Exam 3: Chapter 13

Question 1

The number of adverse events such as falls and pressure ulcers on the unit is increasing. An ideal staffing plan to address this issue
would include which of the following? Increasing the:
a. total number of staff on the unit.
b. staff and RN hours per patient.
c. total number of staff and implementing 12-hour shifts.
d. number of RNs and number of RNs with experience on the unit.

Answer 1

ANS: D
A number of studies have identified that adverse events such as falls and pressure ulcers can be reduced by increasing the number
of RNs on a unit (relative to other personnel) and utilizing experienced RNs. Overtime and 12-hour shifts are linked to greater incidence of errors.

Question 2

A small rural hospital has been designated as a critical access hospital. It has 40 beds and an average occupancy of 34 beds. To prepare the staffing, the chief nursing officer computes the occupancy as being:

a. 90%.
b. 85%.
c. 75%.
d. 60%.

Answer 2

ANS: B
A way to assess a unit’s activity level is to calculate the percentage of occupancy. Formula: daily patient census (rounded) divided
by the number of beds in the unit. The occupancy level is calculated as 34/40, or 85%.

Question 3

To prepare staffing schedules, a nurse manager needs to calculate paid non-productive time. When calculating paid non-productive time, the nurse manager considers:

a. work time, educational time, and holiday time.
b. paid hours minus worked hours.
c. vacation time, holiday time, and sick time.
d. paid hours minus meeting time.

Answer 3

ANS: C

Non-productive hours are hours of benefit time and include vacation, holiday, and personal or sick time.

Question 4

An important aspect of managing the costs on a unit is to plan accurately for staffing needs. Nurse managers use staffing plans to:
a. assign staff on the unit on a daily basis.
b. ensure that days off are planned for the staff.
c. outline the number of individuals by classification on a per-shift basis.
d. predict the numbers and classifications of float staff needed to augment regular
staff.

Answer 4

ANS: C
A nurse manager needs to manage financial resources by developing staffing plans. Staffing plans plan for minimum number of
professional nurses required on a unit at a given time or to the amount of minimum staffing in an extended-care facility or prison,
based on regulatory guidelines.

Question 5

A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the unit’s staffing needs. An external variable to be considered is:

a. organizational staffing policies.
b. staffing models.
c. changes in services that will be offered.
d. department of Health licensing standards.

Answer 5

ANS: D
Licensing regulations of the state can determine staffing models. Staffing regulations can dictate the number of professional nurses
required on a unit at any given time.

Question 6

A nurse manager must also consider a number of internal variables that will affect staffing patterns. An internal variable to be
considered is:
a. organizational staffing policies.
b. state licensing standards.
c. American Nurses Association.
d. consumer expectations.

Answer 6

ANS: A
State licensing standards outline what a nurse can do. Internal policies determine what a nurse may do in a particular setting as well
as the amount of flexibility that is allowed to manage times of high and low volumes, as well as changes in acuity. Organizational
policies can put the nurse manager in a situation where patient safety cannot be maintained or financial obligations met.

Question 7

A nurse manager uses many sources of data when planning the unit’s workload for the year. Which of the following data must be
considered in the planning?
a. Hours of operation of the unit
b. Trends in acuity on the unit
c. Maximum work stretch for each employee
d. Weekend requirements

Answer 7

ANS: B

Acuity levels are determined through classification systems, which determine the nursing resources required.

Question 8

Scheduling is a function of implementing the staffing plan by assigning unit personnel to work specific hours and specific days of
the week. To retain nursing staff, the nurse manager must incorporate into the schedule plan:
a. all weekends off.
b. all holidays off.
c. a variety of scheduling options.
d. rotating shifts.

Answer 8

ANS: C
Creating a flexible schedule with a variety of scheduling options that leads to work schedule stability for each employee is one
mechanism likely to retain staff, which is within the control of nurse managers.

Question 9

The difference between staffing and scheduling is that staffing:

a. puts the right person in the right position.
b. puts the right person in the right time and place.
c. refers to the number of nursing hours per patient per day.
d. looks after interpretation of benefits and compensation.

Answer 9

ANS: A
Nursing staffing involves planning for hiring and deploying qualified human resources to meet the needs of a group of patients. Scheduling, on the other hand, is a function of implementing the staffing plan by assigning unit personnel to work specific hours and days of the week.

