Nursing Delegation and Management of

Patient Care 2nd Edition Motacki Test

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Chapter 12: Staffing and Scheduling
Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition

MULTIPLE CHOICE

1. Which ANA Principles for Nurse Staffing standards are applied to patient care?
a. Staffing levels that must be sufficient for providing quality patient care
b. Mandated staffing ratios
c. Recommended a new method for determining staffing needs
d. Staffing based on patient census
ANS: A
The principles identified by the ANA addressing patient care and staffing recommend that
staffing be maintained to provide quality patient care for the individual patient as well as the
unit population as a whole and not be based on previously used nursing hours per patient day.
Mandated staffing ratios is not a recommendation. The ANA recommended that the old
method be retired or at least questioned for its efficacy. Option D is incorrect because the
recommendation was that staffing be based on patient needs.

DIF: Cognitive Level: Application REF: pages 145-146

2. Which ANA Principles for Nurse Staffing standard is applied to staffing?

a. Nurse/patient ratios should be mandated.
b. Clinical competencies of the staff are standardized for all units.
c. Support of the staff nurses must come from all levels of nursing.
d. Experienced nurses should work the day shift because it is the busiest.
ANS: C
The principles presented by the ANA include the importance of support for the staff nurse
from all levels of nursing. Option A is incorrect because this is not included. Option B is
incorrect because the ANA recommends that staff competencies be consistent with the level
of patient care required. Option D is incorrect because it is not a recommendation of the ANA.

DIF: Cognitive Level: Application REF: pages 145-146

3. Which ANA Principles for Nurse Staffing standard is applied to the organization?
a. Nursing ratios are mandated.
b. The need for documented competencies for all nurses delivering patient care is
supported.
c. That nursing budgeted positions are not filled in a timely manner is accepted.
d. The needs of the staff nurse are secondary to the patient’s needs.
ANS: B
The principles related to the organization are mostly supportive of the nurse. Nursing ratios
are not included. Option C is incorrect because it is recommended that these unfilled positions
be filled in a timely manner. Option D is incorrect because the organization should consider
the needs of the nurse as comparable to the needs of the patients.

DIF: Cognitive Level: Application REF: pages 145-146

4. The process of determining daily staffing incorporates which factor?
a. Competency of staff
b. Nursing degree of staff
c. Acute change in patient acuity
d. Emergency department admissions
ANS: A
Nursing competency (regardless of degree attained) is the most important factor for
determining staffing. Options B and C are not factors determining daily staffing. Option D is
incorrect because emergency department admissions can change the makeup of the unit and
therefore cannot be planned.

DIF: Cognitive Level: Application REF: page 145

5. There are four major types of staffing plans. The centralized method of staff planning refers to
which of the following?
a. The schedule is planned based on the core staff.
b. The schedule is planned on each individual unit.
c. The schedule is planned by the nurses themselves.
d. The schedule is planned by the nursing service.
ANS: D
A centralized method refers to the nursing service or office making plans that affect the entire
organization. Option A is incorrect because it is not a type of scheduling method. Options B
and C are incorrect because they refer to other methods.

DIF: Cognitive Level: Application REF: page 148

6. There are four major types of staffing plans. The decentralized method of staff planning refers
to which of the following?
a. The schedule is planned based on the central or core staff.
b. The schedule is planned on each individual unit by the nurse manager.
c. The schedule is planned by the nurses themselves.
d. The schedule is planned by nursing service.
ANS: B
The decentralized schedule is done by the nurse manager and is very individualized to the
needs of that unit. Option A is not a plan for scheduling and is incorrect. Options C and D
refer to other scheduling methods.

DIF: Cognitive Level: Application REF: page 148

7. There are four major types of staffing plans. The self-scheduling method of staff planning
refers to which of the following?
a. The schedule is planned based on the central or core staff.
b. The schedule is planned on each individual unit by the nurse manager.
c. The schedule is planned by the nurses themselves.
d. The schedule is planned by nursing service.
ANS: C
Self-scheduling allows the nursing staff to accept full responsibility for staffing the unit.
Option A is not a plan. Options B and D are examples of centralized scheduling.
 DIF: Cognitive Level: Application REF: page 148

8. There are four major types of staffing plans. The mixed method of staff planning refers to
which of the following?
a. The schedule uses decentralized scheduling and its staffing needs are
supplemented by the centralized office.
b. The schedule is planned on each individual unit by the nurse manager.
c. The schedule is planned by the nurses themselves.
d. The schedule is planned by nursing service.
ANS: A
The mixed method combines both centralized and decentralized for scheduling. The other
options are incorrect because they refer to other methods.

