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nursing
Leadership Effective staffing
| Question | Answer |
|---|---|
| What is meant by full time equivalent (FTE)? | A measure of the work commitment of an employee who works five days a week or 40 hours per week for 52 weeks a year which amounts to 2,080 hours of work time |
| What are productive hours? | Hours of work and availability for patient care |
| What are non-productive hours? | Benefits such as vacation time, sick time, education time |
| Time spent providing hands on care to a patient? | direct care |
| Time spent that supports patient care but is not directly involved with the patient? | indirct care |
| What are units of measure? | A variety of volume measures that are used to reflect different types of patient encounters as indicators of nursing workload |
| What is nursing hours per patient days (NHPPD)? | Amount of nursing care required per patient in a 24 hr. period and is usually based on midnight census and past unit needs, expected unit practice trends, national benchmarks, professional staffing standards, budget negotiations |
| What does NHPPD reflect? | Only productive nursing time |
| What is nurse intensity? | A measure of the amount and complexity of nursing care needed by a patient |
| What is nurse intensity based on? | severity of illness, pt. dependency for ADL's, complexity of care, amount of time needed for care |
| What is patient turnover? | Measure reflecting patient admission, transfer, discharge; all of which entails RN intensive procedures |
| What is the patient classification system (PCS)? | Measurement tool used to articulate the nursing workload for a specific patient over a specific period of time |
| Measure of nursing workload that is generated for each patient | patient acuity |
| What are the two types of classification systems? | factor and prototype |
| What is the factor system? | Nursing task are assigned time or weighted to reflect the amount of time needed to perform a the task; assessment, planning, intervention and evaluation of pt. outcomes along with written documentation processes |
| What are the advantages of the factor system? | Data is generally readily available to managers and staff for day to day operations; data provides a base of info that one can justify changes in staffing requirements |
| What are the disadvantages of the factor system? | On going workload for nurses in classifying pts daily; documented problems with classification creep whereby acuity levels rise as a result of misuse of criteria; systems do not capture pt. need for psychosocial, environmental and health managment support |
| CONTINUED - What are the disadvantages of the factor system? | These systems calculate nursing time based on a typical nurse; a novice nurse may take longer to perform activities than the average nurse; recommended time may differ from actual time needed based on expertise of the staff |
| What is the prototype system? | Allocates nursing time to large pt. groups based on an average of similiar pts. Example: DRG's which bases the nursing acuity level. Past data is used to determine cost of nursing care and reflect level of nursing care required and provided |
| What is the advantages to the prototype system? | Reduction of work for the nurses because daily classification is not needed. |
| What is the disadvantages to the prototype system? | DRG's do not accurately reflect pt. nursing needs because medical diagnosis alone does not adjust for variances in pts. self care ability and severity of illness |
| CONTINUED - What is the disadvantages to the prototype system? | there is no ongoing measure o fthe ctual nursing work required by individual pts. and no ongoing data to monitor the accuracy of the preassigned nursing care requirements. |
| Which system is the most common? | Factor system |
| How is acuity data and NHPPD helpful? | cost out nursing services for specific patient populations and global patient types; negotiates payment rates with 3rd party payers for reinbursement, preparation of nursing staffing budget for upcoming year, used to develope a staffing pattern |
| What is benchmarking? | Tool used to compare productivity across facilities to establish performance goals |
| What are some considerations in developing a staffing plan? | Benchmarking, regulatory requirements, skill mix, staff support, historical information |
| Percentage of RN staff compared to other direct care staff? | skill mix |
| What is a staffing plan? | Articulates how many and what kind of staff are needed by shift and day to staff a unit or department |
| What are the two ways in developing a staffing plan? | Determine the required ratio of staff to patients; nursing hours and total FTE's are then calculated. OR determine the nursing care hrs. needed for a specific pt. or pts and then generate the FTE's and staff to pt ratio needed to provide care. |
| What is a inpatient unit? | Provides pt. care 24 hrs./day seven days a week |
| What is the average daily census (ADC)? | Calculated by taking the total number of pts at census time,usually midnight, over a period of time (weekly, monthly, yearly)and divide by the number of days in the time period. |
| What is a episodic care unit? | A unit that sees patients for defined episodes of care such as dialysis or ambulatory care units |
| Who is responsible for scheduling of staff? | nurse manager |
| What is continuity of care? | The follow thru in pt. care that is inherent in having the same nurse return to care for pts. in subsequent shifts on sequential days of the week. |
| What is self scheduling? | This is where unit staff take leadership in creating and monitoring the work schedule while working within defined guidelines |
| Oldest model for nursing care delivery? | Case method |
| What is the case method? | The nurse cares for one patient exclusively |
