Ch. 22: Staffing And Scheduling

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.

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).

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

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.

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

ANS: C A conceptual framework provides logic and order to complex processes for administrators and scientists to consider

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.

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.

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

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

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

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).

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.

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

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

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

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

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.

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

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).

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.

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.

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.

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.

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.