CH 17: Staffing Needs and Scheduling Policies

D The use of agency nurses can increase costs and decrease continuity of care. There is no obvious need to change the length of shifts or for nurses to become more reliant on UAPs with the use of agency nurses

A busy medical unit has been increasing the use of agency nurses. The nurse-manager should anticipate what consequence of this staffing alternative? a. Increased reliance on unlicensed assistive personnel by nurses b. A need for 8-hour rather than 12-hour shifts c. Short-term cost savings d. Decreased continuity of nursing care

C, D, E Centralized staffing is generally fairer to all employees because policies tend to be employed more consistently and impartially. Centralized staffing also allows for the most efficient (cost-effective) use of resources because the more units that can be considered together, the easier it is to deal with variations in client census and staffing needs. Centralized staffing, however, does not provide as much flexibility for the worker, nor can it account as well for a worker's desires or special needs. Neither system is noted to have a direct effect on the quality of care.

A centralized staffing department is being created at a health-care facility. What attributes of this system should the nurse-manager expect? Select all that apply. a. Increased individual flexibility b. Improved client care c. Cost savings d. Increased consistency in staffing practices e. Increased impartiality in staffing decisions

A A manager being perceived as granting special treatment to some employees is a risk of decentralized staffing. A single individual or department is responsible in a centralized, not decentralized, system. Similarly, a manager plays a lesser role in a centralized system and the organization possesses more control.

A community health unit is transitioning from centralized staffing to decentralized staffing. The manager should recognize what possible consequence of this change? a. It carries risks that employees may be treated unequally or inconsistently. b. One individual or a computer will perform the staffing functions. c. The manager's role is that of making minor adjustments or providing input. d. The change will increase control over personnel by the organization.

D Flextime entails staff having their shifts begin and end at varied times. This can affect continuity of care if the manager does not take action. It would be unfair to limit the benefits of flextime to only those nurses who have multiple years of experience. Overtime should be used as an action of last resort, not a structured approach to meeting staffing needs. In most cases, weekday shifts are easier to fill than night shifts, holidays, and weekends.

A flextime system has been introduced at a health-care facility. The nurse-manager should take what action to address the consequences of this staffing system? a. Limiting flextime to those staff members who have at least 2 years experience on the unit b. Ensuring that overtime can be used to fill times when there is insufficient staffing c. Providing incentives to ensure daytime weekday shifts are sufficiently staffed d. Working to promote continuity of care when there are multiple start times and end times for staff

A, B, D Twelve-hour shifts have become commonplace in acute care hospitals even though there continues to be debate about whether extending the length of shifts results in increased judgment errors related to fatigue. Because extending the workday with 10- or 12-hour shifts may require overtime pay, the resultant nurse satisfaction must be weighed against the increased costs. There is no notable increase in the need for continuing education with 12-hour shifts.

A health-care facility is considering whether to move from 8-hour shifts to 12-hour shifts. What potential consequences of this change should be considered? Select all that apply. a. Increased overtime pay b. Increased nurse satisfaction c. Decreased cost d. Increased judgment errors e. Increased need for continuing education

D A review of current literature suggests that as RN hours decrease in NCH/PPD, adverse patient outcomes generally increase, including increased errors and patient falls as well as decreased patient satisfaction. There is no evidence that such a change increases interprofessional collaboration

A health-care organization has achieved a decrease in RN hours in the total nursing care hours per patient-day (NCH/PPD). What is a potential outcome of this change? a. Increased interprofessional collaboration b. Decreased numbers of errors c. Decreased client fall rate d. Decreased client satisfaction

D As new practice models are introduced, there must be a simultaneous examination of the existing staff mix and client care assessments to ensure that appropriate changes are made to the staffing and scheduling policies. This change does not necessarily create a need for self-scheduling or more UAPs.

A health-care organization is changing from a functional nursing model to a team nursing model. How should the nurse-manager best address the impact on staffing and scheduling? a. More unlicensed assistive personnel will need to be hired. b. A self-scheduling system will need to be adopted. c. No changes in scheduling policies will likely be necessary. d. The client assignment method will need to be adjusted.

