AFPGMI RAWALPINDI 01/27/18

By the end of this lecture the audient will be

able to:
 oDefine Assignment
 oIdentify purposes of Assignment
 oExplain the principles of personnelAssignment
 oApply characteristics of effective Assignment
in his or her field of specialty
 oHow to apply the process oforganizing patient
care
 oCompare and differentiate between the
different methodsof Assignment.
Outlines
1. Introduction

2. Definition of Assignment

3. Purposes of assignment

4. Principles of personnelassignment

5. Characteristics of effective assignment

6. Process of organizing patient care

Methods OfAssignment

Traditional Methods
a-Case Method
b-Functional Method
c-Team Method d-Modular Method
e-Primary nursing Method

- In Advanced Method PRACTICE

PARTNERSHIPS
Case Management
DIFFERNTIATED
CRITICAL PATHWAYS
PRACTICE
Introduction
One important function of the professional
nurse at the first-line management position of
nursing service department is organizing the
activities of the staff into a workable pattern to
meet patient needs. She/he should establish
effective relationships between the activities to be
performed, the workers to perform them.
Definition of Assignment:

• Assignment refers to “a written

delegation of duties to care for a
group of patients by trained
personnel assigned to the unit
 Purposes of assignment:
1To delegate the work to be done tothe nursing
2To gain the cooperation of the nursing personnel
3To produce high quality level of nursing care
4- Improve stability of the environment

5- Minimize uncertainty.
 Purposes of assignment:
To improve the communication skills
And leadership abilities

To know nursing roles or duties in

advance

To minimize the level ofworking over load .

Principles of personnel assignment:
1Made by the head nurse or nurse in charge for
each individual nurse.
2 Based on :
a.Nursing needs of each patient and
approximate time required to care for him.
b.The capabilities, skill level, previous experience
and the interest of the staff members.
c.Job description.
3 Planned weekly, and revised daily if
necessaryto assure continuity of care.
Cont,:
4Takeinto account all the direct , indirect and unit
activities
5 Consider the geographical location of
the unit and the assigned duties to save
nurse’s time andeffort.

6 Must be balanced among nursing staff.

7 Never to assign the same task tomore than

one nurse.
Characteristics of effective assignment:
1. Definite and easily understood.

2. Simple

3. Clear.

4. Signed.

5. Written.

6. Posted in advance.
Process of organizing patientcare:
The head nurse or the nurse in charge should
carry out their duties and responsibilities
through applying the following steps:

Planning Leading Assigning

 Evaluating Reporting
Nursing care delivery models
Tradition INTEGRAT
al Models ED MODELS
of Care OFCARE
TOTAL PATIENT PRACTICE
CARE PARTNERS
HIPS
PRIMARY
NURSING CASE
MANAGEMEN
FUNCTIONAL
NURSING T
CRITICAL
Team PATHWAYS
nursing
DIFFERNTIATED
MODULAR PRACTICE
NURSING
Nursing Care Delivery Models

 Detail assignments, responsibility, and

authority to accomplish patient care
 Determine who is going to perform what
tasks, who is responsible, and who
makes decisions
 Match number and type of caregivers to
patient care needs
Classic Nursing Care Models

 Total patient care

 Functional nursing
 Team nursing
 Primary nursing
Total Patient Care

 Nurse is responsible for planning,

organizing, and performing all care
 Oldest method of organizing patient care
 Typically performed by nursing students
 Common use areas—intensive care unit
(ICU) and postanesthetic care unit
(PACU)
 Figure 3-3 Total patient care.

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan
Total Patient Care—cont’d

 Advantages
 High degree of autonomy
 Lines of responsibility and accountability are
clear
 Patient receives holistic, unfragmented care
 Disadvantages
 Each RN may have a different approach to care
 Not cost-effective
 Lack of RN availability
Registered Registered Registered
Nurse Nurse Nurse
8-hour shift 8-hour shift 8-hour shift

Patient Care
The registered nurse plans,
organizes,and performs all care

Total Patient Care (Case Method) Delivery

Functional Nursing

 Staff members assigned to complete

specific tasks for a group of patients
 Evolved during World War II as a result
of a nursing shortage
 Unskilled workers trained to perform
routine, simple tasks
 Common use area—operating room
 Figure 3-1 Functional nursing.

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan
Functional Nursing—cont’d

 Advantages
 Care is provided economically and efficiently
 Minimum number of RNs required
 Tasks are completed quickly
 Disadvantages
 Care may be fragmented
 Patient may be confused with many care
providers
 Caregivers feel unchallenged
 Nurse Manager

LPN/ RN Nurse Aide Nurse Aide

PO Meds Assessments Vital signs Hygiene
Treatments Care Plans Hygiene Stocking

Assigned Patient Group

Functional Nursing Care Delivery Model

Team Nursing

 RN as team leader coordinates care for a

group of patients
 Evolved in the 1950s to improve patient
satisfaction
 Goal was to reduce fragmented care
 Common use areas—most inpatient and
outpatient areas
Team Nursing—cont’d
 Advantages
 High-quality, comprehensive care with a high
proportion of ancillary staff
 Team members participate in decision making
and contribute their own expertise
 Disadvantages
 Continuity suffers if daily team assignments
vary
 Team leader must have good leadership skills
 Insufficient time for planning and
communication
 Nurse Manager

RN Team Leader RN Team Leader

RN RN
LPNs LPNs
Nursing Assistants Nursing Assistants

Assigned Patient Group Assigned Patient Group

Team Nursing Model

Modular Nursing

 Modification of team nursing

 Patient unit is divided into modules or units
with an RN as team leader
 The same team of caregivers is assigned
consistently to the same geographic area
 Concept evolved to increase RN
involvement in care
 Figure 3-2 Team/modular nursing.

