CH 2: Organizational Structure of Healthcare Flashcards
visual means of determining the level of centralization or decentralization
organizational chart
__________ organization is one where decisions are make closer to the point of service.
a. decentralized
b. centralized
c. flat
a. decentralized
__________ organization is a typical hierarchy with a chain of command and top-down decision-making.
a. decentralized
b. centralized
c. flat
b. centralized
__________ organization removes the hierarchal layers, allowing authority for action at the point of service.
a. decentralized
b. centralized
c. flat
c. flat
T/F
The more decentralized an organization, the greater the opportunity for shared governance and therefore, the greater the level of job satisfaction.
true
Alignment of nursing practice with the mission, vision, and values of the organization and the nursing department.
professional practice model
A nurse working in an intensive care unit is assigned to provide total patient care for two critically ill patients during their 12-hour shift. Which statement best describes the nurse’s accountability in this model of care?
A. The nurse is responsible for the patients’ care only during their assigned shift.
B. The nurse maintains accountability for patient outcomes beyond their shift.
C. The nurse collaborates with multiple caregivers, sharing responsibility for care.
D. The nurse delegates all direct patient care tasks to unlicensed assistive personnel (UAPs).
A. The nurse is responsible for the patients’ care only during their assigned shift.
Rationale: In the total patient care model, the nurse assumes complete responsibility for a group of patients but only for the duration of their shift. Accountability does not extend beyond that time frame, meaning the next shift’s nurse takes over full responsibility. This model allows for continuity of care during the shift but does not establish long-term continuity across multiple shifts.
A hospital administrator is evaluating whether to implement the total patient care model in a new critical care unit. Which of the following characteristics are associated with total patient care? (SATA)
A. One nurse provides comprehensive care for a group of patients during a shift.
B. The model was first introduced by Florence Nightingale.
C. Nurses in this model are responsible for patient care 24/7.
D. Total patient care is commonly used in private duty nursing and ICUs.
E. This model increases the need for frequent handoff communication between shifts.
A. One nurse provides comprehensive care for a group of patients during a shift.
B. The model was first introduced by Florence Nightingale.
D. Total patient care is commonly used in private duty nursing and ICUs.
Rationale: In the total patient care model, a single nurse is responsible for all aspects of patient care within their assigned shift (A). Florence Nightingale first introduced this approach (B). This model is commonly seen in private duty nursing and intensive care units, where high levels of direct nursing care are required (D). However, accountability is limited to the shift duration, meaning nurses do not maintain responsibility beyond their shift (C is incorrect). Because the same nurse provides care throughout their shift, handoff communication between staff members is minimized, not increased (E is incorrect).
Which of the following is a primary advantage of the total patient care model in an intensive care unit (ICU)?
A. It allows for minimal interaction between staff members during shift changes.
B. It promotes continuity of care within a single shift.
C. It ensures cost-effectiveness by reducing the number of registered nurses needed.
D. It decreases the level of nursing autonomy in patient care decisions.
B. It promotes continuity of care within a single shift.
Rationale: The total patient care model enhances continuity of care because the same nurse provides all aspects of patient care within their shift. This consistency allows for better assessment, intervention, and evaluation of patient needs. While interaction between staff members at shift changes is minimized (A), this is a byproduct rather than the primary advantage. This model requires a higher number of RNs, making it more costly (C is incorrect). Additionally, it increases, rather than decreases, nursing autonomy since nurses are responsible for comprehensive patient care (D is incorrect).
A nurse manager is training new nurses on the benefits and challenges of the total patient care model. Which statements should be included in the training? (SATA)
A. This model provides nurses with high autonomy in patient care decisions.
B. It is a cost-effective model compared to team nursing.
C. Nurses do not need to delegate tasks to unlicensed assistive personnel.
D. Patients benefit from a consistent caregiver during their shift.
E. This model reduces communication time between staff members within a shift.
A. This model provides nurses with high autonomy in patient care decisions.
D. Patients benefit from a consistent caregiver during their shift.
E. This model reduces communication time between staff members within a shift.
Rationale: The total patient care model allows nurses to exercise high levels of autonomy, as they are responsible for all aspects of patient care (A). Patients benefit from having the same caregiver throughout their shift, which improves trust and consistency (D). Communication time between staff members is reduced because there is less need for handoffs within a shift (E). However, this model is more expensive than team nursing, as it requires more RNs (B is incorrect). While RNs provide direct care, they may still delegate appropriate tasks to UAPs when necessary (C is incorrect).
