In the last century, numerous nursing modalities – also called nursing care models – emerged to meet the ever-changing needs of patients and the health-care industry. Each nursing professional plays a critical role in patient care and the way in which patients experience their health care. Nursing care models vary in administration and scope. While some provide quality care for large numbers of patients, others focus on serving the needs of individuals. Nursing care models are fluid, allowing each hospital, clinic or private practice to devise a method to serve patients.
Functional Nursing Model
The functional nursing method is a decades-old, traditional form of patient care. The model relies on a hierarchy of nurses who perform different tasks depending upon their level of education, training and experience.
The team leader, a registered nurse (RN), collaborates with physicians to determine the needs of a patient. The head nurse then delegates tasks to nurses under her supervision. For example, she might assign another registered nurse to administer treatments, while a licensed practical nurse (LPN) monitors blood pressure and a nurse's aide assists the patient with an exercise regime.
Functional nursing applies an assembly-line method of patient care, which can offer economic advantages for the hospital because it maximizes each team member’s skill set. This nursing model works well in periods of high demand, such as wartime or during epidemics. However, functional nursing does not provide the holistic care that many patients need, because the nurses focus on their individual tasks rather than the overall condition or progress of the patient.
Team Nursing Model
Developed in the 1950s, the team nursing model is similar to the functional nursing method, but provides care on a larger scale. The team nursing model assigns an RN as the group leader who delegates tasks to a team of medical professionals who care for multiple patients.
Teams contain at least two nurses, typically with different experience, education and skill levels. An RN team member might dispense medications, while an LPN monitors patient blood pressure. The team might also include a nurse’s aide, who carries out tasks such as bathing and dressing the same group of patients.
Surveys of nurses have yielded high marks for the team nursing model. Inexperienced nurses appreciate the opportunity to work with and learn from their experienced colleagues. Likewise, experienced nurses report that they feel more supported in their duties under a team nursing model. The team nursing approach also benefits medical facilities by enabling inexperienced nurses to learn more quickly, giving them increased value as employee assets. The method also promotes and improves communication among team members, which can result in improved patient care.
Team nursing relies on team leader RNs with good management and leadership skills. Patient needs can impact the success of the team nursing method. Designed to provide care for numerous patients, the team nursing model does not offer appropriate coverage for patients who need constant care and attention.
Primary Nursing Model
The primary nursing model assigns patients to a primary RN, who takes responsibility for their care throughout the hospital stay. By following a patient’s progress, the RN can provide a more holistic level of care, while offering the patient the comfort of having a primary caregiver among the nursing staff.
The primary nursing method developed in the 1970s and quickly gained popularity. It addressed the shortcomings of older models such as functional and team nursing, which left gaps in patient care because of task-oriented approaches. Primary nursing has proven particularly successful in meeting the needs of patients with complex medical conditions. For example, a patient with diabetes might have heart problems, tissue damage and dietary restrictions, which require the type of comprehensive care a primary nurse can provide. Patients respond well to the primary nursing model, because it provides them with a knowledgeable medical contact and a sense of continuous care. Generally, nurses appreciate the feeling of autonomy primary nursing offers, while enabling them to provide patients with a high level of care.
Flexible work schedules, which allow nurses to work three consecutive days of 12-hour shifts, followed by four days off, create a disadvantage to the primary nursing model, particularly for patients who require long-term hospitals stays.
The primary nursing model has remained relatively unchanged since its conception. Most studies indicate that it provides a higher level of job satisfaction for nurses and is popular among patients. However, results have largely offered anecdotal evidence and lack hard data about how primary nursing’s quality of care compares with models such as team and functional nursing.
Total Patient Care Model
Total patient care is the grandfather of nursing models. It requires a patient to receive all nursing care from one nurse. In today’s medical industry, total patient care can only be applied in certain types of situations, including critical care and home health care.
In the total patient care model, the attending nurse typically provides care for the patient from the beginning to the end of his medical care episode. For example, a nurse might provide a few weeks of around-the-clock, in-home care for an elderly patient who has broken a hip. The patient might deal with more than one nurse due to work schedules, but he does not receive care from multiple nurses during a work shift. Total patient care requires nurses to assume all care for their patients. They must closely monitor the patient’s condition and communicate closely with the patient’s physicians.
Typically, patients respond favorably to total patient care, because their nurses attend quickly to their needs. In many cases, the patient and nurse develop a friendship, which makes the experience less stressful and more meaningful for the patient.
In home health care settings, a patient might face a disadvantage if he needs medical care the nurse cannot readily provide. For example, if an in-home patient suddenly develops a breathing problem, the nurse cannot quickly summon a respiratory therapist. Many nurses enjoy the autonomy that total patient care offers them. However, focusing effort on one patient at a time can lead to burnout.
