1. Staffing and 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

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. Total Patient Care (Case Method) Delivery
The registered nurse plans,
organizes, and performs all care
Registered
Nurse
8-hour shift
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. Functional Nursing Care Delivery Model
Nurse Manager
LPN/
PO Meds
Treatments RN
Assessments
Care Plans
Nurse Aide
Vital signs
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 Disadvantages
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. Team Nursing Model Nurse Manager RN Team Leader RN LPNs
Nursing Assistants
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. Modular Nursing Model Nurse Manager Geographic Patient Unit
Patient Care
Team:
RNs
LPNs
Nurse Aides
Meds
Supplies
Linens
LPNs/
Nurse Manager
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 Nursing Model Patient Primary Nurse 24-hour responsibility for
planning, directing &
evaluating patient care
Patient
Associate Nurses
Provide care
when primary
nurse is off duty
Physician and
other members
of the health care
team
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. Patient Patient-Centered Care Model Nurse Manager Patient Care
Respiratory Services
Patient Transportation
Housekeeping ECG
Admission/Discharge
Phlebotomy
Physical/Occupational/Speech Therapy
Dietary Services
Financial Counseling
Supply Management
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. Nursing Case Management Model
NURSE CASE MANAGER
Assesses, plans, implements, coordinates,
monitors, and evaluates patient care
options and services to meet health needs
Onset of
Illness
Resolution of
Collaborates with Nursing,
Physicians, Physical/Speech/
Occupational Therapists, Dietary,
and Ancillary Services
Collaborates With
Patient and Family
Coordinates Services:
Home Care, Hospice,
Extended /Long-term Care
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

37. Clinical Pathways Terminology
Patient outcomes
Transdisciplinary intervention
Variance
Trigger

38. Clinical Pathways Essential Components
Self-care activities
Nutrition
Patient and family education
Discharge planning
Triggers
Consults
Laboratory and diagnostic tests
Treatments
Medications
Safety

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?