Chapter 17 Flashcards

Question

Decentralized and Centralized Staffing #2 Centralized and decentralized staffing is not synonymous with what?

Answer 1

Centralized and decentralized staffing is not synonymous with centralized and decentralized decision making.

Answer 2

Key decisions are made by a small group of top-level leaders or a single central authority.

Answer 3

Information flows from the top down.

Answer 4

Decision-making authority is distributed across various levels or units in the organization.

Answer 5

Information and decision-making flow in multiple directions.

Answer 6

10- or 12-hour shifts Premium pay for weekend work Part-time staffing pool for weekend shifts and holidays Job sharing

Answer 7

A written policy provides a standardized approach to scheduling, ensuring that decisions are consistent across different units or departments, leading to fairness.

Answer 8

When policies are written (not only verbal) the aim to ensure clarity, fairness, accountability,

Answer 9

two people share the same position and divide the shift with each other.

Answer 10

Twelve-hour shifts have become commonplace in acute care hospitals even though there continues to be debate about whether extending the length of shifts results in increased judgment errors related to fatigue and increased sick time and more care left undone.

Answer 11

Over time pay $$$ – increase nurse satisfaction, fewer shift changes mean more time spent with patients and better communication because of fewer handoffs

Answer 12

Not cost effective to the facility, most nurses who work 12 hour shifts do not get enough sleep lack of sleep and fatigue are known to cause poor judgment and significantly higher rate of errors.

Answer 13

lack of sleep and fatigue are known to cause poor judgment and significantly higher rate of errors. In addition, drowsy driving following 12 hour night shift is persistent among nurses resulting in elevated rates of vehicle crash and crash related injuries and death.

Answer 14

*One notable study published in the International Journal of Nursing Studies found that extended shifts (12 hours or longer) are linked to higher rates of errors and negative patient outcomes.

Answer 15

Cyclical staffing, which allows long-term knowledge of future work schedules because a set staffing pattern is repeated every few weeks Cyclical staffing is a scheduling method in which a predetermined staffing pattern is repeated over a specific period, typically a few weeks.

Answer 16

Another relevant piece of research is from the Journal of Nursing Administration, which indicates that nurses working longer hours report higher levels of fatigue, leading to decreased vigilance and an increased risk of patient safety incidents.

Answer 17

Allowing nurses to exchange hours of work among themselves

Answer 18

This scheduling option permits nurses to swap or exchange their shifts or hours of work with their colleagues, provided it aligns with hospital policy and patient care needs.

Answer 19

Use of supplemental staffing from outside registries and float pools

Answer 20

Shift bidding, which allows nurses to bid for shifts rather than requiring mandatory overtime

Answer 21

1. Open shifts or overtime opportunities are posted by the management. 2. Nurses can then bid for these shifts, sometimes based on preferences or seniority, or even how much additional compensation they're willing to accept. 3. The management reviews the bids and awards the shifts based on the set criteria

Answer 22

full time employees internal hospital employees; they receive full salary and benefits. They are those who agree to cross train on multiple units. They can be a resource that can be used in more than one place.

Answer 23

Agency nurses Travel nurses Flextime Self-scheduling Float pools

Answer 24

Float staff must be able to perform the core competencies of the unit they are floating to meet their legal and moral obligations as caregivers.

Answer 25

**Self-scheduling systems for nurses, wherein nurses have the autonomy to choose their shifts or help design their schedules, have gained popularity as a means to improve job satisfaction and reduce burnout as it gives nurses greater control over their work environment and increases employees’ autonomy over their work lives.

Answer 26

Inequities in Shift Distribution: Lack of Experience Mix: Complexity: Potential for Short Staffing: Lack of Consistency: Interpersonal Conflicts: Over-reliance on Technology: Lack of Oversight: Overburdening Some Nurses: Difficulty in Long-term Planning: Potential for Miscommunication:

Answer 27

Without oversight, popular shifts (like day shifts on weekdays) might always be chosen by the same group of nurses, leaving less desired shifts (like night shifts or weekends) for others.

Answer 28

Self-scheduling might unintentionally lead to shifts with either too many novice nurses or too many experienced ones. It's crucial for patient safety and mentoring to have a mix of experience levels on every shift.

Answer 29

If too many nurses prefer and select the same shifts, there could be other shifts where not enough nurses are scheduled, leading to staffing shortages.

Answer 30

While it empowers nurses, self-scheduling can also be a complex process. Collating and coordinating everyone's preferences can be challenging and time-consuming.

