Marquis Leadership 8e Ch 17: Staffing Needs and Scheduling Policies
5. It is 2 PM. You are calculating the nursing care hours for the 3 to 11 PM shift and must decide whether you need to call in additional help. You have three RNs, three nursing assistants, and one ward clerk scheduled. You have 22 patients with the following acuity and nursing care hours allotted for the evening shift: Category I, 4 patients
2.0 hours Category II, 2 patients @ 2.3 hours Category III, 10 patients @ 2.8 hours Category IV, 6 patients @ 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 @Ans: A Feedback: Four category I patients require 8 hours of care; two category II patients require 4.6 hours of care; 10 category III patients require 28 hours; six category IV patients require 20.4 hours; total nursing care hours equal 61.
8. Which statement accurately identifies a concern associated with decentralized staffing? A) It carries risks that employees may be treated unequally or inconsistently B) It uses one individual or a computer to do the staffing C) The manager's role is that of making minor adjustments or providing input D) It provides good control for the organization
Ans: A Feedback: A manager being perceived as granting special treatment to some employees is a risk of decentralized staffing. None of the other options identifies an associated concern.
19. What is the advantage of decentralized scheduling? A) Unit manager understands the needs of the unit and staff intimately B) Employees will be treated equally and consistently C) Manager role is limited to making minor adjustments and providing input D) It allows the most efficient use of resources
Ans: A Feedback: 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. In addition, the staff feels more in control of their work environment because they are able to take personal scheduling requests directly to their immediate supervisor. Decentralized scheduling and staffing also lead to increased autonomy and flexibility, thus decreasing nurse attrition.
21. 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 organizational goals and 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
Ans: A Feedback: Role modeling is a leadership responsibility. The other options are recognized management responsibilities associated with staffing and scheduling.
3. Which statement accurately reflects self-scheduling? A) Self-scheduling requires greater worker accountability B) The manager has little responsibility in self-scheduling C) Self-scheduling has few or no shortcomings D) Self-scheduling works in most organizations
Ans: A Feedback: Self-scheduling requires greater worker participation in decision making and shared responsibility for adequate staffing. None of the remaining options is accurate.
16. When was the veteran generation born? A) 1925 to 1942 B) 1943 to early 1960s C) Early 1960s to 1980 D) Late 1970s to 1986
Ans: A Feedback: The veteran generation is typically recognized as those nurses born between 1925 and 1942.
20. An increasingly common staffing and scheduling alternative is the use of supplemental nursing staff such as agency nurses or travel nurses. Which statement is correct about agency nurses or travel nurses? A) Work for premium pay B) Employed directly by the health-care agency C) Result in increased continuity of nursing care D) They receive the standard facility benefits
Ans: A Feedback: These nurses are usually directly employed by an external nursing broker and work for premium pay (often two to three times that of a regularly employed staff nurse), without benefits. While such staff provide scheduling relief, especially in response to unanticipated increases in census or patient acuity, their continuous use is expensive and can result in poor continuity of nursing care.
25. Which external and internal forces must a manager adjust for when implementing the PCSs associated with unit staffing? Select all that apply. A) 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
Ans: A, B, C, D Feedback: 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 patient 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 organization's classification system may prove to be inaccurate, or the hours allotted for each category or classification of patient may be inaccurate (too high or too low). An anxious patient is not a force that should affect the staffing process.
24. Which statement is true regarding the float pool nurse? 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
Ans: A, D Feedback: Some hospitals have created their own internal supplemental staff by hiring per-diem employees and creating float pools. Per-diem staff generally have the flexibility to choose if and when they want to work. In exchange for this flexibility, they receive a higher rate of pay but usually no benefits. 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. Float pools are adequate for filling intermittent staffing holes but, like agency or registry staff, they are not an answer to the ongoing need to alter staffing according to census since they result in a lack of staff continuity.
23. Since 2008 what is the legal minimum staffing radios for a medicalñsurgical nursing unit? A) 1:4 B) 1:5 C) 1:6 D) 1:7
Ans: B Feedback: The expected legal ratio is 1:5.
6. What is the priority goal for a manager with regard to staffing and scheduling? A) Schedule staff so there is no overtime B) Ensure that there is adequate staff to meet the needs of each patient C) Develop trust in staff by seeing that staffing is carried out in a fair manner D) Ensure that staff members usually have days off and special requests granted
Ans: B Feedback: The manager is tasked with seeing that patient care needs are met first and foremost. While the other options are relevant, they are not the priority goal of the manager.
