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Nursing Care Delivery Systems

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  • A nursing care delivery system defines how work is organized, how nursing staff are deployed, and who does what in providing nursing care.
  • Delivery systems identify who has the accountability for nursing care and clinical outcomes.
  • Delivery systems provide the organization, rules and structure that define responsibility and accountability (who does what).
  • Total Patient Care. The oldest system for organizing patient care. Commonly used in intensive care unit (ICU) and postanesthetic care unit (PACU). in TPC an RN is responsible for planning, organizing, and performing all aspects of nursing care. TPC provides a high degree of autonomy, clear lines of responsibility and accountability, holistic patient care, unfragmented care. TPC is not cost effective. It requires abundant availability of nurses.
  • Functional nursing. Specific tasks are assigned to nurses. The nurse assigned to a specific task has to carry it out at all patients. Registered nurses (RNs) carry out complex nursing tasks. The idea behind functional nursing is that there is a specialist for each task. The head of the ward assigns the different tasks to specific nurses based on the nursing care plans for the different patients.
  • Team nursing. Care is given by a team composed of registered nurses (RNs), Licensed Practical (or Vocational) Nurses (LPNs) and certified nursing assistants (CNAs). In this model, most direct bedside care is given by the CNAs while the RNs spend more of their time at the nursing station. When a ward is organized according to the team nursing system, the nurses are divided in a number of teams. Each team has to provide care for a fixed group of patients. By doing so nurses have a close relation with the patients they have to take care for. Each team has a team leader who is responsible for the performance of the team. Each ward has a supervisor, which is responsible for the whole ward. Nurses like working in teams.
  • Primary nursing. All nurses are RNs. They do personal care as well as care planning, documentation, etc. CNAs assist the nurses, but do not have autonomous roles in patient care. This approach can provide better continuity and more expertise than the Team Nursing model. Primary nursing is a method of nursing practice which emphasizes continuity of care by having one nurse provide complete care for a small group of inpatients within a nursing unit of a hospital.

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