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Leadership and Nursing Care Management 6th Edition Huber Test Bank

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Leadership and Nursing Care Management 6th Edition Huber Test Bank

ISBN-13: 978-0323389662

ISBN-10: 032338966X

 

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Leadership and Nursing Care Management 6th Edition Huber Test Bank

ISBN-13: 978-0323389662

ISBN-10: 032338966X

 

 

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Chapter 22: Staffing and Scheduling

Huber: Leadership & Nursing Care Management, 6th Edition

 

MULTIPLE CHOICE

 

  1. The provision of quality nursing care to clients, wherever delivered, depends on the:
a.appropriate nursing diagnoses.
b.current wage scale.
c.number of nurse leaders.
d.right skill mix.

 

 

ANS:  D

The major goal of staffing management is to provide the right number of nursing staff with the right qualifications to deliver safe, high-quality, and cost-effective nursing care to a group of patients and their families as evidenced by positive clinical outcomes, satisfaction with care, and progression across the care continuum (Eck Birmingham, 2010; T.A. Fitzpatrick, personal communication, August 31, 2016). “Appropriate safe nurse staffing and skill mix levels are essential to optimize quality of care” (ANA, 2016a), and this determination is challenging yet essential.

 

DIF:    Cognitive Level: Apply (Application)                               TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Staffing management is one of the most critical activities for nurse leaders at every level of the health care organization today because it affects:
a.delegation and supervision.
b.unit leadership productivity.
c.organizational outcomes.
d.professional development and quality control.

 

 

ANS:  C

Staffing management is one of the most critical yet highly complex and time-consuming activities for nurse leaders at every level of the health care organization today. How well or poorly nursing leaders execute staff management impacts the safety and quality of patient care, financial results, and organizational outcomes, such as job satisfaction and retention of registered nurses (RNs).

 

DIF:    Cognitive Level: Understand (Comprehension)                  TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Evaluation of the effect of nurse staffing on quality patient, financial, and organizational outcomes is known as:
a.patient acuity.
b.staffing effectiveness.
c.nurse-to-patient ratio.
d.nursing workload.

 

 

ANS:  B

Staffing effectiveness is the evaluation of the effect of nurse staffing on quality patient, financial, and organizational outcomes.

 

DIF:    Cognitive Level: Understand (Comprehension)                  TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The nursing manager of a general medical-surgical unit in a large hospital has gathered data reflecting the average length of time that it takes to provide nursing care to broad categories of client groups with typical characteristics. The patient classification system that the nursing manager has used is criticized for its:
a.lack of reliability.
b.medical elements.
c.stereotyping of patients.
d.subjective basis.

 

 

ANS:  A

Patient classification systems aimed at adjusting staffing for acuity have been plagued with an inability to accurately and reliably measure patient care variability. Further, they have lacked organizational credibility and added documentation burden to the direct-care nurse.

 

DIF:    Cognitive Level: Apply (Application)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The nursing manager of a general medical-surgical unit in a large hospital has gathered data reflecting the average length of time that it takes to provide nursing care to broad categories of client groups with typical characteristics. The nursing manager will most likely use the patient classification data he collected to:
a.avoid management layoffs.
b.change professional nursing roles.
c.obtain staffing reimbursement.
d.staff his nursing unit appropriately.

 

 

ANS:  D

The nurse manager who is accountable for a patient care unit or area executes staffing management strategies to yield an optimal health experience and clinical outcomes for patients and their families; a healthy, satisfying work environment; and cost-effective staffing model for the organization.

 

DIF:    Cognitive Level: Apply (Application)                               TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A(n) ______ provides logic and order to complex processes for administrators and scientists to consider.
a.staffing plan
b.organizational chart
c.conceptual framework
d.nursing care delivery model

 

 

ANS:  C

A conceptual framework provides logic and order to complex processes for administrators and scientists to consider (Edwardson, 2007).

