so much! Virginia Kearney 9 months ago from United States. Hi Nataly! You are welcome to Golf Scorecard shift the focus of the questions to whether governments should take action. New Lab Format Chemistry Ii. - Ppt Video? My questions and topic ideas are just a starting point. I teach my students that there are a variety of Printable Golf Scorecards - Print Scorecard, ways to Amazing Kitchen solve problems and one of those is by having governments or larger groups take action. Golf - Print Scorecard? However, I want my students to focus more on New Lab Chemistry Ii. - Ppt Video Download, how they and their audience can personally take responsibility and Printable - Print action, so often my questions are more locally written. In my class, I focus on having my students address a very particular audience in For Resume 33 For Your their persuasive essays because effective arguments come from really thinking carefully about the viewpoint of the other person and developing points that would persuade that person.

In my class, I do allow TedTalks as sources if the student is using other sources as well. However, I don't think all professors do accept that type of source. Printable Golf Scorecards Scorecard? Most people who do TedTalks have written out Accounting & Writing Tips, their arguments in papers or books, so I'd suggest you research to see if there is an online paper you can cite as well. I find your lists great and really appreciate the idea of Scorecards - Print, providing useful links. Still, I would rather shift the focus of some questions so that they ask students to think more globally, from the point of view of the state and the society. For example, should the Professional Format, state take actions to Golf Scorecard prevent high rate of divorces, which ones? Are people in developed states responsible for providing water and Entry-Level Cover Letter Tips food to the starving people around the globe?, etc. I also wanted to ask you if TedTalks videos are officially recognized as credible resources. Have you ever heard of Scorecards - Print Golf, any cases when professors forbid to use it?

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Kanwal asif 14 months ago. Thank u so much God bless u. Virginia Kearney 17 months ago from United States. Glad this will help you three keys! ThreeKeys 17 months ago from Australia. Im about to try out your suggestions in this great article.

Im excited to see what the outcome will be in how I take a more pointed or comprehensive approach in Services~~element58.jpg a written debate so to speak. Thanks so much! Thank you it is really helpful. Thank you so much for the topics. Printable Golf Scorecard? Trisha Roberts 3 years ago from Rensselaer, New York. Love the great ideas! Absolutely love the list you shared with us. Services~~element58.jpg? Thank you so much for this Article! Kalai 3 years ago from Petaling Jaya, Malaysia.

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This is Printable Golf Golf, very useful to those who must teach essay writing (and to those who must write them). I know I will be using this next time I teach English Comp. Voted up++ ExpectGreatThings 3 years ago from Illinois. Accounting Cover & Writing Tips? Wow! This is a very impressive list and great instructions. I like how you were able to write the questions without giving away your position on Printable Golf - Print Scorecard, each topic. - Ginger. Eric Dierker 3 years ago from Spring Valley, CA. U.S.A.

Very interesting. Fun ideas and great food for thought. Amazing Staff For Resume 33 For? Copyright 2017 HubPages Inc. and respective owners. Other product and Scorecards - Print company names shown may be trademarks of their respective owners. Online? HubPages ® is a registered Service Mark of HubPages, Inc. HubPages and Scorecards - Print Golf Scorecard Hubbers (authors) may earn revenue on this page based on affiliate relationships and advertisements with partners including Amazon, Google, and others.

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The purpose of this essay is to identify and focus on a specific risk to a patient. The purpose of this essay is to identify and focus on Printable Golf - Print Golf Scorecard a specific risk to a patient. In order to do this effectively, a recognised risk assessment tool will be used and a treatment plan. then agreed upon. The efficacy of the assessment tool will be discussed along with the results it provides. Definitions will be offered throughout the Entry-Level Letter | Resume, assignment to assist the readers understanding of Printable Golf - Print terms such as risk and risk assessment. An introduction to the patient and a brief description of the anatomy and physiology of the patient’s condition will also be offered. The assignment will illustrate the use of a recognised nursing model along with the nursing process.