Answer 31

Lack of Consistency: Patient care can benefit from consistency in nursing staff, especially in specialized units. If nurses continuously change their schedules, it might disrupt continuity of care.

Answer 32

Without clear guidelines and oversight, self-scheduling might lead to conflicts among nurses over popular shifts or accusations of favoritism.

Answer 33

If the self-scheduling system is digital, any technical glitches can disrupt the scheduling process. Additionally, some nurses might not be as tech-savvy and could find digital systems challenging to navigate.

Answer 34

While the idea is to empower nurses, complete lack of oversight could lead to chaos, with shifts not aligning with patient needs or not complying with union or legal stipulations (like maximum work hours).

Answer 35

There's a risk that some highly dedicated nurses might take on too many shifts in an attempt to cover gaps, leading to burnout.

Answer 36

With schedules being more fluid, it might be harder for hospital administration to plan for long-term needs, training sessions, or other logistical concerns.

Answer 37

If the self-scheduling system isn't clear or if changes are made without proper communication, it could lead to nurses missing shifts or being unaware of schedule changes.

Answer 38

Staff generally have the flexibility to choose when they want to work. In exchange for this flexibility, they receive a higher rate of pay but usually no benefits.

Answer 39

like agency nurses; external employee; they work for premium pay. They have expertise in oncology, icu or areas in need. Its associated with increased cost to the organization. You get paid more and get to travel all over US. You have to guarantee you are working for a certain amount of time. They travel places and when the need arises, they work and pay is from the agency.

Answer 40

Poor continuity of patient care; nurses are not familiar with the unit and are reluctant to ask for help. Use of agency does not directly increase the need for overtime because they use their regular time. They’re base pay is higher. Hospital only uses when they have to.

Answer 41

allows employees to select among variations among start time and end time. It depends on what the unit needs. They build the schedule among the unit needs. This idea is different from self scheduling.

Answer 42

Nurses with seniority fill their preferences first.

Answer 43

Closed-unit staffing occurs when the staff members on a unit make a commitment to cover all absences and needed extra help themselves in return for not being pulled from the unit in times of low census.

Answer 44

A closed- unit staffing is a model where the nursing staff assigned to a particular unit or department remain within that designated area and are not mandated to float to other units, regardless of staffing needs elsewhere in the facility.

Answer 45

The philosophy behind closed staffing units is rooted in the idea that nurses become specialists in their specific areas, gaining in-depth expertise and familiarity with their particular patient population, equipment, protocols, and team dynamics.

Answer 46

NCH/PPD = Nursing Hours Worked in 24 hours/ Patient Census

Answer 47

Groupings of patients according to specific characteristics

Answer 48

Hours of nursing care assigned for each patient classification

Answer 49

Unique to a specific institution

Answer 50

Ongoing review critical

Answer 51

1. The critical indicator (or Categorical) PCS 2. The summative task (or Enumerative) PCS

Answer 52

The critical indicator (or Categorical) PCS uses broad indicators such as bathing, diet, intravenous fluids, medications, and positioning to categorize patient care activities.

Answer 53

Method: Patients are assessed based on these broad categories, and the assessment is relatively quick. A patient might be categorized as "stable," "unstable," "critical," etc., based on a set of predefined criteria.

Answer 54

Advantages: It's a faster method because it doesn't require enumerating each specific task a patient needs. It can be more intuitive for nurses and staff.

Answer 55

Challenges: It might be less precise than the summative approach because it doesn't capture the full range of tasks and interventions a patient requires.

Answer 56

The summative task (or Enumerative) PCS requires the nurse to note the frequency of occurrence of specific activities, treatments, and procedures for each patient. This approach is based on a detailed list of tasks or interventions a patient might require. Each task has a certain weight, or score associated with it, which reflects the time or skill needed to complete it.

Answer 57

The care a patient needs is assessed by enumerating all the tasks required for that patient. The scores of these tasks are then summed to give a total that represents the patient's acuity or care requirement.

Answer 58

Advantages: It provides a more detailed and potentially more accurate representation of a patient's needs. This can lead to more precise staffing decisions.

Answer 59

It's more time-consuming than the critical indicator approach because each task must be listed and scored. It also requires a comprehensive and regularly updated list of tasks with associated weights, which can be challenging to maintain.

Answer 60

At the national level, the use of a PCS is a condition for participation in Medicare and is required by The Joint Commission for certification.

Answer 61

**The most fiscally responsible method for determining staffing needs for a hospital unit is to use a staffing formula, provided it is based on an accurate patient classification system (PCS).

Answer 62

A Patient Classification System (PCS) is a tool used in healthcare settings to determine the level of care a patient requires.

