Methods of Managing Care on a Nursing Unit

I. Functional Method
Focus - Getting the job done
Divides nursing care into tasks: medication
administration, dressing changes and other
treatments, baths and beds, vital signs.
Separate tasks are assigned to each nurse
based on:

the difficulty of the task or skill to be

performed

the ability/qualifications/experiences of the nurse

How carried outHead or Charge nurse assigns specific tasks to each staff member (Examples: Two Aids do all the
baths; another Aid answers call lights, takes all vital signs, provides fresh water to all patients and
feeds those who cannot help themselves; the RN administers all the IV medications and changes all the
surgical dressings; and the LVN administers all medications).
Impact on unit - things get done, there is efficient use of staff, and it is cost effective.
Impact on staff - often boring to do only one thing all day, little growth.
Impact on client - fragmented care, patient has no one who really knows all about his needs.
Other features - Charge/head nurse has 8 hr. responsibility to plan and coordinate care, staff only does
tasks/skills.

II. Team/Modular Nursing

Focus - Patient centered care & efficient/cost effective
use of available personnel. Divides workers into
teams, each containing nurses with different levels of
knowledge and skill so that each member is 'used' at
the level at which they are capable of performing.
(Example: The RN is used to do complex skills/care
and his/her time which costs the hospital more
money is not "wasted" on tasks that an Aid or LVN
can safely perform.)
How carried out Head nurse picks Team Leaders and the team members for each team. The Team Leader assigns patients to
each team member and decides how he/she will help each team member. The Team Leader often gives all
medications and IV therapy to all the patients being cared for by them. The Team Leader also helps with
complex procedures, teaches staff and patients and conducts conferences to plan care. All team members
feel responsible for all patients assigned to the team.
Impact on the unit - efficient use of staff & reasonably efficient use of time - some might say that time is lost in
the shift reports attended by the whole team and during the team conference. Staff turn over decreased due to
job satisfaction in most cases.
Impact on staff - often staff are happy, see themselves as growing in ability and knowledge, motivation and
satisfaction is fostered, feel important in that their opinions are valued in planning effective care. RNs are
responsible for safe delegation/assignment and support of LVNs and unlicensed staff members. RNs share legal

responsibility for care provided by the members on their team.

Impact on client - Client can identify one RN and an additional team member (an LVN or an Aid) as their nurses
for the shift. All team members know about the patient and can safely answer the call light when the assigned
nurse is on break.
Other features - Head nurse delegates responsibility and authority to Team Leader who manages the team
members. 8 hr. responsibility for planning care, assignments based on ability, and team members learn and
grow.

III. Primary Nursing

Focus - RN is at the bedside planning and giving
expert care. No time wasted on managing others.
Each RN is a Primary nurse to a small group of
patients and an associate nurse to other patients
that he/she helps to care for (by following the plan
prepared by the patient's own primary nurse). The
Head/Charge Nurse also acts as a Primary nurse
with a slightly reduced patient load. This patient
load is possible because he/she spends very little
time in the management role because all the staff
are RNs and do most of the calling/interacting with M.D.'s and other members of the Heath Care Team as they
plan and coordinate their client's care.
How carried out - The Charge nurse assigns patients to the primary and associate nurses. The primary nurse
plans 24 hr. care for his/her primary patients and follows plan while caring for other patients.
Nurses care for their clients during their entire hospital stay and may even make home visits.
Impact on unit - Fewer workers to plan around, tasks get done because RNs totally responsible, and incomplete
or unsafe work is very visible to coworkers. High salary workers - expensive but care may be of higher quality
and there may be fewer complications and few unwanted readmission.
Impact on staff - Can be boring or rewarding to care for the same patient each day. Heavy legal responsibilities
- responsible to some degree even when not present to modify the plan of care. RN's are freed from
management duties to provide patient care which is why many go into nursing, may not always use the nurse's
time and skills efficiently as some tasks (baths, feeding patients, answering call lights) could be done by less
costly staff such as Aids.
Impact on client - Consistent predictable care, good if compatible or bad if pt. doesn't like the nurse. One nurse
is doing all the planning as for home care and doing all the teaching so less confusion and contradiction.
Other features - RN has a high level of autonomy in planning care.

IV. Total Patient Care

Focus - RNs are freed to perform patient care. The nurse provides comprehensive to the assigned patients and
is sometimes referred to as the primary nurse, but the term primary nursing is as described above. LVNs are
used to also provide care for selected patient - Can do most but not all care.

How carried out - The RN Charge or one of the other RNs

with lighter work load will help the LVN with care that
he/she is not capable of performing.
The Charge/head nurse assigns each nurse a group of
patients. The nurse whether RN or LVN is considered
responsible for planning for and providing care for his/her
assigned patients for 8 hr. shift. Again the LVNs may need
some help in caring for some complex patients.
Impact on unit - More cost effective than Primary care in that LVNs are paid less and the RNs aren't paid for
helping the LVNs with their assignments. Fewer nurses for the Charge nurse to manage than in the Team
approach.
Impact on staff - Decreased legal responsibility. Responsible only for won actions not for other staff members
and responsible only for 8 hr. of planning care. More variety in assignments and usually assigned to clients that
are geographically closer together - less time and energy walking from one patient's room to another.
Impact on patient - knows his/her one assigned nursed for the shift. If does not get along with the nurse, it is
easier to change assignments.
Other features - Assignments can be based on interests of staff members and changed to provide variety and
learning opportunities. All shifts plan care - Patient benefits from more input and different point of view or
ideas/approaches.

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