Chapter 11- Mandatory Minimum Staffing Ratios My Nursing Test Banks

 

1.

When reviewing information about mandatory staffing, which of the following would best reflect the current status?

A)

Many of the states in the United States have moved toward imposing mandatory licensed staffing requirements.

B)

Texas has already enacted legislation requiring mandatory staffing ratios affecting hospitals and long-term care facilities.

C)

Research suggests that the average number of patients assigned to RNs for care in acute-care facilities has actually decreased in the past decade, but patients are much sicker.

D)

Consumers and legislators, not nurses, have urged implementation of mandatory staffing ratios because most nurses feel current staffing levels are minimum but adequate.

Ans:

A

2.

Benchmark research completed by Aiken and colleagues in 2002 found

A)

There was no significant difference in patient outcomes when staffing at six patients per nurse rather than four.

B)

There was no rise in patient morbidity until patient-to-nurse ratios exceed eight to one.

C)

There is no direct, provable link between nurse-to-patient ratios and mortality rates from preventable complications.

D)

In hospitals with higher patient-to-nurse ratios, the likelihood of dying within 30 days of admission and mortality complications were increased.

Ans:

D

3.

When evaluating the pros and cons of mandatory regulation of RN-to-patient ratios, which statement most accurately reflects the beliefs of the critics?

A)

Such ratios protect the most basic elements of the public health care consumers take for granted.

B)

Implementing ratios will improve the nursing shortage, at least temporarily over the short term.

C)

Mandatory staffing will lead to a reduction in hospital services and increased expenses due to the need to pay overtime.

D)

Mandatory staffing ratios create significant opportunity costs that encourage employers and payers to respond to market forces.

Ans:

C

4.

Developing draft regulations for minimum staffing ratios was challenging for the California Department of Health Services (CDHS) because

A)

Although standardized patient classification system data were available, hospitals were unwilling to submit the data.

B)

Hospitals had not been required to use patient classification systems prior to the passage of staffing-ratio legislation and had no data.

C)

California Healthcare Association and the California Nurses Association agreed on the minimum ratios, but consumer advocate groups pressed for lower patient-to-nurse ratios.

D)

Proposals received by CDHS suggested a wide range of minimum staffing ratios and even more widely differing estimates of implementation costs.

Ans:

D

5.

Implementing the ratio legislation in California proved to be difficult because

A)

Nursing unions balked when courts ruled that both LVNs and RNs could be used to meet minimum staffing ratios.

B)

The current nursing shortage made it impossible to meet the mandated ratios.

C)

Legislation was introduced to delay implementation of the minimum 1:5 nurse-to-patient staffing ratio on medical-surgical units.

D)

A significant number of hospitals in the state had to close their doors due to the cost of implementing staffing ratios.

Ans:

C

6.

When reviewing the California legislation, legal clarification became necessary due to the at-all-times clause, which referred to which of the following?

A)

Maintaining minimum staffing ratios throughout the day including during breaks and lunches

B)

Having at least one registered nurse on duty at all times

C)

Ensuring no more than a 1:4 nurse-to-patient ratio on any unit in acute-care hospitals

D)

Having to keep emergency departments open 24 hours a day

Ans:

A

7.

Which of the following best describes waivers to the mandatory staffing ratios that were part of the California legislation?

A)

Were typically not allowed for any institution

B)

Were sought by many of the larger hospitals because of the financial costs

C)

Were routinely granted if patient safety was not being compromised

D)

Were allowed but only to rural hospitals under very strict conditions

Ans:

D

8.

An instructor is describing compliance oversight by the California Department of Health Services in acute-care hospitals to a group of students. Which of the following would most likely occur if a hospital was found to be out of compliance with the mandatory minimum staffing ratios?

A)

The hospital would be forced immediately to close its doors until it could demonstrate compliance.

B)

The facility is given 48 hours to correct the deficiency after being fined substantially.

C)

The hospital must discharge or transfer patients within 24 hours to reach a level of compliance.

D)

There is no penalty or monetary fine for a violation unless serious injury or death occurs.

Ans:

D

9.

Which of the following is suggested based on the initial research findings as to the effectiveness of mandated staffing-ratio implementation in California?