 

DIF:    Cognitive Level: Remember (Knowledge)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A common element among nursing care delivery models is the:
a.ratio of nurses to patients.
b.manager is the frontline leader.
c.value of the nurse and patient/family relationship.
d.needs of the patients drive the competency of the nurse.

 

 

ANS:  C

One common element among care models is the value of the nurse and patient/family relationship. Patient assignment technology offers charge nurses access to real-time data in order to match the right nurse (i.e., competency, expertise) with the right patient and provide continuity of care during an episode of care. A second common trend is the evolving role of the charge nurse as the frontline leader with responsibility to coordinate patient flow with expert communication among health care team members.

 

DIF:    Cognitive Level: Understand (Comprehension)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Relationship-based care (RBC) is a common model used in care delivery. Person (2004) articulated that _____ is/are central nursing care delivery models.
a.continuity of care
b.case management
c.coordination of care
d.the needs or characteristics of the patients

 

 

ANS:  A

Person (2004) described the four fundamental elements of any nursing care delivery model as follows: (1) nurse/patient relationship and decision making, (2) work allocation and patient assignments, (3) communication among members of the health team, and (4) management of the unit or environment of care. Translating the nursing care delivery model’s elements and inherent values to staffing management is a key role for nursing leaders. One common element among care models is the value of the nurse and patient/family relationship. Patient assignment technology offers charge nurses access to real-time data in order to match the right nurse (i.e., competency, expertise) with the right patient and provide continuity of care during an episode of care.

 

DIF:    Cognitive Level: Apply (Application)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The core concept of the synergy model for patient care is based on the nurse-patient relationship and acknowledges:
a.frontline charge nurses make informed patient care assignment decisions.
b.organizing and delivering nursing care achieves desired patient outcomes.
c.the needs or characteristics of the patients and families drive the competencies of the nurse.
d.the clinical nurse leader champions innovations that improve patient outcomes, ensures quality care, and reduces health care costs.

 

 

ANS:  C

The synergy model for patient care is presented by the American Association of Critical-Care Nurses (Hardin & Kaplow, 2005). The core concept of the model is based on the nurse-patient relationship and acknowledges that the needs or characteristics of the patients and families drive the competencies of the nurse. Synergy, or optimum outcomes, results when the needs and characteristics of the patient clinical unit, or system, are matched with a nurse’s competencies (Kaplow & Reed, 2008).

 

DIF:    Cognitive Level: Understand (Comprehension)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The Joint Commission’s (TJC’s) staffing regulation states:
a.staffing ratios are recommended in perinatal and critical care areas.
b.nurse managers may determine the nurse-to-patient ratio as long as the patient’s needs are being met.
c.hospitals must also provide the right number of competent staff members to meet the patient’s needs.
d.hospitals may limit the number of admissions to ensure there are an adequate number of staff members to meet patient needs.

 

 

ANS:  C

TJC standards include the human resources function of verifying that nurses are qualified and competent to ensure that the hospital determines the qualifications and competencies for staff positions based on its mission, populations, care, treatment, and services. Hospitals must also provide the right number of competent staff members to meet the patients’ needs (TJC, 2016).

 

DIF:    Cognitive Level: Understand (Comprehension)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. An approach for decreasing nursing RN skill mix was implemented in a one size fits all approach across organizations in the 1990s. These changes in skill mix led to:
a.decreases in RN workload.
b.increased nursing satisfaction.
c.decreased patient satisfaction.
d.decreased patient safety concerns.

 

 

ANS:  C

The approach for decreasing nursing RN skill mix was implemented in a one size fits all approach across organizations and often lacked evaluation of the skill mix change and other changes on the quality of care and nurse job satisfaction and retention (Eck, 1999; Norrish & Rundall, 2001). This was most apparent in California where a leaner RN skill mix was tried by Kaiser Permanente Northern California in the early 1990s. Skill mix was reduced from 55% RNs to 30% RNs in 1995 (Robertson & Samuelson, 1996). The changes in skill mix led to widespread real and perceived increases in RN workload, patient safety concerns, and nurse and consumer complaints (Norrish & Rundall, 2001; Seago et al., 2003).