Answer 63

A review of the literature consistently demonstrates that as RN hours decrease in NCH/PPD, adverse patient outcomes increase. This includes:

Answer 64

Increased medication errors Patient falls Decreased patient satisfaction with pain management

Answer 65

Decisions made must meet state and federal labor laws and organizational policies.

Answer 66

Staff must not be demoralized or excessively fatigued by frequent or extended overtime requests.

Answer 67

Patient care must not be jeopardized.

Answer 68

Minimum staffing criteria refer to the baseline or the least number of healthcare staff (often specifically nursing staff) that must be present in a healthcare setting to provide safe and effective care.

Answer 69

These criteria are often determined by healthcare organizations, regulatory bodies, and sometimes through legislation.

Answer 70

Ensure Patient Safety: The primary goal of minimum staffing criteria is to ensure that patients receive safe, high-quality care. Protect Healthcare Workers:

Answer 71

Insufficient staffing can lead to adverse outcomes, including medication errors, falls, and decreased patient satisfaction.

Answer 72

Protect Healthcare Workers: Adequate staffing levels reduce the risk of burnout, fatigue, and job dissatisfaction among healthcare workers

Answer 73

In mandatory overtime, employees are mandated to work additional shifts, often under threat of patient abandonment. Mandatory overtime for nurses refers to the practice where nurses are required to work beyond their scheduled shift, typically without prior notification.

Answer 74

While mandatory overtime is neither efficient nor effective in the long term, it has an even more devastating short-term impact in terms of staff perceptions of a lack of control and its subsequent impact on mood, motivation, and productivity.

Answer 75

Unforeseen Staffing Shortages: Increased Patient Acuity or Volume: Lack of Relief: Organizational Policies:

Answer 76

This can be due to unexpected call-outs, illnesses, or emergencies among the staff.

Answer 77

A sudden influx of patients, such as in the case of a mass casualty event or during a public health crisis, can necessitate extra hours from the present staff.

Answer 78

If the next shift's staff doesn't arrive on time or at all, the current staff might be mandated to continue working to ensure patient safety.

Answer 79

Organizational Policies: Some hospitals might use mandatory overtime as a staffing strategy, though this can be controversial and is often criticized.

Answer 80

Mandatory overtime should be a last resort, not standard operating procedure because an institution does not have enough staff.

Answer 81

California is the only state in the U.S. that has enacted legislation requiring mandatory staffing ratios in hospitals and long-term care facilities.

Answer 82

The answer as to whether mandated ratios have improved care or created new cost burdens for California is still unclear.

Answer 83

In the United States, labor laws regarding mandatory overtime vary significantly from state to state, and there are federal laws in place as well that broadly govern overtime work for employees, including nurses.

Answer 84

The intent of mandatory staffing ratios for the purpose of improving patient care - Legislation is at the state level not federal, level.

Answer 85

Silent generation 1925 to 1942 Baby Boomer 1943 to early 1960s Generation X Early 1960s to 1980 Generation Y 1980 to mid-1990s Generation Z 1996 to 2015

Answer 86

If not retired, they are more at risk averse and highly respect authority and discipline. They are more risk averse. Hihgh levels of loyalty to the employer. They respect authority. They don’t argue. More disciplined.

Answer 87

50% of the current work force. Traiditonal work values and are more materialistic and willing to work long hours to get ahead.

Answer 88

Gen X: not interested in lifelong employment in one place. They are looking for opportunities of flexibility and more opportunity for time off. They are less economically driven.

Answer 89

Gen Y: require different org culture to meet needs; are more socially conscious.

Answer 90

Gen Z: have more technical skills and they’re looking for more open work culture and open communication.

Answer 91

Managers need to Look at the type of generation in the unit and the types of resistance they may face. And how they are dealing with nursing shortage.

Answer 92

Fiscal accountability to the organization for staffing is not incompatible with ethical accountability to patients and staff.

Answer 93

It should be possible to stay within a staffing budget and meet the needs of patients and staff.

Answer 94

Situation: A hospital's Neonatal Intensive Care Unit (NICU) has a designated budget for staffing. Over the past year, patient admissions have increased, and the current nurse-to-patient ratio is sometimes stretched thin, leading to concerns about patient safety and staff burnout. Fiscal Accountability: The nurse manager reviews the staffing budget and identifies areas of potential efficiency. She finds that several nurses are interested in shifting from full-time to part-time roles and that there are periods during the day when patient needs are predictably lower. By adjusting shift patterns and integrating part-time schedules, the nurse manager can optimize the number of nurses available during peak times without hiring additional staff.

