Week 5- Chapter 16- Staffing and Scheduling

Question 1

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

Answer 1

D

Question 2

To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time. When calculating paid nonproductive 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 2

ANS: C
Nonproductive hours are hours of benefit time and include vacation, holiday, and personal or sick time.

Question 3

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 3

ANS: C
Among the largest expenditures for a nursing unit are employee salaries and benefits. In order to manage the costs on a unit, it is important that the nurse manager develop staffing plans that outline the number of individuals by classification that are needed on a per-shift basis, thus optimizing the management of financial resources.

Question 4

A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the unit’s staffing needs. An external consideration is:
a. Organizational staffing policies.
b. Staffing models.
c. Changes in services that will be offered.
d. Department of Health licensing standards.

Answer 4

D

Question 5

A nurse manager must also consider a number of internal variables that will affect staffing patterns. Which of the following is an internal variable to be considered?
a. Organizational staffing policies.
b. Provincial/territorial licensing standards.
c. Canadian Nurses Association guidelines.
d. Consumer expectations.

Answer 5

A

Question 6

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 the numbers of acutely ill patients on the unit.
c. Maximum work stretch for each employee.
d. Weekend requirements.

Answer 6

ANS: B
The numbers of acutely ill patients are determined through classification systems, which determine the nursing resources required.

Question 7

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 schedule:
a. All weekends off.
b. All holidays off.
c. A variety of scheduling options.
d. Rotating shifts.

Answer 7

C

Question 8

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. Accounts for interpretation of benefits and compensation.

Answer 8

ANS: A
Staffing is concerned with finding and assigning qualified individuals to care for a group of patients. Scheduling assigns personnel to specific hours and days of the week.

Question 9

A busy neurologic intensive care unit and a step-down unit are most likely to use which patient classification system?
a. Factor evaluation.
b. Prototype evaluation.
c. Canadian National Database of Nursing Quality Indicators.
d. Agency for Healthcare Research and Quality (AHRQ) system.

Answer 9

ANS: A
In complex patient care areas, a factor evaluation system, in comparison with a prototype system, would be used. The AHRQ produces studies related to staffing and scheduling. As of yet, there is no National Database of Nursing Quality Indicators in Canada, although it does exist in the United States.

Question 10

Factor evaluation systems involve classification systems in which:
a. Financial data are used to determine staff-to-patient ratios.
b. Diagnosis-related groups are used to determine the numbers of acutely ill patients
on a unit.
c. Interventions and time required for interventions are combined to determine the
levels that are required.
d. Financial resources and nursing interventions are combined to determine patient
contact hours.

Answer 10

ANS: C
In a factor evaluation system, tasks, thought processes, and patient care activities are considered and given a time or rating. These times or ratings are then used to determine the number of patient care hours required.

Question 11

Staff members on your unit raise concern that the number of acutely ill patients on the unit is rising and responsiveness in addressing these needs through appropriate staffing is lacking. They point to increased incidences of adverse and sentinel events on the unit. To address this concern, the best action for your hospital organization is to:
a. Implement a patient classification system immediately.
b. Participate in databases that compare the outcomes and staffing levels versus those
of institutions similar to yours.
c. Provide increased numbers of staff to the unit.
d. Ignore such concerns because the number of acutely ill patients is variable.

Answer 11

ANS: B
Staff morale suffers both when models of acute illness indicate a gap between staffing and the number of acutely ill patients, and when there is no model but perceived acute illness 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 similar institutions.

Question 12

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 do 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 judgements about staffing.

Answer 12

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

Question 13

In evaluating mortality rates, the head nurse on the cardiac unit is surprised to find that they are higher on the weekend 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. Numbers of acutely ill patients.

Answer 13

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

Question 14

What does a nurse staffing plan take 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 14

ANS: B
Nurse staffing plans employ nursing judgement and flexibility that is based on the number of acutely ill patients, nurse experience, and unit configuration rather than set nurse-to-patient ratios.

Question 15

To maintain patient safety, studies suggest that scheduling should avoid which of the
following?
a. Rotating shifts.
b. Weekends.
c. Eight-hour shifts.
d. Mandatory overtime.

Answer 15

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

Question 16

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 16

ANS: C
Strategies to reduce overtime increase patient safety. Studies suggest that every additional 10% of overtime hours worked contributes to a 1.3% increase in hospital-related mortality.

Question 17

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 health care organization:
a. Develops a centralized pool of float nurses.
b. Assigns nurses from less busy units to ones with increased numbers of acutely ill patients.
c. Floats nurses only between units on which the nurses have been cross-trained.
d. Assigns float nurses to basic care only.

Answer 17

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 18

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 nonproductive hours.
c. Minimum benefit hours.
d. Maximum vacation time.

Answer 18

B

Question 19

Your health care 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 19

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 are characteristics of staff self-scheduling models.

Question 20

Patient classification systems have been developed in an effort to give nurse managers the tools and language to describe the acuity of patients. “Sicker” patients receive higher classification scores, indicating that more nursing resources are required to provide patient care. Which of the following describes a factor evaluation system?
a. Subjective and descriptive.
b. More objective.
c. Uses broad categories to predict patient-care needs.
d. Patient-care needs based on diagnosis-related groups.

Answer 20

ANS: B
Factor evaluation system is more objective and gives each task, thought process, and patient-care activity a time or rating. These indicators are then summed to determine the hours of direct care required, or they are weighted for each patient. Used for patients with more complex care needs and a less predictable disease course.

Question 21

Which of the following decrease the risk of patient mortality rates? (Select all that apply.)
a. Staff burnout.
b. Positive leadership support.
c. Increase of casual or temporary positions.
d. Staffing numbers and levels.

Answer 21

A, D

Question 21

The growth in evidence on nursing-sensitive indicators has been accompanied by significant controversy regarding the level of nurse staffing required for various groups of patients, primarily in acute-care hospitals. Two major approaches to sufficient staffing have been put forward in Canada. These are? (Select all that apply.)
a. Mandated nurse-patient ratios
b. Increased numbers of registered nurses
c. Development of a staffing plan for a period of time
d. Better staff mix

Answer 21

ANS: A, C
Although an increase in the number of registered nurses and a better staff mix will support better patient care and decreased mortality rates. It is more important that, in Canada, mandated nurse-patient ratios and development of a staffing plan for a period of time, usually a budget cycle, will provide consistency and ensure the nurse-patient ratio is appropriate based on evidence.