471 Final Exam (New Content)

In the SBAR model, what should be conveyed when explaining the situation? (select all that apply) A)Assessment data collected B)Info in a narrative or story form C)events currently happening D)objective statement of the problem E)recommendations for treatment changes

A, C, D, E

Expense budget

A budget that outlines the anticipated (statistic budget) and actual expenses into fixed and variance of both labor and non-labor cost. "What do we need?"

A nurse is planning to delegate tasks to members of a transcultural team. Which tasks would the nurse consider environmental control when delegating to these members? (select all that apply) A)tasks that require imagination, vision and strategic planning B)tasks that require direct supervision C)tasks that are ambiguous D)Routine tasks that are done every day E)Tasks w/ a degree of predictability requiring independent thinking to accomplish

A, D, E

A new nurse manager with limited budgeting experience is considering what approach to use to determine the budget of the nursing unit for the upcoming fiscal year. Which approach would be easiest to implement? A)incremental B)zero-based C)performance D)flexible

A

Which of the following refers to the system in which facilities join a payment system, whereby they receive a specified fixed payment for each Medicare patient's admission, regardless of the actual cost? A)Prospective payment system (PPS) B)Neither C)Both PPS and DRGs D)Diagnosis-related groups (DRGs)

A

Which budgeting approach can foster overspending? A)incremental B)flexible C)performance D)zero-based

A The incremental method multiplies current-year expenses by a certain figure (inflation rate or consumer price index) and projects the budget for the following year. It is inefficient b/c there is no motivation to contain costs and no prioritization of programs and services.

Delegatee Responsbilities (3)

1)accept activities based on own competence level 2)maintain competence for delegated responsibility 3)maintain accountability for delegated activity

Accountability rests within....while responsibility rests with....

The decision to delegate; the performance of the task

____ budgeting is the most time consuming.

zero-based (starting anew, most accurate and measures value)

Which one of these is not one of the cultural elements to consider when delegating to a culturally diverse staff? A)time B)space C)religion D)social organization

C - religion is apart of social organization

Partnering

One RN, one lpn and/or NA are consistently scheduled to work tg. (attention given to scheduling & pt. assignments). Delegation potential is the highest.

Critical (Clinical) pathways

written documents that detail the expected course of treatment and expected outcomes for a DRG to coordinate care across disciplines

Managers must rejustify their program or needs every budgeting cycle in _________ budgeting.

zero-based

What are some examples of tasks that can be delegated to an LPN? (4)

• Chronic cases • Stable clients • Routine procedures • OBTAIN/GATHER data

What are some examples of tasks that cannot be delegated, and must be performed by the RN? (9)

• Specialty care • Severe cases • Sterile procedures • Assessment • Teaching • Care planning • Evaluation • IV medications • Admissions or discharges

With the advent of state and federal reimbursement for health care in the 1960s, providers were forced to submit ______ and ______ to payers that more accurately reflected their actual cost to provide these services.

budgets & costs

The abilities to _____, _____ and _____ are critical competencies for the 21st century nurse.

delegate, assign & supervise

The 4 major reimbursement methods (4)

1)Charge 2)Cost-based 3)Flat-rate 4)Rate based on services rendered

Licensed Nurse Delegation Responsibilities (3)

1)Determine patient needs and when to delegate 2)Ensure availability to delegatee 3)Evaluate outcomes of and maintain accountability for delegated responsibility

Medicare/Medicaid Reimbursement Progression of Thinking Timeline

1)Incremental budgeting 2)FFS 3)Diagnosis related group (DRG) 4)Prospective Payment Plan 5)Managed care

The Kentucky Board of Nursing Decision Tree (5)

1)Is the task within the scope of practice for a licensed nurse? 2)Is the nursing care plan identified? 3)Is the nurse competent to make a delegation decision? 4)Is the task within the scope of practice of the UAP? 5)Can the nurse adequately supervise task completion?