Answer 95

To Patients: By optimizing the shift patterns, the nurse manager ensures that every neonate receives attentive care during crucial periods. The risk of errors or oversights due to understaffing - decreases.

Answer 96

To Staff: Nurses who wanted more flexible or part-time hours get their desired schedules, leading to improved job satisfaction. Those who were feeling overburdened during peak times now have additional support, reducing the risk of burnout.

Answer 97

Outcome: The NICU stays within its staffing budget while also maintaining a safe nurse-to-patient ratio, ensuring high-quality patient care and improving staff job satisfaction.

Answer 98

Sick leave Vacations Holidays Call offs for low census On-call pay Tardiness and absenteeism Shift work

Answer 99

Name of person responsible for staffing schedule Type and length of staffing cycle used Rotation policies if shift rotation is used Fixed shift transfer policies Time and location of schedule posting When shift begins and ends; day of week schedule begins Weekend off policy; tardiness policy Low census procedures Absenteeism policies

Answer 100

Policy for trading days off; days off request procedures Policy regarding rotating to other units Procedures for vacation time and holiday time requests Procedures for resolving conflicts regarding time off Emergency request policies Transfer request policies Mandatory overtime policy

Answer 101

Priorities in nursing practice are determined using several frameworks such as nursing process, ABC, and Maslow’s Hierarchy of Needs.

Answer 102

In addition to prioritizing and reprioritizing nursing care, nurses must also effectively prioritize and manage their time to avoid nonessential activities that could jeopardize their priorities in delivering nursing care to their patients.

Answer 103

1. Life-threatening problems or those that could result in harm to the patient if left untreated first. 2. Actual problems and needs before potential problems or risks. 3. Acute problems before chronic problems. 4. Problems identified as important to the patient

Answer 104

Using the Eisenhower Matrix can help nurse managers and staff prioritize their workload effectively,

Answer 105

Using the Eisenhower Matrix can help nurse managers and staff prioritize their workload effectively, ensuring that critical patient care tasks are handled promptly while also allowing time for important but non-urgent activities.

Answer 106

This approach supports better time management, enhances patient safety, and contributes to overall job satisfaction by reducing stress and burnout.

Answer 107

Quadrant 1: Important and Urgent Quadrant 2: Important but not Urgent Quadrant 3: Urgent but not Important Quadrant 4: Not Important and Not Urgent

Answer 108

Tasks that are essential for patient care and long-term health outcomes but do not need to be addressed immediately.

Answer 109

*A patient with diabetes needs education on diet and exercise to prevent complications. While this is critical for their long-term health, it can be scheduled for a later visit and is not an immediate concern. *Completing a comprehensive care plan for a patient being discharged tomorrow. While this is vital for their ongoing care, it doesn’t require immediate action if the discharge is still several hours away.

Answer 110

Tasks that require immediate attention but do not significantly impact patient care or long-term outcomes.

Answer 111

* A patient asks for a glass of water urgently while they are waiting for their medication. While it needs to be addressed quickly, it doesn’t have a major impact on their health if it takes a few minutes longer. *A nurse receives a call from another department asking for a routine update on patient numbers, which needs to be answered right away but does not affect patient care directly.

Answer 112

Appropriate staffing is critical to the delivery of quality care at every practice level and in every setting. (ANA, 2020, p. 4)

Answer 113

Nurse leaders and managers are responsible for making sure to have the appropriate number and mix of nursing staff at all times. Because staffing affects the ability of a nurse to deliver safe and effective care at every practice level and in all settings, staffing is a complex process (ANA, 2020).

Answer 114

Nurse leaders and managers must understand and follow federal, state, and local regulations related to scheduling and staffing, uphold nurse practice acts, verify and track licensure of nursing staff, respect nurses’ rights, ensure staff competencies, and substantiate staff complaints with regulatory and professional standards.

Answer 115

inadequate staffing leads to reduced job performance and diminished patient and nurse satisfaction

Answer 116

Unique patient care settings Patient flow (admissions, discharges, and transfers) Patient acuity Skills, education, and experience of the available nursing staff

Answer 117

Research on safe staffing has revealed that it is effective in reducing adverse events, improves quality of care received, and improves nurse satisfaction, which in turn reduces costly nurse turnover.

Answer 118

There is not a perfect method for determining staffing.

Answer 119

Approaches to safe staffing include patient classification systems, ANA’s Principles for Safe Staffing, Agency for Healthcare and Research Quality nurse staffing model, and National Database of Nursing Quality Indicators staffing benchmarks

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Chapter 17 Flashcards

Exam 2

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