 

DIF:    Cognitive Level: Understand (Comprehension)                  TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. A forecasted workload and a recommended care standard determine the:
a.staffing pattern.
b.skill mix of the unit.
c.nurse-to-patient ratios.
d.staffing management plan.

 

 

ANS:  A

The staffing management plan provides the structured processes to identify patient needs and then to deliver the staff resources as efficiently and effectively as possible. An effective plan first focuses on stabilizing the unit core staffing. A staffing pattern, or core coverage, is determined through a forecasted workload and a recommended care standard (e.g., hours per patient day).

 

DIF:    Cognitive Level: Understand (Comprehension)                  TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The workload standard commonly used in nursing when calculating staffing patterns is:
a.patient days.
b.patient acuity system.
c.average length of stay.
d.nursing care hours per patient day.

 

 

ANS:  D

The amount of work performed by a unit is referred to as its workload, and workload volume is measured in terms of units of service. The workload standard commonly used is nursing care hours per patient day, although the validity of this measure is disputed.

 

DIF:    Cognitive Level: Understand (Comprehension)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The staffing method used when units are staffed below maximum workload conditions and staff is then supplemented when needed is called:
a.fixed staffing.
b.variable staffing.
c.strategic staffing.
d.staffing by acuity.

 

 

ANS:  B

With variable staffing, units are staffed below maximum workload conditions and staff is then supplemented when needed.

 

DIF:    Cognitive Level: Understand (Comprehension)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The process of providing and measuring the correct full-time equivalent (FTE), or complement, to adequately staff a given area is known as:
a.scheduling.
b.position control.
c.forecasted workload.
d.demand management.

 

 

ANS:  B

Position control is the process of providing and measuring the correct FTE, or complement, to adequately staff a given area.

 

DIF:    Cognitive Level: Understand (Comprehension)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Key to effective staffing are protocols and processes for daily staffing decision support that are aligned with a budget-sensitive variable staffing plan. In a decentralized model, the responsibility of daily staffing allocation belongs to the:
a.float pool.
b.staffing office.
c.department manager.
d.chief nursing officer.

 

 

ANS:  C

In a decentralized model, individual department managers and directors are responsible for daily staffing allocation.

 

DIF:    Cognitive Level: Understand (Comprehension)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Assigning individual personnel to work specific hours, days, or shifts and in a specific unit or area over a specified period of time is known as:
a.scheduling.
b.staffing effectiveness.
c.nursing direct-care hours.
d.human resources staffing strategy.

 

 

ANS:  A

Scheduling is the process of assigning individual personnel to work specific hours, days, or shifts and in a specific unit or area over a specified period of time (Barnum & Mallard, 1989).

 

DIF:    Cognitive Level: Understand (Comprehension)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The new nursing care model, developed by the American Association of Critical-Care Nurses (2016), focuses on the needs of the patient and the competencies of the nurse. It is known as the:
a.Synergy Model for Patient Care.
b.Case Management Model.
c.Primary Nursing Model.
d.Clinical Nurse Leader Model.

 

 

ANS:  A

The Synergy Model for Patient Care was developed by the American Association of Critical-Care Nurses (2016) and is a patient-centered model focused on the needs of the patient, the competencies of the nurse, and the synergy created when the needs and competencies match. Synergy—or optimum patient outcomes—results when the needs and characteristics of the patient and clinical unit or system are matched with a nurse’s competencies. Patient assignment technology may assist in defining—and thereby aligning—patient needs with the nurse’s abilities, a concept that is central to the model.