A graduate nurse who was new to a unit was caring for an elderly client. The physician on call ordered a treatment that the nurse had not heard of. The nurse should: A)Inform the physician of the nurse's lack of education and experience and refuse to do the treatment without supervision B)Inform the physician of the nurse's lack of education and experience and then proceed to perform the treatment C)Refuse to perform the treatment D)Carry out the treatment o the best of the nurse's ability

A

What two factors help ensure optimal outcomes in delegation? A)communication & collaboration B)Licensure & examination C)Training & authorization D)Certification & endorsement

A

When the nurse is explaining what the issue is, which stage of SBAR is this?

Assessment

A nurse manager is considering the use of critical pathways for a nursing unit. Which statement regarding critical pathways is most accurate? Show Exhibit a)They reduce the need for utilization review. b)They can be used to monitor quality of care. c)They reduce the need for documentation. d)They accurately predict patient progress.

B

Allowing persons to perform a specific nursing activity, skill or procedure that is outside the traditional role and basic responsibilities of the delegatee's current job is the definition for which of the following terms? A)Supervision B)Delegation C)Responsibility D)Accountability

B

The case manager for the unit is helping with discharge plans for a patient who will need multiple services. The patient is a paraplegic female in her 50s who is wheelchair bound and requires help at home from a home health agency. She is homebound due to her disability which she sustained during a car accident in her 30s. The case manager must consider this about her insurance (Medicare and Medicaid) when making these arrangements: A)The patient is likely to have Medicaid because of her long term disability B)Because of her disability, the patient has Medicare which covers her home health services and part of her hospitalization C)The patient will likely decline services because the Medicare and Medicaid coverage she has does not cover these services D)The patient will not have to follow with her primary care provider because she has the insurance and will come back to the hospital for minor urgent care needs

B

The nurse evaluates a patient's condition and determines that it is inappropriate to delegate a nursing activity to the UAP. What should the nurse do next? A)ask the UAP to observe and learn how to perform the skill B)perform the activity himself/herself C)contact the nursing supervisor D)consult another nurse

B

A new nurse manager is learning about fiscal planning. What are barriers for nurse managers' participation in fiscal planning? (select all that apply) A)Nurses lack the intuition necessary for fiscal planning B)Many nurses perceive fiscal planning to be difficult C)Nursing education lacks preparation in fiscal planning D)Nursing input in fiscal planning is undervalued E)Nurses are directly involved in fiscal planning

B,C

A nurse manager is preparing a presentation for her unit staff regarding the current U.S. health system. Which statement about resource utilization is most accurate: A)Limiting spending for health care resources will improve the quality of U.S. health B)Additional funding for health care resources will improve the quality of U.S. health close C)The health care resources that are available in the U.S. are not used cost - efficiently D)At this time in the U.S. there is a shortage of health care resources

C

How does the nurse supervise a delegated activity? A)By observing the delegatee perform the activity B)By encouraging autonomy, creativity, and self-discipline C)By providing support, guidance, and instructions D)By assessing the staff member's knowledge, skills and abilities

C

The nurse asks the unlicensed assistive personnel to measure blood pressure, temperature, pulse & respirations. This is an example of: A)Delegation B)Supervision C)Assignment D)Authorization

C

The nurse is making the assignment for the floor. There is one LPN and three RNs. Which of the following clients should be assigned to the LPN? A)A client who is intubated and a newly diagnosed diabetic. B)A recent ICU transfer and a person with AIDS. C)A client awaiting a nursing home bed and a client with one day post-hernia repair D)A new admission for cholecystectomy and a client one day post-op mastectomy

C

Operating Budget

Combines expense and revenue budget to ask what actions need to be taken to reduce expenses, increase revenue and plan for investing. Smaller orgs. may choose to only use this.

A nurse manager is considering how to gain more staff involvement in meeting budgetary goals. Which activity is most likely to result in staff understanding and participating in budgeting goals? A)Comparing actual expenses w/ budgeted expenses B)Being held accountable for the unit's financial results C)Forecasting or estimating needs using current data D)Communicating budgeting planning goals to staff

D

A nurse manager is preparing a presentation to be delivered to a group of nurses in a nursing unit about the current US healthcare system. Which statement about resource utilization is most accurate? A)Additional funding for health care resources would improve the the status of US Health B)Currently, there is a scarcity of resources available in the US health care system C)Limiting spending for health care resources will improve the quality of US health D)The health care resources that are available in the United States are not used cost-effectively

