Question 1

A hospital has open shifts on its medical-surgical unit. The manager has listed open shifts on the hospital's intranet. This is an example of which type of scheduling?
A) External pools
B) Internal pools
C) Open shift management
D) Float pools

Accepted Answer

1. External pools are nurses employed from outside the organization, such as agency nurses.
2. Internal pools are pools of nurses within the organization from which the unit manager may assign supplemental staff as needed.
3. Open shift management is a technique in which a nurse may self-schedule by monitoring open shifts on the hospital intranet.
4. Float pools are pools of nurses within an organization who work on units in which there is a need. They are typically assigned that day or within 24 hours of their shift.

Question 2

The unpredictability of the labor and delivery area requires a set staff mix for every shift. Which type of staffing pattern should the manager use to ensure this mix?
A) Block staffing
B) Creative scheduling
C) Flexible scheduling
D) Self-staffing

Accepted Answer

1. Block staffing is scheduling a set staff mix for every shift so that adequate staff is available at all times. This staffing is commonly used in areas such as labor and delivery and the emergency care unit.
2. Staffing for this unit is likely to be rather repetitive and predictable rather than creative.
3. Flexible scheduling combines shifts of differing lengths and presents a challenge to nurse managers. It is not as predictable and set as block scheduling.
4. Self-staffing and scheduling is a staffing model whereby managers and their staff completely manage staffing and schedules. This could potentially be done following a block staffing outline but can follow other staffing schedules as well.

Question 3

The nursing staff of a medical-surgical unit would like to work four 10-hour shifts each week. For which reason would the unit nurse manager probably deny this request?
A) There is no overlap of staff.
B) There are not enough nurses working during a 24-hour period.
C) This would create discord and confusion with other healthcare departments.
D) This staffing pattern would not be cost-efficient.

Accepted Answer

1. With 10-hour shifts, there is an overlap of staff.
2. In order to cover 24 hours, three nurses are needed. In order to cover 24 hours with 12-hour shifts, two nurses are needed.
3. There is no evidence that 10-hour shifts for nurses would adversely affect other departments.
4. Since there is substantial overlap when covering 24 hours with 10-hour shifts, this staffing pattern is generally not cost-efficient.

Question 4

A nurse manager needs to supplement the staff for the next schedule. Which option would be the most significant drain on the unit's staffing budget?
A) PRN nurse
B) Internal float nurse
C) Part-time nurse
D) Agency nurse

Accepted Answer

1. PRN nurses are part of an internal float that provides supplemental staffing at a substantially lower cost than using agency nurses.
2. Internal float nurses are part of an internal pool that provides supplemental staffing at a substantially lower cost than using agency nurses.
3. Part-time nurses may work independently of organized supplement pools but still be assigned throughout the facility. Their salary typically is the same as or only slightly higher than that of regular staff.
4. Agency nurses used for supplemental staffing often earn two to three times the salary of in-house nurses.

Question 5

A critical care nurse has reported off because of an illness. Which choice of replacement for this nurse would provide the best continuity of quality nursing care?
A) A nurse from an outside agency
B) A nurse from a hospital unit that has a low census today
C) A nurse from a decentralized internal float pool
D) A nurse from the centralized internal float pool

Accepted Answer

1. Nurses from outside agencies may be unfamiliar with the routine in the unit, and their services are substantially more expensive. They may be used as supplemental staff, but continuity of care may be compromised.
2. Nurses from another unit may not have the expertise needed to care for clients on a highly specialized unit.
3. In decentralized pools, a staff member works for one unit manager or on only one unit. Highly specialized units tend to rely on decentralized internal float pool nurses.
4. A nurse from the centralized internal float pool would likely be familiar with facility policy, layout, and culture, but may not be skilled in caring for critically ill clients.

Question 6

The State Board of Health requests the employee file of all agency nurses employed within the past year. At the end of the review, the organization receives a sanction associated with these nurses. What is the most likely cause of this sanction?
A) No current address on file for the nurse
B) Past employment history not documented in file
C) Evaluation of the nurse's performance missing from file
D) No documentation of past certifications in file

Accepted Answer

1. The agency employing the nurse is required to maintain a file of the nurse's current address, past employment history, and past certifications.
2. The agency employing the nurse is required to maintain a file of the nurse's current address, past employment history, and past certifications.
3. The hiring organization must have a mechanism in place to evaluate agency nurses' performance.
4. The hiring organization is most interested in current certifications, not past certifications.

