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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.
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
Learning OutcomesLearning 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 EditionEleanor J. Sullivan
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
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
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
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
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
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
Figure 3-1 Functional nursing.
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
Functional NursingFunctional 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 EditionEleanor J. Sullivan
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
Effective Leadership and Management in Nursing, Eighth EditionEleanor 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 EditionEleanor J. Sullivan
Figure 3-2 Team/modular nursing.
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
Team NursingTeam 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 EditionEleanor J. Sullivan
Team NursingTeam 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 EditionEleanor J. Sullivan
Team NursingTeam Nursing
• Disadvantages– Role confusion and resentment– Less control for nurses over
assignments– Possibility of unequal assignments
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
Figure 3-3 Total patient care.
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
Total Patient CareTotal Patient Care
• RN is responsible for all aspects of care for one or more patients
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
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
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
Primary NursingPrimary 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 EditionEleanor J. Sullivan
Figure 3-4 Primary nursing.
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
Primary NursingPrimary 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 EditionEleanor J. Sullivan
Primary NursingPrimary 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 EditionEleanor J. Sullivan
Practice PartnershipsPractice 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 EditionEleanor J. Sullivan
Figure 3-5 Practice partnerships.
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
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
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
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
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
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
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
Figure 3-6 Case management.
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
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
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
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
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
Critical PathwaysCritical Pathways
• Advantages– Accommodate unique characters,
conditions of patients– Reduce costs
• Disadvantages– May need revision
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
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
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
Differentiated PracticeDifferentiated Practice
• Maximizes nursing resources• Defined scope of practice and level of
responsibility
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
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
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
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
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
Synergy Model of CareSynergy Model of Care
• Patient characteristics and nurse competencies match
• Meets standards for Magnet certification
Effective Leadership and Management in Nursing, Eighth EditionEleanor 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 EditionEleanor J. Sullivan
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
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
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
Effective Leadership and Management in Nursing, Eighth EditionEleanor J. Sullivan
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