Legal and ethical issues will also be discussed. Before discussing any risk assessment tools it is first necessary to provide definitions for terms such as risk, risk assessment and risk factors. The Mosby Nurse’s Pocket Dictionary defines the term risk as a potential hazard (2003, p303), this hazard could be caused by any number of risk factors. A risk factor could be described as anything, which may cause a person to be more vulnerable to complications (Churchill Livingstone’s Dictionary of Nursing, 2002, p384). These could include injury, disease, compromised nutritional status or pressure damage. Harrison (2003) describes risk assessment as an assessment that can identify those at risk, so that steps can be taken to provide appropriate therapeutic treatment. Further to this, the Churchill Livingstone’s Dictionary of Nursing (2002, p384) suggests that all risk assessments should be clearly structured.

Therefore, an Resume Addendum accurate assessment of a client’s risk is vital in ensuring that the correct care plan is utilised to ensure the best possible outcome for the patient. Risk assessment and management is an integral part of the nurse’s role. Printable Golf Scorecards Golf Scorecard! The Royal College of Sample Business Evaluation Forms - 9+ Nursing’s (RCN, 2002) definition of nursing reinforces the importance of using clinical judgement as a tool when providing care to assist people in maintaining or recovering health. It should also be used to help people to cope with any health problems and to ultimately help them to achieve the Golf Scorecard, best possible quality of life. The utilisation of a recognised framework is an integral part of assessing a patient in Entry-Level Letter & Writing | Resume, order to identify their needs. Scorecards Golf! Roper et al. (2003, p4) provide a model for nursing based on the Activities of Business Forms Free Pdf Living. This framework offers a clear structure for nurses to work around with a problem solving approach and also incorporates the nursing process. The Activities of Living framework covers 12 areas including maintaining a safe environment, communicating, breathing, eating and Printable drinking, eliminating, personal cleansing and dressing, controlling body temperature, mobilising, working and playing, expressing sexuality, sleeping and finally, dying. Assessment is the first stage of the Nursing process as identified by Yura and Walsh (1978) and cited by Holland et al. (2003, p.12), the rest of the process being planning, implementation and evaluation. Mallett and Dougherty (2003, p281) suggest that a thorough assessment focuses on the physical, psychological and psychosocial issues relating to a patient. This is Amazing Staff For Resume Your, necessary to - Print Golf Scorecard enable identification of any risks and to then aid their prevention.

Sharkey (1997, p49-50) suggests that it is of great importance for nurses to be able to & Writing Companion make speedy identification of Scorecards - Print Golf Scorecard risks, as no situation is Amazing 33 For Your, completely risk free. Whitfield (2000) cited by Printable - Print Golf Stevenson (2004) found risk assessment, education and Military Addendum the formulation of protocols to be the most effective prevention strategies when focusing on the prevention of pressure damage. This would suggest that the Golf Scorecards, ability to perform an accurate risk assessment is therefore an essential skill required by each member of the nursing profession. This interpretation is supported by Cover Letter | Resume Companion Marks-Maran et al. (1988, p37). For the purpose of protecting anonymity and Printable Golf Golf Scorecard confidential information throughout this assignment, the patient will be referred to as Elsie so as to comply with Code of Professional Conduct (Nursing and Midwifery Council, 2002). Elsie is a 79-year-old lady admitted to the ward for an elective total knee replacement. A total knee replacement is New Lab Report Format Chemistry Ii. - Ppt Video, a surgical procedure, which replaces damaged or injured parts of the knee joint with artificial parts. To perform this procedure, the muscles and ligaments that surround the knee are separated in order to remove cartilage and bone from the ends of the thigh bone (femur) and the shin bone (tibia). It may also be necessary to - Print Scorecard remove part of the kneecap (patella). The implant is then cemented into place. Total knee replacements are usually performed on people suffering with severe arthritic conditions.

A patient would normally be deemed suitable for the procedure if found to It Professional Professional Format be suffering from Printable Golf Scorecards Golf Scorecard daily pain, significant stiffness, instability or deformity of the knee, or if suffering from Chemistry Ii. - Online Download severe pain which restricts the patients normal daily activities. Printable Scorecards - Print! Elsie has been married 54 years and has 2 daughters, one of which lives abroad. Elsie and Military her husband live in a bungalow with an Printable Golf average sized garden. Of late Elsie has been unable to participate in Forms Documents In Word,, one of her favourite pastimes due to the stiffness and pain in her knee. Upon admission, Elsie underwent an initial admission assessment according to Printable Scorecards - Print Golf Scorecard the trust protocol. This assessment, based around the Activities of Living, also incorporated screening tools such as the Sample Business Evaluation Pdf, Waterlow Scale used to Printable Scorecards - Print Scorecard assess the risk of pressure sores to Amazing Kitchen Staff Job Description For Resume a patient and to aid the prevention of them. It also includes a Moving and Handling risk assessment to assess the clients level of dependence or independence along with their mobility status. A Nutritional-screening tool is also used to assess the patient’s nutritional status and to identify any needs relating to it.

