Nurse Staffing Models
Nurse staffing models are rules or guidelines that determine the number of nurses needed to staff and schedule to provide patient care. Because patient needs and healthcare settings vary, different nurse staffing models are used in different situations, and an appropriate staffing model will consider all relevant factors.
Nurse staffing models frequently involve nurse-to-patient ratios, or the number of patients under each nurse’s care. Some states in the U.S. regulate the maximum number of patients per nurse in a specific setting, or provide other rules for deciding on an appropriate ratio, such as involving staff nurses in policymaking on staffing committees at the facility level. Research suggests that an increased number of patients per nurse is generally associated with an increase in adverse outcomes for those patients when other factors remain the same.
Patient-centered care is a modern culture of care that has been demonstrated to increase patients’ satisfaction with the care they receive. Patient-centered care considers the patient to be a partner in his or her own care along with the healthcare team, and the individual’s personal values and preferences are essential components in determining the plan of care.
Acuity-based, or acuity-adjusted, nurse staffing assigns patients to nurses based on the intensity of care required instead of setting an absolute nurse-patient ratio. In practice, this process can rely on nursing clinical judgment to estimate the level of intervention necessary for each patient based on characteristics such as medical diagnosis and severity of symptoms, but an ideal system allows for an objective acuity rating.
Primary nursing is a care delivery model that maintains continuity of care by assigning the same registered nurse to a patient for the duration of the patient’s care encounter, such as an inpatient hospital admission. In this model, registered nurses provide most of the care, and some settings also include assistive personnel. In some more traditional primary nursing models, the registered nurse maintains responsibility for the patient’s care even outside of a work shift, similar to a physician who is on call.
Team nursing, sometimes called team-based nursing, involves an RN “teamed” with another RN, LPN, unlicensed assistive personnel, or a combination, to provide care to a group of patients. Especially when the team is made up of members with mixed skill sets, the RN is responsible for managing nursing care, including delegating appropriately and performing RN-specific functions.
Modular nursing is considered an adaptation of team nursing in which the nursing care team provides care for a group of patients in close physical proximity, such as a row of consecutive patient rooms in a hallway.
A 12-bed hospital model combines elements of team nursing and modular nursing to assign at least one RN to a group of around 12 patients. Other RNs, LPNs, and UAPs may also be assigned to the same group, with a patient care facilitator, or PCF, overseeing care for the group as a whole and acting as a liaison and point of contact. The PCF is an expert nurse with additional training, often a clinical nurse leader, clinical nurse specialist, or nurse practitioner.
The total patient care delivery model is often contrasted with team nursing. In a total patient care model, also known as patient allocation, a registered nurse is responsible for most or all nursing care for a group of patients during a shift.
Functional nursing divides nursing care into tasks to be completed for a set of patients and assigns nurses to those tasks rather than to individual patients. Functional nursing is more common in long-term care settings, where, for example, UAPs may attend to hygiene needs of residents, LPNs may administer all oral medications, and RNs may be responsible for tasks associated with resident admissions, transfers, and discharges.
It is important to understand that not all models are mutually exclusive. For example, a nursing unit that assigns patients in a total patient care delivery model may also incorporate aspects of primary nursing to allow for continuity of care and acuity-based staffing to balance each nurse’s group of patients as the situation allows. Combining models can optimize resources and draw benefits from the strengths of different models.
Let’s look at a couple of practice questions to review.
The registered nurse is working on an inpatient hospital unit and cares for 5 patients during the shift. There are no LPNs or UAPs working on the unit. The nurse is present in the patients’ rooms when the physicians make their rounds, and patients’ wishes are discussed as treatment options. Under which of the following models is the nurse working? Select all that apply.
- Modular nursing.
- Primary nursing.
- Team nursing.
- Total patient care.
- Patient-centered care.
The correct answers are D and E, total patient care and patient-centered care. A, B, and C are not described in this scenario.
Which of the following care delivery models always require delegation by the RN? Select all that apply.
- Acuity-based nursing.
- 12-bed hospital.
- Functional nursing.
- Primary nursing.
The correct answers are B and C, 12-bed hospital and functional nursing. A and D may exist with or without delegation.
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