DIF: Cognitive Level: Application REF: page 148

9. There are four major types of staffing plans used in the hospital setting. The primary
advantage of self-scheduling is which of the following?
a. It saves the nurse manager time.
b. It encourages negotiation among staff.
c. The most senior staff get first pick.
d. The freshman staff get the more undesirable shifts.
ANS: B
Self-scheduling forces staff to interact at a different level than before and can produce more
camaraderie and a better working environment. Option A is not the primary advantage to
using self-scheduling. Options C and D do not apply.

DIF: Cognitive Level: Analysis REF: page 148

10. What is the best advantage to preference scheduling for nurses?

a. Institutional rules can be applied.
b. Staff decide shifts.
c. Scheduling is determine by first-come, first-served basis.
d. Blocks of time are predictable.
ANS: B
Preference scheduling allows for staff requests or preferences. Option A refers to rules
scheduling. Option C refers to self-scheduling. Option D refers to pattern scheduling

DIF: Cognitive Level: Application REF: page 149

11. Most institutions use one or more types of future scheduling in their planning. Which of the
following provides advantages for the organization’s scheduling policies?
a. Pattern scheduling
b. Preference scheduling
c. Rules scheduling
d. Self-scheduling
ANS: C
 Rules scheduling allows the organization to apply the rules they believe are necessary for
scheduling. The other options do not provide advantages to the organization for scheduling.

DIF: Cognitive Level: Application REF: page 149

12. Most institutions use one or more types of future scheduling in their planning. Which of the
following provides advantages for creativity and staff satisfaction in scheduling?
a. Pattern scheduling
b. Preference scheduling
c. Rules scheduling
d. Self-scheduling
ANS: D
Self-scheduling allows for more creativity and staff satisfaction. The other options do not
provide advantages for the individual staff needs.

DIF: Cognitive Level: Application REF: page 149

13. Automated computerized staffing allows for which advantage to the institution?
a. Reduces workload of nurse manager
b. Provides coverage on weekends
c. Uses part-time staff
d. Provides coverage for daily changes in acuity of patients
ANS: A
Computerized staffing programs relieve the nurse manager of managing scheduling. The other
options are not an advantage to the organization.

DIF: Cognitive Level: Application REF: page 153

14. Automated computerized staffing allows for which advantage to the staff?
a. It reduces the workload of the nurse manager.
b. Staff has many options on a first-come, first-served basis.
c. It provides for changes in daily patient acuity.
d. Weekend options are available.
ANS: B
Everyone has availability at the same time on computers so there is an advantage to the first
user. The other advantages do not apply.

DIF: Cognitive Level: Analysis REF: page 153

15. A new nurse is interested in working a “weekend option.” Which of the following describes
this pattern of scheduling?
a. Nurse works two 12-hour shifts on the weekend and is paid for either 36 or 40
hours a week.
b. Nurse works five shifts a week with alternating weekends.
c. Nurse works three shifts a week and alternates weekends.
d. Nurse works alternating weekends and alternates shifts.
ANS: A
 Weekend option allows nurses to work every weekend and be paid for a full week’s work.
The other options do not reflect the weekend option.

DIF: Cognitive Level: Analysis REF: page 149

16. When calculating for staffing needs, what should be considered?

a. Weekend option
b. Hourly salary of employee
c. Productive versus nonproductive hours of an employee
d. Vacation time accrued
ANS: C
Staffing should include the number of hours each employee has earned in sick time, vacation
time, etc. Hours available to work are productive. Nonproductive hours are vacation, sick
time, etc. The other factors are not included for the FTE calculations.

DIF: Cognitive Level: Analysis REF: page 151

17. The best determinant of staffing needs is based on which factor?

a. Patient acuity
b. Productive time
c. Nonproductive time
d. Nurse/patient ratio
ANS: A
Patient acuity is the most influential determination for staffing. The other factors are not the
best determinant of staffing needs.

DIF: Cognitive Level: Application REF: page 151

18. What factors are primarily used when quantifying patient care required and staffing needs?
a. Number of patients per nurse
b. Number of discharges
c. Acuity and time required for care
d. Number of admissions
ANS: C
Patient acuity and care required are the most important elements in the patient classification
system. The other factors do not apply.