Question 10

A busy neurologic ICU and step-down unit most likely would use which patient-classification system?

a. Factor evaluation
b. Prototype evaluation
c. Hybrid system
d. AHRQ system

Answer 10

ANS: A
A factor evaluation system is considered more objective than a prototype evaluation system. It gives each task, thought process, and patient care activity a time or rating. Some patient types with a single healthcare focus, such as maternal deliveries or outpatient surgical patients, would be appropriately classified with a prototype system. Patients with more complex care needs and a less predictable disease course, such as those with pneumonia or stroke, are more appropriately evaluated with a factor system.

Question 11

A factor evaluation system:
a. utilizes financial data to determine number of staff-to-patient ratios.
b. utilizes DRGs to determine acuity on a unit.
c. combines interventions and time required for interventions to determine levels of care required.
d. combines financial resources and nursing interventions to determine patient
contact hours.

Answer 11

ANS: C
A factor evaluation system considers tasks, thought processes, and patient care activities and gives them a time or rating. These are
then used to determine the number of patient care hours required.

Question 12

Staff members on your unit raise concern that there is rising acuity on the unit and lack of responsiveness in addressing these needs
through appropriate staffing. They point to increased incidences of adverse and sentinel events on the unit. To address this concern,
your hospital organization would do best to:
a. implement a patient-classification system immediately.
b. participate in databases that compare the outcomes and staffing levels versus
those of similar institutions.
c. provide increased numbers of staff to the unit.
d. ignore such concerns because acuity is variable.

Answer 12

ANS: B
Staff morale suffers both when acuity models indicate a gap between staffing and acuity and when there is no model but perceived
acuity that is not being addressed. A truer approach is to monitor patient outcomes and participate in national databases that
measure staffing levels through comparison with like institutions.

Question 13

A particular classification system assigns revenue according to the functional capacity of patients and the progression of patients
during their stay in rehabilitation units. More independent patient activities, such as prompted voiding, require higher staff
utilization than dependent activities but do not result in increased staff resources. This is an example of:
a. bureaucracy.
b. concern related to the validity of classification systems.
c. inadequate reliability of classification systems.
d. inappropriate subjectivity in making judgments about staffing.

Answer 13

ANS: B
Validity of categories and implications for staffing levels are in question in this situation because staffing levels are not reflective of the levels of activity required for patient care.

Question 14

In the past year, you have noticed an increase in patient falls on your unit. In reading studies related to staffing and patient
outcomes, you realize that you will need to plan for:
a. higher patient care hours.
b. safer facilities.
c. institution of a patient-classification system.
d. an increased number of RN positions.

Answer 14

ANS: D
Lower fall rates are shown to be related to higher total nursing hours and a higher percentage of nursing hours supplied by RNs.

Question 15

A strategy to increase RN staff retention at Valley Hospital includes:

a. better compensation and benefits.
b. clearer position descriptions.
c. lay-offs of nursing assistants.
d. adequate staffing to meet acuity levels.

Answer 15

ANS: D
Over the past decade, a significant amount of research has been done in the United States to evaluate links among nursing staffing,
workloads, skills mix, and patient outcomes. An analysis of this research demonstrates that ensuring adequate staffing levels has been shown, among other things, to improve nurse retention and job satisfaction.

Question 16

In evaluating weekend mortality rates, the head nurse on the cardiac unit is surprised to find that they are higher than on weekdays. In exploring the reasons for this apparent anomaly, the head nurse focuses on:

a. availability of diagnostic personnel.
b. availability of physicians.
c. communication with on-call providers.
d. acuity level of patients.

Answer 16

ANS: C
Studies to date of off-peak hours (weekends and nights) are limited, but those that have been done indicate increased mortality
during weekends and nights, when staff work with fewer and often less experienced staff and when there may be strained communication among on-call healthcare providers.

Question 17

A nurse staffing plan takes into account:

a. specific nurse-to-patient ratios per shift.
b. participation of nurses in projecting staffing needs.
c. compensation and benefits for each level of staff.
d. the occupancy load of a unit.

Answer 17

ANS: B
Nurse staffing plans employ nursing judgment and flexibility that is based on acuity, nurse experience, and unit configuration
rather than set nurse-to-patient ratios. The American Nurses Association has opted to support the nurse staffing committee as the
approach to ensure safe staffing. In 2013, national legislation was introduced that requires all acute care hospitals to establish a
committee made up of 55% direct care RNs.

