Leadership 8/24

Organizing Pt Care

Delivery Methods: “When would this be the best choice?”Total Pt Care

You do everythingTeam Nursing

Assign staff based on skillGood for LTC

Primary NursingYou have a primary pt that you work with overtime you work24 hr responsibility for care through care plans with only one ptGood for units like the NICUThis is the most expensive model d/t more RN’s on staff for each ptThere often is blend of all these methods, it is up to the unit manager to distinguish how to assign roles and what type of model to use

Primary Nursing:Uses a large number of Rn’sPrimary nurse assumes 24 hr care/responsibilityThere are better pt outcomes d/t the nurse only having one primary pt and continuity of care through the pts stayCan you see why it could be considered difficult?

Difficult to find a good primary d/t experience with different issuesDo you think it’s a successful care model?

Team Nursing:Usually features one RN per team, plus other interdisciplinary team membersWork is assigned based on the team members ability

Case Management:Facilitates continuum of care, control cots, reduce variations in tx and promote high quality care of individual pts who need extended servicesIdentifies barriers to complianceFinds resources in a communityEnsures tx are doneEnsures outcomes happen within timeframeThere are inpatient and outpatient case managersUse Critical Pathways (Algorithm of expected outcome times)

Ex: Pt has to do rehab for leg amputation, the case manager uses a critical pathway to state that the pt will be done with physical therapy in 4 weeks because that is what the algorithm says

Nurses are case managers because we KNOW what the pt is going to need from here on out… resources, follow up, etc.

Disease Management (DM)Population-based health care for chronic conditionsAcute episodes (cost drivers)

Delegation (Week 9 pg. 467-481)What is delegation

Assigning nursing tasks to another, as you as the RN are licensed to do this task a liable for the care

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careYou can delegate to a UAP, RN, CNA, LPN, family members, etc

Why would you delegate?Understaffed, care needs to continue at home

Who regulates delegation?State Board

5 Rights of Delegation (Keep in mind, it’s your license!!!!!!)1. Right Task (License/No License)2. Under the right circumstances3. To the right person (Do they know how, or been taught?)4. With the right directions and communication5. Under the right supervision and evaluation

10 Steps of Advocacy from the International Council of Nurseswww.whpa.org/ppe_advocacy_guide.pdf

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