A)

Staffing ratios remained essentially unchanged.

B)

Staffing ratios increased the number of worked nursing hours per patient day in hospitals.

C)

Hospitals had less difficulty meeting ratio requirements than originally anticipated.

D)

The at-all-times clause was not a significant hardship.

Ans:

B

10.

Which of the following best reflects the position taken by the Joint Commission on mandated staffing ratios?

A)

Supportive, arguing that more states should follow Californias model

B)

Criticism that ratios as not flexible enough due to failure to address diversity of U.S. hospitals

C)

Watchful waiting by other states until Californias experience can be fully evaluated

D)

Direct opposition to the implementation because of the current nursing shortage

Ans:

B

11.

When reviewing the various alternatives to legislated minimum staffing ratios, which of the following would a nurse expect to find as the position of the American Nurses Association?

A)

A workload system that encompasses existing variables for safe staffing

B)

Use of Continuous Quality Improvement to ensure adequate staffing

C)

Use of market-based incentives for hospitals to maximize nurse staffing

D)

Evaluation of number, competency, and skill mix of staff related to needed services

Ans:

A

12.

A nursing administration is using the legislation in California as a guide to implement appropriate minimum registered nurse staffing ratios for the labor and delivery area. Which of the following ratios would be most appropriate?

A)

1:1

B)

1:2

C)

1:4

D)

1:6

Ans:

B

13.

Various studies have examined the link between staffing mix and patient outcomes. Which of the following best describes the most common finding associated with this research?

A)

Inadequate numbers of RNs has little effect on patient outcomes.

B)

Mortality dropped with increased staffing numbers of nurse aides.

C)

Increased numbers of RNs in staffing mix led to improved patient outcomes.

D)

A decreased prevalence of infections was found with less staffing.

Ans:

C

14.

After describing the arguments for and against mandated minimum staffing, the instructor determines that the teaching was successful when the students identify which of the following as a major argument by critics?

A)

Patient safety is unrelated to the staffing ratios.

B)

Workload of nurses is difficult to translate into numbers.

C)

Standardized ratios do not provide consistency in approach.

D)

Overall cost of care would increase exponentially.

Ans:

D

15.

A nurse is reviewing the events leading up to implementing the California legislation. In addition to identifying ratios for safe staffing, the legislation also addressed which of the following?

A)

Use of LPNs/LVNs as part of the staff mix

B)

Possible cost incentives

C)

Restrictions for procedures of unlicensed personnel

D)

Patient classification systems

Ans:

C

16.

A nursing student is reading a journal article about mandatory staffing ratios and states that have implemented legislation related to staffing. Which state would the student be least likely to read about?

A)

Ohio

B)

Alabama

C)

Connecticut

D)

Nevada

Ans:

B

17.

As student is reviewing the recommendations of the ANA to maintain sufficient staffing. The student demonstrates a need for additional study when the student identifies which of the following as a recommendation?

A)

Creation of staffing plans by administrative personnel

B)

Legislative mandates for regulation of nurse to patient ratios

C)

Staffing plans that reflect the needs of the patient population

D)

Disclosure of staffing levels to a regulatory body

Ans:

A

18.

As part of the Hospital Patient Protection Act (2008), which nurse-to-patient ratio would be appropriate for pediatrics?

A)

1:2

B)

1:3

C)

1:4

D)

1:5

Ans:

B

19.

A student is reviewing research in preparation for a debate on minimum mandatory staffing relies on the study by Aiken et al. (2002) as a basis for arguing in support of this issue. Which of the following best describes the students use of this study?

A)

It is considered the seminal work for supporting legislation of minimum staffing ratios.

B)

It provided the most comprehensive study on costs, staffing, and use of unlicensed personnel.

C)

It supported findings from research performed by the Agency for Healthcare Quality and Research.

D)

It reinforced what was already known about the need for mandatory staffing ratios in acute-care facilities.

Ans:

A

20.

Which of the following would a nurse identify as the primary driving force in dictating changes in the RN skill mix in hospitals?

A)

Rise in use of unlicensed assistive personnel

B)

Growing nursing shortage

C)

Patient outcomes

D)

Economics

Ans:

D

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