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan
Modular Nursing—cont’d
 Advantages
 Continuity of care is improved
 RN more involved in planning and coordinating
care
 Geographic closeness and efficient
communication
 Disadvantages
 Increased costs to stock each module
 Long corridors not conducive to modular
nursing
 Nurse Manager

Geographic Geographic Geographic

Patient Unit Patient Unit Patient Unit
Patient Care Patient Care Patient Care
Team: Team: Team:
RNs RNs RNs
LPNs LPNs/ LPNs/
Nurse Aides Nurse Aides Nurse Aides
Meds Meds Meds
Supplies Supplies Supplies
Linens Linens Linens

Modular Nursing Model

 Primary Nursing

 RN “primary nurse” assumes 24-hour

responsibility for planning, directing, and
evaluating care
 Evolved in the 1970s to improve RN
autonomy
 Common use areas—hospice, home
health, and long-term care settings
Primary Nursing—cont’d

 Advantages
 High-quality, holistic patient care
 Establish rapport with patient
 RN feels challenged and rewarded
 Disadvantages
 Primary nurse must be able to practice with a
high degree of responsibility and autonomy
 RN must accept 24-hour responsibility
 More RNs needed; not cost-effective
 Primary Nurse
24-hour responsibility for
planning, directing & Associate Nurses
Physician and
other members evaluating patient care Provide care
of the health care when primary
team nurse is off duty

Patient

Primary Nursing Model

 Figure 3-4 Primary nursing.

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan
Partnership Model
(Co-Primary Nursing)
 RN is partnered with an licensed practical
nurse/licensed vocational nurse (LPN/LVN)
or nursing assistant to work together
consistently
 Modification of primary nursing to make more
efficient use of the RN
 Figure 3-5 Practice partnerships.

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan
Partnership Model
(Co-Primary Nursing)—cont’d
 Advantages
 More cost-effective than primary nursing
 RN can encourage training and growth of
partner
 Disadvantages
 RN may have difficulty delegating to partner
 Consistent partnerships difficult to maintain
due to varied schedules
Patient-Centered Care
(Patient-Focused Care)
 Cross-functional teams of professionals and
assistive personnel work together as a unit-
based team
 Recent development in nursing care delivery
models
 More patient oriented than department
oriented
 Models vary considerably among facilities
Patient-Centered Care
(Patient-Focused Care)—cont’d
 Advantages
 Patient comes into contact with fewer workers
 Workers are unit based and spend more time
in direct-care activities
 Team is supervised by an RN
 RN is accountable for a wide range of services
and functions at a higher level
 Cost-effective
Patient-Centered Care
(Patient-Focused Care)—cont’d
 Disadvantages
 Major change in organizational structure is
required
 Departments other than nursing must be willing
to accept nursing leadership
 Nurse manager supervises many types of
workers
 Nurse Manager
Patient Care Respiratory Services Patient Transportation
Housekeeping ECG Admission/Discharge Phlebotomy
Physical/Occupational/Speech Therapy Dietary Services
Financial Counseling Supply Management

Patient

Patient-Centered Care Model

Case Management
 Components include:
 Assessment, planning, implementation,
evaluation, and interaction
 Reserved for chronically ill patients,
seriously ill patients, or long-term,
expensive cases
 RN assumes a planning and evaluative
role; usually not responsible for direct-care
duties
 Supplemental form of care delivery; does
not replace direct-care model
 Figure 3-6 Case management.

Effective Leadership and Management in Nursing, Eighth Edition

Eleanor J. Sullivan
RN Case Manager

 Coordinates the patient’s care throughout

the course of an illness from facility
perspective
 Employee of the payer (external case
management)
 Employee of the health care facility (internal
case management)
 Collaborates With
Patient and Family

NURSE CASE MANAGER

Onset of Resolution of
Assesses, plans, implements, coordinates,
Illness Illness
monitors, and evaluates patient care
options and services to meet health needs

Collaborates with Nursing, Coordinates Services:

Physicians, Physical/Speech/ Home Care, Hospice,
Occupational Therapists, Dietary, Extended /Long-term Care
and Ancillary Services Ambulatory Care Services

Nursing Case Management Model

Clinical Pathways

 Delineate a predetermined written plan of

care for a particular health problem
 Specify desired outcomes and
transdisciplinary intervention
 Address a common medical diagnosis
 Dictate the type and amount of care given
and thus have financial implications
Clinical Pathways
Essential Components
 Consults  Self-care activities
 Laboratory and  Nutrition
diagnostic tests  Patient and family
 Treatments education
 Medications  Discharge planning
 Safety  Triggers
Choosing a Nursing Care Delivery
Model
 What staff mix is required?
 Who should make work assignments?
 Work assigned by task? By patient?
 How will communication be handled?
 Who will make decisions?
 Who will be responsible and accountable?
 Fit with unit/facility/organization
management?
Influences on Nursing Care
Delivery Model Selection
 Health care setting
 Acute care, long-term care, ambulatory care,
home care, and hospice
 Organizational structure and resources
 Management, staffing, supplies, and physical
layout
 Patient needs
 Acute, long-term, and chronic
Evaluation of Nursing Care
Delivery Models
 Timely, cost-effective outcomes
achieved?
 Patient and families happy with care?
 Team members satisfied with care?
 Good communication among all team
members?
 RNs utilized and challenged
appropriately?
01/27/18 AFPGMI RAWALPINDI