Staffing%20and%20Nursing%20Care%20Delivery%20Models

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Staffing and Nursing Care Delivery Models
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Key Concepts

• Staffing for health care organizations
• Patient classification systems
• Nursing care delivery models
• Critical pathways
• Nursing case management

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Staffing

• Activities to ensure an adequate number and mix
  of team members
• Staffing considerations
• Patient needs
• Staff satisfaction
• Organizational needs

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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

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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)

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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

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Meeting Organizational Needs

• Budget and financial management
• Number of staff
• Staff mix
• Licensing and accreditation
• Customer satisfaction
• Quality care

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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

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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

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Classic Nursing Care Models

• Total patient care
• Functional nursing
• Team nursing
• Primary nursing

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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 areasintensive care unit (ICU) and
  postanesthetic care unit (PACU)

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Total Patient Carecontd

• 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

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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 areaoperating room

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Functional Nursingcontd

• 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

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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 areasmost inpatient and outpatient
  areas

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Team Nursingcontd

• 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

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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

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Modular Nursingcontd

• 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

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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 areashospice, home health, and
  long-term care settings

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Primary Nursingcontd

• 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

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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

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Partnership Model (Co-Primary Nursing)contd

• 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

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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

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Patient-Centered Care(Patient-Focused
Care)contd

• 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

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Patient-Centered Care(Patient-Focused
Care)contd

• 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

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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

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Case Managementcontd

• 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

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RN Case Manager

• Coordinates the patients 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)

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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

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Clinical PathwaysTerminology

• Patient outcomes
• Transdisciplinary intervention
• Variance
• Trigger

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Clinical PathwaysEssential Components

• Self-care activities
• Nutrition
• Patient and family education
• Discharge planning
• Triggers

• Consults
• Laboratory and diagnostic tests
• Treatments
• Medications
• Safety

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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?

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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

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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?