Effective Leadership and

Management in Nursing
EIGHTH EDITION

CHAPTER

Delivering
Nursing Care

Learning 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.

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Learning Outcomes
4. Describe evolving types of delivery
systems that have emerged.
5. Explain characteristics of effective
delivery systems.

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Nursing 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

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Nursing Care Delivery Systems

Pros and cons debated
Must optimize nurses knowledge, skills
Ensure that patients receive
appropriate care
Lower mortality rates in hospitals with
good environments for nurses

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Functional Nursing
RNs, LPNs, and UAPs are assigned
different tasks
RNs assess patients
Other staff give baths, make beds, take
vital signs, and administer treatments

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Figure 3-1

Functional nursing.

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Team Nursing
Team of nursing personnel provides
total care to a group of patients
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
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Figure 3-2

Team/modular nursing.

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Total Patient Care

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

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Figure 3-3

Total patient care.

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

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

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Figure 3-4

Primary nursing.

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

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

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Figure 3-5

Practice partnerships.

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Case Management
Case manager supervises the care
provided by licensed and unlicensed
nursing personnel
Critical pathways provide direction for
managing care of specific patients

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Figure 3-6

Case management.

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Critical 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

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Differentiated Practice
Structure of roles and functions
differentiated by nurses' education,
experience, and competence
Roles, responsibilities, and tasks
defined for professional nurses, LPNs,
and UAPs

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Patient-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

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Functional Nursing
Advantages
Staff become efficient at performing
assigned tasks

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

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Team Nursing
Advantages
LPNs and UAPs perform tasks that do
not require RN's expertise
Care is more easily coordinated
Saves steps and time

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Team Nursing
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
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Team Nursing
Disadvantages
Role confusion and resentment
Less control for nurses over
assignments
Possibility of unequal assignments

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Total 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

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

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
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Primary Nursing
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
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Practice 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

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Case 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
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Critical Pathways
Advantages
Accommodate unique characters,
conditions of patients
Reduce costs

Disadvantages
May need revision

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Differentiated Practice
Maximizes nursing resources
Defined scope of practice and level of
responsibility

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Patient-Centered Care
Advantages
Promotes efficiency, quality, and cost
control

Disadvantages
Requires considerable time for nurse
manager
Demands a strong leader to manage
staff

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Synergy Model of Care

Patient characteristics and nurse
competencies match
Meets standards for Magnet
certification

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Clinical Microsystems
Small unit of care that maintains itself
Dynamic, interactive, self-aware, and
interdependent
Proven to improve teamwork,
communication, and continuity of care

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Evolution of Models
for Delivering Care
No system perfect or permanent
Change caused by:
Reimbursement changes
Demands for quality
Technologicial changes

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan

Using the System Effectively

Communication skills
Ability to delegate
Problem-solving skills

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan