Considerations of Staffing

Question 1

Definition

Answer 1

Activities required to ensure an adequate number and mix of health care team members to meet patient needs and provide safe, quality care

Question 2

Considerations of Staffing

Answer 2

• patient needs
• nursing characteristics
• organizational needs and the practice environment

Question 3

Primary considerations for staffing a nursing unit

Answer 3

• Number of patients
• Amount and Intensity of care required: Patient Acuity
• Staff experience and preparation
• Geography of the environment
• Available technology

Question 4

Patient classification systems

Answer 4

Categorize patients according to care needs (acuity level)

Higher acuity levels mean that nursing care needs are more intense

Question 5

To determine acuity:

Answer 5

ANA recommends to consider:
age and functional ability
communication skills
cultural and linguistic diversities
severity and urgency of the clinical condition
scheduled procedures
availability of social supports

Question 6

Staff satisfaction

Answer 6

Methods to gain staff input about staffing and to enhance autonomy are the key to staff satisfaction

Question 7

Organizational needs affected by staffing include:

Answer 7

• financial resources
• licensing regulations and accreditation standards
• customer satisfaction

Question 8

Licensing and accreditation agencies do not impose mandatory staffing ratio but do look for evidence that patients are adequately cared for

Answer 8

Know.

Question 9

National Database of Nursing Quality Indicators (NDNQI)

Answer 9

Resource for data on nurse-sensitive outcomes including patient falls, catheter-associated urinary tract infections, and nurse turnover and job satisfaction

Data can be a powerful influence for nurses to advocate for safe staffing

Question 10

Customer satisfaction is critical to an organization’s success

Answer 10

A customer’s personal interaction with employees is key to satisfaction

Question 11

Nursing Care Delivery Models

Answer 11

Basic premise is that the number and type of caregivers are closely matched to patient care needs, in a cost-effective manner

Detail how task assignments, responsibility, and authority are structured to accomplish patient care

Describe which health care worker is going to perform what tasks, who is responsible, and who has the authority to make decisions

Question 12

Classic Nursing Care Delivery Models

Answer 12

• Total pt care
• Team nursing
• Primary nursing

Question 13

Total Patient Care

Answer 13

Nurse is responsible for planning, organizing, and performing all patient care during the assigned shift

Oldest method of organizing patient care, sometimes referred to as case nursing

Question 14

Advantages of Total Patient Care

Answer 14

RN maintains a high degree of practice autonomy

Lines of responsibility and accountability are clear

Patient receives holistic, unfragmented care

Communication at shift change is simple and direct

Question 15

Disadvantages of Total Patient Care

Answer 15

Number of RNs required is very costly

Some tasks could be accomplished by a caregiver with less training and at a lower cost

Nursing shortage will affect RN availability

Question 16

Common use areas of Total Patient Care

Answer 16

ICU

Post anesthesia units

Question 17

Team Nursing

Answer 17

RN functions as a team leader and coordinates care for a small group of patients

Question 18

Team Nursing Def

Answer 18

Lines of responsibility and accountability
RN team leader is responsible for the following:
Planning care
Assigning duties
Directing, supervising, and assisting team members
Giving direct care
RN retains accountability for all patient care
RN team leader is responsible for encouraging a cooperative environment and maintaining clear communication

Question 19

Team Nursing Advantages

Answer 19

High-quality, comprehensive care can be provided with a relatively high proportion of ancillary staff

Each member participates in decision making, problem solving

Each member contributes his/her own special expertise or skills

Question 20

Team Nursing Disadvantages

Answer 20

Continuity of care may suffer with daily team assignments

Team leader may not have the leadership skills required to effectively direct the team

Insufficient time for care planning and communication leads to unclear goals and fragmented care

Question 21

Primary Nursing

Answer 21

RN “primary” nurse assumes 24-hour responsibility for planning, directing, and evaluating the patient’s care from admission through discharge

Provides total patient care while on duty

While off duty, care is provided by an associate nurse, who follows the care plan established by the primary nurse

Question 22

Primary Nursing Responsibility

Answer 22

RN primary nurse has 24-hour responsibility and accountability for patient care

Associate nurses are responsible for following the plan of care

RN primary nurse is responsible for maintaining clear communication among all members of the health care team

Question 23

Primary Nursing Advantages

Answer 23

Direct patient care provided by a small number of nurses allows for high-quality, holistic patient care

Patient able to establish a rapport with the primary nurse, and patient satisfaction is enhanced

***Job satisfaction high because nurses are able to practice with a high degree of autonomy and feel challenged and rewarded

Question 24

Primary Nursing Disadvantages

Answer 24

Implementation may be difficult because primary nurse is required to practice with a high degree of responsibility and autonomy

RN may not be willing to accept 24-hour responsibility as required
Number of RNs required for this method of care may not be cost-effective and may be difficult to recruit and train

Question 25

Common areas of Primary Nursing

Answer 25

Home health
Hospice
LTAC

Question 26

Patient centered care- QSEN

Answer 26

Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patients’ preferences, values, and needs.”

Nurses, physicians, and other health professionals partner with patients and families to ensure that health care decisions respect patients’ wants, needs, and preferences

Question 27

Case Management not responsible for direct care

Answer 27

Case manager assumes a planning and evaluative role and usually is not responsible for direct care

Question 28

Nurse case manager management

Answer 28

Nurse case manager “manages” a “case load” of patients from preadmission (onset of illness) to discharge (resolution of illness)