Introduction
Nursing care delivery models are important, as they can affect patient health outcomes, nurse satisfaction, and organizational outcomes, such as productivity and cost-effectiveness (ARNBC, 2015). There are four main nursing care delivery models used in contemporary hospitals: total patient care, functional nursing, team nursing, and primary nursing. Each care delivery method has advantages and disadvantages, which should be considered prior to its implementation. ARNBC (2015) states that the choice of a nursing care delivery model is influenced by patient, organizational, and provider factors. This paper aims to review two models of nursing care delivery, total patient care, and team nursing, and to discuss their applicability to the chosen organization.
Total Patient Care
Total patient care is the oldest nursing care delivery model, which is also referred to as the case method or patient allocation. This model is widely used all over the world and relies primarily on the input of registered nurses (RNs) into patient care.
As explained by Gunawan (n.d.), in total patient care, “the RN is responsible for all of the care provided to a patient for a shift” (p. 2). Thus, if RNs work in 8-hour shifts, the patient will be attended to by three different nurses in one day. Total patient care requires the RN to attend to all patient’s needs during his or her shift (Gunawan, n.d.). Patients are allocated on a shift-by-shift basis, and thus it is unlikely that one nurse will follow a patient from admission to recovery (King, Long, & Lisy, 2015).
Total patient care has a variety of advantages and disadvantages that affect the implementation and use of this nursing care delivery model. First of all, it ensures the provision of comprehensive care and minimizes the number of medical errors, as only one nurse works with the patient throughout the shift (Gunawan, n.d.). Secondly, it improves communication between nurses and patients, which can help to promote patient satisfaction.
Moreover, it also enhances the cooperation between doctors and nurses in diagnosing and treating patients, as the doctor knows which nurse is responsible for all aspects of patient care for a shift. Total care management was also found to reduce the length of patient stay (Gunawan, n.d.) and to be more cost-effective than the primary nursing model (Fernandez, Johnson, Tran, & Miranda, 2012).
Finally, total patient care is the model that is most frequently used in nursing education programs, which enables recent graduates to be more efficient in providing care (Gunawan, n.d.). Overall, total patient care has a positive impact on many patients and organizational variables, which makes it effective in promoting better health outcomes and improving workforce characteristics, such as autonomy.
However, total care nursing also has some significant disadvantages. For instance, it requires one nurse to perform all patient care for the shift; this feature requires nurses working under the total patient care delivery model to have the necessary qualifications and experience in conducting a wide variety of care procedures. For organizations, this creates difficulties in recruitment and training, thus leading to higher costs.
It also decreases cost efficiency, as most of the procedures that could be performed by nurse associates are performed by highly qualified RNs (Gunawan, n.d.). The total patient care delivery model was also found to be associated with higher pain scores among patients and lower documentation practice scores (Fernandez et al., 2012), which can affect patient satisfaction and treatment outcomes. In general, total patient care nursing is an effective model of care delivery, which has relatively high costs for the organization. Thus, it works best when applied to a private health care setting, where the patients tend to have higher expectations regarding service and treatment quality.
Team Nursing
The team nursing care delivery model is also a popular nursing strategy that is competing with total patient care for popularity in general ward settings (King et al., 2015). Team nursing involves nurses with various skills, qualifications, and levels of experience working together as a group delivering care to patients (King et al., 2015). The RN functions as a team leader who oversees the decisions and actions of other team members and provides services requiring higher qualification and knowledgebase (King et al., 2015). In team nursing, individual nurses share the responsibility for patient treatment and health outcomes, which helps to promote responsible decision-making (King et al., 2015).
Gunawan (n.d.) reviews some of the advantages and disadvantages that are usually attributed to the team nursing model. First of all, the model helps to ensure that each team member’s skills and abilities are developed by promoting knowledge and experience sharing (Gunawan, n.d.). In the team nursing model, more experienced nurses work together with nurse associates and recent graduates, which has a positive impact on learning and skill-building. Secondly, team nursing can improve job satisfaction by increasing engagement and promoting effective workplace communication (Gunawan, n.d.).
Team nursing is also considered to be the most cost-efficient nursing care delivery model, as noted by Fernandez et al. (2012). This is because the number of RN is lower than the number of less experienced nurses, which decreases expenses on personnel.
Nevertheless, team nursing has some important drawbacks that require organizations to consider the implementation carefully. For example, it might be more difficult to manage nurse teams than individual nurses, which creates additional considerations for management. Moreover, team nursing might disrupt the continuity of care, as one patient might be attended by several different nurses in one shift (Gunawan, n.d.).
Finally, organizing nurses into teams might have a negative impact on their communication with other professionals, such as physicians. Gunawan (n.d.) notes that in research studies, “teams tended to communicate only among themselves and not as well with physicians” (p. 6). Overall, team nursing is useful in highly diverse workforces, as it enables using the skills of each employee for maximum efficiency.
Current Nursing Care Model
Total patient care is the nursing model that is currently used in the observed department. Nurses work in 8-hour shifts, and RNs are the primary providers of care to the patients, performing all of the prescribed procedures and administering treatments. Collaboration between nurses is minimal, as nurses communicate more with physicians than with other nurses. Patents are allocated on a shift-by-shift basis, with each RN attending to 6-8 patients throughout the shift.
There is a significant degree of autonomy in the provision of patient care by nurses, as all RNs are supervised by a single head nurse. All of the above features are characteristic of the total patient care nursing delivery method. However, given organizational and workforce factors, it might be useful for the department to consider implementing another nursing model.
Recommendations
Despite the fact that the department has been using total patient care as the primary nursing method for the past years, there are significant concerns regarding the cost-effectiveness of this strategy. All the RNs working in the department are highly qualified and have a lot of work experience, which is why they are paid higher than nurses working in other departments. However, the vast majority of procedures performed by RNs could be carried out by other types of nurses, such as nurse associates or nurse practitioners, who are normally paid less than the more qualified personnel.
Therefore, introducing a team nursing model could help the department to decrease its personnel expenses. Moreover, it would also contribute to the skill mix and communication between nurses, which could result in higher overall job satisfaction. Patient outcomes would not be affected by the transition, as the RNs could act as team leaders, overseeing the actions of other nurses.
Conclusion
The assignment was useful in developing a clear understanding of the four main nursing delivery models. The readings also provided an important insight into the advantages and disadvantages of both studied models, allowing them to suggest areas for their application. Moreover, the assignment allowed for using the knowledge in practice by determining the current nursing care delivery model used in the observed department and for analyzing its appropriateness from a critical perspective.
Based on the readings and observations, the recommended transition would result in reduced expenses and improved workplace communication. Moreover, team nursing could positively affect staff engagement and motivation, as each nurse will be able to apply his or her skills and experience to patient care. Overall, the present assignment allowed us to review nursing care models and their application from a practical perspective, which will be useful for further work and education.
References
Association of Registered Nurses of British Columbia (ARNBC). (2015). Establishing models of care delivery that promote safe and appropriate care. Web.
Fernandez, R., Johnson, M., Tran, D. T., & Miranda, C. (2012). Models of care in nursing: A systematic review. International Journal of Evidence‐Based Healthcare, 10(4), 324-337.
Gunawan, J. (n.d.). The innovation of nursing care delivery model: A hybrid model. Web.
King, A., Long, L., & Lisy, K. (2015). Effectiveness of team nursing compared with total patient care on staff wellbeing when organizing nursing work in acute care wards: A systematic review. JBI Database of Systematic Reviews and Implementation Reports, 13(11), 128-168.