 

DIF:    Cognitive Level: Apply (Application)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

MULTIPLE RESPONSE

 

  1. An RN is relocating and is seeking employment at a hospital that focuses on patient safety. Which staffing issues have a negative impact on patient safety? (Select all that apply.)
a.Eight-hour shifts
b.Twelve-hour shifts
c.Mandatory overtime
d.Student nurses on the unit
e.Unplanned overtime

 

 

ANS:  B, C, E

In this second edition, the ANA (2012) noted that since the initial publication of the original Principles for Nurse Staffing, the evidence has grown supporting the link between adequate nurse staffing and better patient outcomes. Under principles related to the practice environment, the ANA (2012, p. 10) stated “Registered nurses should be provided a professional nursing practice environment in which they have control over nursing practice and autonomy in their workplace,” and “routine mandatory overtime is an unacceptable solution to achieve appropriate nurse staffing. Policies on length of shifts; management of meal and rest periods; and overtime should be in place to ensure the health and stamina of nurses and prevent fatigue-related errors.”

 

DIF:    Cognitive Level: Apply (Application)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The hospital units most likely to employ a decentralized staffing model include: (Select all that apply.)
a.the telemetry unit.
b.labor and delivery.
c.the medical-surgical unit.
d.the emergency department.
e.the neonatal critical care unit.

 

 

ANS:  B, D, E

In a decentralized model, individual department managers and directors are responsible for daily staffing allocation. Units with decentralized staffing are typically units whereby volume and/or acuity may be most unpredictable, and the nursing competencies are unique to that area (e.g., emergency department, labor and delivery, critical care).

 

DIF:    Cognitive Level: Apply (Application)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Community Hospital is having a transient nursing shortage due to a high number of sick calls. The staffing office utilizes the staffing pool to obtain the required number of nurses. The staffing pool may include what types of nurses? (Select all that apply.)
a.Travel nurses
b.Foreign nurses
c.Registry nurses
d.Per diem nurses
e.Full-time nurses

 

 

ANS:  A, C, D

Access to nurses outside the unit to cover transient shortages is critical to meet last-minute, unplanned nurse shortages, such as sick calls and high patient demand. Supplemental staffing resources, frequently referred to as the staffing pool, are defined as a group of nurses who supplement the core unit staffing. This includes per diem nurses, float pool nurses, part-time nurses desiring additional hours, seasonal nurses, agency nurses, and traveling nurses.

 

DIF:    Cognitive Level: Apply (Application)                               TOP:   Nursing Process: Planning

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

COMPLETION

 

  1. When the needs and characteristics of the patient clinical unit, or system, are matched with a nurse’s competencies, _____ results.

 

ANS:

synergy

 

Synergy—or optimum patient outcomes—results when the needs and characteristics of the patient and clinical unit or system are matched with a nurse’s competencies. Patient assignment technology may assist in defining—and thereby aligning—patient needs with the nurse’s abilities, a concept that is central to the model.

 

DIF:    Cognitive Level: Apply (Application)                               TOP:   Nursing Process: Evaluation

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The amount of work performed by a unit is referred to as its _____.

 

ANS:

workload

 

The amount of work performed by a unit is referred to as its workload, and workload volume is measured in terms of units of service. The unit of service is specific to the type of unit, such as the number of patients, patient days, deliveries, visits, treatments, encounters, or procedures.

 

DIF:    Cognitive Level: Remember (Knowledge)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. Betty is calculating the total patient days on her unit. Her average daily census is 35 and her average length of stay is 2.4 days. In numerals, the total patient days on Betty’s unit is _____ days.

 

ANS:

84

 

Total patient days are commonly used in inpatient hospital areas. This is calculated by multiplying the average length of stay and the average daily census.

 

DIF:    Cognitive Level: Apply (Application)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

 

  1. The proportion of direct-care RNs to total direct-care nursing staff, expressed as a percentage of RNs to total nursing staff, is called _____.

 

ANS:

skill mix

 

Skill mix is the proportion of direct-care RNs to total direct-care nursing staff, expressed as a percentage of RNs to total nursing staff.

 

DIF:    Cognitive Level: Remember (Knowledge)

TOP:   Nursing Process: Assessment

MSC:  Client Needs: Safe and Effective Care Environment: Management of Care

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