This document discusses various staffing and nursing care delivery models. It describes patient classification systems used to categorize patients according to care needs. Several classic nursing care models are outlined including total patient care, functional nursing, team nursing, primary nursing, and case management. The document also discusses factors to consider when selecting and evaluating nursing care delivery models.
2. Key Concepts
Staffing for health care organizations
Patient classification systems
Nursing care delivery models
Critical pathways
Nursing case management
3. Staffing
Activities to ensure an adequate number
and mix of team members
Staffing considerations
Patient needs
Staff satisfaction
Organizational needs
4. Meeting Patient Needs
Primary considerations
Number of patients
Intensity of care required
Staff experience and preparation
Patient classification systems/acuity level
Categorize patients according to care needs
5. Classification System Considerations
Age and functional ability
Communication skills
Cultural and linguistic diversities
Severity/urgency of the admitting condition
Scheduled procedures
Ability to meet health care requisites
Availability of social supports
Other specific needs
(Recommended by the American Nurses Association)
6. Meeting Staff Needs
Satisfied nurses provide higher quality,
more cost-effective care
24 hour/day, 365 day/year staffing needs
create staffing challenges
Creative staffing options
Staff input about staffing
7. Meeting Organizational Needs
Budget and financial management
Number of staff
Staff mix
Licensing and accreditation
Customer satisfaction
Quality care
8. The Number One Challenge
Appropriate staffing within budget
constraints with well-trained, competent,
professional staff members who are
committed to providing safe, high-quality
care
9. Nursing Care Delivery Models
Detail assignments, responsibility, and
authority to accomplish patient care
Determine who is going to perform what
tasks, who is responsible, and who
makes decisions
Match number and type of caregivers to
patient care needs
10. Classic Nursing Care Models
Total patient care
Functional nursing
Team nursing
Primary nursing
Variations have been adopted to improve
care
11. Total Patient Care
Nurse is responsible for planning,
organizing, and performing all care
Oldest method of organizing patient care
Typically performed by nursing students
Common use areas—intensive care unit
(ICU) and postanesthetic care unit
(PACU)
12. Total Patient Care—cont’d
Advantages
High degree of autonomy
Lines of responsibility and accountability are
clear
Patient receives holistic, unfragmented care
Disadvantages
Each RN may have a different approach to care
Not cost-effective
Lack of RN availability
13. Registered Registered Registered
Nurse Nurse Nurse
8-hour shift 8-hour shift 8-hour shift
Patient Care
The registered nurse plans,
organizes, and performs all care
Total Patient Care (Case Method) Delivery
14. Functional Nursing
Staff members assigned to complete
specific tasks for a group of patients
Evolved during World War II as a result
of a nursing shortage
Unskilled workers trained to perform
routine, simple tasks
Common use area—operating room
15. Functional Nursing—cont’d
Advantages
Care is provided economically and efficiently
Minimum number of RNs required
Tasks are completed quickly
Disadvantages
Care may be fragmented
Patient may be confused with many care
providers
Caregivers feel unchallenged
16. Nurse Manager
LPN RN Nurse Aide Nurse Aide
PO Meds Assessments Vital signs Hygiene
Treatments Care Plans Hygiene Stocking
Assigned Patient Group
Functional Nursing Care Delivery Model
17. Team Nursing
RN as team leader coordinates care for a
group of patients
Evolved in the 1950s to improve patient
satisfaction
Goal was to reduce fragmented care
Common use areas—most inpatient and
outpatient areas
18. Team Nursing—cont’d
Advantages
High-quality, comprehensive care with a high
proportion of ancillary staff
Team members participate in decision making
and contribute their own expertise
Disadvantages
Continuity suffers if daily team assignments
vary
Team leader must have good leadership skills
Insufficient time for planning and
communication
19. Nurse Manager
RN Team Leader RN Team Leader
RN RN
LPNs/LVNs LPNs/LVNs
Nursing Assistants Nursing Assistants
Assigned Patient Group Assigned Patient Group
Team Nursing Model
20. Modular Nursing
Modification of team nursing
Patient unit is divided into modules or units
with an RN as team leader
The same team of caregivers is assigned
consistently to the same geographic area
Concept evolved to increase RN
involvement in care
21. Modular Nursing—cont’d
Advantages
Continuity of care is improved
RN more involved in planning and coordinating
care
Geographic closeness and efficient
communication
Disadvantages
Increased costs to stock each module
Long corridors not conducive to modular
nursing
22. Nurse Manager
Geographic Geographic Geographic