This essay will focus on the Waterlow scale in particular along with any risks identified as a result of its use for the patient. This assessment tool is used to assess the risk of a patient developing a pressure sore. Dealey (2000, p96) describes a pressure sore as localised damage to the skin. This damage is caused by the blood supply to the area being disrupted and is usually caused by extrinsic factors such as pressure or shearing forces on the skin. Printable - Print! There are also a number of internal factors that determine whether or not a patient will develop pressure damage such as their age, reduced mobility, compromised nutritional status, body weight, incontinence and poor blood supply. The result of pressure sore occurrence can mean a delayed stay in hospital, increased pain and Report Chemistry Ppt Video distress to the patient and increased costs to the National Health Service. The Waterlow scale is used by scoring the patient numerically in a number of areas. The areas covered are build and Golf Golf Scorecard weight according to a persons height, continence, skin type, mobility, sex, age and appetite. - 9+ Documents Pdf! It also scores on a range of special risk areas such as tissue malnutrition, neurological deficit, major surgery or trauma and certain medications such as cytotoxic drugs.

The score is then added up and the perceived risk to Printable Golf - Print Scorecard the patient is identified. Sample Business Evaluation Documents! A client with a score of Printable Scorecards Golf Scorecard 10+ is deemed at low risk of developing pressure damage. A score of 13+ suggests that the client is at high risk while a score of 20+ suggests that the patient is at a very high risk of developing a pressure sore. For any client identified as being at risk of developing a pressure sore, a treatment plan must be agreed upon and implemented. There is a range of pressure relieving equipment available to aid in the prevention of pressure damage such as pressure relieving mattresses and cushions. However, these alone are not fully effective. A patient must still be encouraged or assisted to change position frequently, their nutrition status should be monitored and clients must avoid shearing forces on Format Format their skin which may cause damage. Elsie’s assessment identified her as being at risk of developing a pressure ulcer with a score of Printable Scorecards - Print Scorecard 11. Waterlow (1998) cited by Mallett and Dougherty (2003, p694), recommends that a score of 10+ does not require the Services~~element58.jpg, use of pressure relieving devices but instead requires careful monitoring of the patient and measures such as ensuring frequent position changes. The aim with Elsie was to achieve mobilisation as soon as possible.

However, monitoring and pressure care prevention would be vital in the immediate post-operative period as Elsie would be immobile. As previously mentioned, according to Printable Golf Scorecards Golf Scorecard the Trust protocol Elsie’s admission to the ward included a pressure ulcer risk assessment according to the Waterlow scale. The Waterlow scale is just one of a number of pressure ulcer risk assessment tools available, but is one of the Sample Business Free Documents, most widely used. The majority of the information gathered as part of this assessment is taken from the nurses own observations but should also be collated as part of a discussion between both the Scorecards Golf, nurse and the patient. In Elsie’s case re-evaluations of the risk assessments were not routinely carried out. Pressure area prevention and Military Addendum care were carried out however, the risk assessment was not recalculated therefore, the Scorecards Scorecard, documentation was not completed accurately. The process does not end after the care plan has been formulated following the completion of the first risk assessment. As Elsie’s mobility would be impaired immediately post-operatively it could be anticipated that her risk of Amazing Kitchen For Resume 33 For developing a pressure sore would also increase. This is due to Scorecards - Print Golf Scorecard factors such as mobility restriction due to post-operative pain and reduced appetite. Another contributing factor is the actual surgery itself. It is New Lab Format Ii. - Online Download, recommended that the patient should actually be reassessed at each point that their condition and mobility changes in order to Golf Scorecards - Print formulate accurate and appropriate care plans and Services~~element58.jpg treatment as recognised by Printable Scorecards Golf Hilton and Athorn (2004, p23) and the National Institute for Clinical Excellence (2001).

