Staffing-Ortega Cherry 21

Question 1

How do accrediting agencies such as The Joint Commission address staffing?
a. Imposing maximum staffing levels
b. Requiring a specific staff mix
c. Stipulating nurse-patient ratios
d. Confirming delivery of satisfactory care

Answer 1

ANS: D
Accrediting agencies do not address minimum staffing levels; however, they do look for evidence that patients receive adequate care, and this can occur only with adequate staffing.

Question 2

What is customer satisfaction primarily based upon?
a. Access to modern, up-to-date facilities
b. Availability of an extensive menu selection
c. Personal interactions with employees
d. Having to undergo fewer invasive procedures

Answer 2

ANS: C
Interactions between employees and patients/families affect clinical outcomes, functional status, and even physiologic measures of health.

Question 3

Nurses on a unit provide personal hygiene, administer medications, educate the patient and family about treatments, and provide emotional support. These nurses provide patient care based on which nursing delivery system?
a. Total patient care
b. Partnership nursing
c. Team nursing
d. Functional nursing

Answer 3

a. Total patient care

In total patient care nurses provide all aspects of patient care. This is not true of the other options.

Question 4

A hospital converts to a system of care delivery in which RNs, LPNs, and unlicensed assistive personnel (UAP) are responsible for implementing a specific task, such as medication administration or personal hygiene, for the entire nursing unit. What term is used to describe this type of delivery system?
a. Total patient care
b. Functional nursing
c. Team nursing
d. Primary nursing

Answer 4

ANS: B
In functional nursing members of the team are assigned specific tasks such as assessment or medication administration. This is not true for the other options.

Question 5

What title identifies a nurse who is responsible for following the patient from admission through discharge or resolution of illness while working with a broad range of health care providers?
a. Nurse manager
b. Case manager
c. Coordinator of patient-centered care delivery
d. Team leader in team nursing care delivery

Answer 5

ANS: B
The case manager, in collaboration with an interdisciplinary team, oversees the use of health care services by clients throughout a course of illness.

Question 6

A patient is admitted with coronary artery disease and is scheduled for coronary artery bypass grafting (CABG). According to the clinical pathway the patient should be extubated and discharged from critical care the day after surgery. During surgery the patient‘s oxygen saturation decreased drastically because of chronic tobacco abuse. Subsequently, the patient remained on the ventilator an additional 2 days postoperatively. According to the clinical practice guideline for CABG, this situation results in what type of event?
a. Patient outcome
b. Variance
c. Care goal
d. Nursing standard

Answer 6

ANS: B
A variance is a deviation from the planned path.

Question 7

A patient is admitted with pneumonia. The case manager refers to a plan of care that specifically identifies dates when supplemental oxygen should be discontinued, positive-pressure ventilation with bronchodilators should be changed to self-administered inhalers, and antibiotics should be changed from intravenous to oral treatment, on the basis of assessment findings. This plan of care is referred to by what term?
a. Patient classification system
b. Clinical pathway
c. Patient-centered plan of care
d. Diagnosis-related group (DRG)

Answer 7

b. Clinical pathway

A clinical pathway is a plan that specifies the timing and sequencing of major patient care activities and interventions by the interdisciplinary team for a particular diagnosis, procedure, or health condition.

Question 8

The nurse manager determines that four RNs, five LPN/LVNs, and two unlicensed assistive personnel (UAP) are required per shift to meet the needs of the patient population on the unit, according to acuity and census. The nurse manager is concerned with what related process?

a. Assignments
b. Staffing
c. Output
d. Productivity

Answer 8

ANS: B
Staffing is the activity of determining that an adequate number and mix of health care team members are available to provide safe, high-quality patient care.

Question 9

A nurse manager is mentoring a novice nurse manager in determining staffing needs. The mentor explains that the acuity level of the patient is determining by implementing what process?
a. ―Assessing patient satisfaction with nursing care
b. ―Quantifying the amount and intensity of care required
c. ―Examining the skill mix and educational preparation of the staff
d. ―Determining the number of hospital days required by the patients.

