UNDERSTANDING NURSING MANAGEMENT AND ORGANIZATIONS
Integrated Models of Care Practice Partnerships The practice partnership (Figure 3-5) was introduced by Marie Manthey in 1989 (Manthey, 1989). In the practice partnership model, an RN and an assistant—UAP, LPN, or less experi- enced RN—agree to be practice partners. The partners work together with the same schedule and the same group of patients. The senior RN partner directs the work of the junior partner within the limits of each partner’s abilities and within limits of the state’s nurse practice act.
The relationship between the senior and junior partner is designed to create synergistic en- ergy as the two work in concert with patients. The senior partner performs selected patient care activities but delegates less specialized activities to the junior partner. When compared to team nursing, practice partnerships offer more continuity of care and accountability for patient care. When compared to total patient care or primary nursing, partnerships are less expensive for the organization and more satisfying professionally for the partners.
Disadvantages of this model are:
● Organizations tend to increase the number of UAPs and decrease the ratio of professional nurses to nonprofessional staff. If, for example, one UAP is assigned to more than one RN, the UAP must follow the instructions of several people, making a synergistic relation- ship with any one of them difficult.
● Another problem is the potential for the junior member of the team to assume more responsibility than appropriate. Senior partners must be careful not to delegate inappropriate tasks to junior partners.
Practice partnerships can be applied to primary nursing and used in other nursing care delivery systems, such as team nursing, modular nursing, and total patient care. As organizations restructured, practice partnerships offered an efficient way of using the skills of a mix of professional and nonprofessional staff with differing levels of expertise.
Case Management Following the introduction and impact of prospective payments, nursing case management, used for decades in community and psychiatric settings, was adopted for acute inpatient care. Nursing case management (Figure 3-6) is a model for identifying, coordinating, and monitoring the implementation of services needed to achieve desired patient care outcomes within a specified period of time. Nursing case management organizes patient care by major diagnoses or diagnosis-related groups (DRGs) and focuses on attaining predetermined patient outcomes within specific time frames and resources.