D

The registered nurse arrives at work and is told to report (float) to the intensive care unit (ICU) for the day because the ICU is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the ICU. The nurse should take which action first? A)Call the hospital lawyer B)Refuse to float to the ICU C)Call the nursing supervisor D)Report to the ICU and identify tasks that can be performed safely

D

Which statement about delegation is correct? A) Nurses are accountable for predicting adverse outcomes B) Unlicensed assistive personnel (UAP) must accept any delegated nursing activity C) UAP work under the license of the delegating nurse D) Nurses cannot delegate any element of the nursing process

D

Which statement about members of the nursing team & delegation is correct? A)UAPs can delegate to other UAPs B)LPN/LVNs can delegate to RNs and UAP C)RNs can delegate to APRNs, LPN/LVNs and UAP D)APRNs can delegate to RNs, LPN/LVNs & UAPs

D

Team STEPPS (Strategies and Tools to Enhance Performance and Patient Safety)

Developed by the Department of Defense's Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality (AHRQ). Teamwork system for health professionals to provide higher quality, safer client care. It provides an evidence base to improve communication and teamwork skills (INTERDISCIPLINARY COMMUNICATION).

Clinical Nurse Leader Role

Facilitate, coordinate, and oversee patient care. The CNL should be able to clearly communicate with other health care professionals, integrate evidence-based practices into patient care, and evaluate patient risks and outcomes. The person-centered focus of the CNL role includes functioning as a patient advocate, educator, and provider of patient care in complex situations.

Statistic budget

Forecasts the anticipated volume of work for a defined time period (month, quarter, year) and determines the resources (labor and capital) required.

Unit based scenario

NAP serves the unit. The NAP works off a task list usually found in the job description and has minimal direction from or interaction with RNs. Emphasis on task completion vs. care processes & outcomes.

With DRGs, hospitals join the ____, whereby they receive a specified amount for each Medicare patient's admission, regardless of the actual cost of care. Exceptions occur when the provider can demonstrate that a patient's case is an ____, meaning that the cost of providing care for that patient justifies extra payment.

PPS; outlier

Factors considered when determining the appropriateness of implementing care via the interprofessional team

Patient complexity, patient population acuity, skill of staff, facility's yearly budget

Authority

Right to act in areas where one is given and accepts responsibility

Supervision definition by ANA & NCSBN

The provision of guidance and oversight of a delegated nursing task. (On-site/direct supervision = physical presence & immediate availability; Off-site/indirect supervision = availability of supervising nurse through written/verbal communication)

Assignment

The routine care, activities, and procedures that are within the authorized scope of practice of the RN or LPN/VN or part of the routine functions of the AP. Performing a fundamental skill on the job. "The distribution of work that each staff member is responsible for during a given work period" (ANA & NCSBN)

Assistive Personnel (AP) was formerly referred to as ____.

UAP

*Refer to print out for delegation of tasks from RN to...

UAP's and LPNs

Revenue Budget

a forecast of revenues based on projections of the patient services and other revenue such as meals served in the cafeteria. "how much do we have to spend?"

Incremental Budgeting

a method of budget making that involves adding new funds (an increment) onto the amount previously budgeted (in last year's budget), innovation. ex: increasing salaries

What are the 5 rights of delegation? (select all that apply) A)right time B)right supervision C)right communication D)right circumstance E)right task F)right person

all but A

The NCSBN & ANA joint statement on delegation is applicable to...

all levels of nursing licensure (APRN, RN, LPN/VN)

Delegation

allowing a delegatee to perform a specific nursing activity, skill or procedure that is beyond the delegatee's traditional role & not routinely performed.

Capital budgets plan for the purchase of...

buildings or major equipment. This includes equipment that has a long life (usually greater than 5 years), is not used daily, and is more expensive than operating supplies.

