Nursing Delegation, Setting Priorities, And Making Patient Care Assignments 2nd Edition by Patricia Kelly -TB

Nursing Delegation, Setting Priorities, And Making Patient Care Assignments 2nd Edition by Patricia Kelly -TB

Chapter 4: Time Management, Setting Priorities, and Making Assignments

MULTIPLE CHOICE

1. “A set of related common-sense skills that helps people to use their time in the most effective and productive way possible” is the definition of __________.

a.

making assignments

b.

time

c.

setting priorities

d.

time management

ANS: D

Time management has been defined as “a set of related common-sense skills that helps people to use their time in the most effective and productive way possible” (Mind Tools, 2006). The application of time management principles and techniques enables people to achieve more with the time they have available. Time management can assist nurses in making assignments and setting priorities.

PTS: 1 DIF: Knowledge TOP: General Time Management Techniques

2. The Pareto Principle pertains to a strategy for balancing life and work through the prioritization of efforts. Which is correct regarding this principle?

a.

80% of unfocused effort results in 20% of results.

b.

20% of focused efforts

results in 20% of results.

c.

80% of focused effort results in 20% of results.

d.

30% of unfocused effort results in 70% of results.

ANS: A

The Pareto Principle was designed by Vilfredo Pareto as a means to assist people with managing their given time in the most productive manner. The principle states that 80% of unfocused effort results in 20% of results, and conversely that 20% of focused effort results in 80% of results (Pareto Principle, 2008).

PTS: 1 DIF: Comprehension

TOP: General Time Management Techniques

3. Why do some people choose to not utilize time management principles to assist them in a more productive use of their time? Some reasons for this are listed below. Which is not necessarily correct?

a.

They do not know about time management.

b.

They think they have time to plan.

c.

They do not want to stop to plan.

d.

They love crises.

ANS: B

The utilization of good time management techniques and skills has been proven to assist in achieving desired outcomes. However, not everyone may choose to use good time management skills. Some reasons for this include: 1) they do not know about time management; 2) they think they do not have time to plan (not they think they have time to plan); 3) they do not want to stop to plan; and 4) they love crises.

PTS: 1 DIF: Application TOP: General Time Management Techniques

4. Nursing time is valuable and is compensated through salary and benefits. What percentage do benefits comprise of the total cost per employee?

a.

10 % to 15%

b.

15% to 30%

c.

30% to 50%

d.

50% to 60%

ANS: B

Nursing time is valuable time and, often enough, nurses do not understand how their time is compensated in addition to their salary. Benefits play a key part of nurse and employee compensation and may comprise between 15% to 30% of the total cost per employee.

PTS: 1 DIF: Knowledge TOP: Value of Nursing Time

5. An activity log is another time management tool that can assist nurses in determining how they spend their time in their professional and personal lives. Some considerations regarding the activities that have occurred and what has been logged are listed below. Which is not necessarily correct regarding analysis of activity log information?

a.

Was the least amount of time used for each activity?

b.

What was the outcome achieved by each activity?

c.

Could the activities have been performed by others?

d.

What were your high- and low-energy times during the day?

ANS: A

Activity logs are useful time management tools that can be used to understand how time is spent, whether it was productive, and if it met your goals for that activity. Some considerations when analyzing the entries of an activity time log are: 1) how much time was used for each activity? (not only was the least amount of time used for each activity?); 2) what was the outcome achieved by each activity?; 3) could the activities have been performed by others?; and 4) what were your high- and low-energy times during the day? (activities that take focus and creativity should be planned for those times that are noted to be high-energy).

PTS: 1 DIF: Application TOP: Activity Log

6. Some methods for creating more time are listed below. Which is not necessarily correct?

a.

Get up one hour earlier.

b.

Prioritize work.

c.

Delegate work.

d.

Eliminate tasks you don’t like.

ANS: D

A number of methods and techniques exist to assist individuals with creating more time. Some of these include: 1) get up one hour earlier; 2) prioritize work; 3) delegate work; and 4) eliminate tasks that add no value (not eliminate tasks you don’t like).

PTS: 1 DIF: Comprehension TOP: Creating More Time

7. Some ways that nurses set priorities are listed below. Which is not necessarily correct?

a.

Apply the nursing process.

b.

Constantly reassess patient care needs.

c.

Delegate all duties to others.

d.

Constantly re-prioritize patient care needs.

ANS: C

Setting priorities is a skill that nurses use on a daily basis to ensure safe, quality, and timely patient care. Some techniques that nurses use to set priorities include: 1) apply the nursing process; 2) constantly reassess patient care needs; and 3) constantly re-prioritize patient care needs. While some duties can be delegated to other members of the health care team, not all duties can be delegated.