Answer 9

ANS: B
Patient acuity is measured by determining the amount and intensity of care required.

Question 10

The nurse manager is planning staffing levels and realizes that the first step is to focus on what activity?

a. Knowing the intensity of care needed by patients according to physical and psychosocial factors
b. Examining the educational level of the staff
c. Assessing the skill level of caregivers
d. Reviewing the budget to determine the financial consequences of past staffing patterns

Answer 10

ANS: A
The nurse manager must determine the number and mix of health care providers according to the wide range of care requirements of individual patients.

Question 11

A hospital is concerned with nurse retention and realizes that job satisfaction is a major influence. To best enhance employee satisfaction related to staffing, what intervention should
the management team implement?
a. Begin negotiating for additional agency nurses.
b. Propose hiring more part-time employees.
c. Adopt the concept of participatory staff involvement.
d. Regularly use ―float‖ nurses to cover vacancies.

Answer 11

ANS: C
Staffing methods that include staff participation and enhance staff autonomy have been demonstrated to play a major part in ensuring employee satisfaction

Question 12

A patient is admitted for a hysterectomy, and the RN develops and implements the plan of care but also delegates to the LPN/LVN the responsibility of administering oral medications. While off duty, this RN receives a call requesting a change in the plan of care because the patient has developed deep vein thrombosis. The nurse who originally planned the care is practicing which type of nursing care delivery?
a. Modular
b. Primary
c. Team
d. Functional

Answer 12

ANS: B
The primary nurse assumes 24-hour responsibility for planning, directing, and evaluating the patient‘s care from admission through discharge but may delegate or provide primary care during the shift when present.

Question 13

When deciding which staffing option to use on a nursing unit that will open soon, the manager recognizes what basic fact related to this issue?
a. Continuity of care is enhanced and errors are reduced when nurses provide care over longer shifts and consecutive workdays, such as 12-hour shifts on three
consecutive days per week.
b. The use of part-time nurses provides the variability needed to meet diverse patient needs.
c. Satisfaction of the staff equates to satisfaction of patients.
d. Nurses provide the same level of care, regardless of the work environment.

Answer 13

ANS: C
High nurse satisfaction is generally equated with high patient satisfaction and positive patient outcomes.

Question 14

A task force is considering factors that contribute to high-quality safe staffing. Which statement reflects an understanding of the American Nurses Association‘s (ANA) recommendations?

a. Because patient needs remain constant on a daily shift, staffing needs at the beginning of the shift should be sufficient to provide safe, high-quality care.
b. Staffing should allow time for the RN to apply the nursing process so decisions result in high-quality, safe patient outcomes.
c. Patient acuity levels affect staffing by increasing the need for unlicensed personnel to provide routine basic care rather than increasing RNs in staff mix.
d. RN staffing is not cost-effective; thus, is it important for staffing models to limit the number of RNs assigned per shift.

Answer 14

ANS: B
The ANA recommends that nurses have time to exercise professional judgment; that would include the achievement of outcomes?

Question 15

A nursing unit comparing team nursing to the partnership model would find what statement to be true?

a. With the partnership model, an RN does not have to be part of the mix.
b. Leadership abilities of the RN are a major determinant of effectiveness of care for both models.
c. The RN teaches the LPN/LVN or unlicensed assistive personnel (UAP) how to apply the nursing process in team nursing.
d. With team nursing the RN cares for the patient while the team members work with the family or significant others.

Answer 15

b. Leadership abilities of the RN are a major determinant of effectiveness of care for both models.

The RN leads regardless of whether partnership model or team nursing is practiced.