Case management focuses on the administrative issues of health care, rather than the actual delivery of health care. An RN case manager evaluates a patient’s care to determine her healthcare costs and the likelihood that the insurer will provide coverage. Case managers follow the progression of a patient’s care to determine the likely discharge date and her care needs after discharge.
The case management model stems from the complexity of third party health-care payers and the rising costs of health care. A case manager serves as an intermediary between the patient and third party payers, which may include insurance companies, Medicare or Medicaid. They also ensure that third party payers will reimburse the health-care facilities for services.
Case managers often deal with 12 to 28 patients per day. In the past, they reviewed patient charts and communicated with third party payers every three to seven days. But in today’s digital age, case managers communicate daily with attending doctors, nurses and third party payers.
Effective case management benefits everyone involved. The case manager communicates with the patient to inform her about approvals or denials from her healthcare provider. Likewise, the case manager can help prevent health-care facilities from losing money because of unexpected coverage denials.
Case managers must stay abreast of every aspect of the patient’s care, from diagnostic tests to surgery schedules and from outpatient therapies to home health-care requirements. For example, a case manager must keep track of the number of days a patient’s insurance company will pay for inpatient care. If a patient experiences a discharge delay due to a rescheduled surgery, the case manager must communicate with the third party payer and coordinate new surgery and discharge dates with health-care staff. A case manager must work closely with the patients to assess the effectiveness of treatments and help devise self-care plans for after discharge.
About Nursing Careers
The nursing profession includes a variety of career paths, which require different levels of education. The demand for nurses is on the rise, offering bright job prospects for all nurses.
Licensed Practical and Licensed Vocational Nurses (LVNs)
Technical schools and community colleges offer LPN or LVN educational programs. Most LPN and LVN programs take about one year to complete. These programs include hands-on exercises, along with coursework in subjects such as pharmacology and biology. After completing their courses, graduates must pass the National Council Licensure Examination before they can obtain a required license to practice nursing.
LPNs and LVNs work directly with patients, administering basic care such as changing bandages, checking blood pressure, inserting catheters and dressing and bathing patients. LVNs and LPNs help maintain patient records and discuss changes in patients’ conditions with other medical staff.
More than 720,000 LVNs and LPNs worked in the United States in 2016, according to the U.S. Bureau of Labor Statistics (BLS). Nursing homes employ the majority of LPNs and LVNs.
In 2017, LPNs and LVNs earned a median wage of more than $45,000. A median wage represents the middle of the occupation’s pay scale.
The BLS projects the need for LVNs and LPNs to increase by around 12 percent through 2026.
RNs work closely with doctors to devise and administer patients’ treatment plans. They dispense medications, assist in medical tests, oversee treatments and operate medical equipment. RNs maintain patient records, inform doctors of changes in patients’ conditions, and help educate patients about their illnesses and treatments.
RNs come to their profession after completing an Associate’s Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) program. ADN programs typically require two to three years of study, while BSN programs usually take four years to complete. Both degree programs typically include clinical exercises, as well as courses in chemistry, biology, anatomy and nutrition. After completing an ADN or BSN program, an RN graduate must obtain a license before she can practice nursing.
About 3 million RNs worked in the United States in 2016. More than 60 percent of RNs work in hospitals. According to BLS estimates, opportunities for RNs should increase by around 15 percent from now until 2026.
In 2017, RNs earned a median wage of around $70,000. RNs at the top of the pay scale took home more than $100,000.
Nurse Anesthetists and Nurse Practitioners
Nurse anesthetists and nurse practitioners – also called advanced practice registered nurses (APRNs) – are among the most highly educated people in the nursing profession. APRNs must complete their RN education and hold an RN license before they can enter a master’s degree program to become a nurse anesthetist or nurse practitioner. Many APRN programs only accept candidates who hold a BSN. APRN programs include practical exercises and advanced coursework in subjects such as physiology, pharmacology and anatomy. Most states require APRNs to obtain a license or certification before they can practice.
Nurse practitioners often serve as their patients’ primary care provider. They diagnose illnesses, perform medical tests, devise treatment and wellness plans, and dispense medications. Nurse practitioners often work in partnership with a doctor.
Nurse anesthetists administer anesthesia to patients during surgery, dispense pain medications and monitor patients as they wake up in the recovery room. They prepare for surgery by taking the patient’s medication history, to avoid complications from drug interactions or allergies that can occur from anesthesia.
Around 155,000 nurse practitioners worked in the United States in 2016, along with just 42,000 nurse anesthetists. The BLS estimates APRN job opportunities will increase by more than 30 percent from now until 2026.
In 2017, nurse practitioners and nurse anesthetists took home a median wage of more than $110,000. Top earners made more than $180,000.