PTS: 1 DIF: Application TOP: Setting Priority Patient Outcomes

8. Patient care can be prioritized through the use of the “ABCs.” Which of the following is correct regarding these ABCs?

a.

A=airway; B=breathing; C=caring

b.

A= analysis; B=background; C=care plan

c.

A=airway; B=breathing; C=circulation

d.

A=airway; B= breathing; C=communication

ANS: C

The acronym “ABC” can be used to assist nurses with prioritization of patient care and assessment of patient needs. ABC stands for: A=airway (patent airway?); B=breathing (respiratory status?); and C=circulation (circulatory compromise?).

PTS: 1 DIF: Knowledge TOP: First Priority: Problems with ABCs

9. Several priority levels have been identified to assist nurses with categorizing patient care activities to ensure safe patient outcomes. Which of the following is not correct regarding these priority level categories?

a.

first priority: problems with ABCs

b.

second priority: activities essential to safety

c.

third priority: comfort, healing, and teaching

d.

fourth priority: planning and prevention

ANS: D

Another way that nurses make effective use of available time is by setting priorities. Three priority areas have been identified to assist nurses in categorizing tasks for safe patient outcomes. These categories are: 1) first priority: problems with ABCs; 2) second priority: activities essential to safety; and 3) third priority: comfort, healing, and teaching. While planning and prevention are also important parts of nursing, they can be located under the other three categories depending on the task and patient need.

PTS: 1 DIF: Analysis TOP: Setting Priority Patient Outcomes

10. After the patient handoff report has been delivered, a shift action plan is developed. Some of the considerations used by nurses when making shift action plans are listed below. Which is not necessarily correct?

a.

considers the big picture

b.

considers interventions for the shift

c.

considers the desired outcomes

d.

considers assessment for the shift

ANS: D

Shift action plans are used to assist nurses in decision making required to make assignments and ensure that the needs and goals of the patients and shift are met. These shift action plans consider: 1) the big picture; 2) interventions for the shift; 3) desired outcomes; and 4) evaluation of patient care for the shift.

PTS: 1 DIF: Application

TOP: Patient Handoff Report, Shift Action Plan, and Making Assignments

11. Nurses should also evaluate the outcome achievement of the shift after it has ended. Some of the key questions that nurses should ask regarding post-shift evaluation of outcome achievement are listed below. Which is not necessarily correct?

a.

Did the staff achieve the outcomes?

b.

Did the patients achieve the outcomes?

c.

Did the health care providers achieve the outcomes?

d.

Were there staffing problems or patient crises?

ANS: C

Post-shift evaluation of outcome achievement is an important function for nurses in order to determine the success or need for improvement in shift-oriented patient care. Some questions that should be asked in regard to this post-shift evaluation include: 1) did the staff achieve the outcomes?; 2) did the patients achieve the outcomes? (not did the health care providers achieve the outcomes?); 3) were there staffing problems or patient crises?; and 4) what was learned from this for future shifts?

PTS: 1 DIF: Analysis TOP: Evaluating Outcome Achievement

12. One identified time waster is perfectionism. Which of the following is not correct regarding perfectionists?

a.

hate criticism

b.

are devastated by failure

c.

value themselves for who they are

d.

remember mistakes and dwell on them

ANS: C

The behaviors of perfectionism are considered to be time wasters and should be avoided by nurses. Instead of striving for perfection, striving for a pursuit of excellence is considered to be a worthwhile endeavor. Some behaviors specific to perfectionism/perfectionists are: 1) hate criticism; 2) are devastated by failure; 3) have to win in order to maintain high self-esteem (not value themselves for who they are, which is a characteristics of those who pursue excellence); 4) remember mistakes and dwell on them; and 5) can only live with being number one.

PTS: 1 DIF: Application TOP: Creating More Time

13. Which of the following is correct regarding pursuers of excellence?

a.

value themselves for what they do

b.

correct mistakes, then learn from them

c.

learn from failure

d.

enjoy meeting high standards within reach

ANS: A

Pursuers of excellence have certain behaviors that differ from those of perfectionists. These behaviors tend to be more positive-oriented than perfectionism. Some of these behaviors by pursuers of excellence include: 1) correct mistakes, then learn from them; 2) learn from failure; 3) enjoy meeting high standards within reach (not value themselves for what they do, which is a characteristic of perfectionists); 4) do not have to win in order to maintain high self-esteem; and 5) are pleased with knowing they did their best.

