Chapter 15

Question 1

A new staff nurse is hired as a full-time employee who works 40 hours a week. The nurse would be referred to as which of the following?

a. .5 FTE c. .9 FTE
b. .8 FTE d. 1.0 FTE

Answer 1

D: A full-time employee who works 40 hours a week or 80 hours in a 2-week period is referred to as a 1.0 FTE. A .5 FTE works 50 percent or 40 hours in a 2-week period. A .8 FTE works 80 percent or 64 hours in a 2-week period. A .9 FTE works 90 percent or 72 hours in a 2-week period.

Question 2

A full-time employee works how many hours per year?

a. 1,040 c. 1,664
b. 2,080 d. 1,872

Answer 2

B: A full-time employee works 5 days a week or 40 hours per week for 52 weeks a year. This amounts to 2,080 hours of work time.

Question 3

At the end of the shift, nurses document the care provided each of the clients. The time spent on this type of accounting activity would be considered which of the following?

a. Direct care c. Indirect care
b. Productive time d. Nonproductive time

Answer 3

C: Indirect care is time spent on activities that are patient related but not done directly to the patient. Examples of indirect care are order entries and documentation. Direct care is time spent providing hands-on care to patients. Hours worked and available for patient care are designated as productive hours. Benefit time such as vacation, sick time, and education time is considered nonproductive time.

Question 4

When completing the staffing assignment, the nurse manager must include holiday time for the staff members. In terms of financial budgeting, holiday time is considered which of the following?

a. Productive time c. Direct care
b. Nonproductive time d. Indirect care

Answer 4

B: Holiday time is considered benefit time; therefore, it is nonproductive time. Hours worked and available for patient care are designated as productive hours. Direct care is time spent providing hands-on care to patients. Indirect care is time spent on activities that are patient related but not done directly to the patient.

Question 5

A measurement tool to articulate the nursing workload for a specific patient or group of patients over a specific period of time is called:

a. benchmarking. c. staffing pattern.
b. skill mix. d. patient classification.

Answer 5

D: A patient classification system is a measurement tool used to articulate the nursing workload for a specific patient or group of patients over a specific period of time. Benchmarking is a management tool for seeking out the best practices in one’s industry. Skill mix is the percentage of RN staff to other direct care staff. Staffing pattern is a plan that articulates how many and what kind of staff are needed by shift to staff a unit or department.

Question 6

A patient classification system that uses units of measure that equate to nursing time is called:

a. prototype. c. factor system.
b. seven domain. d. scorecard.

Answer 6

C: The factor system uses units of measure that equate to nursing time. Nursing tasks are assigned time or are weighted to reflect the amount of time needed to perform the task. A prototype system allocates nursing time to large patient groups based on an average of similar patients. The seven domain patient classification system identifies seven domains of patient care needs for nurse intervention: cognitive status, self-care ability, emotional/social/spiritual well-being, family information needs/support status, treatments and interventions, interdisciplinary coordination, and transitions. A scorecard is a tool to display data on organizational priorities.

Question 7

An advantage of the factor-type patient classification system is:

a. ongoing workload for nurses to classify patients.
b. capturing holistic patient needs.
c. data are readily available.
d. capturing typical nursing time.

Answer 7

C: An advantage of the factor-type patient classification system is that data are generally readily available. Disadvantages of the factor-type system are ongoing workload for the nurse in classifying patients every day, higher acuity levels, system does not holistically capture the patient’s needs, and the factor system calculates nursing time needed for a typical nurse.

Question 8

An advantage of the prototype patient classification system is:

a. reduction of work.
b. ongoing data to monitor accuracy of the nursing requirements.
c. ongoing measure of the actual nursing work required.
d. commonly used system.

Answer 8

A: The advantage of the prototype patient classification system is the reduction of work for the nurse, who is not required to classify patients daily. Major disadvantages of the system are no ongoing measure of the actual nursing work required by individual patients, no ongoing data to monitor the accuracy of the preassigned nursing care requirements, and the system is much less common than the factor system.

Question 9

Acuity data and nursing hours per patient day (NHPPD) are concrete data parameters that are primarily used to:

a. benchmark. c. develop a nursing budget.
b. adjust staffing levels. d. review patient care outcomes.

Answer 9

B: NHPPD measure productive nursing hours as a tool to monitor staffing and scheduling.