Question 18

As the unit manager, you post the staffing plan and compliance reports. This initiative is aimed at:

a. maintaining unit morale.
b. complying with national requirements.
c. demonstrating patient outcomes.
d. inviting staff participation in decision making.

Answer 18

ANS: A
Hospitals are responsible for monitoring the extent to which actual staffing matches the staffing plans, making revisions as
necessary. The Joint Commission accreditation reviews staffing plans against any obvious staffing deficiencies and patient care concerns. Posting of the staffing plan is required in some states so that staff may view it. Adequate staffing, as demonstrated
through a staffing plan, and compliance reports contribute to staff morale.

Question 19

To maintain patient safety, studies suggest that scheduling should avoid:

a. rotating shifts.
b. weekends.
c. 8-hour shifts.
d. mandatory overtime.

Answer 19

ANS: A
Rotating shifts and overtime past 12 hours (mandatory or not) are being shown to increase nurse error and jeopardize patient safety.

Question 20

In a job interview for a staff position, which of the following indicates your knowledge of patient safety?

a. “Will I be able to get overtime hours on your unit?”
b. “If there is an opportunity to work extra shifts, I would really like that.”
c. “Is there a strategy in place to reduce the number of overtime hours on the unit?”
d. “I see no reason why I wouldn’t be able to work overtime.”

Answer 20

ANS: C
Overtime, whether voluntary or mandatory, to fill staff vacancies is seen as a risk to both patients and nurses because it is more
likely to lead to compromised decision making and technical skills because of fatigue.

Question 21

To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages. To maximize patient safety and reduce costs, the healthcare organization:

a. develops a centralized pool of float nurses.
b. assigns nurses from less busy units to ones with increased acuity levels.
c. floats nurses only between units on which the nurses have been cross-trained.
d. assigns float nurses to basic care only.

Answer 21

ANS: A
A centralized pool usually includes experienced nurses who maintain a broad range of competencies. Other approaches are less
satisfying for nurses, are less efficient, and may be less safe.

Question 22

To project staffing needs and to avoid understaffing, it is important that nurse managers consider which of the following?

a. Maximum productive hours
b. Average non-productive hours
c. Minimum benefit hours
d. Maximum vacation time

Answer 22

ANS: B
To avoid understaffing, average non-productive or benefit hours need to be taken into account, so the unit is properly staffed when
staff members are off.

Question 23

Your healthcare organization has a decentralized system for scheduling. As part of this process, after you have developed a draft
schedule, you may need to:
a. seek budgetary approval.
b. balance personal schedules against institutional needs.
c. negotiate the schedule with unit staff.
d. submit the schedule to a centralized staffing office for review.

Answer 23

ANS: D
In a decentralized model, you may be completely responsible for approving all schedule changes and for development of the
schedule, or you may need to submit a draft to a centralized office for review and determination of supplemental staff. Balancing personal schedules and negotiation describes staff self-scheduling models.

Question 24

The American Nurses Association has advocated for the Registered Nurse Safe Staffing Act. This legislation is based on ANA Safe Staffing Principles and takes what factors into consideration for planning staffing on a nursing unit?

a. Patient acuity and complexity
b. Education and training of the nurses
c. Technology available and use on the unit
d. All factors listed are to be considered

Answer 24

ANS: D
ANA has opted to support the nurse staffing committee as the approach to ensure safe staffing. For the last decade, the ANA has advocated for a Registered Nurse Safe Staffing Act. The legislation is based upon the ANA Safe Staffing Principles (Box 13-2) and
considers the following:
RN educational preparation, professional certification, and level of clinical experience
The number and capacity of available healthcare personnel
Geography of the unit
Available technology
Intensity, complexity, and stability of patients

Question 25

In reviewing the job description of a nurse manager, the staff becomes aware that a nurse manager’s role is complex. Which of the following duties are required of a nurse manager? (Select all that apply.)

a. Ensure unit productivity reports.
b. Develop policy and legislation to protect nurses’ well-being.
c. Plan staffing of UNPs only.
d. Prepare a unit budget that reflects unit staffing needs.
e. Monitor nurse-sensitive indicators such as falls and incidence of infections.

Answer 25

ANS: A, D, E

A nurse manager manages financial resources by developing business and staffing plans.