| What is total patient care method? | The nurse is responsible for the total care for assigned patients for the shift worked |
| What is the advantages of total patient care? | Consistency of one individual caring for patients for an entire shift and allows the pt. & family to develop a relationship based on trust; provides higher # of RN hours of care, allows the nurse more opportunity to observe and monitor the patient |
| What is the disadvantage of total patient care? | Utilizes a higher number of RN nursing hours to deliver care and is more expensive |
| What is the best setting to use this model? | specialized units such as hospice where pt. and family needs are unstable & require frequent RN assessment and interventiions |
| What is the functional nursing method? | Allows LPN's and UAP's to take on task that were previously carried out by the RN in the case method; divides the nursing work into functional roles that are then aassigned to one of the team members. |
| What are the advantages of functional nursing? | Care can be delivered to a large number of pts., utilizes healthcare workers when there is a shortage of RN's, pt. get care by several staff in one shift |
| What are the disadvantages of functional nursing? | Communication blocks, pt. receive technical care vs. professional nursing care, pt. become the sum of the tasks of care vs. an integrated whole |
| What is team nursing? | Care delivery model that assigns staff to teams that then are responsible for a group of patients |
| What is modular nursing? | Delivery system that is a kind of team nursing that divides a geographic space into modules of patients with each module cared for by a team of staff led by an RN |
| What are the advantages of modular nursing? | the RN is able to get work done thru others |
| What are the disadvantages of modular nursing? | Patients often receive fragmented, depersonalized care. Communication is complex, the shared responsibility can cause confusion & lack of accountability, RN dissatisfaction with these modules |
| What qualities must a RN possess to run a modular nursing? | good delegation and supervision skills |
| What is primary nursing? | Care delivery model that clearly delineates the responsibility and accountability of the RN and designates the RN as the primary provider of care to patients. |
| What are the advantages of primary nursing? | Patients and families are able to develop a trusting relationship with the nurse, there is defined accountability and responsibility, facilitates continuity of care vs. shift to shift focus, nurses find it rewarding |
| What are the disadvantages of primary nursing? | High cost due to higher RN skill mix, RN needs to be match up w/pt. appropiately, nurses may have to travel long distance to care for pt., nurse to pt. ratio must be realistic to ensure enough time is allotted for pt. care, nurses perform lower skill work |
| What is patient centered care or patient focused care? | Designed to focus on pt. needs rather than staff needs. In this model required services and care are brought to the patient |
| What are the advantages of the pt. centered care or pt. focused care? | Most convenient for pts. and expedited services to pts. |
| What are the disadvantages of the pt. centered care or pt. focused care? | Extremely costly, seen as a way of reducing RN's and cutting cost at the hospital |
| What is work flow analysis? | Tool used to determine what activities are value added and how to streamline or eliminate those that do not contribute to improved patient outcomes |
| What is value added? | Activities that the customer is willing to pay for, that must be done right the first time, and somehow change the product or service in some desireable manner |
| What is LOS? | Length of stay |
| Why was DRG's created? | payment system for hospitals based on a specific patient type |
| What is clinical pathways? | Care management tools that outline the expected clinical course and outcomes for a specific pt. type; should be evidence based reflecting the best knowledge to date for pt. care |
| CONTINUED - What is clinical pathways? | It outlines the normal course for a pt and for each day, expected outcomes are articulated. Patient progress is measured against expected outcomes |
| What are the advantages of clinical pathways? | Powerful tool for managing care, very instructive for new staff, saves time in the process of care, improves care, reduces variabiliy and shortens LOS, allows for data collection |
| What are the disadvantages of clinical pathways? | Some practitioners see it as a cookbook medicine and are reluctant to participate, multidisciplinary pathways require a lot of work, non-standard pt. populations it is less effective because of the constant modificaiton of the pathway to reflect pt. needs |
| What is case management? | Strategy to reduce care and improve hospital cost thru coordination of care; the case manager is responsible for coordinating care and establishing goals from preadmission thru discharge. A nurse is assigned to a specific high risk population of pts |
| What do patient classification systems predict? | nursing time required for groups of patients; the data can be utilized for staffing, budgeting, and benchmarking |
| What does it require to determin the number of FTE's needed? | Review of pt. classification data, units of service, regualatory requirements, delivery systems, skill mix, staff support, historical information, physical environment of the unit |
| What must the nurse manager need to consider when scheduling staff? | patient need and intensity, volume of pts., needs and experience of the staff |
| What is critical to assess when staffing plans are chosen? | It is critical to assess the effect of staffing decisions on patient care and finances |
| What does self scheduleing promote? | morale and professional growth |
| What is needed for self scheduling to be a success? | clear boundaries and guidelines |