Question 10

How many FTEs per day would you need if your target NHPPD was 8, and you expected to have 22 patients on your 24-bed unit?

a. 20 c. 24
b. 22 d. 26

Answer 10

B: You would multiply 8 NHPPD times 22 patients to get 176 productive hours needed every day. Dividing 176 by 8-hour shifts worked by an FTE gives you 22 FTEs per day.

Question 11

Whose responsibility is it to schedule staff?

a. Staff members themselves c. Nurse manager
b. Nursing scheduling office d. Director of Nursing

Answer 11

C: Scheduling of staff is the responsibility of the nurse manager. Scheduling may be overseen by the nursing department’s staffing and scheduling office. Staff may become involved in self-scheduling, which is a process in which staff on a unit collectively decide and implement the monthly work schedule. The ultimate responsibility of self-scheduling still falls to the nurse manager. The fiscal department may be a resource for financial staffing software, but it is ultimately the responsibility the nurse manager to schedule staff.

Question 12

California was the first state to mandate nurse-to-patient staffing:

a. plans. c. patterns.
b. ratios. d. departments.

Answer 12

B: By January 2005, California hospitals were required to meet a 1:5 staffing ratio in all medical-surgical units by the California legislature. Similar legislation is pending in other states.

Question 13

The nurse manager must take into account which of the following when scheduling staff?

a. Staffing pattern c. Volume of patients
b. Volume of staff d. Staff needs

Answer 13

C: The nurse manager must take into account the following when scheduling staff: volume of patients, patients’ needs and intensity, experience of the staff, and supports available to the staff.

Question 14

When doing self-scheduling, one of the guidelines should include:

a. nurse manager outcomes. c. staff outcomes.
b. patient outcomes. d. scheduling period.

Answer 14

D: Self-scheduling guidelines should include scheduling period, schedule timeline, staffing pattern, weekends, holidays, vacation time, unit vacation practices, requests for time off, short-staffed shifts, on call, cancellation guidelines, sick calls, military leave, schedule changes, shifts defined, committee time, seniority, and staffing plan for emergency situations. There is a relationship between patient outcomes and nurse staffing and between nurse staffing and nurse outcome. Evaluating the outcomes of scheduling on patients, staff, and the organization is a critical activity that should be done daily, monthly, and annually.

Question 15

In which model of care delivery does the nurse have responsibility for the total care for the patient assignment during the shift?

a. Case method c. Functional nursing
b. Total patient care d. Team nursing

Answer 15

B: In total patient care, the nurse is responsible for the total care for the patient assignment during the shift worked. In the case method, the nurse has one patient that is cared for exclusively. Functional nursing divides the nursing work into functional units that are then assigned to one of the team members. In team nursing, staff is assigned to teams who then are responsible for a group of patients.

Question 16

An advantage of the total patient care and the case method model of care delivery is:

a. cost. c. continuum of care.
b. same patients. d. consistency of care.

Answer 16

D: The advantage of total patient care and the case method for the patient is the consistency of one individual caring for the patient or patients for an entire shift. This enables the development of a relationship based on trust. Disadvantages of these models are that the nurse may not have the same patients from day to day and is therefore not providing a continuum of care; they require a high level of RN nursing hours to deliver care; they require a high level of nurse intensity that is not needed and is costly.

Question 17

A disadvantage of functional nursing is:

a. it serves a large number of patients.
b. it utilizes different skill levels to deliver care.
c. the patient receives task-focused care.
d. the patient receives care from several staff members.

Answer 17

C: A disadvantage of functional nursing is that the patient receives task-focused care. Advantages of functional nursing are that care can be delivered to a large number of patients, other skill levels are utilized, and the patient receives care from several staff members.

Question 18

A model of care delivery that consists of a group of patients who are being cared for by an RN, an LPN, and a UAP is called:

a. functional nursing. c. total patient care.
b. team nursing. d. primary nursing.

Answer 18

B: Team nursing consists of a group of patients who are being cared for by an RN, an LPN, and a UAP. Functional nursing is task oriented. Total patient care is described as patients cared for by an RN with some support by other support staff, but they are not assigned to a specific group of patients. Primary nursing delegates the RN as the primary provider of care.

Question 19

In which model of care delivery is the focus on patient needs rather than on staff needs?

a. Primary c. Differentiated practice
b. Patient-centered d. Modular

Answer 19

B: Patient-centered care is designed to focus on the patients’ needs rather than on the staff’s needs. Primary nursing delineates the responsibility and accountability of the RN and designates the RN as the primary provider of care to patients. Differentiated practice sorts the roles, functions, and work of registered nurses according to some identified criteria. Modular nursing divides a geographic space into modules of patients, with each module cared for by a team of staff led by an RN.

