Staffing

Question 1

Staffing

Answer 1

• Activities required to ensure an adequate # & mix of health care team members to meet pt needs & provide safe, quality care.
• Considerations are pt needs, staff satisfaction, & organizational needs.
• Usually a primary responsibility of the nurse manager
• Must address pt acuity levels, provide nurses time exercise professional judgment, & acknowledge that pt needs can change from moment to moment.

Question 2

Primary considerations for staffing a nursing unit?

Answer 2

• # pts
• Intensity of care required
• Staff experience & preparation
• Geography of the environment
• Available technology

Question 3

Patient Classifications Systems

Answer 3

Categorize pts according to specific criteria & care needs & thus help quantify the amt & level of care needed. (acuity level)

Question 4

ANA recommendations for factors to consider w/ patient classification systems?

Answer 4

• Age & functional ability
• Communication skills
• Cultural & linguistic diversities
• Severity & urgency of admitting condition
• Scheduled procedures
• Ability to meet health care requisites
• Availability of social supports
• Other specific needs identified by pt & RN

Question 5

3 basic organizational needs that are significantly affected by staffing?

Answer 5

1. Financial resources
2. Licensing regulations & accreditation
3. Customer satisfaction

Question 6

Total Patient Care

Answer 6

• Nurses responsible for planning, organizing, & performing ALL pt care during assigned shift.

Question 7

Total patient care advantages?

Answer 7

• Autonomy
• Lines of responsibility & accountability clear
• Communication at shift change is simple & direct

Question 8

Total patient care disadvantages?

Answer 8

• # RNs required is very costly
• Some tasks could be accomplished by a caregiver w/ less training & at a lower cost
• Nursing shortages will affect RN availability

Question 9

What areas is total patient care commonly used?

Answer 9

ICU, PACU

Question 10

Functional Nursing

Answer 10

Staff members are assigned to complete certain tasks for a group of pts rather than care for specific pts.

• RN nurse manager assigns responsibility for completion of tasks to a group of health care workers
• RN is responsible for planning care & supervising workers
• RN retains accountability for pt care provided

Question 11

Functional nursing advantages?

Answer 11

• Economic & efficient
• Minimum # RNs required for pt care
• Tasks completed quickly, little confusion about responsibilities

Question 12

Functional nursing disadvantages?

Answer 12

• May be fragmented; possibility of overlooking priority pt needs
• Pt may feel confused bc of many different care providers
• Caregivers may feel unchallenged when performing repetitive functions

Question 13

What areas is functional nursing commonly used?

Answer 13

OR

Question 14

Team Nursing

Answer 14

RN functions as a team leader & coordinates care for a sm group of pts.
- RN team leader is responsible for:
planning care
assigning duties
directing, supervising & assisting team members
giving direct care
- RN retains accountability for all pt care
- RN team leader responsible for encouraging a cooperative environment & maintaining clear communication

Question 15

Team nursing advantages?

Answer 15

• High-quality, comprehensive care can be provided w/ a relatively high proportion of ancillary staff
• Each member participates in decision making, problem solving
• Each member contributes their own special expertise or skills

Question 16

Team nursing disadvantages?

Answer 16

• Continuity of care may suffer w/ daily team assignments
• Team leader may not have the leadership skills required to effectively direct the team
• Insufficient time for care planning & communication leads to unclear goals & fragmented care

Question 17

What areas is team nursing commonly used?

Answer 17

Inpt & outpt health care settings

Question 18

Modular Nursing

Answer 18

• Modification of team nursing
• Pt unit divided into modules: same team of caregivers assigned consistently to same geographic location
• Each location or module has RN as team leader
• Goal: to increase the involvement of the RN in planning & coordinating care
• Designated modules should contain all the supplies needed by the staff to maximize efficiency

Question 19

Primary Nursing

Answer 19

• RN “primary” nurse assumes 24hr responsibility for planning, directing, & evaluating the patient’s care from admission through discharge
• Provides total pt care while on duty
• Off duty - care is provided by an associate nurse who follows the care plan established by primary nurse

Question 20

Primary nursing advantages?

Answer 20

• Direct pt care provided by a sm # of nurses allows for high-quality, holistic pt care
• Pt able to establish a rapport w/ the primary nurse & pt satisfaction is enhanced
• Job satisfaction high bc nurses are able to practice w/ high degree of autonomy & feel challenged & rewarded

Question 21

Primary nursing disadvantages?

Answer 21

• Implementation may be difficult bc primary nurse is required to practice w/ a high-degree of responsibility & autonomy
• Inadequately prepared primary nurse may not be able to make the necessary clinical decisions or to communicate effectively w/ the health care team
• RN may not be will to accept 24 hr responsibility as required
• # RNs required for this model may not be cost-effective, & may be difficult to recruit & train

Question 22

What areas is primary nursing commonly used?

Answer 22

Home health, hospice, LTC

Question 23

Partnership Model (Co-Primary Nursing)

Answer 23

• RN is partnered w/ an LPN or NAC; pair work together consistently
• Modification of primary nursing designed to ensure more efficient use of RN
• RN is responsible for planning care, assigning duties, coordinating care, & supervising the partner
• RN is accountable for patient care for all assigned patients

Question 24

Partnership model advantages?

Answer 24

• More cost-effective than primary nursing model

- RN can encourage training & growth of partner

Question 25

Partnership model disadvantages?

Answer 25

• RN may have difficulty delegating to the partner

- Consistent partnerships are difficult to maintain on the basis of varied staff schedules

Question 26

Patient-Centered Care

Answer 26

Providing care that is respectful & responsive to individual patient preferences, needs, & values & ensuring that patient values guide all clinical decisions
- Philosophy of care

Question 27

Ways to involve pts & their families as partners in care?

Answer 27

• Include them in developing care plans & discharge plans
• Include them in change of shift or hand off reports
• Provide them with info & education needed to make informed decisions
• Establish family advisory councils to engage pts & their families in decision making

Question 28

Telehealth Nursing

Answer 28

- Important method of providing nursing care in ambulatory settings
Nurses roles:
- Triage
- Interventions
- Consultation
- Surveillance & follow-up