Which scenario best exemplifies the use of total patient care?
A. A registered nurse leads a team of licensed practical nurses (LPNs) and unlicensed assistive personnel (UAPs) in providing patient care.
B. A nurse assumes full responsibility for the assessment, planning, intervention, and evaluation of care for assigned patients during their shift.
C. A nurse delegates all direct patient care to LPNs and UAPs while focusing on documentation and coordination.
D. A group of nurses work together to provide care to a large number of patients, with each nurse assigned a specific task.
B. A nurse assumes full responsibility for the assessment, planning, intervention, and evaluation of care for assigned patients during their shift.
Rationale: In the total patient care model, the assigned nurse provides all aspects of care, including assessment, planning, intervention, and evaluation, for their patients during their shift. This contrasts with team nursing (A and D), where multiple caregivers share responsibilities. The total patient care model does not focus on delegation to the extent seen in primary nursing or functional nursing models (C is incorrect).
A nurse is assigned as the team leader in a team nursing model. Which of the following responsibilities is most essential to ensure effective patient care?
A. Coordinating, supervising, and evaluating the care provided by the team
B. Performing all direct patient care independently
C. Assigning only licensed nurses to perform patient care
D. Limiting communication among team members to avoid confusion
A. Coordinating, supervising, and evaluating the care provided by the team
Rationale: In the team nursing model, the team leader is responsible for coordinating, supervising, and evaluating the care provided by the team members. This ensures that patient care is effective, safe, and meets established standards. The team leader delegates tasks based on the skills and scope of practice of each member, ensuring collaborative work and proper patient care.
A nurse manager is educating new nurses about the team nursing model. Which statements correctly describe this model? (SATA)
A. A nurse leads a group of staff members to provide patient care.
B. Effective communication is essential for success.
C. Each team member independently decides on the care they provide.
D. The team leader is responsible for supervision and evaluation.
E. This model eliminates the need for collaboration among team members.
A. A nurse leads a group of staff members to provide patient care.
B. Effective communication is essential for success.
D. The team leader is responsible for supervision and evaluation.
Rationale: In team nursing, a nurse leads a group of staff members to provide patient care, ensuring efficient and coordinated care delivery. Effective communication is critical to ensure that all members understand their roles and responsibilities. The team leader is responsible for supervising and evaluating the care provided, ensuring quality and efficiency in patient care.
Which factor is most critical for the success of the team nursing model?
A. The ability of the team leader to delegate and communicate effectively
B. Assigning all patient care tasks to unlicensed assistive personnel (UAPs)
C. Having each nurse work independently without collaboration
D. Limiting the role of the team leader to administrative tasks only
A. The ability of the team leader to delegate and communicate effectively
Rationale: Effective delegation and communication by the team leader are crucial for the success of the team nursing model. The team leader must ensure that tasks are assigned appropriately based on skill level and that all members work collaboratively to provide efficient, high-quality patient care.
A nurse working in a primary nursing model is responsible for coordinating a patient’s care across multiple shifts. Which of the following best describes the nurse’s accountability in this model?
A. The primary nurse is accountable for the patient’s care 24/7, even when not on shift.
B. The primary nurse is only responsible for care provided during their shift.
C. The primary nurse delegates all decision-making to charge nurses on each shift.
D. The primary nurse is responsible for developing and evaluating the plan of care, even when other nurses provide direct care.
D. The primary nurse is responsible for developing and evaluating the plan of care, even when other nurses provide direct care.
Rationale: In the primary nursing model, the primary nurse is accountable for the overall plan of care for a patient, ensuring continuity and individualized care. While the nurse is not physically present 24/7, they remain responsible for coordinating care across shifts and ensuring that other staff members implement the plan effectively.
