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NR 447 Week 5 Nursing Care Models Paper

Care and Service Team Models

NR 447 Week 5 Nursing Care Models Paper

Care and Service Team Models, “Key elements of these models are empowered staff, interprofessional collaboration, skilled workers, and a case management approach to patient care-all elements related to the more current views of leadership and management (IOM, 2011).  (e.g., multiskilled workers, nurse extenders, and UAP) (Finkelman, p.113).”   I believe this is the nursing model we incorporate on my dialysis unit. The nurses, dialysis technicians, social worker, and dietician work together collaboratively on a daily basis. Each group needs each other in order to give the patients the best overall care possible.  

On a daily basis we have 24 patients for each 3 shifts in a day.  There are usually 2 RN’s on the floor and the patients are split in half.  Each RN works with 3 technicians whose main task is to set up machines, put patients on and off the machine as well as stocking the floor. The social worker comes on the floor during each shift to speak with the patients ensuring they have everything they need such as insurance, transportations, kidney transplant information, and so on.  The dietician gives them dietary information and supplements.  Each group has an important job and we work together to help the patient understand the information given by asking follow-up questions about their diet and food intake.  Its not just the dietician and social workers responsibilities.  We all help each other out by communicating with each other about daily issues.  We have a communication book that everyone must read each day to see what is going on with the patients and what needs to be addressed that day.  We also have morning huddles were we discuss important issues in each disciplines. Everyone is involved in the huddle and anyone can lead the huddle not just the nurses.

NR 447 Week 5 Nursing Care Models Paper

The nurses help each other on their shifts.  We help cover each other for breaks, we can ask each other for help when needed.  We can put patients on for each other and help each other with assessments.  Our team is close, closer than my other job.  The technicians help us identify issues with the patients since we have 12 we are responsible for.  “team nursing gains with its emphasis on teamwork and structure and allows for the supported articulation of multiple skill and experience levels,41,53 a factor critical to the retention of new graduates (Fairbrother, p. 1)”.  The team consist of new staff and people with 10 plus years experiences.  The staff with the most experience are expert cannulators so they help with difficult accesses and newly placed fistulas and graft.  They help out the other technicians when they have a difficult stick with out complaining.  We depend on each other to help get through the fast-paced days of dialysis.

Working in a team-based setting is good for the staff and the patients.  The staff feels more secure knowing that they can ask for help without receiving backlash and they know they are not alone. Patients feel safer if they see that their health team works together to take care of them.  “There was however a substantial increase in morale when the TNC model was adopted confirming the findings of numerous studies that work group teamwork leads to higher staff job satisfaction, increased patient safety, improved quality of care, and greater patient satisfaction [11, 12]. Another study reported that participants’ levels of job satisfaction with current position and satisfaction with occupation were both higher when they rated their teamwork higher [13] and these findings suggest that efforts to improve teamwork and ensure adequate staffing in acute settings can improve staff satisfaction., (Zimbudzi, p. 3)”.  Staff satisfaction leads to better workers and a welcoming environment which is very well needed in dialysis since the patients are there 3 days a week and nurses and technicians for 12-14 hours a day.

NR 447 Week 5 Nursing Care Models Paper

Functional Nursing Model

“The model of functional nursing is a task-oriented approach, focusing on jobs to be done. When it was more commonly used, it was thought to be more efficient. The nurse in charge assigned the tasks (e.g., one nurse may administer medications for all or some of the patients on a unit; an aide may take vital signs for all patients). A disadvantage of this model is the risk of fragmented care. In addition, this type of model also leads to greater staff dissatisfaction with staff feeling they are just grinding out tasks. When different staff members provide care without awareness of other needs and the care provided by others, individualized care may also be compromised. (Finkelman, p.111)”.  This model sounds good on paper but may not work for all facilities.  When a nurse is only concentrating on a certain task, they may not gather all the information on a patient so other needs may fall through the cracks because there may be miscommunication or lack of communication from the staff.

Functional nursing may be time effective but in the long run it may cause bigger issues as it may lack communication which can to lead to errors.   Everyone has their own tasks that they are focused on and may not be looking at the patient’s whole health history.   Functional nursing model is time effective paring tasks to skills, so everything gets done. “work was divided into tasks in this model. Tasks were assigned to nursing and ancillary personnel based on the complexity of the task in terms of judgment and technical knowledge. Less skilled workers were assigned most of the routine tasks, and the Registered Nurse addressed the more complex needs. Functional nursing depends on both rules and rituals (Fairbrother)”.

NR 447 Week 5 Nursing Care Models Paper

I think the main reason why this model may not work in all facilities is because it lacks team care.  If this was implemented into this model, then it could become an ideal model.  You can still assign staff assignments, and everyone knows their duties for the day, but they can communicate with each other and provide additional support if needed.  “They are characterized by a lower proportion of care hours provided by RNs, and by nurses’ perception that the practice environment is less supportive of a ‘professionalized’ approach to RNs’ work” (Dubios).  Nurses and ancillary staff need to feel supported, so they can safely provide patient care.

Another model that can be used by facility is the Total Patient/Case Method.  Since the same nurses are in all three shifts, they can be assigned to provide all care for patients during each shift.  The patient would benefit because they would know who their dedicated RN is and won’t get confused as to whom is caring for them.  The technicians would be delegated to getting the patients on and off the machine, except for the CVC’s which are put on by the RN.  The RN does the pre and post assessment and the technicians monitor patients while on the machine. This will give the nurse time to prepare medications and to work on care plans.  This model also requires team work as the RN’s are trusting the technicians to help monitor patients.  They have to communicate if blood pressures drop or any other form of change in patient’s status.  This would not be an issue with my team since we work well together is caring for our patients.

NR 447 Week 5 Nursing Care Models Paper

This assignment gave me some insight as to what type of nursing model my facility uses.  We are a team centered facility that focus on patient care.  I also notice that we take from other models as well like the functional model where we as RN’s assign our technician tasks at the beginning of the day.  In the Total Patient/Case Method we do take care of our own set of patients, but we help each other when needed.  Not all the models work for every facility.  It depends on the size of facility, staffing, and type of care given.  With dialysis, you need more of a team-oriented type of model because of the patient load is heavy and there is always something going on, so we need support from the technicians.  These models gives a break down to show what type of style would work best in a facility to help create a staff environment that is a cohesive team. 

NR 447 Week 5 Nursing Care Models Paper


DuBois, C.,  D’amour, D., Tchouaket, W., Clarke, S., Rivard, M., Blais R.,; Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals, International Journal for Quality in Health Care, Volume 25, Issue 2, 1 April 2013, Pages 110–117, https://doi.org/10.1093/intqhc/mzt019

Fairbrother, G., Chiarella, M., & Braithwaite, J. (2015). Models of care choices in today’s nursing workplace: Where does team nursing sit? Australian Health Review, 39(5), 489-493. doi:10.1071/AH14091

Fairbrother, G, Jones, A., Rivas, K,. Contemporary Nurse : a Journal for the Australian Nursing Profession , Vol. 35, No. 2 , June 1, 2010

Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). Boston, MA: Pearson.

Zimbudzi, E., Department of Nephrology, Monash Medical Centre, www.sciedu.ca/journal/index.php/jnep/article/viewFile/2633/1726

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