Risk assessments must be completed and acted upon to prevent them from becoming useless exercises. As well as identifying actual or potential risks and Entry-Level Accounting Cover Letter & Writing Tips | Resume reducing accidents and ill health, properly completed risk assessments also serve to protect the professionals using them. The assessments must be documented as they may be used if something goes wrong (Royal College of Nursing, 1999). In today’s litigation society this is more important than ever as each nurse is Golf - Print Golf, accountable for New Lab Report Chemistry Ii. - Ppt Video Online Download their own decision-making along with the Printable Golf Scorecards - Print, care they provide. In Elsie’s case, a care plan was formulated from the Accounting Letter Tips | Resume, results of Printable Golf Golf Scorecard her assessments that included factors such as assessing her skin daily, ensuring satisfactory dietary intake and hydration levels, educating and encouraging Elsie to relieve her own pressure by mobilising as much as possible. To enable Elsie to do this involvement from a number of the multi-disciplinary team was required. Each day various healthcare assistants, student nurses and staff nurses from the ward assisted Elsie in checking her skin integrity by assisting with washing and moisturising.

Doctors and pharmacists also provided care; in particular, post-operative pain control is an important factor to address when facilitating a patient’s mobilisation. If a patient is in a lot of pain it is going to prove more difficult for them to mobilise. Elsie was also seen by Resume a physiotherapist who provided her with a walking frame and a range of exercises to aid her rehabilitation. The physiotherapist then had daily involvement while working towards Elsie’s discharge. Prior to discharge, Elsie had a check x-ray to Scorecards - Print Scorecard ensure that everything was as it should be from an orthopaedic perspective as well as participating in an activities of Evaluation - 9+ Free Documents In Word, Pdf living assessment to assess whether she would benefit from the provision and installation of any equipment at - Print her home. Social circumstances must be taken in to account and assessed in order to establish whether any further help is required. As Elsie lived with her husband who was able to assist with cooking and It Professional Resume Professional Resume Resume cleaning and a daughter that would also be able to help out, she was able to return home without the need for any further social input such as carers.

As a result of the care she received, Elsie did not develop a pressure sore and so was discharged home without suffering any delays. As previously mentioned, the Waterlow scale is used as part of the Trust protocol. However, other assessment tools routinely used to assess the risk of developing a pressure ulcer include the Printable Scorecards - Print Scorecard, Norton scale and Addendum the Braden scale. There has been much discussion and many studies carried out in an attempt to evaluate the efficacy of the differing risk assessment scales. A study conducted by Smith (1989) and cited by Mallett and Golf Scorecards - Print Golf Dougherty (2003, p693) concluded that the Waterlow scale was the most effective at Sample Business Evaluation Forms - 9+ predicting the risk of developing pressure sores.

In contrast to this, studies carried out by Pang and Wong (1998, p153) and Stevenson (2004, p81) found the Printable Scorecards, Braden scale to be the most accurate risk assessment. A more recent study conducted by Defloor and Grypdonck (2004) concluded that the pressure sore risk assessment tools currently available are only of limited value. As a result of this many patients may be falsely identified as being at risk or not at risk. It appears that the Evaluation - 9+ Pdf, efficacy of the tool is Scorecards Golf, relative to the users own experience of the tool. Risk assessment scales should be evaluated in combination with the particular preventive measures used. The main criticism of the Entry-Level Cover Letter Companion, care planning relating to Elsie was the lack of formal reassessment. Whilst the staff provided a good level of care, the Printable, lack of documentation could in some cases lead to problems for Services~~element58.jpg the patient, as certain increased risks could be overlooked. In conclusion, the use of the Waterlow scale as a risk assessment tool to predict and prevent pressure damage was effective in Elsie’s situation. Elsie was discharged back home without ever developing pressure damage.

Although Elsie would be unable to return to gardening she felt more positive that she would be able to enjoy this again in the future. This outcome was achieved through assessment along with the involvement of the multidisciplinary team in Elsie’s care. However, it should always be remembered that while assessment tools are useful they should never replace clinical judgement, but should work in conjunction with it (National Institute for Clinical Excellence, 2001). Athorn, S. and Hilton, P. A. - Print Golf! (2004). Mobilizing.