14. There are advantages and disadvantages to each type of scheduling. What is true about extending the workday with 10- or 12-hour shifts? 1. Requires overtime pay 2. Increases nurse satisfaction 3. Decreases cost 4. Increases judgment errors A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4
Ans: B Feedback: There are advantages and disadvantages to each type of scheduling. 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.
7. Which is the most accurate statement regarding staffing and scheduling policies? A) It is more important to communicate policies verbally than in writing B) It is necessary that policies are written in a manner that allows some flexibility C) Policies should focus on the process D) Managers should have autocratic control over scheduling and staffing policies
Ans: B Feedback: 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.
11. What term identifies a system that allows employees to select among variations in work start-time schedules to meet their personal needs? A) Self-scheduling B) Flextime C) Decentralized staffing D) Cyclical staffing
Ans: B Feedback: 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.
1. 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 currently in use D) Total beds on the unit
Ans: C Feedback: A staffing formula is the best way to determine staffing needs, provided it is based on an accurate patient classification system (PCS). The remaining options are not as fiscally responsible since they involve uncontrollable factors.
4. Which is an outcome of decentralized staffing? A) Increased fairness to employees through consistent, objective, and impartial application B) Cost-effectiveness through better use of resources C) Greater manager autonomy to control the staffing on the units, 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
Ans: C Feedback: 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. The other options are not associated with decentralized staffing.
13. 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 patient care D) They are necessary to reduce costs
Ans: C Feedback: Several states have proposed or passed mandatory staffing ratios for the purpose of improving patient care, although there is no guarantee improved care will result from such legislation. None of the other options are associated with minimum staffing ratios.
9. What outcome is associated with a good PCS? A) It eliminates most staffing problems B) It decreases the amount of overtime C) It provides an understanding of staffing problems D) It eliminates the need for adjustment or review
Ans: C Feedback: The main strength of the PCS is that it provides data with which to make staffing decisions. It will not solve all staffing problems, and it will not replace a manager's judgment.
17. What generational work group values the more flexible part-time and 12-hour shift options? A) Veteran generation B) Baby boomer C) Generation X D) Generation Y
Ans: C Feedback: ìGeneration Xersî (born between 1961 and 1981), a much smaller cohort than the baby boomers who preceded them, or the Generation Yers who follow them, 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.
22. What is an advantage of centralized staffing? Select all that apply A) It is flexible B) It is staff focused C) It is cost-effective D) It is consistent and impartial
Ans: C, D Feedback: Centralized staffing is generally fairer to all employees because policies tend to be employed more consistently and impartially. In addition, centralized staffing frees the middle-level manager to complete other management functions. 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 patient 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. In addition, managers may be less responsive to personnel budget control if they have limited responsibility in scheduling and staffing matters.
15. What occurs when RN hours decrease in a unit's calculation of nursing care hours per patient day (NCH)/(PPD)? A) Adverse patient outcomes generally increase B) Decreased errors C) Decreased patient falls D) Decreased patient satisfaction
Ans: D Feedback: 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.
12. Which statement is correct concerning prenegotiated budget management? A) It is incompatible with ethical accountability B) It is only the responsibility of the centralized staffing office C) It is inappropriate with new practice models D) It is a critical responsibility of managers
Ans: D Feedback: Accountability for a prenegotiated budget is a management function. The other options are incorrect regarding this function.
10. What positive impact do new practice models have on the staffing mix? A) Automatically cancel the PCS B) Will result in fiscal savings C) Require no changes in scheduling policies D) Impact patient care assignment methods
Ans: D Feedback: As new practice models are introduced, there must be a simultaneous examination of the existing staff mix and patient care assessments to ensure that appropriate changes are made to the staffing and scheduling policies. They are not associated with the impact suggested by the other options.
2. Which statement about PCSs is accurate? A) Classification systems are able to solve staffing problems B) Nursing care hours assigned to a classification system should remain constant C) A good classification system is without fault D) Internal and external forces may affect classification systems
Ans: D Feedback: 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. None of the remaining options is totally accurate because of uncontrollable factors.
18. What must staff and scheduling policies not violate? 1. Local laws 2. Labor laws 3. State or national laws 4. Union contracts A) 1, 2, 3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4
Ans: D Feedback: Staffing and scheduling policies must not violate labor laws, state or national laws, or union contracts.
