A Labor Day Poll - Your Preferred Model Of Care

[DoGoodThenGo]

A light hearted poll in honor of Labour Day; which care model in the best of all very best possible worlds would you as a nurse want to work under?

Here are the five main choices:

Patient Focused Care - RNs used as care managers with unlicensed assistive personnel (UAP) in expanded roles such as drawing blood, performing EKGs, and performing certain assessment activities.

Primary or Total Nursing Care - All RN staff that provides all direct patient care and the RN does so for the same patient throughout their stay. No UAP staff to provide care.

Team or Functional Nursing Care - RN as a team leader with Licensed Vocational or Practical Nurses and Unlicensed Assistant Personnel performing activities such as bathing, feeding, and other duties common to nurse aides and orderlies. Assignments can also be divided by function such as "medication nurse", treatment nurse", etc...

Magnet Hospital Environment/Shared governance - High degree of RN autonomy, MD-RN collaboration, and RN control of practice; allows for shared decision process by RNs and managers.

Just a fun little poll, not to turn into a "BSN vs. ADN" or "LPN vs. RN" thing.

[smf0903]

Patient focused all the way. We just finished a month from h-e-double-hockey-sticks "trying out" team nursing (MS floor). I'm sure team nursing has its place but it isn't with us in an acute setting.

[Here.I.Stand, BSN, RN]

We do a blend of patient focused and shared governance.

Would hate primary care...phlebotomists are better at it than I am. Our dieticians are better at placing NJ feeding tubes than I am. It's a fact. One of my priorities is patient comfort; part of how we maintain that is by letting the experts do what they do better.

Team nursing in acute care doesn't sound ideal at all...the RN is still ultimately responsible for a larger number of patients, even if an LPN and CNA are helping. If they want to give me an LPN and a CNA for the same number of pts so that we can provide more in-depth care than I am able to by myself, great....as far as I know, that's not what happens. The pt:RN ratio increases due to the addition of an LPN and CNA

[TheCommuter, BSN, RN]

When I worked the floor, I preferred team nursing. When the poop hit the fan, it was nice to have one or two other people on the team to pull through and get the job done.

[AutumnApple]

*For Me*

Patient Focused Care is what a lot of LTC facilities go with. On paper, it looks wonderful and efficient. RNs do the things no one else can from a "care manager" (as you put it) role. Too many potholes in this system for it to do what it theoretically should. Personalities get in the way. For one, the care manager role is just that, a role. Rarely is the RN given the support to truly manage. They are handed a shift short on staff, what staff are there are disgruntled to all heck and when action needs taken, administration plays Pontius Pilate about it. End result is the RN becomes the care manager doing the duties of the UAP AND housekeeping AND................

For all four choices you could say reality and theory never quite meet each other. With Patient Focused Care though, the gap is too large and nothing like what the intended outcome was meant to be.

I vote for shared governance because I have seen this work, to a degree. With nursing being more a part of the decision making, we can act as patient mediators. Pontius Pilate still shows up at most meetings but he has less to say. In this system, nurses act as wardens of policy making, keep it from becoming as profit driven as it tends to be in other systems. Profit still drives the decision making, but there is at least some patient care focus to it.

Perhaps I should have voted "other". I don't have any faith in any of the existing systems. I believe we are yet to discover the mode of care delivery that will be efficient enough to make the CEOs happy, autonomous enough to remain patient focused and theory driven enough to become universally respected.