Question 7

A new nurse manager asks to see the Joint Commission manual in order to determine adequate staffing for the next shift. How should the supervisor respond to this request?
A) "The Joint Commission manual is kept with the other unit manuals."
B) "For that information you will need to refer to the human resources department's policy on employment manual."
C) "You need to look at the policy and procedure manual for the organization, not the Joint Commission manual."
D) "Before you look any further, refer to the unit's current schedule."

Accepted Answer

1. While this is likely a true statement, it does not get to the problem with the manager's statement.
2. Human resources policy on employment will refer to general employment guidelines for all employees, not guidelines on staffing ratios.
3. The policy and procedures of the organization will set staffing criteria. The Joint Commission only determines if the organization is following its own policy.
4. The current schedule will list vacancies but not the staffing guidelines for the unit.

Question 8

The hospital has elected to use the demand management staffing system instead of the client classification system. Because of this decision, the nurse manager who is staffing must focus on which of the following?
A) Immediate client needs
B) Historical data of expected client outcomes
C) Using hospital-wide data to staff individual units
D) Reduction of nursing care hours

Accepted Answer

1. Client classification systems focus on immediate client needs.
2. Demand management uses unit-specific historical data to determine client outcomes and nursing hours needed to meet these outcomes.
3. The data used to staff are client outcome data.
4. The goal is appropriate use of nursing care hours, not reduction.

Question 9

The unit has open shifts even after staff members have signed up for overtime. The chief nurse officer (CNO) does not want to hire agency nurses to cover these shifts. The nurse manager does not understand why the CNO is offering staff an incentive versus hiring agency nurses. Which would be a reasonable conclusion?
A) It takes a significant amount of time to orient agency nurses.
B) The agency nurses are costly.
C) There is a significant amount of documentation required for agency nurses.
D) The physicians are not comfortable with agency nurses.

Accepted Answer

1. Although it does take time and a significant amount of documentation to orient the agency this is not as big a problem as the cost.
2. Agency nurses are a considerable cost to an organization and their use may cause staff resentment since agency nurses may be making two or three times the salary of the in-house nurse. Usually it is more cost-effective to offer an incentive and overtime to the current nursing staff.
3. Although it does take time and a significant amount of documentation to orient the agency this is not as big a problem as the cost.
4. The physicians may not know that the nurse is from an agency. Their primary interest is that their client's needs are met.

Question 10

A newly hired nurse manager is being mentored in this new role. How should the mentor advise this manager regarding staffing for the next shift?
A) "First you must determine the nursing care hours needed."
B) "First you must become familiar with the classification system we use."
C) "First consider how to modify the schedule to meet client needs."
D) "First consider the need to supplement the current nursing staff so that arrangements can be made."

Accepted Answer

1. Nursing care hours can be determined after the nurse manager has become familiar with the current client classification.
2. The individual responsible for staffing should first become familiar with the staffing method used.
3. Modification of the schedule is part of the implementation process. Supplementing staff as needed is part of the implementation process.
4. Supplementing staff as needed is part of the implementation process.

Question 11

On two recent occasions, the experienced nurse manager has found it nearly impossible to discuss upcoming events with all the staff on the unit. What is a common reason for this problem?
A) The hospital is experiencing a nursing shortage, so staff members are very busy.
B) The client mix on the unit is much more varied.
C) The unit has just adopted combined staffing patterns.
D) There is a 1-hour overlap of staff between shifts.

Accepted Answer

1. A nursing shortage and a busy staff should not impact the manager's ability to communicate information to staff.
2. The amount of variation in client mix should not adversely affect the manager's ability to provide information to the staff.
3. A combined staffing pattern allows for such variation in shifts that the manager may not come into contact with all of the staff during the manager's work hours.
4. An overlap of staff should make communication easier for the manager.

