Nursing Care Delivery Systems

Nursing Care
Delivery Systems
Issues and Trends

Five Major Types of Nursing Care Delivery
Systems
• Total Patient Care

• Functional Nursing
• Team or Modular Nursing
• Primary Nursing
• Case Management
Total Patient Care
• Registered Nurse assumes responsibility for a group

of patients for a shift – provides all care to the
patient.
• Advantages – continuity for the shift, responsibility is
clear, generally satisfying for nurses.
• Disadvantages – can be very expensive, may not
utilize RN time wisely and may not be possible with
staffing shortages.
Functional Nursing
• Staff Members are assigned to a specific task or

group of tasks for patients – example Medication
Nurse, IV Nurse, Vital Signs --- RN assumes overall
direction of care.
• Advantages – incorporates the use of LPNs and UAPs
and maximizes their skills, can be cost effective.
• Disadvantages – Can lead to fragmentation and gaps
in patient care – not holistic.
Team Nursing/Modular Nursing
• RN Team Leader coordinates care for a group of
patients working with other team members (RNs,
LPNs and UAPs) utilizing their skills.
• Advantages – if done well can be very satisfying to
staff and patients as well as cost effective.
• Disadvantages – requires high level leadership skills
from RN – harder to do with high patient acuity and
inconsistent team members.
Primary Nursing
• Registered Nurses assume 24/7 accountability for

their Primary Patients – establish plan of care and
coordinate care even in their absence.
• Advantages – can result in high job satisfaction and
excellent holistic care for patients.
• Disadvantages – requires high RN mix, difficult to do
with today’s flexible scheduling, some staff don’t
want the accountability and responsibility.
Case Management
• RN Case Manager supervises the care of the patient

and use of resources across the continuum – focus is
on individual patients.
• Advantages – can be very cost effective and
satisfying for patients who are high risk/problem
prone.
• Disadvantages – Case Management is not a true
inpatient delivery system but rather the
management of patient care.
Leadership Responsibilities in Selecting a
Model
• Determine whether the • Ensure that the model will
patient acuity and patient allow your nursing staff to
needs in the setting fits the do their best work.
model being recommended.
• Determine the economic
• Assess whether your staff is
ready and trained to utilize feasibility.
a new model. • Assess the adequacy of your
• Ensure that your staff nursing resources to
understand scope of support the model.
practice issues.
Hot Issues with Nursing Care Delivery
Systems
• Movement of Nursing back to a
Team or Modular Approach
• Increasing Numbers of Associate
Degree Nurses with no Leadership
Training who are assigned as Team
Leaders.
• Confusion about Scope of Practice
particularly with LPNs in Acute
Care has led to reduction of LPN
use but an increase in PCA or PCT
Use.
What Every Nursing Leader needs to
know about the Florida Nurse Practice
Act before introducing a New Nursing
Care Delivery System
Supervision - Definition
“Supervision is the provision of guidance by a qualified

nurse and periodic inspection by the nurse for the
accomplishment of a nursing task or activity”
Florida Nurse Practice Act
Delegation - Definition
“Transferring to a competent individual the authority to

perform a selected nursing task in a selected situation.”
National Council of State Boards of Nursing

Practice of Professional Nursing
• Observation, Assessment, Nursing Diagnosis, Planning,
Intervention, Evaluation of Care and Health Teaching.
• Administration of Medications and Treatments as

prescribed by a duly authorized licensed practitioner in
the state.
• Supervision and Teaching of other personnel in the

performance of the above acts.
Florida Nurse Practice Statute 464

Practice of Practical Nursing
• Performance of selected acts including administration

of treatments and medications in the care of the ill,
injured, or infirm and the promotion of wellness,
maintenance of health and prevention of illness of
others.
• Works under the direction of a Registered Nurse, a

Licensed Physician, a Licensed Osteopath, a Licensed
Podiatric Physician or a Dentist.
Florida Nurse Practice Statute 464

Unlicensed Assistive Personnel - UAPs
• Certified Nursing Assistants

• Personnel Care Assistants
• Student Nurses
• Patient Care Technicians
• None of the above are licensed

Registered Nurses Cannot Delegate the Following
• Assessment or
Reassessment of Patients
• Planning of Care
• Evaluation of Care
• Decisions about whether
to contact a Physician
about Changes in a
Patient’s Condition
Registered Nurses can Delegate
• Tasks involving Activities
of Daily Living
• Data Collection such as

Intake/Output, Weights,
Vital Signs, Glucose Finger
Sticks
• Administration of
Medications or
Performance of
Treatments
Supervision of Care
• Supervision of Care in an Acute Care Setting is

ALWAYS the responsibility of a Registered Nurse.
• Licensed Practical Nurses in Nursing Home Setting

can supervise care given by other LPNs or UAPs
providing that have 6 months experience and a 30
hour supervisory course.
That’s All Folks

Nursing Care Delivery Systems

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Nursing Care

Issues and Trends

• Total Patient Care

• Registered Nurse assumes responsibility for a group

• Staff Members are assigned to a specific task or

• Registered Nurses assume 24/7 accountability for

• RN Case Manager supervises the care of the patient

“Supervision is the provision of guidance by a qualified

“Transferring to a competent individual the authority to

National Council of State Boards of Nursing

• Administration of Medications and Treatments as

• Supervision and Teaching of other personnel in the

Florida Nurse Practice Statute 464

• Performance of selected acts including administration

• Works under the direction of a Registered Nurse, a

Florida Nurse Practice Statute 464

• Certified Nursing Assistants

• None of the above are licensed

• Data Collection such as

• Supervision of Care in an Acute Care Setting is

• Licensed Practical Nurses in Nursing Home Setting

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