01.03 Nursing Care Delivery Models

So in this lesson, we are going to take a look at some different models of delivering health care to our patients.

So, what are nursing care delivery models?

Well, they’re different methods that hospitals and nurses use to set up and deliver care. They can include charge nurses, team leaders, other nurses, and care techs or assistants.

The four we are going to look at today are Functional Nursing, Team Nursing, Total Patient Care and Primary Nursing. So let’s take a look at each of them.
Functional nursing is really unique. It involves multiple nurses, who have very specific tasks. For instance, let’s say you have Jon, Nichole and Tony, all nurses on the floor. Well, Jon is responsible for giving meds, Nichole is responsible for, let’s say, IVs, and Tony is responsible for assessments. So during the shift, Jon would pass out all of the medications, Nichole would manage the IVs and Tony would assess all of the patients.

There are definitely pros and cons to this setup. The biggest pro is that it is extremely efficient. Because every nurse has a specific job, they’re not doing all aspects of care, so every individual task gets done more efficiently. But, that actually leads to one of the major cons of functional nursing. Holistic care. This is a fractured model, and it doesn’t paint the big picture as to how well a patient is or isn’t doing. It also relies on multiple nurses, so if there are staffing issues, then there could be gaps in care. This is why this model isn’t prevalently used.

However, here’s a great situation where it DOES work well. That’s a code team. Every nurse has their own individual responsibility. This means that care is clear and concise, and efficient. You have a med nurse, a recorder, someone doing compressions, someone doing lines, someone running to get supplies...this is where it’s extremely beneficial. But on the whole, for patient-centered care, this model can really fall short in areas of care.
Team nursing is a very popular delivery model, and it’s often seen in high-acuity areas like ICUs or Emergency Departments.

Basically, it works like this. You have a team leader, or a charge nurse, who makes assignments, coordinates care with other doctors and other team members and who speaks to all of the nurses on the unit. Under them, you have the multiple RNs who are caring for the patients on the unit. They’re responsible for directly giving care to the patients. They can delegate certain aspects of care, which is where the CNAs or PCTs come in. CNA stands for certified nurse assistant and PCT is a patient care tech. The techs and assistants can provide care like bathing, turning, assisting to the bathroom or other things that don’t require nursing assessment.

This is a really common type of nursing care model, but it does have some drawbacks. A common complaint is that the charge nurse or team leader doesn’t have direct interaction with the patient, or only with those who are acutely ill (like new admissions in an ICU). The other is that the team nursing model can create gaps in care, mainly because nurses may be pulled in different directions, depending on how sick other patients are on the unit. Other than that, the model allows nurses to collaborate to deliver high-quality care.

Total patient care is the model that we most commonly see. It’s basically shift based, so the nurse shows up for their shift, say, 7 a to 7 p and provides care for a patient or patients for the duration of that shift. Nurses are also responsible for all aspects of care (which also takes into account the care that you delegate). Also, the nurse coordinates care and care plans with the medical team or whatever providers are assigned for that patient.

Now, you can also have a combination of models. For example, in the ICU, it’s not uncommon to see the nurses delivering Total Patient Care, but they also function in a team nursing model. And in the event of a code, those nurses would then break down into a functional model, and then go back to their care when the code ended.

Now the last model isn’t too common but is still out there. And it’s the primary nursing model.

The way this model works is that you have a nurse assigned to care for a patient. They care for the patient for the duration of their stay. So let’s say you’re working in a skilled nursing facility, and they use a primary nursing model. You’d be required to create care plans, coordinate care and talk to the medical team for that patient during the entire duration of their stay, until they were either discharged or transferred to another facility. The other important thing to note about this model is that the nurse manages the case even when they’re not there - meaning that the care plans are followed by the primary nurse, unless something happens which requires some pretty course altering intervention (for example, the patient develops an acute respiratory infection and decompensates). This model helps to foster the nurse-patient relationship, especially when a patient has to be in one place for a long time. Sometimes, it’s more than one client, so think home health or hospice. Not all care is required by the nurse, but all of the care given to the patient or patients is the RESPONSIBILITY of the nurse, so think about that when you’re delegating tasks. Delegation is covered in pretty good detail in another lesson, so check that one out.

Nursing care delivery models focus heavily on how we give care to our patients. We focus on teamwork and collaboration and putting the patients in our main area of focus. We work to make their care as high of quality as we can, and try to use models or variations of models to do that. Also, we want to focus on professionalism, and how we deliver care in a meaningful and professional manner.

So to recap, in functional nursing, every nurse has their own task. Overall, it’s efficient, but it has some flaws. Team nursing is just that - team focused, where nurses can collaborate with care, and there’s a nurse who serves as their leader. In total patient care, the nurse is responsible for all of the care throughout a shift, including what’s delegated. Primary nursing is set up to foster the nurse-patient relationship, so a nurse is assigned to that patient for the duration of their care. And lastly, know your model that you’re working in and know what your responsibilities are. These models can change frequently. A code in an ICU can shift from total patient and team to functional quickly and then resolve back to a team model in no time.

Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!