Patient Unit Patient Unit Patient Unit
Patient Care Patient Care Patient Care
Team: Team: Team:
RNs RNs RNs
LPNs/LVNs LPNs/LVNs LPNs/LVNs
Nurse Aides Nurse Aides Nurse Aides
Meds Meds Meds
Supplies Supplies Supplies
Linens Linens Linens
Modular Nursing Model
23. Primary Nursing
RN “primary nurse” assumes 24-hour
responsibility for planning, directing, and
evaluating care
Evolved in the 1970s to improve RN
autonomy
Common use areas—hospice, home
health, and long-term care settings
24. Primary Nursing—cont’d
Advantages
High-quality, holistic patient care
Establish rapport with patient
RN feels challenged and rewarded
Disadvantages
Primary nurse must be able to practice with a
high degree of responsibility and autonomy
RN must accept 24-hour responsibility
More RNs needed; not cost-effective
25. Primary Nurse
24-hour responsibility for
planning, directing & Associate Nurses
Physician and
other members evaluating patient care Provide care
of the health care when primary
team nurse is off duty
Patient
Primary Nursing Model
26. Partnership Model
(Co-Primary Nursing)
RN is partnered with an licensed practical
nurse/licensed vocational nurse (LPN/LVN)
or nursing assistant to work together
consistently
Modification of primary nursing to make more
efficient use of the RN
27. Partnership Model
(Co-Primary Nursing)—cont’d
Advantages
More cost-effective than primary nursing
RN can encourage training and growth of
partner
Disadvantages
RN may have difficulty delegating to partner
Consistent partnerships difficult to maintain
due to varied schedules
28. Patient-Centered Care
(Patient-Focused Care)
Cross-functional teams of professionals and
assistive personnel work together as a unit-
based team
Recent development in nursing care delivery
models
More patient oriented than department
oriented
Models vary considerably among facilities
29. Patient-Centered Care
(Patient-Focused Care)—cont’d
Advantages
Patient comes into contact with fewer workers
Workers are unit based and spend more time
in direct-care activities
Team is supervised by an RN
RN is accountable for a wide range of services
and functions at a higher level
Cost-effective
30. Patient-Centered Care
(Patient-Focused Care)—cont’d
Disadvantages
Major change in organizational structure is
required
Departments other than nursing must be willing
to accept nursing leadership
Nurse manager supervises many types of
workers
31. Nurse Manager
Patient Care Respiratory Services Patient Transportation
Housekeeping ECG Admission/Discharge Phlebotomy
Physical/Occupational/Speech Therapy Dietary Services
Financial Counseling Supply Management
Patient
Patient-Centered Care Model
32. Case Management
First introduced in the 1970s by insurance
companies
Hospitals adopted the model in the 1980s
Value demonstrated through research
Components include:
Assessment, planning, implementation,
evaluation, and interaction
33. Case Management—cont’d
Variations are found in most health care
organizations
Reserved for chronically ill patients,
seriously ill patients, or long-term,
expensive cases
RN assumes a planning and evaluative
role; usually not responsible for direct-care
duties
Supplemental form of care delivery; does
not replace direct-care model
34. RN Case Manager
Coordinates the patient’s care throughout the
course of an illness from a payer or facility
perspective
Employee of the payer (external case
management)
Employee of the health care facility (internal case
management)
35. Collaborates With
Patient and Family
NURSE CASE MANAGER
Onset of Resolution of
Assesses, plans, implements, coordinates,
Illness Illness
monitors, and evaluates patient care
options and services to meet health needs
Collaborates with Nursing, Coordinates Services:
Physicians, Physical/Speech/ Home Care, Hospice,
Occupational Therapists, Dietary, Extended /Long-term Care
and Ancillary Services Ambulatory Care Services
Nursing Case Management Model
36. Clinical Pathways
Delineate a predetermined written plan of
care for a particular health problem
Specify desired outcomes and
transdisciplinary intervention
Address a common medical diagnosis
Dictate the type and amount of care given
and thus have financial implications
39. Choosing a Nursing Care Delivery
Model
What staff mix is required?
Who should make work assignments?
Work assigned by task? By patient?
How will communication be handled?
Who will make decisions?
Who will be responsible and accountable?
Fit with unit/facility/organization
management?
40. Influences on Nursing Care
Delivery Model Selection
Health care setting
Acute care, long-term care, ambulatory care,
home care, and hospice
Organizational structure and resources
Management, staffing, supplies, and physical
layout
Patient needs
Acute, long-term, and chronic
41. Evaluation of Nursing Care
Delivery Models
Timely, cost-effective outcomes
achieved?
Patient and families happy with care?
Team members satisfied with care?
Good communication among all team
members?
RNs utilized and challenged
appropriately?