Delegation and Delivery of care (Week 2)--REARDON Flashcards
ADVANTAGES OF HAVING A IMPROVED NURST-TO-PATIENT
iMPROVED OUTCOMES FOR PATIENT
Considerations for determing the number of staff needed to fulfull staffing on any specific floor
- Number of patients
- level of intensity of care required by those patients (acuity)
- Contextual issues
- architechture
- geography
- technology
- level of preparation and experience of staff members
- Quality of the nurses work life
The higher the acuity…the more ______________ the level of care required for the patient
intense
Three basic organizational concerns that are significantly affected by staffing are….
-
FINANCIAL RESOURCES
- Need to balance productivity, bottom line and proper staffing
-
LICENSING REGULATIONS / ACCREDITATION
- mandated nurse-patient ratios vs “staffing plans”
-
CUSTOMER SATISFACTION
- Tied directly to financial rewards for hospital
Which care delivery model is this?
Advantages? Disadvantages?
Where is this nursing delivery model often used?
Total Patient Care
- RN is responsible for all aspects of care
ADVANTAGES
- *Receives holistic care by one nurse-per shift*
- *easy to communicate between nurses during shift change*
- *Nurse maintains high degree of autonomy*
- *lines of responsibility and accountability are clear*
DISADVANTAGES
- *RN’s are COSTLY*
- *RN availability- can be a problem if availability if low*
OFTEN SEEN :
- *ICU*
- *PACU (Post Anesthesia Care Unit)*
WHICH NURSING DELIVERY MODEL IS THIS?
ADVANTAGES? DISADVANTAGES?
OFTEN SEEN WHERE?
FUNCTIONAL NURSING
- Staff members assigned to complete certain tasks for a group of patients rather than specific patients
ADVANTAGES:
- Economic / efficient- lower cost workers are used in areas where task completion is the focus
- Less RN for patient care
- Clear responsibilites-everyone knows their duties
DISADVANTAGES
- Fragmented care
- Multiple care providers- leads to pt confusion and dissatisfaction
- Staff Morale low…feeling unchallenged d/t repetative tasks
OFTEN SEEN:
- OPERATING ROOM
- SOME MED SURG
- LONG TERM CARE
Movement away from this model d/t emphasis on patient satisfaction
WHICH NURSING CARE DELIVERY MODEL IS THIS?
ADVANTAGES? DISADVANTAGES
OFTEN SEEN WHERE?
TEAM NURSING
- model used most today
- created in response to functional nursing and the fragmented care provided with it
ADVANTAGES
- HIGH QUALITY CARE with ancillary staff
- Equal member participation /contribution
DISADVANTAGES
- decreased continuity of care d/t numerous caregivers
- there is POTENTIAL for RN with poor leadship skills
OFTEN SEEN…?
- INPATIENT / OUTPATIENT SETTING
WHICH NURSING CARE DELIVERY MODEL IS THIS?
ADVANTAGES? DISADVANTAGES?
OFTEN SEEN WHERE?
PRIMARY NURSING
- RN assumes 24 hour responsibility for all care related to pt.
- associate nurse covers when primary off duty and follows plan set by “primary nurse”
- Primary RN is notified of any problems that may develop
ADVANTAGES:
- small numbers of RN’s- high quality holistic care (one-one relationship)
- higher level of patient satisfaction
- RN autonomy
DISADVANTAGES
- Implementation difficult-would be difficult for inexperienced RN
- 24 hour responsibility
- not cost effective
OFTEN SEEN:
- Home health
- Hospice
- Oncology
- Long Term Care
providing care that is respectful of and responsive individual patient preferences, needs and values and ensuring that patient values guide all clinical decisions
PATIENT CENTERED CARE
(or)
PATIENT FOCUSED CARE
MOST IMPORTANT ASPECT OF
PATIENT CENTERED CARE?
Not only engaging your patient in their care, but to engage their family and significant others as well.
ADVANTAGES OF PATIENT CENTERED CARE?
DISADVANTAGES OF PATIENT CENTERED CARE?
ADVANTAGES
- More time in direct care
- Supervised by the RN
- Cost-Effective
DISADVANTAGES
- Leadership problems-if RN doesnt have good leadership qualities
- TEAM CONFLICTS- can include conflict with family of the patietn as well
CASE managers focus on________, ____________ and _____________
QUALITY
OUTCOMES
COST OF CARE
Two case management models for Acute
Care Case Management
-
UTILIZATION (nurse navigator)
- help pt access resources (free food, housing, ) and management of chronic medical conditions
-
DISCHARGE PLANNING (Transitional Care)
- transitions for chronically ill patients to ensure good communication across settings and providers
- appropriate follow up
- clear understand on RX medications
What is a clinical pathway ?
advantages?
Disadvantages:
Used for…?
- Care map that uses evidenced based practice and applies it to a structured care plan which provides guidelines for protocosl and best practices
ADVANTAGES
- DEFINES KEY PROCESSES AND PT GOALS IN THE DAY TO DAY MANAGEMENT OF CARE
- COST EFFECTIVE CARE PLAN
DISADVANTAGES
- NEGATIVE VARIANCE (loss in budget)
USED FOR:
- heart failure
- pneumonia
accountability
to be answerable to oneself and other for one own
choices, decisions, and actions
DELEGATION
TRANSFERRING TO A COMPETENT STAFF MEMBER THE AUTHORITY AND RESPONSIBILITY TO PERFORM
SELECTED NURSING TASK THAT THE STAFF MEMBER WOULD NOT NORMALLY BE ALLOWED TO PERFORM
<em><span>(THE RN RETAINS ACCOUNTABILITY FOR DELEGATED TASK)</span></em>
ASSIGNMENT
DISTRIBUTION OF WORK THAT EACH STAFF MEMBER IS RESPONSIBLE FOR DURING A GIVEN WORK PERIOD
SUPERVISION
ACTIVE PROCESS OF DIRECTING, GUIDING, AND INFLUENCING THE OUTCOME OF AN INDIVIDUALS PERFORMANCE OF AN ACTIVITY OR TASK
________ is a two-way process in which the RN requests that a qualified staff member perform a specific task…while understanding that the RN is still accountable for that task if it is not completed.
DELEGATION
DIFFERENCE BETWEEN “ASSIGNMENT” AND “DELEGATION”
ASSIGNMENT is a skill or task that the individual is expected to accomplish on a regular basis
DELEGATION is when the RN asks another individual to perform a task (or skill) that is not part of that individuals regular assigned work.
In delegation, the nurse transfers the _____________ for completing the task, but not the __________
RESPONSIBILITY
ACCOUNTABILITY
In DELEGATION…
–the “DELEGATOR” (RN) is accountable for:
–the “DELAGATEE” (UAP) are accountable for:
DELEGATOR (R.N) is accountable for:
- act of delegation
- supervision
- assessment / follow-up
- interventions / corrective actions
DELAGATEE (UAP) is accountable for:
- own actions
- accepting delegation within the parameters of his or her competency level
- completing the task
What should and should NOT be delegated?
(7)
- State Nurse Practice Acts
- Patient needs
- Job Descriptions / competencies
- Policies of organization
- Clinical situation
- Professional standards of nursing
- Standards of care
PROVIDES THE LEGAL AUTHORITY FOR NURSING PRACTICE INCLUDING DELEGATION
STATE NURSE PRACTICE ACT
