Effective Leadership and Management in Nursing CHAPTER EIGHTH EDITION Delivering Nursing Care 3

Effective Leadership and Effective Leadership and Management in NursingManagement in Nursing

CHAPTER

EIGHTH EDITION

Delivering Delivering Nursing CareNursing Care

3

Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan

Learning OutcomesLearning Outcomes

1. Describe how the delivery system structures nursing care.

2. Describe what types of nursing care delivery systems exist.

3. Discuss the positive and negative aspects of different systems.


Learning OutcomesLearning Outcomes

4. Describe evolving types of delivery systems that have emerged.

5. Explain characteristics of effective delivery systems.


Nursing Care Delivery SystemsNursing Care Delivery Systems

• Provide structure for delivering care• Delivery of care includes:

– Assessing care needs– Formulating plan of care– Implementing plan– Evaluating patient's responses


Nursing Care Delivery SystemsNursing Care Delivery Systems

• Pros and cons debated• Must optimize nurse’s knowledge, skills• Ensure that patients receive

appropriate care• Lower mortality rates in hospitals with

good environments for nurses


Functional NursingFunctional Nursing

• RNs, LPNs, and UAPs are assigned different tasks

• RNs assess patients• Other staff give baths, make beds, take

vital signs, and administer treatments


Figure 3-1 Functional nursing.


Functional NursingFunctional Nursing

• Advantages– Staff become efficient at performing

assigned tasks

• Disadvantages– Uneven continuity– Lack of holistic understanding of patient– Problems with follow-up


Team NursingTeam Nursing

• Team of nursing personnel provides total care to a group of patients by diagnosis or provider services.

• RN leads team– May include other RNs, LPNs, and UAPs

• Leaders must be skilled in delegating, communicating, and problem solving

• All members of effective teams are good communicators


• Team leader time spent in indirect pt care e.g.:

- Developing or updating nsg care plan- Resolving problems encountered by

team members.- Conducting nsg conferences- Communicating with physicians and

other care providers


Figure 3-2 Team/modular nursing.



• Advantages– LPNs and UAPs perform tasks that do

not require RN's expertise– Care is more easily coordinated– Saves steps and time



• Disadvantages– Time needed for communicating,

supervising, and coordinating team members

– Affect of changes in team leaders, members, and assignments on continuity of care

– Total patient not considered by any one person



• Disadvantages– Role confusion and resentment– Less control for nurses over

assignments– Possibility of unequal assignments


Figure 3-3 Total patient care.


Total Patient CareTotal Patient Care

• RN is responsible for all aspects of care for one or more patients


Total Patient CareTotal Patient Care

• Advantages– Continuous, holistic, expert nursing care– Total accountability– Continuity of communication

• Disadvantages– RNs perform tasks that could be done

more cost-effectively by less skilled persons


Primary NursingPrimary Nursing

• RN designs, implements, and is responsible for nursing care for duration of the patient's stay on the unit


Figure 3-4 Primary nursing.



• Advantages– Knowledge-based practice model– Decentralization of decisions, authority,

and responsibility– 24-hour accountability– Improved continuity and coordination of

care– Increased nurse, patient, and physician

satisfaction



• Disadvantages– Excellent communication required– Accountability of associate nurses– Patient transfers disrupt continuity of

care– Compensation and legal responsibility

for staff nurses– Unwillingness of associates to take

direction


Practice PartnershipsPractice Partnerships

• RN and partner (UAP, LPN, or less experienced RN) work together on same schedule with same group of patients


Figure 3-5 Practice partnerships.


Practice PartnershipsPractice Partnerships

• Advantages– Improved continuity of care and

accountability for care

• Disadvantages– Decreased ratio of RNs to

nonprofessional staff– Potential for junior team members to

assume too much responsibility


Case ManagementCase Management

• Is a model for identifying, coordinating, and monitoring the implementation of services needed to achieve desired patient care outcomes within specific period of time

• Case manager supervises the care provided by licensed and unlicensed nursing personnel

• Critical pathways provide direction for managing care of specific patients


Nsg case management requires Nsg case management requires

• Collaboration of all members of the health care team

• Identification of expected patient outcomes within specific time frame

• Use of principles of continuous quality improvement

• Promotion of professional practice


Figure 3-6 Case management.


Case ManagementCase Management

• Advantages– All professionals equal team members– Members take ownership of patient

outcomes

• Disadvantages– Requires qualified nurse case manager,

team collaboration, and quality management system

– Established critical pathways needed


Critical PathwaysCritical Pathways

• Provide care strategies to achieve expected outcomes

• Used in case management system• Include ways to identify variances

easily and whether outcomes have been met


Critical PathwaysCritical Pathways

• Advantages– Accommodate unique characters,

conditions of patients– Reduce costs

• Disadvantages– May need revision


Differentiated PracticeDifferentiated Practice

• Structure of roles and functions differentiated by nurses' education, experience, and competence

• Roles, responsibilities, and tasks defined for professional nurses, LPNs, and UAPs


Differentiated PracticeDifferentiated Practice

• Maximizes nursing resources• Defined scope of practice and level of

responsibility


Patient-Centered CarePatient-Centered Care

• Nurse coordinates a team of multifunctional, unit-based caregivers

• All patient care services are unit-based• Focused on:

– Decentralization– Promotion of efficiency and quality– Cost control


Patient-Centered CarePatient-Centered Care

• Advantages– Promotes efficiency, quality, and cost

control

• Disadvantages– Requires considerable time for nurse

manager– Demands a strong leader to manage

staff


Synergy Model of CareSynergy Model of Care

• Patient characteristics and nurse competencies match

• Meets standards for Magnet certification


• Pt ch:ch include:• Resiliency, vulnerability, stability,

complexity, resource availability • participation in care, participation in

decision making, predictability


The chch of pt should match with The chch of pt should match with nurse competenciesnurse competencies

• Clinical judgment• Advocacy and moral agency• Caring practice, collaboration, systems

thinking, response to diversity, facilitation of learning, clinical inquiry


Clinical MicrosystemsClinical Microsystems

• Small unit of care that maintains itself• Dynamic, interactive, self-aware, and

interdependent• Proven to improve teamwork,

communication, and continuity of care


Evolution of Models Evolution of Models for Delivering Care for Delivering Care

• No system perfect or permanent• Change caused by:

– Reimbursement changes– Demands for quality– Technologicial changes


Using the System EffectivelyUsing the System Effectively

• Communication skills• Ability to delegate• Problem-solving skills

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Effective Leadership and Management in Nursing CHAPTER EIGHTH EDITION Delivering Nursing Care 3