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Flashcards in Chapter 18 Deck (25):
1

A nurse is deciding on an appropriate time management strategy. Which of the following time management strategies does not belong?
a. Outcome delivery c. Focus on priorities
b. Analysis of time cost and use d. Visualization of the big picture

A: Some basic time management strategies include outcome orientation (not delivery), an analysis of the cost of use of time, a focus upon priorities, and the ability to visualize the big picture. KEY CONCEPTS

2

The nurse manager is trying to plan the shifts in the most effective manner. The manager knows that one characteristic of effective shift planning includes which of the following?
a. Getting the job done in the least amount of time
b. Nobody died
c. Everybody showed up for work
d. Evaluation of optimal and reasonable outcomes

D: Effective shift planning involves deciding what goals or outcomes they want to achieve. Identifying optimal outcomes (best possible objectives), as well as reasonable outcomes (realistic objectives given the resources at hand), and evaluating progress made toward these outcomes during and at the end of the shift are qualities that lead to effective planning during one’s shift. Often enough, nurses do not allow themselves permission to do less-than-optimal work, but sometimes, due to circumstances beyond their control (short staffed), achieving reasonable goals is the best that can be expected KEY CONCEPTS

3

A nurse manager is providing instruction on related commonsense skills that can help nurses to use their time in the most effective and productive manner possible. These skills are best known as which of the following?
a. Pareto principle c. Shift planning
b. Time management d. Effective leadership

B: A definition of time management is “a set of related common-sense tools that helps you use your time in the most effective and productive way possible” (Mind Tools, 2006). The Pareto principle concerns the concept that 20 percent of focused efforts results in 80 percent of outcome results. Shift planning deals with the organization and prioritization of patient care and tasks per shift. While the use of time management skills is a quality of effective leadership, it encompasses a variety of other attributes and qualities such as management skills, knowledge of leadership techniques, theory, and practice.GENERAL TIME MANAGEMENT CONCEPTS

4

A nursing instructor wants to determine whether a nursing student understands the importance of the Pareto principle. Which of the following responses would indicate that the student understands?
a. It is the principle that 80 percent of unfocused effort results in 20 percent of outcome results.
b. It is a way to record your activities over a period of time to see how your time is spent.
c. It is the principle that 20 percent of focused efforts equals 20 percent of outcome results.
d. It is the principle that 80 percent of focused efforts results in 80 percent of focused time.

A: The Pareto principle is based upon the prioritization of work effort through such measures as managing one’s time effectively. The basic premise is that 80 percent of unfocused efforts results in 20 percent of outcome results or that 20 percent of focused efforts results in 80 percent of outcome results. THE PARETO PRINCIPLE

5

A nurse manager observes that a few of the new employees continue to mismanage their time, which results in a flurry of activities that do not achieve the expected outcome goals for the time spent. The most likely cause of this behavior is that the nurses:
a. want to appear busy.
b. love crises.
c. know about time management but do not think it applies to them.
d. think they are far too superior to need to plan their time.

B: Unfortunately, many people still function in the crisis mode to get things done. An example of this would be a student who does not study for an exam until the night before, thereby creating a “crisis” that stimulates them to do the work. People continue to mismanage their time for other reasons: they do not know about time management, or they think they do not have time to plan or do not want to stop to plan. THE PARETO PRINCIPLE

6

When developing long-term goals, the nurse manager is always aware that these goals should remain:
a. long. c. flexible.
b. short. d. inflexible.

C: It is important, when making long-term goals and outcomes, that they remain flexible. The concept of flexibility should be built into any outcome orientation such as goal setting because, at times, the long-term goals may no longer be realistic or may need to be changed as circumstances change. OUTCOME ORIENTATION

7

The nurse manager suggests that a subordinate nurse use a time management tool that may benefit the nurse when determining how much time is spent. Which time management tool would the manager most likely suggest?
a. Shift assignments c. Shift action plan
b. Nursing chart d. Activity log

D: The activity log is a time management tool in which behaviors are logged consistently over a period of days to determine how time is spent. Nursing charts, shift action plans, and shift assignments are all good methods for organizing time and tasks. TIME ANALYSIS

8

You are planning your schedule for the day. Your plan includes a list of objectives that should be achieved given less-than-optimal circumstances and limited resources. These objectives are called:
a. optimal outcomes. c. reasonable outcomes.
b. general outcomes. d. unreasonable outcomes.

C: Outcomes can be categorized in a variety of different groups. Reasonable (realistic) outcomes are those that can reasonably be expected to occur given limited resources and less-than-optimal circumstances. Unreasonable outcomes are those that are expected to occur under unreasonable circumstances. While many nurses decide they will settle only for optimal outcomes, it is wise to plan for the less-than-optimal circumstances and situations and to be more reasonable and realistic. FORMULATE THE PLAN FOR THE SHIFT

9

A nurse preceptor wants to determine if a novice nurse is able to organize tasks and categorize them according to patient needs and conditions. Which of the following categories, if included by the novice, would indicate to the preceptor that further teaching is needed?
a. Life-threatening or potentially life-threatening conditions
b. Activities essential to patient safety
c. Activities essential to the plan of care
d. Activities essential to hospital/governmental regulation

D: Prioritizing care is one means nurses have of organizing their patient care. Life-threatening or potentially life-threatening conditions (such as assessing the ABCs) are always the top priority, with patient safety second (availability of crash carts and equipment to help prevent patient falls or injury), followed by items relating to the plan of care (pain medication and patient positioning). FORMULATE THE PLAN FOR THE SHIFT

10

A nurse manager is trying to implement the Joint Commission (JC) patient safety goals for 2006 pertaining to time organization. One of those goals is to:
a. improve the effectiveness of critical alarm systems.
b. eliminate wrong-site, wrong-patient, and wrong-procedure.
c. improve the safety of infusion pumps.
d. standardize the approach to hand off communication.

D: Improving the effectiveness of communication among caregivers (hospital goal # 2) was expanded in 2006 (hospital goal # 2E) to “implement a standardized approach to ‘hand off’ communications, including an opportunity to ask and respond to questions,” which pertains directly to end-of-shift reports and the “handing off” of patients from one location (such as surgery or admission from another unit) to another. UTILIZE SHIFT HANDOFF REPORT

11

A nurse manager is deciding whether or not to employ audiotaped end-of-shift handoff reports. The nurse manager would recognize that which of the following is a potential disadvantage of this method?
a. Report is brief.
b. Previous shift provides care during report.
c. Information may be inaccurate.
d. Report is taped before the new shift arrives.

C: Disadvantages of audiotaped end-of-shift reports are that the information may be inaccurate due to the report’s being taped earlier in the shift and the quality of the report (equipment, diction, and clarity of the speaker) may not be easy to hear. The report’s being brief due to lack of interruptions from questions, patients being cared for by the outgoing shift, and the fact that the report is ready for the incoming shift when they arrive are all advantages of audiotaped reports. UTILIZE SHIFT HANDOFF REPORT

12

A nurse manager is addressing concerns in the shift action plan. Which of the following would be least likely to be addressed in the shift action plan?
a. Resources c. Task completion due dates/times
b. Optimal outcomes d. Guidelines for task completion

B: Concerns that can be addressed in shift action plans include understanding the big picture (staffing issues, number of patients, environmental concerns), task completion due dates/times (time frame for accomplishment of tasks), understanding the priorities (emergency equipment checks, identification of patients at greatest risk for life-threatening complications), reasonable outcomes (those that are realistic to accomplish, not optimal outcomes), and resources (staff available to do work). TABLE 18-5 FACTORS TO CONSIDER IN PLANNING FOR A SHIFT

13

The nurse manager is making nursing assignments for the day shift. When making patient assignments, which of the following should not be a consideration?
a. Complexity of patient care
b. Skill, education, and competency of staff members
c. Staff preferences
d. Attitude and dependability of staff

C: A number of factors would be considered when making the shift assignment. Some of these factors would include the complexity of patient care; skill, education, and competency of staff members; attitude and dependability of the staff; the nurse practice acts; other responsibilities of the staff; and the need for continuity of care. Staff preferences would not be a major consideration. TABLE 18-6 FACTORS CONSIDERED IN MAKING ASSIGNMENTS

14

A nurse manager is dealing with a series of issues related to procrastination, inability to delegate, inability to say no, management by crisis, haste, indecisiveness, interrupting telephone calls, socialization, and complaining. These issues can all be categorized as examples of which one of the following?
a. Mistakes c. Time wasters
b. Errors d. New nurses

C: Marquis and Huston (2005) identified five criteria that contributed to wasting time and hindered the outcomes being achieved: procrastination, inability to delegate, inability to say no, management by crisis and/or haste, and indecisiveness. Sullivan and Decker (2009) added interrupting telephone calls and socialization, and Reed and Pettigrew (2006) added complaining to this rather lengthy list. EVALUATE OUTCOME ACHIEVEMENT

15

A nurse manager is giving a briefing to the nursing staff regarding traps nurses can fall into related to prioritization, as described by Vacarro (2001). Which of the following is not one of those traps?
a. Doing what hits first c. Relying on misguided judgment
b. Taking the path of least resistance d. Completing tasks by default

C: Vacarro (2001) identified five potential “traps” of prioritizing that nurses need to be aware of and avoid. They are doing what hits first, taking the path of least resistance, responding to the squeaky wheel, relying on misguided inspiration (not judgment), and completing tasks by default. AVOID PRIORITY TRAP

16

A nurse provides assistance to the NAP during a patient transfer. This activity would be considered an example of which type of prioritization?
a. First priority: life-threatening or potentially life-threatening
b. Second priority: activities essential to safety
c. Third priority: activities essential to the plan of care
d. Fourth priority: activities essential to the patient’s well-being

B: Second priority activities pertain to the patient, and obtaining assistance during patient transfers is one way of providing safe care for the patient and the nurse. First priority activities are related to conditions that are potentially life-threatening to the patient such as having IV access and continuous monitoring of vital signs on critical patients. Third priority activities are related directly to the plan of care and include such items as medications, nutrition, and ambulation. The phrase “fourth priority” is not generally used in nursing. SECOND PRIORITY: ACTIVITIES ESSENTIAL TO SAFETY

17

A nurse needs to create more time. Three ways to do this are:
a. delegating, getting up 1 hour earlier, and eliminating tasks that add no value.
b. getting up 1 hour earlier, eliminating tasks that have value, and delegating.
c. going to bed 1 hour earlier, delegating, and hiring people to do work.
d. eliminating tasks that add no value, taking a nap during the day, and hiring people to do work.

A: Three major ways to create more time are delegating work to others, getting up 1 hour earlier (this can free up about 2 weeks per year of extra time), hiring someone else to do work (hiring people to do boring tasks), and eliminating chores that add no value (not those that have value). CREATE MORE PERSONAL TIME

18

A nurse is trying to avoid personal time distraction. Which type of distraction will be avoided if the nurse uses the strategies of providing encouragement and making conscious decisions?
a. Procrastination c. Interruptions
b. Perfectionism d. Requests for assistance

D: There are numerous distractions available for invading one’s personal time. Two strategies for dealing with requests for assistance are to provide encouragement, but to send the requester back to finish the task; and to make a conscious decision about whether or not to respond to the request for assistance. It should be your choice whether to provide help or not. CONTROL UNWANTED DISTRACTIONS

19

A nurse is striving to become a pursuer of excellence, rather than a perfectionist. After reading White's (2000) Critical Thinking in Practical/Vocational Nursing, the nurse understands that which of the following applies to perfectionists?
a. Perfectionists experience disappointment but keep going, must be number one, and get depressed.
b. Perfectionists hate criticism, must be number one, and correct mistakes and learn from them.
c. Perfectionists value themselves for what they do, welcome criticism, and remember mistakes and dwell on them.
d. Perfectionists have to win to maintain high self-esteem, are devastated by failure, and value themselves for what they do.

D: White’s (2000) description of behaviors consistent with pursuers of excellence versus perfectionists listed the perfectionist behaviors as having to win to maintain high self-esteem, being devastated by failure (not learning from failure), valuing themselves for what they do (not for who they are), hating criticism (not welcoming criticism), getting depressed and giving up (not experiencing disappointment but keeping on going), only being able to live with being number one (not pleased with knowing they did their best) and remembering mistakes and dwelling on them (not correcting mistakes and learning from them). TABLE 18-8 BEHAVIORS OF PERFECTIONISTS VS. PURSUERS OF EXCELLENCE

20

A nurse is returning to school and is considering some personal time management items. Which of the following tips for personal time management are offered by Flaherty?
a. Study on the run, be careful of sacrifices, be aware of the demands of school, and focus on the outcome.
b. Develop computer skills, let your friends know you are interested in returning to school, manage your time, and do not take breaks—go straight through.
c. Be careful of sacrifices, be aware of the demands of school, develop computer skills, and do not let your employer know you are interested in returning to school.
d. Develop computer skills, study at specified times, be aware of the demands of school, and manage your time.