Question 20

An advantage of primary nursing is:

a. accountability. c. geographic boundaries.
b. cost. d. performing all interventions.

Answer 20

A: An advantage of this model is the defined accountability and responsibility for the nurse to develop a plan of care with the patient and family. Disadvantages of this model are its high cost, lack of geographical boundaries, and the fact that nurses often perform interventions that could be completed by other staff.

Question 21

A disadvantage of clinical pathways is the:

a. ability to manage care. c. ability to collect variances.
b. ability to shorten length of stay. d. template for care.

Answer 21

D: An issue with pathways is that some physicians perceive pathways to be template (cookbook) medicine. Advantages of clinical pathways are that they are a tool for managing care, instructive for new staff, and time savers. In addition, they improve care, shorten the length of stay, and allow for data collection regarding variances to the pathway so care can be improved.

Question 22

A strategy to improve patient care and reduce hospital costs through coordination of care is termed:

a. clinical pathways. c. primary nursing.
b. case management. d. utilization review.

Answer 22

B: Case management coordinates patient care. Clinical pathways were an initiative to reduce LOS, enhance outcomes, and contain costs; however, these were not achieved through coordination of care. Primary nursing is a care delivery model where the patient is assigned a primary nurse. Utilization review is a review of patient charts daily to ensure the patients’ acuity warrants continued hospitalization.

Question 23

As the nurse manager of a pediatric unit, your daily staff assignments would be based on which of the following?

a. Patient acuity and nursing care hours needed
b. Number of nurses that are available
c. Patient acuity and cost of care
d. Staff preference and patient difficulty

Answer 23

A: As the nurse manager, you would base your assignment on the patient acuity and the number of care hours required. Other items to take into consideration are the complexity of patient care and the experience of the staff.

Question 24

Your unit is staffed by 4 nurses who work 12-hour shifts, 6 nurses who work 8-hour shifts, and 6 nurses who work 5-hour shifts. How many FTEs do these nurses represent?

a. 11 FTEs c. 14.5 FTEs
b. 12.6 FTEs d. 16 FTEs

Answer 24

B: The total FTEs for a nurse on the unit would be 12.6. It is computed as follows:
4 nurses  0.9FTEs = 3.6 FTEs
6 nurses  1.0 FTEs = 6 FTEs
6 nurses  0.5FTEs = 3.0 FTEs
Total = 3.6 + 6 + 3 = 12.6 FTEs

Question 25

You recently hired a new staff nurse to work from 12 Noon until 8 P.M., 4 days per week. This new staff nurse would add how many additional FTEs to your unit?

a. 0.8 FTEs c. 1.6 FTEs
b. 0.9 FTEs d. 2.5 FTEs

Answer 25

A: A staff nurse who works from 12 Noon until 8 P.M is working an 8-hour shift. Since the nurse only works 4 days per week, the nurse would work a total of 32 hours each week. A full-time nurse works 40 hours a week, which is equal to 1 FTE. The percentage of time worked by the new nurse is 40 divided by 32, which equals 0.8. The nurse would add 0.8 FTEs to your unit.

Question 26

Each nurse on your unit receives a benefits package that includes a 2-week vacation, 1 sick day each month, 6 holidays, and 2 days to attend an educational conference. How many nonproductive hours would each nurse on your unit represent?

a. 60 hours c. 240 hours
b. 120 hours d. 360 hours

Answer 26

C: The calculation would be as follows:
2 weeks vacation each year = 10 days  8 hours/day = 80 hours
1 sick day per month = 12 days  8 hours/day = 96 hours
6 holidays per year = 6 days  8 hours/day = 48 hours
2 days per year to attend an educational conference = 2 days  8 hours/day = 16 hours

The total would be 80 hours + 96 hours + 48 hours + 16 hours = 240 hours.

Question 27

A nursing unit schedule has one RN on admission assessments and discharges; an LPN assigned to pass medications to all patients; one RN for IVs, IV meds, and blood administration; two NAPs for baths; and two NAPs for assisting with patient feeding. This unit most likely uses which form of patient care delivery?

a. Team nursing c. Managed care
b. Primary nursing d. Functional nursing

Answer 27

D: The unit most likely is following a functional nursing care delivery system. Functional nursing divides the nursing work into functional roles that are then assigned to one of the team members. In this model, each care provider has specific duties or tasks for which they are responsible.