1
CARE DELIVERY MODELS AND
STAFFING
NURSING CARE DELIVERY
 A framework for providing a cost-
effective, practical way to care for
patients using limited resources.
 It strikes balance the COST of CARE
and QUALITY OUTCOMES.
 Cost- refers to the expense of
delivering patient care based on the
definition of care.
 Quality Outcomes- refers to the
quality of care that patients receive
from the staff.
Nursing care delivery models are evidence-
based and consider the changing demands
of:
 Patient care
 Advancement in technology
 Healthcare care reimbursement practices
 Available staffing
 Patient’s expectations
*Note: Nurse managers blend together different
nursing are delivery method to create a model that
works for a particular healthcare facility.
A. CASE MODEL
 Is one of the first nursing care delivery
models and was introduced in the 1800
to provide a framework for caring for
sick family members of working
families.
 This model is similar to today’s private
duty nursing where the nurse cares for
one patient.
B. FUNCTIONAL NURSING MODEL
 Introduced during the world war in the
1940s.
 This model specifies that one nurse performs
the same procedure on every patient that
requires the procedure.
Advantage of Functional Modelp
 Each healthcare provider becomes proficient
in the procedure she performs.
 Drawback:
 No one views client as a whole
 Health care provider views the
patient only in relation to the
procedure she performs.
 It tends to confuse the patient.
 The patient sees a number of
caregivers each shift and feels lack
continuity of care.
 The patient is not sure who to speak
to about his care.
*Note: Functional nursing model works well in
situation where the nurse manager personally
directs relatively inexperienced.
C. TEAM NURSING MODEL
 Uses a team of health care providers to care
for the patient.
 The team is a discrete unit led by the nurse
manager.
 Team nursing model requires that the nurse
manager become an active team leader and
use interpersonal skills to keep up the team
spirit during challenging times.
 A transformational leadership style will find
success using the team nursing care model,
 2

this helps the nurse manager to demonstrate performing procedures ordered by a

integrity and to earn the team’s trust. physician.
 This model is used in long-term care
facilities.

Advantages of Team Nursing Model:

Advantages of Primary Nursing Model:
 Each team members feels responsible for
total patient care thus there is an open and  Responsibility for patient care is

continuous line of communication among decentralized from the nurse manager to the

team members. primary nurse.

 The patient becomes familiar with the team,  There is one nurse who is responsible for

patient interacts with same group of health care of the patient 24 hours a day while the

care professionals everyday. patient is in the unit.

 Assignments are based on each team  It is clear to everyone who is in charge of

member’s level of education. patient care, which leads to increase

satisfaction of the patient, patient’s family,
Disadvantages of Team Nursing Model:
patient’s physician and the primary nurse.
 The team spends time discussing the  The primary nurse is the coordinator of the
patient’s progress. These meetings often patient’s care among other units in the
take time. hospital. The primary nurse identifies and
 Schedule changes among team resolves conflicts regarding tests,
compromise the continuity of care. medication, and procedures that the patient
 The nurse manager must have excellent receives.
communication skills for resolving  Primary nurse is recognized as professional.
conflicts among team member.
Disadvantages of Primary Nursing Model:
D. PRIMARY NURSING MODEL  The model is costly, because it is perceived

 One nurse is responsible for the total care of that a registered nurse must provide all

a group of patients. patient care.

 Major objectives, to place the nurse back at  In reality, one nurse can be responsible for

the patient’s bedside. the patient’s care 24 hours a day, 7 days a

 The primary nurse is responsible for all week.

aspects of patient care while patient remains  The primary nurse cannot be responsible for

on the unit. care given outside the unit such as when the

 This supports the philosophy of nursing that patient is transferred.

states “nursing is knowledge-based  The primary nurse and associate nurses may

profession not a task-oriented skill” that is not fully communicate with each other when

the nurse must ASSESS; ANALYZE; they hand off the patient.

PLAN; IMPLEMENT; and EVALUATE *Note: This model works well for nurse managers
when caring for a patient rather than simply who adopt democratic and transactional style of
management.
 3

E. CASE MANAGEMENT NURSING

STAFFING
MODEL
 The process of having the appropriate
 Is based on nursing care plan (sometimes
number and mix of healthcare providers
referred to as multidisciplinary plan MAP)
available to care for the actual or projected
that specifies what is to be accomplished
number of patients to achieve cost-effective,
each day while the patient is in the hospital
quality patient care.
according to diagnosis.
Note:
Advantages of Case Management Nursing Model:
 The nursing care model gives the framework
 Close attention paid to the patient by one
within which to analyze their needs to set
nurse who closely follows the patient’s
their staffing budget.
progress through the care plan; reduce
 Staffing Budget- for a unit is defined in full-
length of stay in the hospital.
time equivalents.
Disadvantages of Case Management Nursing  Full-time equivalents- is the total number of
Model: full-time hours of workers. A full-time
employee works 8 hours per shift.
 When the model is poorly implemented.
Staffing requirements are determined by:
F. TOTAL NURSING CARE MODEL
 Patient’s acuity
 It is similar to primary nursing care model in
 Length of time that the care is given
that the nurse assume the total care of the
 Level of care for each patient
patient.
 Patient classification
 The nurse is not responsible after her shift
ends and the patient is not followed to Predicting Staffing Needs:
another unit.  Is there current nursing shortage
Advantages of Total Nursing Care Model:  Supply and demand factors leading
to the shortage
 There is better communication with
 Aging workforce with
colleagues from other discipline and with
imminent retirement
family members.
 Inadequate nursing education
Disadvantages of Total Nursing Care Model: enrollments, brought about

 The professional nurse is doing certain tasks inadequate resources to

that could be delegated to an ancillary staff. provide nursing education to

 4

those interested in pursuing

nursing career.
 “Graying” of the nursing faculty also
contribute to shortage.

EMPLOYEE DISCIPLINE

 The process of generating employee

compliance to institutional rules and
regulations.
 Must be properly communicated
 Be done privately, promptly and
consistently, progressive in nature.
 Should be preceded by counseling
 Disciplinary procedures should be instituted
with extreme caution.

Steps to addressing disciplinary problems:

 Coaching
 Confrontation
 Disciplinary conference