PTS: 1 DIF: Application TOP: Creating More Time

14. Some patient conditions which have the potential to threaten a patient’s ABCs are listed below. Which is the highest priority?

a.

child or elder abuse

b.

hemorrhage

c.

hypoglycemia

d.

chest trauma

ANS: D

Patient conditions are triaged according to their real or potential threats to a patient according to the ABCs (airway-breathing-circulation). Some conditions which would be top priority due to real or potential impact on airway and breathing are chest trauma, choking, and airway compromise. Conditions which impact circulation are cardiac arrest, shock, and hemorrhage. Conditions which are important but do not fall directly under the airway-breathing-circulation categories include hypoglycemia and child or elder abuse.

PTS: 1 DIF: Analysis TOP: First Priority: Problems With ABCs

15. Third priority needs pertain to comfort, teaching, and healing activities. Which of the following is not correct regarding third priority activities?

a.

self-esteem

b.

positioning

c.

infection control

d.

ambulation

ANS: C

Patient needs and nursing care can be categorized according to three priority levels: first priority: ABCs; second priority: safety; and third priority: comfort, healing, and teaching. Some aspects of the third priority of comfort, healing, and teaching include: 1) self-esteem; 2) love and belonging; 3) ambulation; 4) comfort; and 5) positioning. Infection control is a second priority need that relates to patient safety.

PTS: 1 DIF: Knowledge TOP: Third Priority: Comfort, Healing, and Teaching

16. Nurse Q has spent a good part of her shift listening to patient Z’s mother demand more nursing care for her son. She has repeatedly demanded additional pain medication and that he be repositioned every hour even though he is snoring loudly each time Nurse Q enters his room. Four hours into her shift, Nurse Q decides to change her activity plan and requests another nurse and NAP to take on additional duties so that she can spend more time attending to patient Z, thus causing his mother to stop hovering around the nurses’ station. Into which of the following priority traps did Nurse Q fall?

a.

doing what hits first

b.

taking the path of least resistance

c.

relying on misguided inspiration

d.

responding to the squeaky wheel

ANS: D

The above scenario with patient Z’s mother constantly demanding more nursing care for her son even though he appears to be sleeping soundly can be a rather common occurrence for nurses. When Nurse Q reprioritizes her workload and reassigns some of her duties to others, she is responding to the squeaky wheel, which is considered to be a prioritization trap.

PTS: 1 DIF: Synthesis TOP: Priority Traps

17. Which of the following does not pertain to “intervene” considerations when making shift action plans?

a.

What are the tasks to be accomplished?

b.

When are staff breaks and lunches scheduled?

c.

What are the priorities?

d.

When should the actions be completed?

ANS: C

“Intervene” considerations are shift actions used by nurses to assist them with the prioritization and distribution of care after the patient handoff report has been received. Considerations are grouped under three areas: plan, intervene, and evaluate. Some considerations related to intervening include: 1) what are the tasks to be accomplished?; 2) when are staff breaks and lunches scheduled?; 3) when should the actions be completed?; and 4) who is available to do the work and what skills and attributes do the personnel have? Questions such as “what are the priorities?” and “what is the big picture?” pertain to planning rather than intervention.

PTS: 1 DIF: Analysis

TOP: Patient Handoff Report, Shift Action Plan, and Making Assignments

18. According to Fitzgerald, Pearson, Walsh, Long, and Heinrich’s (2003) study on nursing time distribution, how much nursing time is spent on other activities such as looking for personnel or equipment, and professional reading?

a.

8%

b.

34%

c.

13%

d.

7%

ANS: D

Fitzgerald, Pearson, Walsh, Long, and Heinrich’s (2003) study on how professional nursing time is distributed noted that the majority of time (38%) was spent on indirect care activities. 34% was spent on direct care activities; 7% on other activities such as looking for personnel or equipment, and professional reading; 13% on personal time for breaks, personal conversations, or reading; and 8% on unit activities such as cleaning and tidying.

PTS: 1 DIF: Comprehension TOP: Use of Time

19. How much time do nurses spend on indirect care activities such as documentation, obtaining supplies, and professional communication?

a.

34%

b.

38%

c.

42%

d.

19%

ANS: B

Fitzgerald, Pearson, Walsh, Long, and Heinrich’s (2003) study on how professional nursing time is distributed noted that the majority of time (38%) was spent on indirect care activities. 34% was spent on direct care activities; 13% on personal time for breaks, personal conversations; or reading; 8% on unit activities such as cleaning and tidying; and 7% on other activities such as looking for personnel or equipment, and professional reading.

PTS: 1 DIF: Comprehension TOP: Use of Time

MULTIPLE RESPONSE

1. A study done by Fitzgerald, Pearson, Walsh, Long, and Heinrich (2003) defined how nursing time was distributed. Which of the following is correct regarding this study and how nurses distribute their time?

a.

34% on direct care

b.

48% on direct care

c.

38% on indirect care

d.

