Week 7 (Module F) Flashcards
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 the number of RNs with experience on the unit.
ANS: D
A number of studies (for example, Dunton et al., 2007) have demonstrated that adverse events such as falls can be reduced by increasing the number of RNs on a unit (relative to other personnel), and the number of experienced RNs. Overtime and 12-hour shifts are linked to a higher incidence of errors.
A small rural hospital has been designated as a critical access hospital. It has 40 beds and an average occupancy rate of 34 beds. To prepare the staffing, the chief nursing officer computes the occupancy as being:
a) 90%
b) 85%
c) 75%
d) 60%
ANS: B
The occupancy level is calculated as 34/40, which is equal to 85%.
To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time. When calculating 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.
ANS: C
Nonproductive hours are hours of benefit time and include vacation, holiday, personal or sick time
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 number and classification of float staff needed to augment regular staff
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 develops staffing plans to outline the number of individuals by classification that are needed on a per-shift basis, thus optimizing the management of financial resources.
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
ANS: D
Internal considerations are staffing policies, regulations, or recommendations and how they can relate to the minimum number of regulated or professional nurses on an acute care unit at a given time, or to the amount of minimum staffing in an ambulatory care program, a continuing care facility, or a correctional facility. Licensing standards and staffing recommendations by provincial and territorial professional associations and regulatory bodies affect staffing plans and are considered to be external, or outside of the organization.
A nurse manager must also consider a number of interval 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
ANS: A
Internal policies determine what a nurse may do in a particular setting - for example, organizational staffing policies. External variables to consider are provincial/territorial licensing standards that outline what a nurse can do; the Canadian Nurses Association is a national regulatory organization; and consumer expectations fall within the public realm, which is also an external variable that affects staffing plans.
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 number of acutely ill patients on the unit
c) maximum work stretch for each employee
d) weekend requirements
ANS: B
The number of acutely ill patients is determined through classification systems, which determine the nursing resources required.
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
ANS: C
It is important for staff retention to have a variety of scheduling options. Exact constraints regarding weekends and holidays are determined through contracts and policies.
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 the interpretation of benefits and compensation
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.
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 for nursing quality indicators
d) agency for healthcare research and Quality (AHRQ) system
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.
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 number of acutely ill patients on the 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.
ANS: C
In a factor evaluation system, 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.
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.
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.
A particular classification system assigns according to the functional capacity of patients and the progression of patients during their stay in rehabilitation units. More independent patient activities such as prolonged 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 judgments about staffing
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.
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.
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.
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.
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 works with fewer and often less experienced staff, and when communication among on-call healthcare providers may be strained.