A: Tips for personal time management when returning to school as offered by Flaherty (1998): study on the run, be careful of sacrifices, be aware of the demands of school, focus on the outcome, develop computer skills, let your employer know you are interested in returning to school (not withholding this information), manage your time, and take a break if you find you need one (do not force yourself to continue if you need a break). TABLE 18-9 PERSONAL TIME MANAGEMENT WHEN RETURNING TO SCHOOL

21

The nurse has just finished the change-of-shift report. Which patient should the nurse assess first?
a. The patient who needs assistance transferring from the bed to a wheelchair
b. The client with COPD who is having difficulty breathing
c. A client who is being discharged today
d. An elderly client who has requested medication for pain

B: The nurse should assess the client with COPD first. This client is having difficulty breathing, which could be a life-threatening situation. Remember to follow the ABCs (airway, breathing, circulation). The other three patients are not experiencing life-threatening situations. FIRST PRIORITY: LIFE-THREATENING AND POTENTIALLY LIFE-THREATENING CONDITIONS

22

The nurse has just finished the change-of-shift report. Which client should the nurse assess second?
a. The client who needs assistance transferring from the bed to a wheelchair
b. The client with COPD who is having difficulty breathing
c. A client who is being discharged today
d. An elderly client who has requested medication for pain

A: The client needing assistance with transferring from bed to wheelchair would be seen second. Having already assessed the client with COPD because of issues with breathing, attention would be turned to the next priority. Because the client needs help transferring, the issue of safety must be addressed, and it would, therefore, becomes the second priority. The client requesting pain medication is experiencing a comfort issue which would be addressed after safety. Also, the client being discharged is not experiencing a major health situation. SECOND PRIORITY: ACTIVITIES ESSENTIAL TO SAFETY

23

You have just returned from your morning break, and the nurse who has been covering your patients gives you an update on their conditions. Which patient would you assess first?
a. Mr. Akerman whose wife is angry because his discharge papers have not been completed
b. Mrs. Samuels who needs to be taught how to use her new crutches
c. Mr. Donaldson who is complaining of chills and is having surgery today
d. Mrs. Smith who is scheduled for surgery tomorrow morning and needs to have her consent signed

C: The client who should be assessed first is Mr. Donaldson. Because the client is scheduled for surgery, it is of utmost importance to determine the cause of his chills. The client’s condition could have a negative effect on his recovery from surgery. Addressing Mr. Akerman’s discharge papers and Mrs. Samuels’ teaching would not be as critical. Since Mrs. Smith’s surgery is not scheduled until tomorrow morning, this issue can be addressed after checking on Mr. Donaldson. FIRST PRIORITY: LIFE-THREATENING OR POTENTIALLY LIFE-THREATENING CONDITIONS

24

You have just completed the change-of-shift report. Which of the following clients would you see first?
a. An elderly client who needs help with transferring to the commode
b. A client admitted 2 hours earlier after receiving 2nd-degree burns on his face and torso
c. An obese client who needs assistance with changing position
d. A client who is 2 days post-op and has an IV that has infiltrated

B: You should see the client admitted 2 hours earlier with burns to the face and torso. This type of burn injury has the potential for compromising the client’s ability to breath. The client’s respirations and oxygen saturation level must be assessed. Following the ABC’s of prioritizing, this client becomes the priority. FIRST PRIORITY: LIFE-THREATENING OR POTENTIALLY LIFE-THREATENING CONDITIONS

25

You are working on the evening shift with eight patients assigned to your care. Which patient issue would receive first priority?
a. A client who complains of a sore throat and requests something to gargle with
b. A client with COPD who is resting quietly with 2 liters of O2 running
c. A client in respiratory isolation who requests a sleeping pill
d. A client with tubular necrosis and a urine output of only 15 mL for each of the past 2 hours

D: The client with tubular necrosis who has only had a total of 15 mL of urine output in the last 2 hours should be seen first. Requests for something to gargle with and a sleeping pill focus on comfort issues. The client with COPD is stable. FIRST PRIORITY: LIFE-THREATENING OR POTENTIALLY LIFE-THREATENING CONDITIONS