A nurse educator is teaching a group of nurses about the primary nursing model. Which of the following statements correctly describe this model? (SATA)
A. One nurse assumes accountability for a patient’s care throughout their hospital stay.
B. The primary nurse collaborates with other nurses on different shifts to coordinate care.
C. All decision-making occurs at the administrative level rather than at the patient’s bedside.
D. The primary nurse can delegate care to other staff members as needed.
E. The primary nurse is responsible for developing and evaluating the patient’s plan of care.
A. One nurse assumes accountability for a patient’s care throughout their hospital stay.
B. The primary nurse collaborates with other nurses on different shifts to coordinate care.
D. The primary nurse can delegate care to other staff members as needed.
E. The primary nurse is responsible for developing and evaluating the patient’s plan of care.
Rationale: The primary nursing model ensures continuity of care by assigning one nurse to oversee a patient’s care throughout their hospital stay. The primary nurse collaborates with nurses on other shifts to maintain consistency in care. Decision-making occurs at the patient’s bedside, allowing for personalized care. The primary nurse can delegate appropriate tasks while still maintaining responsibility for the patient’s overall plan of care.
Which of the following best describes a key advantage of the primary nursing model?
A. It ensures continuity of care by assigning one nurse to oversee a patient’s care plan.
B. It reduces the need for nurses to collaborate with each other.
C. It eliminates the need for delegation to other healthcare team members.
D. It limits bedside decision-making by shifting responsibility to administrative staff.
A. It ensures continuity of care by assigning one nurse to oversee a patient’s care plan.
Rationale: A major advantage of the primary nursing model is the continuity of care it provides. The primary nurse is responsible for coordinating and overseeing all aspects of the patient’s care, which enhances communication, consistency, and patient outcomes.
A nurse manager is considering implementing primary nursing in a hospital unit. Which factors must be in place for this model to be successful? (SATA)
A. Strong communication and collaboration among nurses across shifts.
B. Nurses who can assume accountability for a patient’s care throughout their hospital stay.
C. Minimal delegation to other staff members.
D. Decision-making that takes place at the patient’s bedside.
E. A reliance solely on team nursing principles.
A. Strong communication and collaboration among nurses across shifts.
B. Nurses who can assume accountability for a patient’s care throughout their hospital stay.
D. Decision-making that takes place at the patient’s bedside.
Rationale: For primary nursing to be effective, nurses must communicate effectively across shifts to ensure continuity of care. The model requires nurses who can take full accountability for a patient’s care throughout their hospital stay. Decision-making at the patient’s bedside is essential to providing individualized, patient-centered care.
In the primary nursing model, how does the primary nurse ensure continuity of care when they are not on shift?
A. By developing a comprehensive plan of care and collaborating with other nurses across shifts.
B. By assigning a different nurse to be the primary caregiver for each shift.
C. By limiting the role of other nurses to only performing basic tasks.
D. By ensuring that care decisions are made exclusively by the healthcare administration.
A. By developing a comprehensive plan of care and collaborating with other nurses across shifts.
Rationale: The primary nurse ensures continuity of care by creating and evaluating the patient’s plan of care while collaborating with other nurses to maintain consistency in treatment. This model enhances communication and patient outcomes by having one nurse oversee the overall care process.
A nurse is working in a hospital that utilizes the functional nursing model. Which of the following best describes how patient care is organized in this model?
A. One primary nurse is responsible for coordinating all aspects of patient care across shifts.
B. Each nurse is assigned a small group of patients and provides total care for them.
C. Nurses are assigned specific tasks based on their technical skills rather than comprehensive patient care.
D. Nurses collaborate equally in decision-making and share responsibility for each patient’s overall care.
C. Nurses are assigned specific tasks based on their technical skills rather than comprehensive patient care.
Rationale: In the functional nursing model, work is allocated based on specific tasks and technical skills rather than holistic patient care. Nurses and other healthcare personnel are assigned specific duties, such as medication administration, wound care, or treatments, making this model efficient during staff shortages but requiring strong communication for continuity of care.
