Introduction
In recent years, much scholarly debate has been focused on understanding the effectiveness of various models of nursing care on important care indicators, such as medication errors, patient falls, pain management, patient satisfaction, and staff job satisfaction (Fernandez, Johnson, Tran, & Miranda, 2012). The broad consensus existing among nursing scholars is that these models fall into several key domains, namely patient allocation, team or functional nursing care, and shared governance or magnet nursing care (Aggleton & Chalmers, 2011). The main objective of the present paper is to identify a nursing care model used in practice settings and compare it with a different care model with the view to assessing the effectiveness of the models and enhancing knowledge and understanding of how these models impact the management of care in healthcare settings.
Identification of Nursing Care Model
The nursing care model observed and identified in the acute care setting is commonly referred to as a team nursing model of care. Specifically, care was being delivered to a collection of acutely sick patients by a team of nursing professionals and other staff members (enrolled nurses, TENs and Acute care AINs) with diverse levels of education, skills, competencies, and experience, under the supervision or direction of a registered nurse (RN).
Review and Summary of Scholarly Sources
Sources related to the Identified Model
Fergusson and Cioffi (2011) used a qualitative descriptive design with the view of exploring and describing nurse managers’ personal experiences with a team-based model to nursing care implemented in an acute care environment. This particular study found that the adoption of the team nursing model is influenced by factors such as the existing skill mix, insufficient supervision of less experienced staff by senior staff (nursing staff is increasingly becoming less experienced and less skilled, hence require an enhanced level of direct supervision), the shifting role of the enrolled nurse, and nursing attrition.
The benefits of the team nursing model identified in the study included enabling nurses to have a complete understanding of all the patients, enhancing superior coverage over breaks, supporting more autonomy of staff members, and positioning senior nursing professionals to accept bigger responsibility for coordinating less skilled staff members. The patient-oriented benefits of the model included more contact with nursing professionals, the superior quality of care, and a safer environment. However, the study identified inefficient communication skills, lack of good interactions between the nursing teams and medical staff, and inability to function well in multidisciplinary team contexts as some of the challenges facing the team nursing model of care.
Hastings, Suter, Bloom, and Sharma (2016) used a mixed methods research design and administrative data to investigate the effects of a new team-based care model in a general medical unit in Alberta, Canada. The study found that the introduced model of care delivery was effective in enhancing unit culture and collaboration, addressing issues of role ambiguity, reducing staff absenteeism, and improving various issues associated with the scope of practice and patient care. For patients, the team nursing model was found to be effective in decreasing the length of hospital stay and 30-day readmissions, increasing patient satisfaction, and fostering closer relationships between patients and nursing professionals.
Sources Describing a Different Nursing Model
In their study, da Silva Copelli et al. (2015) used a qualitative research approach and a grounded theory design with the view to not only building an explanatory model on nursing governance but also developing an in-depth understanding of the meanings of governance of nursing professionals on nursing practice. The authors were clear that, in nursing contexts, governance or magnet nursing care models relate to all those frameworks that support the development of participatory management models, shared decision making by RNs and managers, high levels of RN independence, as well as effective MD-RN collaboration. The findings of this study showed that the shared governance model of care is typified by several characteristics, namely participative management, RN autonomy in decision making, self-managed teams, a collaboration between and within teams, control over nursing practice, elevated job satisfaction, decentralized organizational models, high patient satisfaction, effective conflict management, and taking responsibility for decision making.
Al-Faouri, Ali, and Essa (2014) used a quantitative research approach and a descriptive survey design to investigate the perceptions and dynamics of shared governance in a Jordanian University hospital. The authors cited other literature sources to define the shared governance model of care delivery as a decentralized approach that provides nursing professionals with “a greater authority and control over their practice and works environment, engenders a sense of responsibility and accountability, and allows active participation in the decision-making process” (Ali-Faouri et al., 2014, p. 255). One of the main findings of this particular study was that the sampled nursing experts perceived good control over their professional practice, access to information and resources, and shared participation in making important decisions in the work environment as a direct consequence of the shared governance/magnet model of care delivery.
Implementation and Recommendations
The current nursing care model is being delivered under the supervision and coordination of a senior RN, who is the team leader and coordinator of care. All the other RNs, ENs, Acute Care AINs, and TENs are expected to work as a collaborative group, with responsibility for care being delegated according to the nurses’ educational background, skills, competencies, and experience. The team leader uses a multiplicity of communication, team-building, and delegation skills to ensure that the group of nurses and other support staff are effective in providing care to a large cohort of inpatients admitted at one of the acute care wards in the hospital. The group of nurses works on a shift basis, meaning that they are routinely replaced with another functional team after the lapse of 8-12 hours.
The recommended nursing model entails a hybrid of team nursing and shared governance/magnet nursing care models. While it is important to keep the team-based approach to care due to the many advantages described in this paper, it is believed that more efficiency and productivity could be achieved by incorporating the components of participative management, nurse autonomy in decision making, decentralized organizational models, MD-RN collaboration, and self-management into the model. Indeed, available literature demonstrates that nurses who participate in independent decision-making processes are more likely to attain high levels of job satisfaction and become deeply committed to the aims and objectives of the organization (Al-Faouri et al., 2014; Fernandez et al., 2012). Since the quality of nursing care and patient safety is to a large extent determined by the level of nurse satisfaction with the job, it is important to include these components of the shared governance model into the team nursing model to come up with a hybrid model of care with the capacity to ensure optimal care outcomes.
Conclusion
Overall, this experience has stimulated an in-depth understanding of different nursing care models, their effectiveness, and how these models could be applied in actual practice settings to improve the quality of nursing care, safety, as well as patient and staff satisfaction. The main learning point is that nurses can guarantee optimal care outcomes when they are provided with a working environment that underscores the importance of collaboration in care delivery while ensuring that the professionals are facilitated to make independent decisions depending on their scope of practice and skill levels.
References
Aggleton, P., & Chalmers, H. (2011). Nursing models and nursing practice (3rd ed.). London, UK: Palgrave Macmillan.
Al-Faouri, I.G., Ali, N.A., & Essa, M.B. (2014). Perception of shared governance among registered nurses in a Jordanian university hospital. International Journal of Humanities and Social Science, 4, 254-262. Web.
da Silva Copelli, F.H., de Oliveira, R.J.T., Erdmann, A.L., Gregorio, V.R.P., Pestana, A.L., & dos Santos, J.L.G. (2015). Understanding nursing governance practice in an obstetric center. Anna Nery School Journal of Nursing, 19, 239-245. Web.
Fergusson, L., & Cioffi, J. (2011). Team nursing: Experiences of nurse managers in acute care settings. Australian Journal of Advanced Nursing, 28, 5-11. Web.
Fernandez, R., Johnson, M., Tran, D.Y., & Miranda, C. (2012). Models of care in nursing: A systematic review. International Journal of Evidence-based healthcare, 10, 324-337. Web.
Hastings, S.E., Suter, E., Bloom, J., & Sharma, K. (2016). Introduction of a team-based care model in a general medical unit. BMC Health Services Research, 16(1), 1-12. Web.