Chapter 21: Confronting the Nursing Shortage

Huber: Leadership & Nursing Care Management, 6th Edition

Multiple Choice

1. A situation in which the demand for employment of nurses (how many nurses employers would like to employ) exceeds the available supply of nurses willing to be employed at a given salary is known as a nursing: a. abundance. b. deficit. c. shortage. d. surplus.

ANS: C

The number of nurses that employers would like to employ in relation to the number of nurses willing to be employed at a given salary is known as a nursing shortage. In a nursing shortage, the demand for employment of nurses exceeds the available supply for employment at a given salary.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

2. The medical unit of the hospital conducts regular programs for nurses based on an annual staff survey. The recruitment and retention strategy is known as: a. counseling and coaching. b. orientation. c. staff development. d. performance evaluation.

ANS: C

Staff development has been identified in the literature as an important factor in job satisfaction. It provides employees with an opportunity to improve their practice, level of competency, or other areas of self-interest. Programs for staff development are typically determined based on annual staff surveys. Programs are usually posted for staff selection, and the institution provides scheduling flexibility and funding for employees to participate.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. actualized b. employable c. turnover d. vacancy

3. The total number of nurses who left a unit in 1 year divided by the total number of nurses employed on that unit is the _____ rate.

ANS: C

The total number of nurses who left a unit in 1 year divided by the total number of nurses employed on that unit is the turnover rate.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

4. The failure to retain an employee who is performing at or above a satisfactory level is: a. selection. b. transfer. c. voluntary turnover. d. termination.

ANS: C

Resignation/voluntary turnover is the failure to retain an employee who is performing at or above satisfactory level. Although all turnovers have an associated cost to the organization, the most costly are those dealing with termination and resignations. The number of people who report directly to a single manager and encompass the functions of planning, organizing, and leading is known as the span of control.

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

5. The future projected demand for nurses is related to the aging population and the increase in: a. acute illnesses. b. chronic illnesses. c. medication costs. d. primary prevention.

ANS: B

The future projected demand for nurses is related to the aging population and the increase in chronic illnesses.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. 26 b. 36 c. 45 d. 56

6. The average age of the registered nurse (RN) population is _____ years.

ANS: C

According to the Bureau of Health Professions’ (BHPr, 2013) report The U.S. Nursing Workforce: Trends in Supply and Education, the average age of the RN has increased by almost 2 years, moving from 42.7 years in 2000 to 44.6 (2010).

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. 40% b. 80% c. 60% d. 50%

7. The Institute of Medicine recommends increasing the proportion of nurses with a baccalaureate degree to _______ by 2020.

ANS: B

One recommendation by the Institute of Medicine is to increase the proportion of nurses with a baccalaureate degree to 80% by 2020.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. demographic b. geographic c. socioeconomic d. psychological

8. Factors that affect supply include nursing education factors, work environment factors, and _____ factors.

ANS: A

Three factors that affect the supply of RNs are nursing education, work environment, and demographics.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

9. Nursing jobs need to be developed that increase nurses’ professional: a. autonomy. b. behavior. c. culture. d. salaries.

ANS: A

Managerial visibility and support are viewed as strengths in promoting autonomy. Nurses also wanted to have control over their practice (autonomy) and collaborative relationships with physicians relative to care management. This study and the follow-up study conducted by Kramer and Hafner (1989) 5 years later were the basis for the ANA’S Magnet Recognition Program®

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

10. The ability to continue the employment of qualified individuals, that is, nurses and/or other health care providers/associates who might otherwise leave the organization is called: a. transfer. b. selection. c. turnover. d. retention.

ANS: D

Retention is the ability to continue the employment of qualified individuals, that is, nurses and/or other health care providers/associates who might otherwise leave the organization. The impact of this action is to maintain stability and enhance the quality of care while reducing cost to the organization.

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

11. An important predictor of job satisfaction with new graduates is: a. culture. b. compensation. c. benefit package. d. staffing adequacy.

ANS: D

Stam and colleagues (2013) found that new graduates viewed “staffing adequacy” as an important predictor of job satisfaction. In addition to the relationship between staffing levels and nurse satisfaction, there is also a growing body of literature demonstrating a correlation between nurse staffing levels and patient outcomes.

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Democratic b. Laissez-faire c. Authoritarian d. Transformational

12. An important factor in nurse retention is managerial leadership. Which leadership style has the greatest impact on nurse job satisfaction?

ANS: D

Another important factor in retention of nurses is managerial leadership (Acree, 2006; Kleinman, 2004). The two leadership styles that predominate in the literature are transformational and transactional. Managerial use of transformational leadership has been shown to have the greatest impact on nurse job satisfaction.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

13. The United States recruits more internationally educated nurses (IENs) than any other country. The largest group of IENs in the United States is from: a. India. b. Canada. c. Great Britain. d. the Philippines.

