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Nurse Performance: Outcome Indicators, Models of Evaluation and the Issue of Value
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ANS: BEmployment contracts can be confusing. As a new APRN the best option is to hire an attorney
who specializes in health care employment contracts to review the contract.
195. An APRN is reviewing an employment contract as it pertains to malpractice insurance
coverage. The insurance offers payment for claims but only if the claim occurs and is reported
during the policy coverage period of time. This describes which type of coverage?
a. Institutional liability coverage
b. Occurrence coverage
c. Tail coverage
d. Claims-made coverage
ANS: D
Claims-made malpractice insurance covers claims that occur during the policy coverage period
but only if the claim is also reported during the same policy period. Tail coverage must be
purchased additionally to cover claims that may be reported after the policy period has ended.
196. An APRN is reviewing an employment contract as it pertains to malpractice insurance
coverage. The insurance offers payment for claims that occur during the policy period and
generally has no restrictions regarding when the claims are reported. This describes which type
of coverage?
a. Tail coverage
b. Claims-made coverage
c. Occurrence coverage
d. Personal balloon liability coverage
ANS: C
Occurrence malpractice insurance covers claims that occur during the policy coverage period and
has no restriction of time regarding when the claim must be reported.
197. An APRN who has practiced for 20 years is nearing retirement. He or she has no plans to
continue working at his or her practice. Which of the following insurance malpractice types
would be of greatest interest to the APRN at this time?
a. Institutional liability coverage
b. Tail coverage
c. Occurrence coverage
d. Claims-made coverage
ANS: B
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, When an APRN is changing jobs or nearing retirement they should obtain tail coverage malpractice
insurance. Some employment contracts include this and can be a large financial incentive. Tail
coverage covers claims that are made during a previous policy period but are reported after the
policy has ended. Tail coverage is typically purchased in addition to claims- made policies.
198. Which of the following will most likely increase the success of employment of an APRN
in a new market? (Select all that apply.)
a. Sending multiple résumés
b. Joining local or national organizations
c. Volunteer opportunities
d. Understanding geographical limitations
ANS: B, C, D
APRNs are typically well suited to enter the job market but commonly encounter many hurdles.
Professional networking whether through peers, volunteer opportunities, online support groups, or
national organizations as well as understanding geographic limitations or restrictions can further
the APRN’s success. Simply sending multiple résumés is inappropriate without adequate
understanding of the APRN’s unique value to an organization or institution, geographic
restrictions, and other issues that may arise.
Chapter 24. Measuring Advanced Practice Nurse Performance: Outcome Indicators, Models of
Evaluation and the Issue of Value
MULTIPLE CHOICE
1. The plan-do-study-act cycle begins with:
a. three questions. c. five agendas.
b. four stages. d. two concepts.
ANS: A
The plan-do-study-act (PDSA) cycle, a process improvement tool, starts with three questions: 1)
What are we trying to accomplish?, 2) How will we know that a change is an improvement?, and 3)
What changes can we make that will result in improvement?
PTS: 1 DIF: Comprehension
REF: THE PLAN DO STUDY ACT CYCLE
2. A staff nurse asks the nurse manager, What does the mnemonic FOCUS in FOCUS methodology
stand for? The best response by the nurse manager is that it stands for:
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,a. Focus, Organize, Clarify, Understand, Substantiate.
b. Focus, Opportunity, Continuous, Utilize, Substantiate.
c. Focus, Organize, Clarify, Understand, Solution.
d. Focus, Opportunity, Continuous (process), Understand, Solution.
ANS: C
The FOCUS methodology uses a stepwise process for how to move through the improvement
process. The five steps involved are 1) focus on an improvement idea, 2) organize a team that
knows the work process, 3) clarifythe current process, 4) understand the degree of change needed,
and 5) solution (select a solution for improvement).
PTS: 1 DIF: Comprehension
REF: THE FOCUS METHODOLOGY
3. The nurse manager recognizes that the goal of studying outcomes is to:
a. determine staff needs. c. predict the quality of patient care.
b. identify potential problems. d. incorporate change in nursing
practice.
ANS: B
By studying outcomes, the nurse manager is able to identify potential areas of concern (problems).
The outcomes can be short or long term and may lead to an investigation of the structure and
process to determine any root causes for a negative outcome.
PTS: 1 DIF: Application
REF: GENERAL PRINCIPLES OF QUALITY IMPROVEMENT
4. An educator wants to determine if the nursing students know the work of W. Edwards Deming.
Which statement by the students would indicate that the students know the focus of Demings work?
a. Pioneer of the continuous quality improvement movement
b. Quality expert known for his studies on surgical and ambulatory care
c. Father of risk management
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, d. Guru of the PDSA movement
ANS: A
W. Edwards Deming is one of the primary pioneers of the continuous quality improvement
movement. Some of the contributions to the science of improvement made by Deming are
appreciating a system, understanding variation, and applying knowledge and psychology.
PTS: 1 DIF: Application REF: INTRODUCTION
5. A local hospital is implementing a systematic process of organization-wide participation and
partnership in planning and implementing improvement methods to test evidence-based practices at
all levels of the services. The hospital is most likely implementing which of the following?
a. QI c. QM
b. QA d. TM
ANS: A
QI (quality improvement) is an organization (system-wide) process of organization-wide
participation and partnership in planning and implementing improvement methods to understand
and meet customer needs and expectations. It is proactive in its approach, and other terms that may
be used interchangeably for QI are TQM (total quality management) and PI (process improvement).
PTS: 1 DIF: Application REF: INTRODUCTION
6. A nursing instructor is evaluating a students understanding of the primary difference between QA
and QI. Which response by the student would indicate that the student understood?
a. QI is reactive, and QA is proactive.
b. QAs emphasis is on maintaining minimum standards of care, and QIs emphasis is
upon identifying real and potential problems.
c. QA documents quality, and QI reports incidents and errors.
d. QI is more a single program, and QA is more a management approach.
ANS: B
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