DIF: Cognitive Level: Analysis REF: page 147

19. What is the disadvantage to the institution in using external agency nurses?
a. Cost
b. Competency
c. Availability
d. Staff relationships
ANS: A
Agency nurses are very expensive compared with employees. A large percentage of the cost
to agencies is the overhead of the agency itself. The other options are incorrect because most
agencies have diminished this as a factor affecting patient care or job performance.
 DIF: Cognitive Level: Application REF: page 152

20. What is the advantage to the institution in using external agency nurses?
a. Competency
b. Availability
c. Cost
d. Staff relationships
ANS: B
Availability is the greatest advantage to the institution for using agency nurses. Competency
may or may not be a factor, and until the nurse is working on the unit, one can never know for
sure. The other options are not an advantage to the institution.

DIF: Cognitive Level: Application REF: page 152

21. Travel nurses have become very popular, especially among single, unattached nurses. Which
of the following is an advantage of contracting with a travel nurse to the agency?
a. Cost
b. Availability
c. Competency
d. Contractual agreement
ANS: D
Most travel nurses are contracted for 3 to 6 months and provide greater benefit to the
institution because of the longer employment time. The other factors are not an advantage to
the institution.

DIF: Cognitive Level: Application REF: page 152

22. Overtime to cover shortages in staff coverage can be a daunting problem. Which of the
following can be a short-term solution to a nursing shortage?
a. Increase length of shift.
b. Work a double shift.
c. Use an agency nurse.
d. Ask each shift to work 4 extra hours.
ANS: D
Asking both shifts prevents exhaustion of one nurse, which can lead to errors. The other
factors are not the best methods to use.

DIF: Cognitive Level: Application REF: page 153

23. In interviewing for a new position, a nurse may want to inquire about the institution’s views
on autonomy in the workplace for nurses. The nurse concludes that autonomy is valued when
told that the unit has
a. infrequent “floating.”
b. self-scheduling.
c. cover of another nurse’s assignment while she or he is on break.
d. hourly pay differential for the night shift.
ANS: B
 In a self-governance working environment, staff are encouraged to be autonomous, which
includes self-scheduling. Infrequent “floating” does not address autonomy. Option C is
incorrect because they are decisions made by the organization and are practiced throughout
the organization. Option D is incorrect because they are decisions made by the organization
and practiced throughout the organization.

DIF: Cognitive Level: Application REF: pages 148-149

24. The student nurse learns about the advantages and disadvantages of various patient care
delivery models. The student understands that besides an historical perspective of nursing
practice, a patient delivery care model may need to be instituted to adapt to
a. alterations in available staff due to weather emergencies.
b. the financial environment of the patient population.
c. a wide range of ages among the staff.
d. a limited number of unlicensed staff on the unit.
ANS: A
Patient delivery models are instituted based on various elements including clinical decision
making and work allocation; thus, changes may need to be made in an emergency based on
availability of staff. The other options are not fundamental elements used in the
decision-making process for delivery mode.

DIF: Cognitive Level: Application REF: pages 17-18

25. An agency nurse is assigned to work on a unit that uses the team nursing model of health care
delivery. Which of the following would the nurse expect to experience in this environment?
a. UAP taking vital signs and giving baths
b. RN taking vital signs and giving baths
c. RN delegating patient care delivery to a group of patients
d. Charge nurse delegating care delivery
ANS: C
In a team nursing environment, an RN delegates patient care to a group of patients. Option A
is incorrect because it is practiced in a functional model environment. Option B is incorrect
because it is seen in primary nursing. Option D is incorrect because it may be seen in all types
of health care delivery models.

DIF: Cognitive Level: Application REF: pages 20-21

26. In which health care delivery model would the nurse expect to see “point-of-care” decision
making occur?
a. Primary care nursing
b. Team nursing
c. Functional nursing
d. Modular nursing
ANS: A
Primary nursing allows the nurse to practice autonomously and make most bedside decisions.
The other options may not allow for the autonomy required for “point-of-care” decisions.

DIF: Cognitive Level: Application REF: page 21

27. A nurse has accepted a position on a nursing unit where the nurse manager promotes
autonomy and staff involvement in decision making. What would the nurse expect to observe
on this unit?
a. Nurse manager mandates changes.
b. Staff takes responsibility for assignments.
c. Staff participates on hospital committees.
d. Nurses are recognized for excellence in practice.
ANS: C
Work environments that promote autonomy and decision making encourage participation on
hospital committees so that staff may become involved in the decisions that are made. Option
A is incorrect because this is not an environment in which staff are encouraged to participate
in decision making. Option B is incorrect because it should be seen in all environments
regardless of autonomy. Option D is incorrect because it is not seen solely in autonomous
environments.