ANS: D

According to McHugh and colleagues (2008), the United States recruited more internationally educated nurses (IEN) than any other country. Approximately half of the IENs were originally from the Philippines (48.7%), 11.5% from Canada, and 9.3% were from India (BHPr, 2010).

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

14. According to McHugh et al. (2008), a major barrier to the recruitment of IENs has been related to: a. limited visas. b. language barriers. c. cultural differences. d. the inability of IENs to pass state board exams.

ANS: A

According to McHugh et al. (2008), major barriers to recruitment of IENs have been related to both limited visas and ethical concerns related to depletion of nursing resources in other countries.

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

15. The process of identifying applicants for potential employment is called: a. selection. b. retention. c. recruitment. d. human resources.

ANS: C

Recruitment, defined as replenishment, is the process used by organizations to seek out or identify applicants for potential employment. The impact is to ensure that an adequate number of qualified workers are available for selection and employment.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

16. A shortcoming that needs to be addressed related to the advertising of open nursing positions is: a. inadequate use of Internet advertising. b. insufficient funds allotted for advertising. c. lack of follow-up with potential candidates. d. short supply of advertising space in nursing journals.

ANS: C

A shortcoming that needs to be addressed related to advertising is that organizations often spend a considerable amount of money on advertising only to miss the most important aspect, that of a quick, effective, courteous follow-up with potential candidates (Curran, 2003).

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

17. The newest approach to orienting is referred to as: a. selecting. b. onboarding. c. submersion. d. precepting.

ANS: B

The newest approach to orienting is referred to as onboarding (Lee, 2008). Onboarding expands the orientation beyond the employee’s initial introduction to the organization and role expectations by providing ongoing coaching and mentorship through a defined program.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

18. A mechanism for giving feedback related to progress to employees new and experienced is called: a. coaching. b. mentoring. c. counseling. d. performance evaluation.

ANS: D

Performance evaluation is a mechanism for giving feedback to employees new and experienced.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Staff mix b. Budget c. Generational diversity d. Unit culture

19. Marcy, the medical surgical unit manager, has promised her staff a pizza party if they reduce their patient fall rates by 10%. Which factor does Marcy consider when developing staff rewards?

ANS: C

With four generational groups now in the workplace, it is important that managers and staff consider differences when developing strategies for change or rewards. Each generation has its own perspective, and diversity exists even within each generation. Therefore it is imperative that generational groups have representation or opportunity for input in planning and decision making.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Evaluation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Multiple Response

1. To determine the presence of a nursing shortage, experts generally use indicators such as: (Select all that apply.)

a. retention.

b. vacancy rates.

c. staffing levels.

d. nursing salary.

e. employer reports.

f. forecasting models.

g. organizational budgets.

ANS: B, C, E, F

Experts generally use indicators such as employer reports, vacancy rates, turnover, recruitment difficulty, staffing levels, RN supply per population, or forecasting models to determine a nursing shortage.

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. Aging of current nurses and inability of hospitals to meet nursing salary demands b. Younger nurses in the workforce and their preference for non-traditional nursing jobs c. Significant changes in the health care delivery system as the nation moves into health care reform d. Aging of the American population and struggles to expand capacity to meet demand for care e. Lower numbers of students entering nursing as a career

2. The nursing shortage cycles over the past few decades have been primarily driven by factors including which of the following? (Select all that apply.)

ANS: C, D, E

The nursing shortage cycles over the past few decades have been primarily driven by five factors: aging of current nurses in the workforce and their preparation for retirement, lower numbers of students entering nursing as a career and a shift in need for both bachelor’s- and master’s/doctorate-prepared nurses, aging of nursing faculty and inability of schools of nursing to meet education demands, aging of the American population and struggles to expand capacity to meet demand for care, and significant changes in the health care delivery system as the nation moves into health care reform.

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. more competitive salaries. b. increased workforce diversity. c. reduction in retirement age. d. maintaining current levels of nursing education. e. improved workforce data collection.

3. The new and enhanced recommendations in the IOM Future of Nursing report (2016) affect the nursing shortage by formally calling for: (Select all that apply.)

ANS: B, E

In 2016, The IOM published Assessing Progress on the Institute of Medicine Report: The Future of Nursing. The new and enhanced recommendations around diversity in the workforce and workforce data collection are designed to directly influence state implementation plans and initiatives. Thus the Future of Nursing report affects the nursing shortage by formally calling for increased workforce diversity and improved workforce data collection.

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. grief. b. anger. c. burnout. d. job dissatisfaction. e. emotional exhaustion.

