Preview Extract
Chapter 5
1. Two medical−surgical nursing directors are evaluating the efficiency and effectiveness of
the current nursing care delivery model. Which of the following factors would the directors
include in the evaluation of the current model of care?
Select all that apply.
1. Quality patient care
2. Patient satisfaction
3. Nursing job satisfaction
4. Cost-effectiveness
5. Design of nursing unit
6. Availability of labor pool
Answer: 1. Quality patient care
2. Patient satisfaction
3. Nursing job satisfaction
4. Cost-effectiveness
Rationale:
Quality patient care. The efficiency and effectiveness of any system usually is evaluated by
measuring four factors: quality patient care, patient satisfaction, nursing job satisfaction, and
cost-effectiveness. Patient satisfaction. The efficiency and effectiveness of any system usually
is evaluated by measuring four factors: quality patient care, patient satisfaction, nursing job
satisfaction, and cost-effectiveness. Nursing job satisfaction. The efficiency and effectiveness
of any system usually is evaluated by measuring four factors: quality patient care, patient
satisfaction, nursing job satisfaction, and cost-effectiveness. Cost-effectiveness. The
efficiency and effectiveness of any system usually is evaluated by measuring four factors:
quality patient care, patient satisfaction, nursing job satisfaction, and cost-effectiveness.
Design of the nursing units. The intent of the unit design is to reduce the time licensed nurses
spend performing non-nursing tasks. The American Institute of Architects published design
standards that promote the safety of clients and staff. Availability of labor pool. The
availability of the labor pool is an important variable to consider when selecting a nursing
care delivery system.
2. A registered nurse is providing care for a client who lived alone prior to hospitalization.
The client’s functional status has changed to the point of being unable to live alone anymore.
The client is considering moving into an extended care facility. After communicating this
information to the charge nurse of the unit where team nursing is practiced, the charge nurse
would:
1. Assist the registered nurse in setting up a multidisciplinary conference to discuss the
discharge needs of the client.
2. Assist the registered nurse in getting a case manager involved in the discharge process for
the client.
3. Assume the responsibility for discharge planning for the client.
4. Assume responsibility for the care of the registered nurse’s patients to allow for direct
communication by the registered nurse with the client’s health care provider.
Answer: Assist the registered nurse in setting up a multidisciplinary conference to discuss the
discharge needs of the client.
Rationale:
In team nursing, the registered nurse performs decision making and coordinates care
conferences for patients with complex health needs. The charge nurse in this system is
responsible for facilitating communication between multidisciplinary caregivers; thus, the
charge nurse can assist the registered nurse in arranging for a multidisciplinary care
conference. The charge nurse in the case method would suggest getting a case manager
involved, representing a collaborative effort between the bedside nurse, case manager, and
health care provider to ensure the continuity of care for clients with changes in their level of
care requirements. In functional nursing, the charge nurse would assume the role of discharge
planer for the client. Charge nurses are not involved in the direct communication between the
nurse and the health care provider regarding client care issues in the primary nursing model
of care. The charge nurse would assist the registered nurse with other client care issues while
the primary nurse managed the care of a client with a changing condition.
3. The nurse is providing care to patients for whom she has 24-hour accountability and
responsibility. The care delivery system within which the nurse is functioning is most likely:
1. Primary nursing.
2. Case method.
3. Functional nursing.
4. Team nursing.
Answer: Primary nursing.
Rationale:
Primary nursing is defined as a system in which each patient is assigned to a nurse who has
24-hour responsibility for the nursing care delivered to the patient. The case method of
delivering nursing care is sometimes referred to as total patient care. The RN is responsible
for the patient and has total care responsibility for the patient during the shift worked.
Functional nursing is a delegation of tasks over one shift worked. In team nursing, patients
are assigned to a nursing team that is usually led by an RN. The team is responsible for the
patients’ care during the one shift of duty.
4. A nurse has been practicing in a functional nursing care delivery system. Which of the
following is the nurse most likely going to demonstrate?
1. Boredom
2. Joy
3. Success
4. Satisfaction
Answer: Boredom
Rationale:
In a functional nursing care delivery system, nurses report a lack of satisfaction with their
work because tasks are boring or because there is difficulty identifying the effect of their
work on their patients. Functional nursing resembles assembly-line tasking and the
fragmentation of tasks results in a perceived lack of accountability and increased frustration.
Nurses in a functional nursing care delivery system are not characterized by feelings of
satisfaction.
5. A hospital utilizes the functional nursing care delivery system and the client satisfaction
scores have been decreasing in each quarter of the past year. The decrease in client
satisfaction could be due to the:
Select all that apply.