Question 16

When a nurse uses a criteria such as ―high risk for falls,‖ ―infection protocols,‖ and ―special communication needs‖ to determine the mix and number of staff needed on a telemetry unit, what is the nurse is using?
a. A patient classification system
b. Diagnostic-related groups
c. Case management
d. Clinical pathways

Answer 16

ANS: A
Patient classification systems group patients according to care needs to determine safe staffing levels.

Question 17

A nurse makes patient care assignments as follows: RN1 has rooms 200-210; RN2 has rooms 211-221; RN3 has rooms 222-232. The two unlicensed assistive personnel have half the rooms, with one assigned to 200-215 and the second to 216-232. What term is used to identify the care delivery model being used?
a. Team
b. Primary
c. Partnership
d. Modular

Answer 17

ANS: D
Modular (or geographic) assignments are based on a geographic location in the nursing unit.

Question 18

A patient has decided to stop hemodialysis because his renal failure progresses and he wishes to spend more time with family. Palliative care will continue, and the approach will be discussed with the patient and family as needed and at change of shift. The care delivery model in this situation is referred to by what term?
a. Partnership
b. Patient-centered
c. Case management
d. Total patient care

Answer 18

ANS: B
Patient-centered care models entail the health care team partnering with the patient and family to ensure that patients‘ wants, needs, and preferences are the priority while allowing the patient and family to participate in decisions and educational needs.

Question 19

19. A nurse plans care knowing when specific recovery milestones are expected. The nurse is providing care via what delivery model?
    a. Patient classification systems
    b. Clinical pathways
    c. Functional nursing
    d. Case management

Answer 19

ANS: B
Clinical pathways plans patient care activities and interprofessional interventions and desired patient outcomes within a specified time period for a particular diagnosis or health condition.

Question 20

An orthopedic unit is considering different types of care delivery models and staff have an opportunity to ask questions about how the models differ. The nurse manager provides an overview and uses the above visual to demonstrate which model of care delivery?

a. Team
b. Partnership
c. Primary
d. Functional

Answer 20

ANS: D
Functional care delivery models assign tasks to each provider. In the above visual, the LPN is responsible for oral medication administration, the unlicensed assistive personnel provide hygiene, and the RN is assigned to task that require the nursing process.

Question 21

MULTIPLE RESPONSE

1. While participating in a task force to proactively plan for nursing care delivery over the next 20 years, a nurse learns that dramatic changes will occur because of what factor? (Select all that apply.)
   a. The increases in the number of minimally invasive procedures being performed for disease treatment
   b. Care provided for patients over an extended period in acute care settings
   c. The reduction in the number of nurses and other health care professionals who are available to provide care
   d. The widespread illiteracy and decreased self-efficacy of the aging patient population
   e. The need to focus on social and environmental influences, educational level, and individual characteristics and values of the patient
   f. The devaluing of nursing as a means of improving patient outcomes

Answer 21

ANS: A, C, E
Invasive surgical procedures are being replaced by laparoscopic procedures. The demand for nurses and other health care professionals cannot keep pace with the increased need for health care required by the growing older population. Care will focus on the unique lifestyles and values of a diverse population.

Question 22

Which factors would be considered in the first steps in developing an effective patient classification system? (Select all that apply.)
a. Planned procedures
b. Ethnic diversity of patients
c. Clinical competency of staff
d. Educational level of nurses
e. Age of patients

Answer 22

ANS: A, B, E
The first step in developing a patient classification system is to understand the intensity of care needs, which requires identifying specific patient characteristics and care requirements.

Question 23

A nurse responsible for staffing a medical-surgical unit must consider what factors? (Select all that apply.)
a. The patient census
b. Physical layout of the unit
c. Complexity of care required
d. Educational level of all staff
e. Task preferences of the nurses

Answer 23

ANS: A, B, C, D
The primary considerations for staffing a specific nursing unit are the number of patients; the level of intensity of care required by those patients (commonly referred to as patient acuity); contextual issues, such as architecture, geography of the environment, and available technology; level of preparation and experience of the staff members providing the care; and the quality of the nurses‘ work life.