How can a nurse leader bridge the authority-power gap?

by making a genuine effort to know and care for each individual

The decision to delegate is based upon the RN's judgment concerning the...(3)

condition of the patient competence of all members of the team degree of supervision required of the RN if delegated

Health insurance marketplaces, also called ______, are online insurance supermalls, created for individuals without access to ________ through a job or for small businesses who wish to buy affordable and qualified health benefit plans in a competitive insurance marketplace.

exchanges; health insurance

The licensed nurse cannot delegate...(3)

nursing judgment, critical thinking, the nursing process itself (assessment, planning, evaluation)

Employer/Nurse Leader Delegation Responsibilities (5)

1)identify a nurse leader 2)determine nursing responsibilities that can be delegated, to whom, and what circumstances 3)develop delegation policies & procedures 4)periodically evaluate delegation process 5)promote positive culture/work environment

Budget cycle (same as nursing process)

1)assess needs 2) diagnosis - goal/purpose for funds, how will you ensure proper use of funds? 3)plan - amount $ and timeframe 4)implement - utilize funds 5)evaluate - review monthly statement and how accurate you were in quantifications, modify, approval,

Steps of the NCSBN decision tree for delegation (4)

1)assessment & planning 2)communication 3)surveillance & supervision 4)evaluation & feedback

____ is the easiest budgeting method but has limitations.

incremental

5 Rights of delegation

1. Right task 2. Right circumstance 3. Right person 4. Right direction/communication 5. Right supervision/evaluation

Using the SBAR model, when the nurse is providing the background of a patient to teammates, what information should the nurse include? (Select all that apply) A)admitting dx. B)patients name and room # C)current meds D)medical history E)issues identified for discussion

A, B, C, D

Which of the following are steps in the flexible budgeting process? (select all that apply) A)Separate the costs into fixed, variable and mixed B)Determine the time period for the budget C)List all current and proposed objectives and activities in the process D)Analyze the cost patterns over that period of time E)Forecast the cost for each of these categories of activities

A, B, D, E

______ are groups of providers and suppliers of service who work together to better coordinate care for Medicare patients (does not include Medicare Advantage) across care settings with the expectation that efficiency, as well as quality of care, will result in shared savings.

ACOs (Accountable care organizations)

The nurse manager is beginning to plan for fiscal year 2020. He considers the unit's needs and what the staff has requested. He knows the hospital has a tight budget and will not be considering any large expenditures. He does need to consider hiring two new full-time nurses. As he begins to place expenses into categories, where would the hiring of new employees fall? A)Hiring employees is a capital budget item B)Hiring new employees falls under the personnel budget category C)The overtime budget category is for hiring new personnel D)The operating budget is for hiring new employees

B

Which factor can have a negative impact on delegation? A)Shortage of training programs for UAPs B)Variation in roles & responsibilities of UAP C)Inconsistent use of a decision tree for delegation D)Lack of standardized patient handoffs

B

Which of the following is NOT a responsibility of the employer and/or nurse leader involving delegation? A)ensuring appropriate policies & procedures regarding delegation are in place B)ensuring adequate staffing C)establishing scope of practice guidelines for UAPs D)Promoting & maintaining a positive culture

B

A nurse manager is reviewing the budget for the nursing unit. Which budget covers the expenditures for the units workforce? A)Operating B)Personnel C)Volume D)Capital

B The personnel budget pertains to the workforce

A nurse manager is considering revising the budget cycle for the nursing unit. Which budget cycle has the greatest probability for error? A)Calendar year budget B)Planning for the distant future C)Fiscal year planning D)Short-sighted planning

B Projecting too far in advance results in error while short sighted planning is more likely to have lack of planning

In the SBAR model, when giving recommendations, what kinds of things should be communicated? (select all that apply) A)the patients condition and state what you think the problem is B)any new treatments or changes ordered C)opinions for further action D)the background or context of the situation E)a concise evaluation of the situation in a sentences

B, C

The nurse is supervising a newly trained certified nurse aide (CNA). An adult patient has just arrived on the unit after surgery. Which of the following is the most appropriate task for the nurse to assign to the CNA and under what type of supervision? A)Taking the client vital signs while the nurse watches B)Suctioning the client's tracheostomy and reporting back to the nurse. C)Changing the client's post-operative surgical dressing then describing it to the nurse D)Testing the urine with a reacting strip, and recording and reporting the results

D

Which statement about regulation and scope of practice is correct? A)Any licensed nurse can delegate and supervise unlicensed assistive personnel (UAP) B)Only registered nurses can delegate & supervise UAP C)All states prohibit LPN/LVNs from delegating & supervising D)Some states prohibit LPN/LVNs from delegating & supervising UAP

D

Who is ultimately accountable for the outcome of the delegation? A)The health care provider B)The health care employer C)The nurse leader D)The nurse who delegates the activity

D

Work complexity assessment (WCA) program

consultant-led process by Tom Ingalis. Helps define & quantify various levels of care complexity based on the knowledge and skill required to perform the work. The correlation b/t consistency of care givers & delegation potential (the amt. of nursing care that can legally & safely be assigned to a non-professional staff member) is explored.

