Functional nursing.
Charge nurse
Team/module leaderTeam/module leaderTeam/module leader
RN, LPN, UAP RN, LPN, UAP RN, LPN, UAP
Patients Patients Patients
Figure 3-2 • Team/modular nursing.
32 PART 1 • UNDERSTANDING NURSING MANAGEMENT AND ORGANIZATIONS
Advantages of team nursing are:
● It allows the use of LPNs and UAPs to carry out some functions (e.g., making beds, trans- porting patients, collecting some data) that do not require the expertise of an RN.
● It allows patient care needs requiring more than one staff member, such as patient trans- fers from bed to chair, to be easily coordinated.
● The geographical boundaries of team nursing help save steps and time.
Disadvantages of team nursing are:
● A great deal of time is needed for the team leader to communicate, supervise, and coordi- nate team members.
● Continuity of care may suffer due to changes in team members, leaders, and patient assignments.
● No one person considers the total patient. ● There may be role confusion and resentment against the team leader, who staff may
view as more focused on paperwork and less directed at the physical or real needs of the patient.
● Nurses have less control over their assignments due to the geographical boundaries of the unit.
● Assignments may not be equal if they are based on patient acuity or may be monotonous if nurses continuously care for patients with similar conditions (e.g., all patients with hip replacements).
Skills in delegating, communicating, and problem solving are essential for a team leader to be effective. Open communication between team leaders and the nurse manager is also im- portant to avoid duplication of effort, overriding of delegated assignments, or competition for control or power. Problems in delegation and communication are the most common reasons why team nursing is less effective than it theoretically could be.
Total Patient Care The original model of nursing care delivery was total patient care, also called case method (Figure 3-3), in which a registered nurse was responsible for all aspects of the care of one or more patients. During the 1920s, total patient care was the typical nursing care delivery system. Student nurses often staffed hospitals, whereas RNs provided total care to the patient at home. In total patient care, RNs work directly with the patient, family, physician, and other health care staff in implementing a plan of care.
The goal of this delivery system is to have one nurse give all care to the same patient(s) for the entire shift. Total patient care delivery systems are typically used in areas requiring a high level of nursing expertise, such as in critical care units or postanesthesia recovery areas.