DIF: Cognitive Level: Analysis REF: pages 155-156

28. Leadership structures in health care can be centralized or decentralized. The nurse understands
that she is working in a centralized structured environment when which of the following
occurs?
a. All organizational decisions must be approved by the CEO.
b. Changes can be made rapidly based on immediate needs.
c. Nurses must work under a dual-authority structure.
d. Decisions can be made at the “point of care.”
ANS: A
In a centralized leadership structured environment, all decisions are made from the top down,
usually without input from staff. The other options are examples of a decentralized
environment in which decisions can be made more quickly as needed.

DIF: Cognitive Level: Application REF: page 148

29. The fundamental element of any patient care delivery combines work allocation with
a. patient acuity.
b. leadership.
c. clinical decision making.
d. delegation.
ANS: C
Work allocation is necessary in any patient care delivery system. The other factors are not
necessarily useful in determining the appropriate patient care delivery systems needed.

DIF: Cognitive Level: Analysis REF: page 23

30. A nurse who is interested in developing clinical decision-making skills would look for a unit
that practices which model for health care delivery?
a. Primary nursing
b. Team nursing
c. Functional nursing
d. Case management
 ANS: A
Clinical nursing skills are enhanced in a primary nursing environment because of the
autonomy nurses receive. The other models do not necessarily promote the development of
decision-making skills.

DIF: Cognitive Level: Application REF: page 21

31. A nurse would expect to see which action on a unit that uses the team nursing model of health
care delivery?
a. The nurse makes patient care decisions at the bedside.
b. The nurse delegates patient care to other team members.
c. The nurse works on discharge plans on admission.
d. The UAP takes vital signs on the patients on one hallway.
ANS: B
The nurse delegates and works collaboratively with the members of the team in team nursing.
Option A is an example of primary nursing. Option C is an example of case management
nursing. Option D is an example of functional nursing.

DIF: Cognitive Level: Application REF: pages 20-21

32. A nurse working on a unit using the primary care delivery model would expect to observe
which practice specific to primary care delivery?
a. The UAP measures blood sugar levels on all patients.
b. The RN administers medications to a team of patients.
c. The RN verifies a new order for patient started on an antihypertensive with a blood
pressure of 100/60 mm Hg.
d. The RN holds the morning dose of insulin for a patient scheduled for surgery later
that day.
ANS: D
In a primary nursing environment, nurses function autonomously and make clinical decisions
at the bedside. Option A is an example of functional nursing. Option B is seen in team
nursing. Option C is seen in all patient care delivery models.

DIF: Cognitive Level: Analysis REF: page 21

33. Which action by the nurse indicates a primary care delivery model environment?
a. Development of the plan of care by primary RN to be used on all shifts
b. Calling the physician for clarification after an illegible order is written
c. The unit secretary takes off all orders initially.
d. The charge nurse makes all patient care assignments.
ANS: A
The nurse develops the plan of care on admission for the remainder of the admission. The
other actions are seen in many delivery care models.

DIF: Cognitive Level: Analysis REF: page 21

34. In a team nursing health care delivery model environment, the nurse would observe for which
action by the staff?
a. The UAPs answer all call lights.
 b. The charge nurse is notified when there are patient complaints about care.
c. The UAPs answer their patients’ call lights.
d. The RN is notified when there are patient care complaints.
ANS: D
Nurses are completely responsible for the needs of their patients in a primary care delivery
model. Option A is seen in functional nursing. Option B can be seen in models other than
primary nursing. Option C is seen in team nursing.

DIF: Cognitive Level: Analysis REF: pages 20-21

MULTIPLE RESPONSE

1. Part-time staffing by nurses includes which advantages? (Select all that apply.)
a. Provides a backup
b. Maintains skills
c. Increases income
d. Provides life outside of family
e. Maintains education
ANS: B, C, D
Options B, C, and D are an advantage to the individual. The advantage to the institution is to
cover and support the full-time staff. The other options are not advantages to part-time staff.

DIF: Cognitive Level: Analysis REF: page 152

2. The patient care delivery system used by an institution should be based on which fundamental
elements? (Select all that apply.)
a. Work allocation
b. Accountability
c. Allocation of resources
d. Mission statement
e. Leadership style
f. Cultural diversity of patients
ANS: A, B, D
According to the text work allocation, accountability, and mission statement are fundamental
elements of any patient care delivery system. The other options are not fundamental elements
of a patient care delivery system.

DIF: Cognitive Level: Application REF: pages 18-19