Staffing Shortage: Who can handle CRRT?

What is the most significant negative impact of implementing mandatory overtime to cover staffing shortages?

Risk to patient safety and health While mandated staffing can give staff the perception of a lack of control and increase staff stress related to difficulties in maintaining an appropriate work-life balance, both of which can lead to a drop in staff productivity and motivation, the most significant impact could be to patient safety and health. A nurse who is exhausted is more prone to errors, whether it be forgetting to complete and/or document tasks, or making mistakes when completing tasks.

A nurse has been assigned an extra patient during the middle of the day after a fellow nurse went home sick. Which statement by the nurse indicates a need for additional coaching related to time management?

I will wait until the end of the day to get all my charting done at one time. Taking the time to plan and establish priorities is a key first step in time management. Some other ways to be time efficient include: (1) gathering all necessary supplies and equipment prior to beginning an activity; (2) grouping activities together that are in the same location; (3) using time estimates to assist in planning. Although a nurse may feel that completing charting all at once at the end of the day may save time, this can increase the risk of inaccurate and incomplete documentation. In addition, it could lead to patient care errors if charting is not up to date in real time. Therefore, documentation should be done as soon as possible after an activity is completed.

A charge nurse received report on a patient with complex needs that will soon be admitted to the unit. The unit's complement of four experienced nurses each already has a four-patient load. Which nursing assignment demonstrates the charge nurse has applied the critical elements of the decision-making process in selection of the nurse to be assigned to the new patient?

The nurse whose current patients are lower acuity In using critical decision making, the charge nurse would take the time to gather necessary data, generate alternatives, choose, and act based on the data. As the new patient has complex needs, it is important to assign the patient to a nurse that has adequate training, experience, and time. As all of the nurses on the unit are experienced, it would be best to assign the new patient to the nurse who has patients that are lower acuity. Assigning the patient to the nurse just because the patient will be in an adjacent room, or because one nurse has more years of experience than another, does not demonstrate an adequate amount of data gathering in the decision-making process, and could make it difficult on the nurse if their current complement of patients is higher acuity already. While many units often assign new admits based on a rotating list, this also does not demonstrate adequate data gathering for making decisions.

A nurse who is having difficulty with a patient care assignment has not asked for any help but keeps saying things like, "As usual, I'll just have to stay late until I get it all done." What response by the charge nurse would be best to address the nurse's passive-aggressive behavior?

It sounds like you are a little behind. What can I do to help? In addressing passive-aggressive behavior, reflection can help focus on the affective components of the message. The statement "It sounds like you are a little behind" provides reflection, which is then followed by an offer of assistance. Statements that begin with "why" (e.g., "why are you" or "why don't you") would only serve to put the nurse on the defensive, increasing the use of passive-aggressive behavior or leading to more aggressive communication. Nurses should always try to leave work on time and maintain full lunch and break periods, without which the nurse could become exhausted, leading to potential poor patient outcomes.

A new nurse manager started out having an open-door policy so that the manager was always available to staff and could meet their needs immediately. However, the manager has found this prevents important work being completed in a timely manner and results in the manager having to work a few extra hours each day. What important steps could the manager take to change this policy?

Post a "Do Not Disturb" message board on the door on which staff can also leave messages. The nurse manager should have a plan in place to demonstrate that he/she must have some protected time to complete priority tasks (time-sensitive phone calls, emails, reports, etc.). Using a "Do Not Disturb" sign can demonstrate that the nurse manager should not be interrupted, except in cases of emergency. Adding the ability for staff to leave messages for non-urgent situations allows the nurse manager to address them as soon as the priority tasks are finished. Emails can be just as distracting as an open-door policy, especially if the nurse manager states that responses will be provided quickly. Work should never have to be done outside of the office; completing work at home would have a detrimental effect on the nurse manager's work-life balance. Refusing to answer the door when someone knocks, especially if it is known that the nurse manager is in the office, would serve to damage the manager's relationship with staff. In addition, patient outcomes could be affected if the nurse manager fails to answer when urgent issues arise.

Which patient care classification tool requires nurses to note the frequency of specific activities during their shift in order to determine patient acuity?

Summative task tool A summative task tool is a patient care classification (PCS) tool that requires the nurse to note the frequency of occurrence of specific tasks, such as treatments, procedures, and medication administration. This data is then used to provide an acuity classification for the patient. A critical indicator worksheet is a PCS tool that uses broad indicators of patient care (e.g., bathing, medications, fluids) and category levels to determine patient acuity. NCH/PPD is a not a PSC tool, but a basic measure for workload management, which does not take into account patient acuity. Bedside rounding is used for handoff that occurs between shifts, but not as a patient acuity assessment to assign patients for the following shift.

Identifying alternatives in the decision-making process would compare to what step in the nursing process?

Plan In the decision-making process, identifying criteria for making a decision and identifying possible alternatives correlates to the Plan step in the nursing process. Identifying the decision that needs to be made and gathering appropriate data would correlate with the Assess step, the first step in the nursing process. Choosing and implementing the alternative correlates with the Implement step. Evaluating the steps in the decision-making process, as well as the outcomes, correlates with the Evaluation step.

Which staffing model provides for greater autonomy and flexibility among the individual staff nurses?

Decentralized staffing In decentralized staffing, individual staff members are able to make requests directly to the manager, who has greater control over staffing. This allows for greater autonomy and flexibility for the staff. Centralized staffing, while more cost-effective, does not take into account the desires and needs of individual staff. While staffing may be based on legislated mandates for nurse-to-patient ratios, mandated staffing is not a staffing model. Staffing may be based each day on patient acuity in order to assign nurses, but acuity-based staffing does not provide for individual staff autonomy and flexibility.