Effective Leadership and Management in Nursing, 8th Edition

2P U T - 3 - 3 Click to edit Master text styles Second level Third level Fourth level Fifth level Click to edit Master title style Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Effective Leadership and Management in Nursing CHAPTER EIGHTH EDITION Click to edit Master text styles Second level Third level Fourth level Fifth level Click to edit Master title style Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Click to edit Master text styles Second level Third level Fourth level Fifth level Click to edit Master title style Click to edit Master text styles Second level Third level Fourth level Fifth level Delivering Nursing Care Learning Outcomes Describe how the delivery system structures nursing care. Describe what types of nursing care delivery systems exist. Discuss the positive and negative aspects of different systems. Learning Outcomes Describe evolving types of delivery systems that have emerged. Explain characteristics of effective delivery systems. Nursing Care Delivery Systems Provide structure for delivering care Delivery of care includes Assessing care needs Formulating plan of care Implementing plan Evaluating patient s responses Nursing Care Delivery Systems Functional Nursing RNs, LPNs, and UAPs are assigned different tasks RNs assess patients Other staff give baths, make beds, take vital signs, and administer treatments Figure 3-1 Functional nursing. Team Nursing Team of nursing personnel provides total care to a group of patients RN leads team May include other RNs, LPNs, and UAPs Leaders must be skilled in delegating, communicating, and problem solving All members of effective teams are good communicators Figure 3-2 Team/modular nursing. Total Patient Care RN is responsible for all aspects of care for one or more patients Figure 3-3 Total patient care. RN designs, implements, and is responsible for nursing care for duration of the patient s stay on the unit Figure 3-4 Primary nursing. Practice Partnerships RN and partner (UAP, LPN, or less experienced RN) work together on same schedule with same group of patients Figure 3-5 Practice partnerships. Case manager supervises the care provided by licensed and unlicensed nursing personnel Critical pathways provide direction for managing care of specific patients Figure 3-6 Case management. Critical Pathways Provide care strategies to achieve expected outcomes Used in case management system Include ways to identify variances easily and whether outcomes have been met Differentiated Practice Structure of roles and functions differentiated by nurses education, experience, and competence Roles, responsibilities, and tasks defined for professional nurses, LPNs, and UAPs Patient-Centered Care Nurse coordinates a team of multifunctional, unit-based caregivers All patient care services are unit-based Focused on Decentralization Promotion of efficiency and quality Cost control Functional Nursing Advantages Staff become efficient at performing assigned tasks Disadvantages Uneven continuity Lack of holistic understanding of patient Problems with follow-up Team Nursing Advantages LPNs and UAPs perform tasks that do not require RN s expertise Care is more easily coordinated Saves steps and time Team Nursing Disadvantages Time needed for communicating, supervising, and coordinating team members Affect of changes in team leaders, members, and assignments on continuity of care Total patient not considered by any one person Team Nursing Disadvantages Role confusion and resentment Less control for nurses over assignments Possibility of unequal assignments Total Patient Care Advantages Continuous, holistic, expert nursing care Total accountability Continuity of communication Disadvantages RNs perform tasks that could be done more cost-effectively by less skilled persons Advantages Knowledge-based practice model Decentralization of decisions, authority, and responsibility 24-hour accountability Improved continuity and coordination of care Increased nurse, patient, and physician satisfaction Disadvantages Excellent communication required Accountability of associate nurses Patient transfers disrupt continuity of care Compensation and legal responsibility for staff nurses Unwillingness of associates to take direction Practice Partnerships Advantages Improved continuity of care and accountability for care Disadvantages Decreased ratio of RNs to nonprofessional staff Potential for junior team members to assume too much responsibility Advantages All professionals equal team members Members take ownership of patient outcomes Disadvantages Requires qualified nurse case manager, team collaboration, and quality management system Established critical pathways needed Critical Pathways Advantages Accommodate unique characters, conditions of patients Reduce costs Disadvantages May need revision Differentiated Practice Maximizes nursing resources Defined scope of practice and level of responsibility Patient-Centered Care Advantages Promotes efficiency, quality, and cost control Disadvantages Requires considerable time for nurse manager Demands a strong leader to manage staff Synergy Model of Care Patient characteristics and nurse competencies match Meets standards for Magnet certification Clinical Microsystems Small unit of care that maintains itself Dynamic, interactive, self-aware, and interdependent Proven to improve teamwork, communication, and continuity of care Evolution of Models for Delivering Care No system perfect or permanent Change caused by Reimbursement changes Demands for quality Technologicial changes Using the System Effectively Communication skills Ability to delegate Problem-solving skills