Question 12

Which group determines the level of nursing care and hours of care necessary to meet the needs of the hospitalized client?
A) American Nurses Association (ANA)
B) The Joint Commission
C) Nurse managers
D) Hospital administrators

Accepted Answer

1. The American Nurses Association (ANA) has developed principles for nurse staffing, and the nurse managers follow these guidelines.
2. The Joint Commission does not identify specific levels of nursing care hours for specific client populations.
3. Staffing and scheduling is the responsibility of the nurse manager.
4. Although the hospital administration must ensure that the right number of competent staff is provided to meet client needs, the responsibility of staffing has been delegated to the nurse manager or charge nurse.

Question 13

A unit requires a great deal of staffing flexibility. To fill this need, the manager should use which strategy?
A) Maximizing the availability of nursing staff
B) Good communication among staff
C) A high RN-skill mix
D) Overlap between shifts

Accepted Answer

1. Maximizing the availability of nursing allows for more nurses but does not take into account the staffing mix. If the RN number is low, flexibility is lower.
2. Good communication among staff is very important but does not create the greatest flexibility.
3. A high RN-skill mix allows for more flexibility to meet client needs. An RN is educated and licensed to provide care that an assistant or LPN cannot provide.
4. Overlap between shifts may provide more staff, but if the staff members are not RNs, flexibility is not appreciably increased.

Question 14

The medical-surgical unit is at capacity and the clients have a high acuity, requiring care such as turning, bathing, toileting, and feeding. Which level of supplementary staff would be cost-effective?
A) Additional RNs
B) Additional unit clerks
C) Additional licensed practical nurses
D) Additional unlicensed assistive personnel

Accepted Answer

1. Additional RN staff would not be cost-effective for these tasks.
2. Additional unit clerks are not likely to alleviate this staffing issue.
3. Additional LPN staff would be less expensive than additional RN staff but are not the least expensive choice.
4. Additional unlicensed assistive personnel could provide the care needed if supervised.

Question 15

The medical-surgical unit's census has decreased since the previous shift. The manager is reviewing the staffing grid. Which factor is used to determine staffing mix?
A) Average daily census of the hospital
B) Client care needs
C) Number of staff on vacation
D) Financial productivity of the unit

Accepted Answer

1. The average daily census of the hospital probably will not have a direct bearing on the staffing mix of this unit.
2. The staffing mix should be based on the needs of the clients currently on the unit. A higher need for assessment, education, or discharge planning requires more RNs.
3. The number of staff on vacation is not an issue, as the clients still need care.
4. The financial productivity of the unit should not be an issue as that is historical data, not current client care need data.

Question 16

The administration of a healthcare organization has proposed a new client care area staffing system. Which components of this system do not meet the American Nurses Association (ANA) requirements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
A) RNs from across the facility were included on the committee that developed the system.
B) RNs will be required to accept flexible schedules that might require the nurse to practice on any unit in the facility.
C) The nurse's level of educational preparation will be considered in staffing decisions.
D) The number of clients and their acuity will be considered for staffing purposes.
E) When low census occurs the unlicensed assistant category will be first to be furloughed.

Accepted Answer

1. The ANA requires that staffing systems be developed with input from direct-care RNs.
2. The ANA requirements state that the RN cannot be forced to work on a unit without "having established that he or she is able to provide professional care on such a unit."
3. The ANA requirements state that staffing will "reflect the level of preparation and experience of those providing care."
4. The ANA requirements state that staffing will be "based on the number of clients and client-acuity level."
5. There is no mention of low census furlough in the ANA requirements for staffing systems.

Question 17

The nurse manager is explaining the organizational staffing policy to a newly hired nurse. The nurse will be scheduled on an as-needed basis. The manager explains this policy is a supplemental scheduling policy. Which staffing strategies would be included in this policy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
A) Contracting with outside agency nurses
B) A decentralized float pool
C) Using non-licensed personnel as substitutes for nurses
D) Establishing an internal float pool of nurses who are cross-trained
E) Developing a float pool of nurses shared with another hospital in the system

Accepted Answer

1. Agency nurses can be used as supplements, but their cost can be significant.
2. A decentralized float pool provides personnel who usually work only for one nurse manager or only on one unit.
3. Non-licensed personnel cannot be used as substitutes for nurses.
4. This can be an effective way to provide supplementary staff.
5. This is an innovative idea that creates a system-wide internal float pool.