In P. A. Hilton (eds.) Fundamental Nursing Skills. London: Whurr Publishers Ltd. Churchill Livingstone’s Dictionary of It Professional Resume Format Professional Resume Format Nursing (2002). 18 th edition. Edinburgh: Churchill Livingstone. Dealey, C. (2000). Printable Golf Scorecards - Print Golf Scorecard! The Care of Wounds – A Guide for Nurses.

2 nd edition. Oxford: Blackwell Science. Defloor, T. and Grypdonck, M. (2004). Validation of Pressure Ulcer Risk Assessment Scales: A Critique. Journal of Advanced Nursing. 48 (6), 613-621. Harrison, A. (2003). A Guide to Report Format Ii. - Ppt Video Online Risk Assessment. Nursing Times.

99 (9), 44-45. Holland, K (2003). An Introduction to the Roper-Logan-Tierney Model for Printable Scorecards Golf Scorecard Nursing. Based on Activities of Living. In K. Holland, J. Entry-Level Cover & Writing Tips | Resume Companion! Jenkins, J. Soloman S. Whittam (eds.) Applying the Roper-Logan-Tierney Model in Practice.

London: Churchill Livingstone. Mallett, J. and Dougherty, L. Golf Golf! (2003). The Royal Marsden Hospital Manual of Clinical Procedures. Business Forms - 9+! 5 th edition. Printable Golf Scorecards - Print Scorecard! Oxford: Blackwell Science. Marks-Maran, D. J. Docking, S. P. Maunder, T. and Scott, J. (1988).

Skills for Care Planning – A Guide for Teaching the Nursing Process. Middlesex: Scutar Press. Mosby Nurses Pocket Dictionary (2003). 32 nd edition. London: Mosby. National Institute for Military Clinical Excellence (2001). Pressure Ulcer Risk Assessment and Prevention. London: National Institute for Clinical Excellence. Nursing and Midwifery Council (2002).

Code of Professional Conduct. London: NMC. Pang, S. Printable - Print Scorecard! M and Wong, T. K. (1998). Predicting pressure sore risk with Norton, Braden and Waterlow. Services~~element58.jpg! Nurse Researcher. Golf Golf! 47 (3), 147-153. Royal College of Nursing (2003). Defining Nursing.

London: Royal College of Nursing. Royal College of Resume Resume Format Nursing (2002). RCN Code of Practice for Patient Handling; Working Well Initiative [Website]. Scorecards - Print Scorecard! Available from www.rcn.org.uk [Accessed: 20 January 2005] Sharkey, S. Kitchen Staff Job Description For Resume 33 For Your! (1997). - Print Golf Scorecard! Clinical Risk and Depression. Nursing Standard. 11 (18). Sample Business Evaluation Forms Pdf! 49-50.

Stevenson, T. (2004). Scorecards! Improving Policy and Practice in the Prevention of It Professional Resume Format Resume Pressure Ulcers. Golf Scorecards - Print! Nursing Times. 100 (9), 80-84. If this essay isn't quite what you're looking for, why not order your own custom Coursework essay, dissertation or piece of coursework that answers your exact question? There are UK writers just like me on hand, waiting to help you. Each of us is qualified to a high level in our area of expertise, and Resume Format Resume Format Resume we can write you a fully researched, fully referenced complete original answer to your essay question. Just complete our simple order form and you could have your customised Coursework work in your email box, in as little as 3 hours. This coursework was submitted to Printable - Print Golf Scorecard us by a student in order to help you with your studies. This page has approximately words. If you use part of this page in your own work, you need to provide a citation, as follows:

Essay UK, The Purpose Of This Essay Is To Identify And Focus On A Specific Risk To A Patient . Available from: http://www.essay.uk.com/coursework/the-purpose-of-this-essay-is-to-identify-and-focus-on-a-specific-risk-to-a-patient.php [03-10-17]. If you are the original author of this content and no longer wish to have it published on our website then please click on the link below to request removal: Essay UK offers professional custom essay writing, dissertation writing and coursework writing service. Our work is high quality, plagiarism-free and delivered on time. Essay UK is a trading name of Student Academic Services Limited , a company registered in Accounting Tips, England and Wales under Company Number 08866484 . Registered Data Controller No: ZA245894.