Leadership 8/24

Organizing Pt Care
Delivery Methods: When would this be the best choice?
Total Pt Care
You do everything
Team Nursing
Assign sta based on skill
Good for LTC
Primary Nursing
You have a primary pt that you work with overtime you work
24 hr responsibility for care through care plans with only one pt
Good for units like the NICU
This is the most expensive model d/t more RNs on sta for each pt
There often is blend of all these methods, it is up to the unit manager to distinguish how to
assign roles and what type of model to use
Primary Nursing:
Uses a large number of Rns
Primary nurse assumes 24 hr care/responsibility
There are better pt outcomes d/t the nurse only having one primary pt and continuity of care
through the pts stay
Can you see why it could be considered dicult?
Dicult to find a good primary d/t experience with dierent issues
Do you think its a successful care model?
Team Nursing:
Usually features one RN per team, plus other interdisciplinary team members
Work is assigned based on the team members ability
Case Management:
Facilitates continuum of care, control cots, reduce variations in tx and promote high quality care
of individual pts who need extended services
Identifies barriers to compliance
Finds resources in a community
Ensures tx are done
Ensures outcomes happen within timeframe
There are inpatient and outpatient case managers
Use Critical Pathways (Algorithm of expected outcome times)
Ex: Pt has to do rehab for leg amputation, the case manager uses a critical pathway to state
that the pt will be done with physical therapy in 4 weeks because that is what the algorithm
says
Nurses are case managers because we KNOW what the pt is going to need from here on out
resources, follow up, etc.
Disease Management (DM)
Population-based health care for chronic conditions
Acute episodes (cost drivers)
Delegation (Week 9 pg. 467-481)
What is delegation
Assigning nursing tasks to another, as you as the RN are licensed to do this task a liable for the
care

care
You can delegate to a UAP, RN, CNA, LPN, family members, etc
Why would you delegate?
Understaed, care needs to continue at home
Who regulates delegation?
State Board
5 Rights of Delegation (Keep in mind, its your license!!!!!!)
1. Right Task (License/No License)
2. Under the right circumstances
3. To the right person (Do they know how, or been taught?)
4. With the right directions and communication
5. Under the right supervision and evaluation
10 Steps of Advocacy from the International Council of Nurses
www.whpa.org/ppe_advocacy_guide.pdf