C In an institution that has no human resources department and no nurse recruiters, the unit manager does the hiring and has greater autonomy in personnel matters. Centralized staffing is more closely associated with increased impartiality, cost-effectiveness, and availability of data.

A health-care organization is transitioning from a centralized staffing system to a decentralized staffing system. A nurse-manager should anticipate what outcome of this change? a. Increased fairness to employees through consistent, objective, and impartial application b. Increased cost-effectiveness through better use of resources c. Greater manager autonomy, resulting in an increase in self-esteem and teamwork d. Increased availability of data for monitoring the effect of staffing size and composition, quality of care, and costs

D Frequent use of overtime creates a safety risk because exhausted nurses are much more likely to commit an error. This practice is costly but does not have a major bearing on continuity of care. Ethics violations can occur in any staffing situation and are not necessarily more common when overtime is used.

A hospital unit has an exceptionally high census for several weeks and mandatory overtime is being routinely required. What is the priority consequence of this practice? a. Ethics violations b. Increased continuity of care c. Temporary cost savings d. Decreased client safety

A, B, C, D Regarding PCS, the middle-level manager must be alert to internal or external forces affecting unit needs that may not be reflected in the organization's client care classification system. Examples of such forces could be a sudden increase in nursing or medical students using the unit, a lower skill level of new graduates, or cultural and language difficulties of recently hired foreign nurses. The hospital's accreditation status should not influence the use of the PCS.

A manager is implementing a patient classification system (PCS). Which external and internal variables should the manager address when implementing the PCS? Select all that apply. a. The presence of nursing students on the unit b. The hiring of two graduates as staff c. The increase of scheduled medical students d. Language barriers presented by nursing staff e. The hospital's accreditation status

D Generational diversity allows clients to receive care from both the most experienced nurses as well as those with the most recent education and likely greater technology expertise. Managers must be alert to how generational diversity may impact staffing needs. Up to five generations of nurses are now working together. In previous years, earlier retirement from nursing and shorter life spans kept the workforce typically to three generations. Some researchers suggest that the different generations represented in nursing today have different value systems that may impact staffing. For example, most experts now identify five generational groups in today's workforce: the veteran generation (also called the silent generation or the traditionalist), the baby boomers, generation X, generation Y (also called the millennials), and generation Z.

A nurse manager is in charge of a unit that consists of a generationally diverse group of staff nurses. The nurse manager knows that this type of staffing arrangement will: a. require the baby boomer nurses have more flexibility in scheduling and time off as compared to the generation X nurses. b. create a nursing environment that will be more structured and focused on the use of technology to provide the best care. c. allow generation Y and Z nurses to create a secure and stable work environment. d. establish a diverse working environment based on experience and technology.

C Regardless of the specifics of a PCS, the starting point is the needs of each client. Other variables such as the mix and number of staff are accommodated to this priority consideration. It is simplistic to presume a baseline of three clients per nurse across all care settings

A nurse-manager is applying the facility's patient classification system (PCS) to the unit's staffing needs before the beginning of a shift. What task should the manager perform first? a. Identify the number of staff members scheduled for the shift. b. Create a preliminary work assignment based on the unit norms. c. Appraise the care needs of each client. d. Assign three clients to each nurse and then adjust according to client needs.

A, B, D, E Millennials tend to be technologically savvy, eco-aware, comfortable with multiculturalism, and skilled at working in teams. Long-term loyalty to a single employer is more closely associated with the veteran generation, which changes jobs much less frequently.

A nurse-manager is in charge of a unit that has a large proportion of recent graduates, most of whom are members of Generation Y (millennials). The manager should anticipate that many of these nurses will have what characteristics? Select all that apply. a. Technologically savvy b. Adept at teamwork c. Loyal to a single, long-term employer d. Comfortable with multiculturalism e. Committed to environmental issues

B To retain employees, the staffing policies must allow some flexibility, which could include job sharing, flextime, a part-time staffing pool for weekends, or allowing employees to exchange hours of work among themselves. Policies must be written, not only verbal. Having individual employees adopt different systems would result in chaos. Even in a decentralized system, individual managers do not have absolute autonomy of staffing issues.

A nurse-manager is working with a team of colleagues to update the organization's staffing and scheduling policies. What principle should the manager follow during this process? a. It is more important to communicate policies verbally than in writing. b. Policies should be written in a way that allows some flexibility. c. Each employee should be given the right to opt into the type of system that he or she wishes. d. Each unit manager should be granted full control over scheduling and staffing.

A Although self-scheduling offers nurses greater control over their work environment, it is not easy to implement. Success depends on the leadership skills of the manager to support the staff and demonstrate patience and perseverance throughout the implementation. The manager cannot afford to take a fully hands-off approach. It is more likely that junior staff would need advocacy than senior staff. Because the organization's staffing is decentralized, it would not likely be possible for the nurse-manager to refer disputes to a personnel department.

A nurse-manager works on a unit that has a decentralized self-scheduling system. When managing with this scheduling option, the manager should: a. oversee the system carefully to ensure sufficient staff coverage at all times. b. avoid becoming involved with the system so that staff remain autonomous. c. advocate for the most senior staff to receive the most desirable shifts. d. refer any disputes to the organization's personnel department.

A The veteran generation is typically recognized as those nurses born between 1925 and 1942. Members of this generation are often noted to possess a high level of loyalty to employers. Flexibility was valued more by subsequent generations. Individualism is noted as a particular characteristic of later generations, and social consciousness is associated with millennials.

A nurse-manager's immediate supervisor is a member of the veteran generation. What generational characteristic is the supervisor most likely to possess? a. Strong loyalty to the employer b. A high value on workplace flexibility c. High individualism d. Social consciousness

A Self-scheduling can increase worker satisfaction by giving employees more control over their work life. This form of scheduling does not absolve the manager from participation, and there is a possibility that the advantages and disadvantages may be distributed unequally. This system is challenging to implement effectively and fairly.

A self-scheduling system has been proposed at a health-care facility. What potential benefit of this system should the manager recognize? a. Self-scheduling increases employees' autonomy over their work lives. b. The manager no longer has to participate directly in staff scheduling. c. Self-scheduling ensures an equitable distribution of benefits to employees who participate. d. Self-scheduling can be more easily implemented and sustained than other alternative systems.

A Four category I clients require 8 hours of care; two category II clients require 4.6 hours of care; ten category III clients require 28 hours; six category IV clients require 20.4 hours. Therefore, the total nursing care hours needed is 61.

It is 2 PM and the nurse-manager is calculating the nursing care hours for the 3 to 11 PM shift. There are three RNs, three nursing assistants, and one ward clerk scheduled and there are 22 clients with the following acuity and nursing care hours allotted for the evening shift: Category I, 4 clients at 2.0 hours Category II, 2 clients at 2.3 hours Category III, 10 clients at 2.8 hours Category IV, 6 clients at 3.4 hours What are the needed hours of nursing care? a. 61 hours b. 52.6 hours c. 68.4 hours d. 48.4 hours

D Critics of mandatory staffing ratios identify the fact that increased numbers of staff do not necessarily translate into improved care. Legislation of this type tends to be supported by clients and families and it is recognized that this increases staffing costs. Mandatory staffing ratios have not been noted to reduce new graduates' employment opportunities.

Mandatory minimum staffing ratios are being considered in the jurisdiction where a nurse-manager works. Based on experiences of other states, the nurse should identify what possible result of this legislation? a. There may be a backlash from clients and families. b. Predicted cost savings may take many years to realize. c. Health-care organizations may be more reluctant to hire new graduates. d. Increased numbers of staff may not necessarily improve client care.

A, B, D The use of agency nurses is expensive and can result in poor continuity of nursing care. As well, agency nurses are often unfamiliar with the unit, which can negatively affect care. The use of agency nurses does not directly increase the need for overtime. Agency nurses are fully licensed.

The increased use of agency nurses has been proposed by a health-care organization's personnel department. What implications of this practice should be considered? Select all that apply. a. Increased costs b. Consequences of unfamiliarity with the unit c. Liability from the use of unlicensed nurses d. Decreased continuity of client care e. Increased need for overtime

A Advantages of decentralized staffing are that the unit manager understands the needs of the unit and staff intimately, which leads to the increased likelihood that sound staffing decisions will be made. The increased use of overtime and agency nurses should not be considered as long-term solutions due to cost. A self-scheduling system is unlikely to address the fact that the centralized staffing department does not understand the unit's needs

The manager of a hospital unit is frustrated that the centralized staffing department does not understand the unique staffing needs of the unit. What is the manager's best action? a. Advocate for a change to decentralized staffing. b. Introduce a self-scheduling system. c. Temporarily increase the use of agency nurses. d. Increase the use of overtime to meet the unit's staffing needs.

