392 PART TWO Management

TABLE 13-2 Pros and Cons of Various Assignment Systems

Assignment System Pros Cons
Case method Total patient care is provided by one Different nurses provide care on
nurse on each shift. different shifts and different days.
Functional nursing Efficiency is increased. Nurses do managerial work.
Nurses’ aides perform patient care.
Team nursing Care is provided through team effort. Time is needed to coordinate
Patient care coordinator is freed to delegated work.
manage the unit.
Nursing care conferences help problem
solve and develop staff.
Nursing care plan is developed.
Modular nursing System is useful when there are few Paraprofessionals perform technical
registered nurses (RNs). aspects of care.
RNs plan care.
Primary nursing RNs give total patient care. Nurse’s talents are confined to a
Primary nurse has 24-hour limited number of patients.
responsibility. Associate nurse may change care
Associate nurse works with patient plan without discussing with
while the primary nurse is off duty. primary nurse.
Accountability is in place.
Continuity of care is facilitated.
Number of errors from relay of orders
is reduced.
There are fewer patient complaints.
Hospital stays are shorter.
Managed care Case management is incorporated. Continuity of care is questionable.
Method can be used with any nursing
care delivery system.
Standard critical paths are used.
Efficiency is increased.
Cost is reduced.
Case management Entire episode of illness is the focus. Coordination requires effort.
Achievement of outcomes is
emphasized.
Care is coordinated by a case manager.
Care is provided by second-generation
primary nursing.
Critical paths are used.
Variation analysis is conducted.
Intershift reports are created.
Health care team meetings are held.
Interdisciplinary approach is used.

nurse, treatment nurse, and bedside nurse are all
products of this system. The functional method
implements classic scientific management prin-
ciples, which emphasize efficiency, division of
labor, and rigid controls. It is an efficient system
that is the least costly because it requires few
RNs. Procedural descriptions are used to define
the standard of care, and psychological needs
typically are slighted. Care tends to be fragment-
ed and depersonalized. RNs may keep busy with
managerial and nonnursing duties, and nurses’
aides deliver the majority of patient care.
Although superficially cost efficient because it
uses the smallest number of staff, the functional
assignment method does not encourage patient
and staff satisfaction. Research indicates that