A nurse manager is considering implementing functional nursing in a hospital experiencing a staffing shortage. Which of the following characteristics describe this model? (SATA)
A. The charge nurse assigns tasks based on technical skills.
B. It is commonly used in agencies with a large classification of staff.
C. Nurses provide total patient care within their assigned shifts.
D. Strong communication between team members is necessary to ensure quality care.
E. The focus is on completing tasks rather than individualized patient care.
A. The charge nurse assigns tasks based on technical skills.
B. It is commonly used in agencies with a large classification of staff.
D. Strong communication between team members is necessary to ensure quality care.
E. The focus is on completing tasks rather than individualized patient care.
Rationale: In the functional nursing model, the charge nurse assigns tasks based on technical skills, making it efficient in settings with a variety of healthcare staff. This model is commonly used in agencies with a large classification of staff and relies heavily on strong communication among team members to maintain quality care. The primary focus is on task completion rather than individualized, holistic care.
Which of the following is a primary advantage of the functional nursing model?
A. It enhances continuity of care by assigning one nurse to a patient for their entire hospital stay.
B. It increases efficiency, especially during staff shortages.
C. It allows for comprehensive, patient-centered decision-making at the bedside.
D. It ensures that each staff member has an equal level of responsibility for patient care.
B. It increases efficiency, especially during staff shortages.
Rationale: The functional nursing model is highly efficient because it divides patient care into specific tasks, allowing available staff to complete duties quickly. This approach is particularly beneficial in settings with staffing shortages, as it maximizes the use of personnel with varying levels of training.
A hospital administrator is evaluating whether to continue using the functional nursing model. Which of the following are potential challenges of this approach? (SATA)
A. Lack of holistic, individualized patient care.
B. Increased need for strong communication among team members.
C. Reduced efficiency during staff shortages.
D. Fragmentation of patient care due to task-based assignments.
E. Difficulty in ensuring continuity of care across shifts.
A. Lack of holistic, individualized patient care.
B. Increased need for strong communication among team members.
D. Fragmentation of patient care due to task-based assignments.
E. Difficulty in ensuring continuity of care across shifts.
Rationale: The functional nursing model presents challenges such as a lack of individualized patient care due to its task-oriented structure, the need for strong communication to prevent errors, fragmentation of care, and difficulty ensuring continuity across shifts. While it is efficient during staff shortages, its task-based approach can sometimes hinder a patient-centered focus.
Which situation would most likely indicate that the functional nursing model is not effectively meeting patient care needs?
A. Nurses are able to complete all assigned tasks within their shift, ensuring timely medication administration and treatments.
B. Patients report feeling like they are interacting with multiple caregivers but lack a primary nurse overseeing their care.
C. The facility is experiencing a staffing shortage, and functional nursing is helping to maximize available personnel.
D. Staff members efficiently perform their assigned roles with minimal overlap in responsibilities.
B. Patients report feeling like they are interacting with multiple caregivers but lack a primary nurse overseeing their care.
Rationale: A common drawback of functional nursing is the potential for fragmented care, where patients feel disconnected from their healthcare team because they interact with multiple caregivers without a single nurse coordinating their care. This can impact patient satisfaction and continuity of care.
T/F
The disadvantages of functional nursing are decreased patient and nurse satisfaction.
true
T/F
The nurse manager is responsible for communicating all aspects of patient care to the next shift.
charge nurse
A hospital unit is transitioning to a modular nursing model. Which of the following characteristics best defines this approach?
A. Nurses and staff members are assigned to a specific group of patients based on the physical layout of the unit.
B. One nurse is responsible for the total care of a group of patients throughout their hospital stay.
C. Nurses are assigned specific tasks rather than being responsible for a cluster of patients.
D. Patient assignments change frequently, with staff members rotating between different areas of the unit.
A. Nurses and staff members are assigned to a specific group of patients based on the physical layout of the unit.
Rationale: Modular nursing is a variation of team nursing in which nurses and staff members are assigned to a specific group of patients based on the physical layout of the unit. This model improves efficiency by having staff stationed close to their assigned patients, promoting ease of communication and workflow.