4. One of the findings of a study by Aiken and colleagues (2002) was that nurses with the highest nurse-to-patient ratios were more likely to describe feelings of: (Select all that apply.)

ANS: C, D, E

One of the findings of a study by Aiken and colleagues (2002) was that nurses with the highest nurse-to-patient ratios (fewer nurses for the number of patients) were more likely to describe feelings of burnout, emotional exhaustion, and job dissatisfaction than nurses with lower ratios (more RNs for the number of patients).

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. nursing schools increasing their capacities. b. more young people enrolling in nursing programs. c. RNs delaying retirement or returning to work from retirement. d. licensed RNs working in non-traditional nursing jobs returning to traditional nursing. e. increasing the supply of nurses by motivating part-time RNs to work more hours or full time.

5. The impact of the recessionary decade on the nursing workforce included: (Select all that apply.)

ANS: B, C, E

The impact of the recessionary decade increased the supply of nurses by motivating part-time RNs to work more hours or full time; RNs to delay retirement or return to work from retirement; licensed RNs working in non-nursing jobs to return to nursing; and young people to enroll in nursing programs, a demand occupation with future stability (Staiger et al., 2012).

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

6. Using the targeted interview ensures that all candidates are interviewed based on the same criteria. The targeted selection process is built on: (Select all that apply) a. organizational values. b. analysis of work per job. c. development of interview skills. d. clear identification of competencies for key positions. e. compliance with equal opportunity employer guidelines.

ANS: A, B, C, D

The targeted selection process is built on analysis of work per job, organizational values, clear identification of competencies for key positions, and development of interview skills and confidence of the interviewers. Using the targeted interview ensures that all candidates are interviewed based on the same criteria.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. What are your goals for the future? b. Do you plan on having any more children? c. How do you feel about taking call on weekends? d. How does your husband feel about you working? e. Will going to church interfere with Sunday shifts?

7. Inappropriate or illegal questions that should be avoided during the interview include which of the following examples? (Select all that apply.)

ANS: B, D, E

Questions that should be avoided during the interview relate specifically to personal information about the candidate, such as the following: age, marital status, living arrangements, children, limitations or disabilities, religion, substance abuse, and membership in professional organizations.

DIF: Cognitive Level: Apply (Application)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. orientation. b. formal education. c. in-service education. d. career development. e. continuing education.

8. Staff development has been identified in the literature as an important factor in job satisfaction. The areas of professional staff development defined in the Magnet studies include: (Select all that apply.)

ANS: B, C, D, E

Staff development, as defined in the Magnet studies (Halfer, 2007; Kramer & Hafner, 1989; McClure et al., 1983), was identified as having four areas of professional development beyond orientation. The four areas included in-service education, continuing education, formal education, and career development.

DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Evaluation

MSC: Client Needs: Safe and Effective Care Environment: Management of Care a. vacancy costs. b. accident rates. c. competitor wages. d. advertising expenses. e. orientation and training.

9. Stacy has been asked by the corporate financial officer to report on the current organizational costs for nurse turnover. To determine the cost of nurse turnover, Stacy should review: (Select all that apply.)

ANS: A, B, D, E

The most common factors used in determining nurse turnover costs include advertising and recruitment, vacancy costs, hiring, orientation and training, decreased productivity, termination, potential patient errors/decreased quality of care, poor work environment and culture, loss of organizational knowledge, increased accident and absenteeism rates, and increased nurse and medical staff turnover (Hunt, 2009).

DIF: Cognitive Level: Understand (Comprehension)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Completion

1. Authentic respect for others requiring time, presence, engagement, and intention to seek common ground is called _____.

ANS: civility

Civility is authentic respect for others requiring time, presence, engagement, and intention to seek common ground.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

2. _____ is the process in which the application is reviewed before determining whether the nurse meets the preestablished criteria for the position.

ANS: Screening

Screening is the process in which the application is reviewed before determining whether the nurse meets the preestablished criteria for the position. During this activity, the reviewer selects who should be interviewed.

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe and Effective Care Environment: Management of Care

Other

1. In the context of a nurse shortage, recruitment is a major human resources strategy. List the nine major processes or phases of recruitment in the appropriate order.

a. Selecting b. Orienting c. Screening d. Advertising e. Interviewing f. Position posting g. Staff development. h. Counseling/coaching i. Performance evaluation

ANS:

F, D, C, E, A, B, H, I, G

The nine major processes or phases of recruitment in the correct order are as follows:

1. Position posting

2. Advertising

3. Screening

4. Interviewing

5. Selecting

6. Orienting

7. Counseling/coaching

8. Performance evaluation

9. Staff development

DIF: Cognitive Level: Remember (Knowledge)

TOP: Nursing Process: Planning

MSC: Client Needs: Safe and Effective Care Environment: Management of Care