| How often should evaluations on the outcomes of your staffing plan on pts., staff and the organization be done? | It should be done daily, monthly, annually |
| Care management tools that have been developed to improve patient care and reduce hospital cost and should be evidence based? | Case management and clinical pathways |
| What is ADC? | Average daily census-take total number of patients in a time period and divide it by the number of days in that time period |
| How do you know what your staffing needs are? | Better matching of patient needs to nursing resources; look at acuity level |
| NHPPD only reflects what? | productive time |
| How we classify patients; a tool used to determine nursing workload for a specific patient or group of patients over a specified period? | PCS - patient classification system |
| Measure of the amount and complexity of nursing care needed by a patient? | nursing intensity |
| Classification system that uses unit of measure that equates to nursing time & attempts to capture the nursing process along with written documentation process; most popular type of classification system; made daily & sometimes every shift? | factor classification system |
| What are the advantages and disadvantages of factor classification systems? | Data readily available for day to day operations & justifies changes in staffing. Disadvantages are ongoing work load, classification creep & bases time on typical nurse; does not capture total pt. needs |
| Classification system that allocates nursing time to large pt. groups based on an average of similiar patients? | prototype systems |
| What are the advantages and disadvantages of protype system? | Reduces work for nurses due to not classifying pt.s daily. Disadvantage is that it doesn't reflect pt. nursing needs; no ongoing measure of actual nursing work required by pt. or data to monitor the accuracy of the preassigned nursing care requirements |
| Does Joint Commision regulate staffing levels? | no, but they will ask what system you are using to staff such as are you staffing by acuity level or number of patients) |
| Can be helpful in establishing a starting point for staffing pattern but is a tool used to compare productivity across the facility to establish performance goals? | benchmarking |
| Percentage of RN staff to other levels of staff? | mixed skill |
| What is staff support? | Supports to help the unit function (transportation, secretarial services, maintenance, dietician, ect....) |
| What are the two ways to establish a staffing plan? | 1. Determine ratio of staff to pts. then calulate nursing hours and FTE's 2. Determine the nursing care hours for patient(s) then generate the staff to pt. ratio needed to provide care |
| In this model each care provider is responsible for specific duties or tasks; technical rather than professional nursing care often results | functional nursing |
| What are the advantages of functional nursing? | Delivers care to a large number of patients, uses other types of healthcare workers when there is a shortage of RN's |
| What are the disadvantages of functional nursing? | lack of continuity of care and pt. may feel that care is disjointed |
| What is team nursing? | A unit is divided into two or more teams led by RN which supervises & coordinates her team; care is divided among workers according to skill level |
| What are the advantages to team nursing? | Maximizes role of RN & nurse able to get work done through others |
| What are the disadvantages to team nursing? | Pt. get fragmented, depersonalized care, communication is complex, shared responsibility and accountability can cause confusion |
| Team nursing divided up by geographical location? | modular nursing delivery system |
| Clearly delineates the responsibility & accountability of the RN and places the RN as the primary provider of care regardless of location & other nurses caring for the same pt. must follow the RN's plan of care for those pts? | Primary nursing |
| What are the advantages of primary nursing? | Trusting relationship built between RN and pt./pt. family, accountability & responsibility of plan of care clearly defined, facilitates continuity of care, authority of decision making given to RN at the bedside |
| What are the disadvantages of primary nursing? | cost is high due to the higher RN skill mix, Lack of geographical location boundaries of pts., nurse to pt. ratio must be realistic |
| Designed to focus on pt. needs rather than staff needs? | pt. centered or pt. focused care |
| Tool used to determine what activities are value added; helps to eliminate activities that doesnt contribute to pt. outcomes? | work flow analysis |
| Same as core measures? | clinical pathways |
| What are clinical pathways? | Multidisciplinary management tool based on evidence-based practice that outline the expected clinical course & outcomes for specific pt. type; includes expected outcomes specified for ea. day of care; pt. progress is measured against expected outcomes |
| What are the advantages of clincal pathways? | Very instructive to new staff, saves time in process of care, improved care and shortened length of stay in most cases; allows for data collection of variances to the pathway |
| What are the disadvantages of clinical pathways? | Some MD think of it as cookbook medicine & are resistant to it; development takes alot of work and time; less effective for pt. populations that are nonstandard due to constant modifying of needs |
| Is responsible for coordinating care and establishing goals from preadmission through discharge; evaluates pt. outcomes daily & compares that to predicted outcomes; works with all disciplines to facilitate care? | case manager |
| Two care management tools used to improve pt. care; reduce hospital cost and is evidence based? | clinical pathways and case management |
Created by:
lcm484