A nurse manager is explaining the benefits of modular nursing to a group of staff members. Which of the following statements accurately describe advantages of this model? (SATA)
A. Staff members are stationed closer to their assigned patients.
B. The unit is divided into smaller patient care areas or “pods.”
C. Modular nursing eliminates the need for consistent staffing levels.
D. Nurses and staff members work with the same cluster of patients within their designated area.
E. It allows for more efficient communication among staff members within a module.
A. Staff members are stationed closer to their assigned patients.
B. The unit is divided into smaller patient care areas or “pods.”
D. Nurses and staff members work with the same cluster of patients within their designated area.
E. It allows for more efficient communication among staff members within a module.
Rationale: Modular nursing improves efficiency by stationing staff closer to their assigned patients, dividing the unit into smaller patient care areas, and assigning nurses to the same cluster of patients. This model also facilitates better communication within each module, enhancing patient care coordination.
Which of the following is a potential challenge of implementing modular nursing in a hospital unit?
A. Increased workload for individual nurses due to a lack of delegation.
B. Limited opportunities for communication among staff members.
C. The need to maintain consistent staffing levels within each module.
D. Decreased efficiency in patient care due to staff proximity to patients.
C. The need to maintain consistent staffing levels within each module.
Rationale: One of the main disadvantages of modular nursing is the requirement for a consistent number of staff members in each module to ensure effective patient care. Variations in staffing can disrupt workflow and impact the quality of care within a designated patient cluster.
A hospital is considering adopting modular nursing in its medical-surgical unit. Which factors should be considered before implementing this model? (SATA)
A. The physical layout of the unit and the ability to create patient care “pods.”
B. The need for staff members to work within a designated cluster of patients.
C. Whether the facility can consistently maintain appropriate staffing levels.
D. The ability to eliminate all other nursing care models within the hospital.
E. The potential for improved efficiency and communication within each module.
A. The physical layout of the unit and the ability to create patient care “pods.”
B. The need for staff members to work within a designated cluster of patients.
C. Whether the facility can consistently maintain appropriate staffing levels.
E. The potential for improved efficiency and communication within each module.
Rationale: Successful implementation of modular nursing requires assessing the unit’s physical layout to determine if patient care pods can be created. Consistent staffing levels are necessary for this model to function effectively. Working within a designated cluster of patients allows for improved efficiency and communication among team members.
A nurse is working within a modular nursing model. Which of the following best demonstrates an advantage of this model?
A. Staff members rotate frequently between different patient modules to increase flexibility.
B. Nurses are assigned patients without consideration of unit layout.
C. Decision-making occurs primarily at the administrative level rather than at the bedside.
D. Nurses are positioned closer to their assigned patients, improving response time and workflow.
D. Nurses are positioned closer to their assigned patients, improving response time and workflow.
Rationale: In modular nursing, nurses are stationed near their assigned patients, allowing for quicker response times and more efficient patient care. This proximity facilitates better communication among team members, leading to smoother workflow and improved patient outcomes.
Which type of structure is a hierarchy that follows a chain of command concept and is characterized by top-down decision making?
A.Decentralized
B.Organizational
C.Functional
D.Matrix
A.Decentralized
You are the charge nurse on the night shift. One of your tasks is to assign both direct patient care activities and indirect patient care activities to staff members. You are aware that one of the direct patient care activities is:
A.Restocking supplies
B.Transporting patients
C.Clerical activities
D.Electrocardiogram tracing
D.Electrocardiogram tracing
You are the nurse supervisor listening to report and observe a nurse delegating a task to a nursing assistant that should be done by a nurse. What should you do?
A.Discuss with charge nurse
B.Discuss at the next staff meeting
C.Openly discuss that she is wrong
D.Discuss why the task is not appropriate for the nursing assistant
D.Discuss why the task is not appropriate for the nursing assistant
Which of the following is a list of delegation factors?