24% on indirect care

e.

8% on unit activities

f.

13% on personal time for breaks, personal conversations, and reading

ANS: A, D, E, F

Fitzgerald, Pearson, Walsh, Long, and Heinrich’s (2003) study of how nurses distribute their time discovered findings that are similar to other time studies of this type. Some of their findings include: 1) 34% is spent on direct care; 2) 24% is spent on indirect care such as documentation, obtaining supplies, and professional communication; 3) 8% is spent on unit activities such as tidying and cleaning; 4) 13% is spent on personal time for breaks, personal conversations, and reading; and 5) 7% is spent on other activities such as looking for equipment or other personnel, and professional reading.

PTS: 1 DIF: Analysis TOP: Use of Time

2. Some strategies for avoiding time wasters are listed below. Which are correctly defined?

a.

Clutter: Keep your work area clear and clean.

b.

Interruptions: Break a task into smaller manageable segments.

c.

Perfectionism: Become a pursuer of excellence, not a perfectionist as you pursue goals.

d.

Unplanned phone calls: Use an answering machine or voice mail and set a time to return calls.

e.

Procrastination: Organize your papers, open mail over the garbage, and respond, delegate, or throw it out.

f.

Casual visitors: Make your environment less inviting, remain standing, and remove the visitor chair.

ANS: A, C, D, F

A number of time wasters have been identified that can impact an individual’s time and attainment of goals. Some of these are: clutter, interruptions, perfectionism, unwanted or low priority jobs, requests for assistance, procrastination, and perfectionism. Some strategies for avoiding some of these time wasters are: 1) Clutter: Keep your work area clear and clean; 2) Perfectionism: Become a pursuer of excellence, not a perfectionist as you pursue goals; 3) Unplanned phone calls: Use an answering machine or voice mail and set a time to return calls; and 4) Casual visitors: Make your environment less inviting, remain standing, and remove the visitor chair.

PTS: 1 DIF: Analysis TOP: Creating More Time

3. Vacarro (2001) noted that there are several types of traps into which nurses can fall that can hinder effective prioritizing of tasks. Which of the following are some of these traps?

a.

relying on others to prioritize

b.

doing what hits first

c.

taking the path of least resistance

d.

relying on misguided inspiration

e.

not responding to the squeaky wheel

f.

completing tasks by default

ANS: B, C, D, F

Nurses are susceptible to a number of different “traps” that can impede effective prioritization of tasks and patient care duties. Vacarro (2001) has identified five such traps of which nurses should be aware. They are: 1) doing what hits first; 2) taking the path of least resistance; 3) relying on misguided inspiration; 4) responding to the squeaky wheel (instead of not responding to—or ignoring—the squeaky wheel); and 5) completing tasks by default (not relying on others to prioritize).

PTS: 1 DIF: Analysis TOP: Priority Traps

4. Which of the following are correct regarding the use of a walking rounds report for patient hand off?

a.

advantage: nurse giving report as actual audience and can include all pertinent information

b.

advantage: patient is included in the planning and evaluation of care

c.

disadvantage: lack of privacy in discussing patient information

d.

disadvantage: easy to get side tracked or discuss non-patient-related issues

e.

advantage: accountability of outgoing care provider promoted

f.

disadvantage: time consuming

ANS: B, C, E, F

Two effective means of delivering the patient handoff report are through face-to-face meetings or walking rounds. The following are some of the advantages and disadvantages of the walking rounds-type of patient hand off report: 1) advantage: patient is included in the planning and evaluation of care; 2) disadvantage: lack of privacy in discussing patient information; 3) advantage: accountability of outgoing care provider promoted; and 4) disadvantage: time consuming. Some advantages and disadvantages of face-to-face meetings for the patient handoff report are: 1) advantage: nurse giving report as actual audience and can include all pertinent information; and 2) disadvantage: easy to get side tracked or discuss non-patient-related issues.

PTS: 1 DIF: Synthesis

TOP: Patient handoff Report, Shift Action Plan, and Making Assignments

5. A number of factors that should be considered when making assignments are listed below. Which are correct?

a.

staff environmental needs and control of environment

b.

priority of patient needs

c.

attitude and dependability of staff

d.

insurance liability coverage for staff during patient care activities

e.

unit routines

f.

geography of the nursing unit

ANS: B, C, E, F

When nurses make assignments per shift, a number of important factors should be considered. Some of these are: 1) priority of patient needs; 2) attitude and dependability of staff; 3) unit routines; 4) geography of the nursing unit; 5) insurance education program (not insurance liability coverage for staff during patient care activities); and 6) environmental concerns (not necessarily staff environmental needs and control of environment).

PTS: 1 DIF: Analysis TOP: Making Assignments