CARE DELIVERY MODELS

and STAFFING

Fidela B. Ansale, R.N.,

Doctor of Science in
Nursing
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
. Patients’ expectations
* Nurse managers blend together different nursing care delivery model 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 nursing model:
. Each healthcare provider becomes proficient in the procedure she performs.
Drawback:
- No one views the 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.
* Functional nursing model works well in situation where the nurse manager
personally directs relatively inexperienced nurses.

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.
Advantages:
. Each team members feels responsible for total patient care thus there is an
open and continuous line of communication among team members.
 . The patient becomes familiar with the team, patient interacts with same
group of health care professionals everyday.
. Assignments are based on each team member’s level of education.

Disadvantages:
. The team spends time discussing the patient’s progress. These meetings
often take time.
. Schedule changes among the team compromise the continuity of care.
. The nurse manager must have excellent communication skills for resolving
conflicts among team member.
* 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, this helps the nurse manager to demonstrate integrity and to earn
the team’s trust.
- This model is used in long-term care facilities.
d. Primary Nursing Model
- One nurse is responsible for the total care of a group of patients.
Major objectives. To place the nurse back at the patient’s bedside.

The primary nurse is responsible for all aspects of patient care while
patient remains on the unit.

* This supports the philosophy of nursing that states “Nursing is a knowledge

based profession, not a task oriented skill” that is the nurse must:
. Assess, analyze/diagnose, plan, implement, and evaluate when caring for
a patient rather than simply performing procedures ordered by a physician.
Advantages of Primary Nursing Model
. Responsibility for patient care is decentralized from the nurse manager
to the primary nurse.
. There is one nurse who is responsible for care of the patient 24 hours a
day while the patient is in the unit.
. It is clear to everyone who is in charge of patient care, which leads to increase
satisfaction of the patient, patient’s family, patient’s physician and the
primary nurse.
 . The primary nurse is the coordinator of the patient’s care among other units
in the hospital. The primary nurse identifies and resolves conflicts regarding
tests, medication, and procedures that the patient receives.
. Primary nurse is recognized as professional.

Disadvantages:
. The model is costly, because it is perceived that a registered nurse must
provide all patient care.
. In reality, one nurse can not be responsible for the patient’s care 24 hours a day
7 days a week.
 . The primary nurse can not be responsible for care given outside the unit
such as when the patient is transferred.
. The primary nurse and associate nurses may not fully communicate with
each other when they hand off the patient.
* This model works well for nurse managers who adopt democratic and
transactional style of management.
e. Case Management Nursing Model
- is based on nursing care plan (sometimes referred to as multidisciplinary
plan MAP) that specifies what is to be accomplished each day while the
patient is in the hospital according to diagnosis.
Advantage:
. Close attention paid to the patient by one nurse who closely follows the
patient’s progress through the care plan; reduce length of stay in the
hospital.
Disadvantage:
. When the model is poorly implemented.
f. Total Nursing Care Model
- It is similar to primary nursing care model in that the nurse assume the
total care of the patient.
. The nurse is not responsible after her shift ends and the patient is not
followed to another unit.
Advantage:
- There is better communication with colleagues from other discipline and
with family members.
Disadvantage:
- The professional nurse is doing certain tasks that could be delegated to an
ancillary staff.
 STAFFING

- The process of having the appropriate number and mix of healthcare providers
available to care for the actual or projected number of patients to achieve
cost-effective , quality patient care.

Note:
. The nursing care model gives the framework within which to analyze their
needs to set their staffing budget.
Staffing Budget for a unit is defined in full-time equivalents
Full-time equivalents – is the total number of full-time hours of workers. A full
time employee works 8 hours per shift.
Staffing requirements are determined by
. Patient’s acuity
. Length of time that the care is given
. Level of care for each patient
. Patient classification
Predicting Staffing Needs
. Is there current nursing shortage
- supply and demand factors leading to the shortage
. Aging workforce with imminent retirement
. Inadequate nursing education enrollments
- brought about by inadequate resources to provide nursing education
to those interested in pursuing nursing career
-” graying “ of the nursing faculty also contribute to shortage
 EMPLOYEE RECRUITMENT, SELECTION, PLACEMENT and
INDOCTRINATION

Recruitment
- is the process of actively seeking out or attracting applicants for existing
positions and should be ongoing process

a. Interview (as a selection tool)

- a verbal interaction between the individuals for a particular purpose.
. It focuses on whether or not the candidate will be a good team leader
rather than on the candidate’s caregiving skills
Purposes of Interview
. It seeks to obtain enough information to determine applicant’s suitability
for the position
. The applicant obtains adequate information and to make intelligent decision
about accepting the job should it be offered
. The interviewer seeks to conduct the interview in such a manner that regardless
of the result, the applicant will continue to have respect for and goodwill
toward the organization
.
Types of interview
. Structured – requires greater planning
. Semi structured – requires some planning the flow is focused and directed at
major topic although there is flexibility on the approach
. Unstructured – requires little planning because the goals for hiring is not clear

Limitations of interview:
. Subjectivity
. Belief that interviewing is just about talking to people
. Belief that Interviewing is just about good conversation
Legal Aspect of Interviewing
. Make sure that the application form does not contain questions that violate
various employment acts. Unlawful questions must be avoided.
. Inquiries regarding age, marital status, children, race, sexual preference,
financial or credit status, race of origin, religion = these are deemed
discriminatory
 Interviewing Tips for Applicants

. Prepare in advance for the interview

. Obtain copies of the philosophy and organizational chart of the organization
to which you are applying
. Schedule an appointment for the interview
. Dress professionally and conservatively
. Practice responses to potential interview questions in advance
. Arrive early on the day of interview
 . Greet the interviewer formally and do not sit down before she does unless
given permission to do so
. Shake the interviewers hand upon entering the room and smile
. During interview sit quietly , be attentive, and take notes only if absolutely
necessary
. Do not chew gum, fidget, slouch, or play with your hair, keys or writing pen
. Ask appropriate questions
. Avoid a” what can you do for me”
. Answer interview questions honestly and confidently
. Shake the interviewer’s hand at the close of the interview and thank him
for her time
. Send a brief thank you note to the interviewer within 24 hours of the interview