A.Your state’s nurse practice act, hospital policies and procedures, job descriptions, patient needs, staff competencies, clinical situation, professional standards
B.Your state’s nurse practice act, hospital policies and procedures, job descriptions, patient needs, staff competencies, clinical situation
C.Your state’s nurse practice act, hospital policies and procedures, job descriptions, patient needs, staff competencies, professional standards
D.Your state’s nurse practice act, hospital policies and procedures, patient needs, staff competencies, clinical situation, professional standards
D.Your state’s nurse practice act, hospital policies and procedures, patient needs, staff competencies, clinical situation, professional standards
A model of care in which the nurse assumes full accountability for care of a group of patients is:
A.Case management
B.Total patient care
C.Primary care
D.Functional nursing
B.Total patient care
The type of patient care in which the nurse caring for the patient makes most decisions is:
A.Functional
B.Team
C.Case management
D.Total patient care
D.Total patient care
What type of structure combines both function and service line in an integrated service structure?
A.Matrix structure
B.Integrated structure
C.Product line structure
D.Point of care structure
A.Matrix structure
Which of the following is a disadvantage of team nursing?
A.Facilitation and oversight of novice nurses
B.Increase time to communicate within the team
C.Fixed teams relate to higher-quality patient care
D.Team leader has knowledge of patient needs and can provide coordination of care
B.Increase time to communicate within the team
The fundamental elements of any patient care delivery system decision making are with:
A.Leadership style
B.Work allocation
C.Nursing productivity
D.Patient acuity
B.Work allocation
The nurse manager is planning a meeting with the staff members on group process. Which of the following functional roles should be discussed?
A.An effective team needs a spokesperson
B.The group needs to have equal roles with their leader
C. Each group needs an individual with responsibility to coordinate and maintain records
D.The team rallies around group leader
C. Each group needs an individual with responsibility to coordinate and maintain records
In interviewing for a new position, a nurse may want to inquire about the institution’s views
on autonomy in the workplace for nurses. The nurse concludes that autonomy is valued when
told that the unit has
a. infrequent “floating.”
b. self-scheduling.
c. cover of another nurse’s assignment while she or he is on break.
d. hourly pay differential for the night shift.
b. self-scheduling.
Rationale: In a self-governance working environment, staff are encouraged to be autonomous, which
includes self-scheduling. Option A is incorrect because it does not address autonomy. Option
C is incorrect because they are decisions made by the organization and are practiced
throughout the organization. Option D is incorrect because they are decisions made by the
organization and practiced throughout the organization.
The student nurse learns about the advantages and disadvantages of various patient care
delivery models. The student understands that besides an historical perspective of nursing
practice, a patient delivery care model may need to be instituted to adapt to
a. alterations in available staff due to weather emergencies.
b. the financial environment of the patient population.
c. a wide range of ages among the staff.
d. a limited number of unlicensed staff on the unit.
a. alterations in available staff due to weather emergencies.
Rationale: Patient delivery models are instituted based on various elements including clinical decisionmaking and work allocation; thus, changes may need to be made in an emergency based on
availability of staff. The other options do not describe a fundamental element used in the
decision-making process for delivery mode.
An agency nurse is assigned to work on a unit that uses the team nursing model of health care
delivery. Which of the following would the nurse expect to experience in this environment?
a. UAP taking vital signs and giving baths
b. RN taking vital signs and giving baths
c. RN delegating patient care delivery to a group of patients
d. Charge nurse delegating care delivery
c. RN delegating patient care delivery to a group of patients
Rationale: In a team nursing environment, an RN delegates patient care to a group of patients. Option A
is incorrect because it is practiced in a functional model environment. Option B is incorrect
because it is seen in primary nursing. Option D is incorrect because it may be seen in all types
of health care delivery models.
In which health care delivery model would the nurse expect to see “point-of-care” decision
making occur?
a. Primary care nursing
b. Team nursing
c. Functional nursing
d. Modular nursing
a. Primary care nursing
Rationale: Primary nursing allows the nurse to practice autonomously and make most bedside decisions.
The other options are incorrect because they may not allow for the autonomy required for
“point-of-care” decisions.
A nurse has accepted a position on a nursing unit where the nurse manager promotes
autonomy and staff involvement in decision making. What would the nurse expect to observe
on this unit?
a. Nurse manager mandates changes.
b. Staff takes responsibility for assignments.
c. Staff participates on hospital committees.
d. Nurses are recognized for excellence in practice.
c. Staff participates on hospital committees.