The NCSBN & ANA Joint statement delegation guidelines do not apply to the transfer of responsibility for care of a patient between ___________.

licensed health care providers (RN to RN, LPN to LPN)...This is considered a HANDOFF.

Pairing

one RN works with an LPN and/or a NA for the shift. Increases delegation potential

In VBP, providers are held accountable for the quality and cost of the health-care services they provide by a system of rewards and consequences, conditional upon achieving prespecified ________ measures.

performance

The __________ budget often accounts for the majority of health-care organization's expenses because health care is labor intensive.

personnel-workforce

Delegation is one of the top 3 most difficult skills for nurse leaders along with ____ and ____.

prioritization and time management

ANA & NCSBN defined delegation as the...

process for a nurse to direct another person to perform nursing tasks and activities

If some units inflate their budgets to cushion against administrative cuts....

then the entire institutions budget may be ineffective.

The NCSBN has a delegation decision ____ for delegation to nursing _____.

tree; assistive personnel

WCA uses three scenarios of delegation:

unit based, pairing & partnering

What are some examples of tasks that can be delegated to UAP? (2)

• Routine procedures • ADL's

Critical Pathways Cons

1)more paperwork to justify deviations from pathway 2)seen as inflexible, limits use of clinical experience 3)not adaptable to unexpected changes 4)continual updates and development from administration and staff 5)may be slow to adapt to new info or technology

Organizational accountability involves...

1)sufficient staffing w/ an appropriate staff mix 2)Documenting competencies for all staff providing direct care & ensuring RN access to info 3)Organizational policies on delegation are developed w/ active participation from nurses RESOURCES

In the last World Health Report conducted by WHO in 2000, the U.S. ranked in the top ___%

20% (ranked 37/191 member nations)

Operational budgets are financial plans for the entire organization day-to-day operations. This type of budget includes which of the following? A)Payroll, supplies, and expenses B)Payroll, monthly expenses, and large purchase items C)Supplies, expenses and equipment purchases D)Expenses, equipment purchases, and payroll

A

What is the term for the notion that the person w/ the most direct control or influence on financial elements such as revenues, expenses, assets and liabilities, should be held accountable for them? A)Responsibility accounting B)Cost containment C)Cost Effectiveness D)Affordable accounting

A

Which of the following is NOT one of the 5 rights of delegation? A)Right reason B)Right person C)Right task D)Right communication

A

What are some of the primary focuses of the health care interprofessional team? (select all that apply) A)reduce mortality rates B)improving quality patient care C)Colllaborative problem solving D)Increasing professional experiences for health care workers E)Providing patient centered care

ALL

Which of the following are delegation errors by nurse leaders? (select all that apply) A)Failure to follow up B)Failure to release control of task C)Failure to provide clear directions D)Failure to delegate E)Failure to provide adequate directions

ALL

The definition of licensed nurse includes...

APRNs, RNs, LPN/LVNs

A nurse manager is using a budgeting approach that requires justification for each budgetary need. What approach is being used? A)performance B)zero-based C)flexible D)incremental

B - zero based requires justification for each budgetary need rather than just using b/c its been used and worked in past

Which aspects of creating a successful interprofessional team are addressed by SBAR? (select all that apply) A)Determining leadership of the team B)Ensuring role clarity C)Maintaining a shared vision D)Offering a recommended plan of action or next steps E)Communicating effectively or efficiently

B, C,D,E

A nurse manager wants to improve the efficiency and effectiveness of budgetary expenditures. Which budgetary approach would be best used in this situation? A)zero-based B)incremental C)flexible D)performance

D Performance budgeting aims to improve the efficiency and effectiveness by linking funding to outcomes.