B, C, D, E Staffing and scheduling policies must not violate labor laws, state or national laws, or union contracts. There is no prohibition against violating local norms and traditions. There are not normally local laws that address work scheduling.

The policies around scheduling and staffing are being amended in a health-care facility. Managers must ensure that the policies to not violate which of the following? Select all that apply. a. Local laws b. Labor laws c. State laws d. Union contracts e. Federal laws f. Local norms

B The manager is tasked with seeing that client care needs are met first and foremost. Although the other options are relevant and appropriate, they are not the priority goal of the manager.

What goal should the nurse-manager prioritize when organizing staffing and scheduling? a. Schedule staff so there is a minimum of overtime. b. Ensure that there is adequate staff to meet the needs of each client. c. Develop trust in staff by seeing that staffing is carried out in a fair manner. d. Ensure that staff members achieve a healthy work-life balance.

A Role modeling is classified as a leadership responsibility. The other options are recognized management responsibilities associated with staffing and scheduling.

What is a leadership role associated with staffing and scheduling? a. Role models the use of evidence in making appropriate staffing and scheduling decisions b. Uses patient classification tools to minimize understaffing c. Periodically examines the unit standard of productivity to determine if changes are needed d. Evaluates scheduling and staffing procedures and policies on a regular basis

C A staffing formula is the best way to determine staffing needs, provided it is based on an accurate patient classification system (PCS). A robust formula considers the other variables listed, none of which can be used in isolation to determine staffing needs accurately.

What is the most fiscally responsible method for determining staffing needs for a hospital unit? a. Maximum patient load capacity of the unit b. Numbers of patients present for an upcoming shift c. An agreed-upon staffing formula based on client acuity d. Total beds on the unit

B When a hospital uses flextime, employees arrive at the unit and leave at many different times. The other options are not associated with the system described.

What term identifies a system that allows employees to select among variations in work start-time and end-time schedules to meet their personal needs? a. Self-scheduling b. Flextime c. Decentralized staffing d. Cyclical staffing

C Generation Xers may lack the interest in lifetime employment at one place that prior generations have valued, instead valuing greater work hour flexibility and opportunities for time off.

What was the first generational work group that tended to value work hour flexibility and opportunities for time off? a. Veteran generation b. Baby boomer c. Generation X d. Generation Y

D Examples of internal and external forces that may affect a PCS are a sudden increase in nursing or medical students using the unit, a lower skill level of new graduates, or cultural or language difficulties of recently hired foreign nurses. PCSs are not able to independently solve staffing challenges and cannot resolve every staffing challenge. Care hours will be constantly changing due to the interplay of numerous variables.

Which statement about patient classification systems is accurate? a. Classification systems are able to solve staffing problems if applied consistently. b. Nursing care hours assigned to a classification system should remain constant. c. A good classification system can resolve all staffing challenges. d. Internal and external forces may affect classification systems.

C The intent of mandatory staffing ratios is for the purpose of improving client care, although there is no guarantee that improved care will result from such legislation. Legislation is at the state, not federal, level. California is the only state that has legislated minimum staffing ratios. Their focus is quality of care and working conditions, not cost.

Which statement is true regarding legislated minimum staffing ratios? a. They are mandated by federal law. b. They are required by 28 states. c. They are proposed to improve client care. d. They are necessary to reduce costs.

D, E Float pools are generally composed of employees who agree to cross-train on multiple units so that they can work additional hours during periods of high census or worker shortages. They are not necessarily hired on a per diem basis and do not receive less pay. Float nurses receive benefits.

Which statements are true regarding float pool nurses? Select all that apply. a. They are classified as per diem staff. b. The nurse trades increased personal flexibility for less pay. c. Float pool nurses do not receive usual staff benefits. d. They are crossed-trained on multiple units. e. They are internal, not external, employees.