Question 18

The nurse manager of an intensive care unit has several open shifts that require an RN to fill. Several nurses have taken overtime shifts but there are still several uncovered shifts. The chief nurse officer (CNO) decides to fill these vacancies with agency nurses. The CNO realizes that agency personnel must have which requirements prior to working in the facility? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
A) Current licensure to practice within the state
B) Orientation to the facility and the unit
C) Certification as an agency nurse
D) Documentation of malpractice insurance
E) Documentation of ability to work unsupervised in the environment

Accepted Answer

1. An agency nurse must have a current licensure to practice in the state in which the requesting organization resides.
2. The agency nurse must be oriented to both the facility and the agency.
3. There is not a certification for agency nurses.
4. Either the nurse or the supplying agency must have documentation of malpractice insurance that covers the nurse.
5. The nurse must be supervised by an in-house nurse and cannot work unsupervised.

Question 19

The nurse manager is explaining her staffing budget to the hospital administration. The manager has developed a flexible staffing pattern. The administration questions the manager as to why this pattern was developed. Which answer is most correct?
A) Staff members would prefer to make out their own schedules.
B) Nursing shortages and salary constraints have affected staffing patterns.
C) Lower client acuity has contributed to the need for more flexibility.
D) Flexible pattern staffing is the easiest method available.

Accepted Answer

1. The fact that staff members like to make out their own schedule is not pertinent to a flexible pattern.
2. Nursing shortages and wage constraints have necessitated an innovative approach to using the staff available to cover client care needs. A flexible staffing pattern can help fill this need.
3. Client acuity has risen, not lowered.
4. Flexible staffing can be very complex from a management standpoint.

Question 20

The nurse manager is determining the day's nursing care hours (NCHs) by analyzing the client workload. The unit census is 30 and there is a total of 220 nursing care hours. The average nursing hours per patient per day (NHPPD) figured to the nearest hundredth decimal point is ________.

Accepted Answer

The answer of The nurse manager is determining the day's...

Quiz 17: Staffing and Scheduling

A hospital has open shifts on its medical-surgical unit. The manager has listed open shifts on the hospital's intranet. This is an example of which type of scheduling?

The unpredictability of the labor and delivery area requires a set staff mix for every shift. Which type of staffing pattern should the manager use to ensure this mix?

The nursing staff of a medical-surgical unit would like to work four 10-hour shifts each week. For which reason would the unit nurse manager probably deny this request?

A nurse manager needs to supplement the staff for the next schedule. Which option would be the most significant drain on the unit's staffing budget?

A critical care nurse has reported off because of an illness. Which choice of replacement for this nurse would provide the best continuity of quality nursing care?

The State Board of Health requests the employee file of all agency nurses employed within the past year. At the end of the review, the organization receives a sanction associated with these nurses. What is the most likely cause of this sanction?

A new nurse manager asks to see the Joint Commission manual in order to determine adequate staffing for the next shift. How should the supervisor respond to this request?

The hospital has elected to use the demand management staffing system instead of the client classification system. Because of this decision, the nurse manager who is staffing must focus on which of the following?

A newly hired nurse manager is being mentored in this new role. How should the mentor advise this manager regarding staffing for the next shift?

On two recent occasions, the experienced nurse manager has found it nearly impossible to discuss upcoming events with all the staff on the unit. What is a common reason for this problem?

Which group determines the level of nursing care and hours of care necessary to meet the needs of the hospitalized client?

A unit requires a great deal of staffing flexibility. To fill this need, the manager should use which strategy?

The medical-surgical unit is at capacity and the clients have a high acuity, requiring care such as turning, bathing, toileting, and feeding. Which level of supplementary staff would be cost-effective?

The medical-surgical unit's census has decreased since the previous shift. The manager is reviewing the staffing grid. Which factor is used to determine staffing mix?

The nurse manager is explaining her staffing budget to the hospital administration. The manager has developed a flexible staffing pattern. The administration questions the manager as to why this pattern was developed. Which answer is most correct?

The nurse manager is determining the day's nursing care hours (NCHs) by analyzing the client workload. The unit census is 30 and there is a total of 220 nursing care hours. The average nursing hours per patient per day (NHPPD) figured to the nearest hundredth decimal point is ________.