Effective Leadership and
Management in Nursing
EIGHTH EDITION
CHAPTER
3
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 nurse’s 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
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
• 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
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
• 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
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
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
Figure 3-3
Total patient care.
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
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
• 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
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
• 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
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
• 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
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
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
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
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
• 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
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
• 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
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
• 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
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
• Pt ch:ch include:
• Resiliency, vulnerability, stability,
complexity, resource availability
• participation in care, participation in
decision making, predictability
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan
The chch of pt should match with
nurse competencies
• Clinical judgment
• Advocacy and moral agency
• Caring practice, collaboration, systems
thinking, response to diversity,
facilitation of learning, clinical inquiry
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