1. Fragmentation of the nursing care.
2. Lack of confidence in the caregivers.
3. Lower health care costs.
4. Utilization of advanced practice nurses.
5. Efficiency of the nursing staff.
Answer: 1. Fragmentation of the nursing care.
2. Lack of confidence in the caregivers.
Rationale:
Fragmentation of the nursing care. Functional nursing is a type of industrial model of
efficiency that resembles the assembly-line tasking and fragmentation of tasks among the
nursing staff and results in an appearance of lack of accountability and increased frustration.
Lack of confidence in the caregivers. Reduced patient satisfaction is linked to fragmented
care and results in the lack of confidence in caregivers. Lower health care costs. Facilities
choose the functional nursing model in an effort to be efficient and to lower labor costs by
hiring lower-paid workers such as unlicensed assistive personnel. Lower health care costs,
however, do not usually result in a decrease in client satisfaction. Utilization of advanced
practice nurses. Advanced practice nurses are possibly used as health care provider extenders
and not in the role of providing coordinated care. This is not usually associated with a
decrease in client satisfaction. Efficiency of the nursing staff. Clinical decision making rests
with the charge nurse, and the registered nurse is responsible for delegating tasks to personnel
in congruence with the state nurse practice act. Efficiency of skill is a desired outcome for
management. This is not usually associated with a decrease in client satisfaction.
6. A registered nurse is seeking employment at a hospital with magnet status after hearing
about the high nurse satisfaction at this hospital. High nursing satisfaction in a hospital with
magnet status rating is a result of the utilization of:
1. Professional autonomy.
2. Unlicensed assistive personnel.
3. Charge nurses.
4. Team nursing.
Answer: Professional autonomy.
Rationale:
Professional autonomy allows nurses to have control over their individual nursing practice.
The use of unlicensed assistive personnel (UAP) calls for the delegation of nursing practice
based on the skill and experience of the UAP. Charge nurses may have more autonomy than
the bedside nurse when functional nursing or team nursing care delivery models are utilized.
Charge nurses in the case method are more attuned to day-to-day operations of the units and
providing consultation for the bedside nurse. Delegation of tasks is also part of the RN role in
the team nursing model and can lead to dissatisfaction if communication skills are not
effective among the team members.
7. A registered nurse (RN) wants to delegate the insertion of an anchored catheter to a
member of the unlicensed assistive personnel (UAP) staff. The RN bases the decision to
delegate on which of the following?
1. The RN decides who is competent to perform the catheterization based on the state’s nurse
practice act.
2. The RN determines who has the most time to insert the catheter.
3. The RN relinquishes the accountability for the outcome of the procedure to the UAP.
4. The RN recognizes there is no need to evaluate the outcome of the procedure performed by
the UAP.
Answer: The RN decides who is competent to perform the catheterization based on the state’s
nurse practice act.
Rationale:
The state’s nurse practice act authorizes the scope of responsibility and grants the authority to
delegate based on the competency and qualification of the person who is receiving the
delegation. The time involved in the procedure is not a valid criterion for delegation;
delegation is based on competency, qualifications, job descriptions, and state nurse practice
acts. The RN retains the authority and accountability for the outcome of the worker’s
performance. The RN must know how to supervise the personnel to whom he/she delegates
and must intervene when necessary.
8. “To delegate is to transfer authority to a competent individual for completing selected
nursing tasks/activities/functions” is the formal definition of delegation by the:
1. The National Council of State Boards of Nursing.
2. The Joint Commission.
3. The California Nursing Outcomes Coalition.
4. The American Nurses Credentialing Center.
Answer: The National Council of State Boards of Nursing
Rationale:
The National Council of State Boards of Nursing oversees the state boards of individual
states and is one of the governing bodies that guide the practice of nursing. The Joint
Commission has no definition for delegation. The California Nursing Outcomes Coalition is
an organization developing a database of patient outcomes and hospital statistics. The
American Nurses Credentialing Center established the 14 forces of magnetism.
9. A registered nurse is working in a facility where delegation to unlicensed assistive
personnel is part of the nursing care delivery system. The type of care delivery model that is
being practiced in this facility is either _________________ or _______________________.
1. Functional nursing; team nursing
2. Case method; functional nursing
3. Team nursing; primary care nursing
4. Primary care nursing; relationship-based care
Answer: Functional nursing; team nursing
Rationale:
The functional nursing and team nursing models rely heavily on the use of unlicensed
assistive personnel to provide care that is task-oriented. In the case method, the registered
nurse (RN) provides total patient care in an all-RN environment. The primary care and
relationship-based care models do not utilize UAPs; these systems are more likely to
incorporate the advanced practice nurse into their care delivery.
10. The nurse manager has been charged with evaluating and determining if the current
system of team nursing is efficient and cost effective for the unit. Which of the following
statements supports the cost-effectiveness of team nursing on this unit?
1. Team nursing is cost-effective since it allows for the use of unlicensed assistive personnel
to provide care delegated by the registered nurse.
2. The Institute of Medicine’s 2004 report Keeping Patients Safe identified team nursing as
being the most cost-effective care delivery system.
3. Research conducted by Aiken, Buerhaus, Kramer, and Needleman concludes that team
nursing is the most cost-effective care delivery system.
4. Managed care organizations provide financial incentives to institutions that use team
nursing as a means to decrease the high cost of registered nurse salaries.
Answer: Team nursing is cost-effective since it allows for the use of unlicensed assistive
personnel to provide care delegated by the registered nurse.
Rationale:
In response to nursing shortages, health care institutions tend to utilize a nursing care delivery
system that uses a variety of licensed nurses and unlicensed assistive personnel. Team nursing
is a model that utilizes licensed and unlicensed personnel. The Institute of Medicine and the
nurse researchers have not found sufficient evidence that supports any one particular model
of care delivery as being the most cost-effective. Managed care financial initiatives are
centered on directing patients to the most cost-effective and efficient treatment center.
11. The nursing care delivery model that would not be preferred during economic downturns
and nursing shortages would be:
1. Primary care nursing.
2. Case method.
3. Functional nursing.
4. Team nursing.
Answer: Primary care nursing.
Rationale:
Primary care nursing may not be the preferred system during downturns in the economy and
cyclical nursing shortages because of the perception that labor costs are high due to the large
numbers of registered nurses employed by a facility. The case method utilizes an exclusive
registered nurse staff in intensive care units where client acuity is high and there is a need for
the holistic and comprehensive care delivered by a registered nurse. Functional and team
nursing allows for the inclusion of unlicensed personnel who are lower-paid workers to
whom the registered nurse can delegate tasks.
12. A health care organization has a limited salary budget. Which of the following care
delivery systems would be the most cost prohibitive for this organization?
1. Case method
2. Functional nursing
3. Primary care nursing
4. Team nursing
Answer: Case method
Rationale:
In the case delivery system, all patients have a registered nurse (RN) assigned to them. This
type of delivery system requires exclusive use of an all-RN staff. Functional, primary, and
team nursing all include the use of licensed (practical nurse) and unlicensed assistive
personnel when providing patient care.
13. The scope of practice of an advanced practice nurse in any nursing care delivery model is
determined by:
1. The state board of nursing.
2. The Joint Commission standards for nursing practice.
3. The job description for the advance practice nurse.
4. The educational preparation of the advance practice nurse.
Answer: The state board of nursing
Rationale:
The state board of nursing of the state in which the nurse resides determines the scope of
practice of the advanced practice nurse. The Joint Commission does not determine the scope
of practice for nursing. The job description delineates the roles and responsibilities of
individuals within an organization. The advanced practice nurse is a registered nurse with
advanced education, knowledge, and skills whose practice can vary based on the scope of
practice of the state in which the nurse works.
14. A health care organization frequently uses case managers. The care delivery system that
would most likely support this role of the nurse would be:
1. Functional nursing.
2. Case method.
3. Primary care nursing.
4. Team nursing.
Answer: Functional nursing.
Rationale:
The chief function of the case manager is to collaboratively plan, coordinate, and evaluate
services in a cost-effective manner. Nurse case managers interact with health care team
members to reduce fragmentation and improve outcomes. In many settings, case managers do
not provide direct patient care. Because functional nursing is the most fragmented type of
care, case managers are necessary. In the case method of patient care, the registered nurse
often will serve as the manager of patient care. Within the primary care nursing model, the
primary nurse will function in the role of case manager. Within team nursing, the team leader
can function in the role of case manager.
15. The chief function of the ________________ is to collaboratively plan, coordinate, and
evaluate services in a cost-effective manner.
1. Nurse practitioner
2. Clinical nurse specialist
3. Case manager
4. Clinical nurse leader
Answer: Case manager
Rationale:
The chief function of the case manager is to collaboratively plan, coordinate, and evaluate
services in a cost-effective manner. The nurse practitioner in the hospital setting extends the
health care provider’s capabilities and offers consultative services to the registered nurse in
all delivery care models. The clinical nurse specialist can provide expertise and education to
the bedside nurse in all care delivery systems. The clinical nurse leader manages client
services across multidisciplinary boundaries at the bedside and can be a resource to the
bedside nurse.
Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268
