Nursing Model in University of Miami Hospital


Selection of an appropriate model of nursing care coordination is interrelated with the management of such diverse organizational issues as cost-efficiency, customer satisfaction increase, achievement of positive treatment outcomes, and provision of high-quality healthcare service to all patients. When an efficient model is implemented, the internal communication among nursing staff members can be significantly improved, and it may lead to the development of multiple benefits both organizational and individual. To achieve greater professional results while selecting a model, a care delivery organization needs to consider multiple factors including economic position, organizational values, ability to comply with the norms of safety, leadership qualities, and staff turnover.

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Identified Nursing Care Model: Team Nursing

It is observed that the major traditional nursing care models are functional, total patient care, primary nursing (PN), and team nursing (TN) models (Finkelman, 2006, p. 143). At the same time, a lot of non-traditional innovative, and hybrid models of care delivery can be distinguished, such as nursing handover model aimed to improve the completion of various nursing activities and documentation (Kerr, Klim, Kelly, & McCann, 2016, p. 89). Although a hospital or a medical center can apply any model chosen from the variety of options, it is possible to say that the efficiency of a model implementation is primarily determined by its relevance to the organizational environment. In this way, the strategic approach towards selection of care models, as well as the evaluation of short-term and long-term outcomes of its implementation is essential to the achievement of high professional efficiency.

Nursing Care Model: University of Miami Hospital

University of Miami Hospital (UMH) is a large hospital setting characterized by the provision of healthcare service in a great number of specialties and a staff structure comprised of a large number of physicians and nurses. The coordination of nursing activities is initiated by nurse leaders who are responsible for nurses’ education, supervision, and assignment of tasks. The central element of UMH care delivery model is patient, and his/her needs. Thus, the nursing staff strives to ensure patient safety and satisfaction.

The model applied by UMH nursing staff is based on collaboration and pursuit to provide the individualized approach to patients. The nursing teams provide care services to a group of patients in a particular UMH ward, and the work of the nurses is supervised by a few registered nurses (RNs) leaders. The RNs train less experienced colleagues and accomplish the tasks which other staff members are not qualified to perform. The RNs assign patients to the nurses who then become responsible for the provision of the direct patient care and communicating treatment outcomes with other team members and RNs. Based on this, it is possible to conclude that UMH implements TN care model.

As Cioffi and Ferguson (2009) argue, TN model is associated with a significant amount of professional support and it is regarded as a major advantage in TN situations (p. 8). At the same time, TN entails an increase in the degree of RN leaders’ responsibilities who need both to take care of patients and supervise team members’ work (Cioffi & Ferguson, 2009, p. 7). However, it may be possible to resolve this issue by encouraging nurses to be more autonomous and stimulating their self-education and professional growth.

As stated by Fairbrother, Jones, and Rivas (2010), TN principle was developed in the 1950s ” as a response or reaction to functional nursing,” and it is grounded in the collaboration within the groups of nurses with different levels of education, proficiency, and registration status (p. 203). It is observed that the focus on nurses’ cooperation and shared responsibilities may help to increase job satisfaction, and enhance team cohesion (Fairbrother et al., 2010, p. 218). Thus, the implementation of TN care delivery model leads to the enhancement of communication patterns, group thinking, decision making, and correlation of nurses’ autonomy and collaboration.

Recommendations: Primary Nursing Model

It is possible to presume that more patient-oriented primary nursing (PN) model can provide UMH with the opportunity to enhance patient satisfaction and increase nurses’ autonomy in decision making and selection of treatment methods.

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According to Duffield et al. (2010), PN was “focuses on providing care in a one patient to one nurse relationship that promotes continuity of care” (p. 2243). This principle is the major one in the model, and it means that a nurse becomes authorized to examine, plan, design, and implement healthcare strategy for his/her patients and communicate his/her decisions with other nurses to ensure that they follow the treatment plan while the nurse has a day off.

The implementation of PN model requires the nurses to apply skill mix principle that implies the ability to perform a variety of procedures and activities by one nurse. Although it is considered that initiation of PN provokes the necessity to hire more RNs, Manthey (2009) argues that when skill mix is based on the character of patient acuity and not on the nursing care system, PN becomes more efficient in the provision of holistic patient intervention (p. 37). Moreover, PN provides the opportunity to establish good relationships with patients and understand their needs and preferences through personal communication more deeply and apply the knowledge about them in order to enhance intervention program and achieve better outcomes.

Duffield et al. (2010) observe that PN model is frequently used in Magnet-designated hospitals striving to achieve greater nursing excellence, and it is associated with “positive patient outcomes…and staff satisfaction” (p. 2243). As a Relationship-Based Care model, PN serves as the expression of the belief that the establishment of nurse-patient relationships is essential to continuity and effectiveness of care. Moreover, the model entails the increase in nurses’ autonomy which is linked to the achievement of higher proficiency and competence level in primary care nurses, and it may help to eliminate the factor of RNs excess responsibility and prevent their burnouts by equally spreading responsibilities among all nursing staff members.


The practical experience and the literature review helped to reveal that similar care delivery models can be organized in a different way, and the factors defining the success of a model implementation include staff availability, overall organizational environment, and culture, as well as the identified hospital setting’s objectives. It is possible to say, that along with economic considerations organizational personnel needs to take into account the ability to align a chosen model with corporate values and professional beliefs, as well as the level of nurses’ knowledge and competence.

It is possible to conclude that PN model implementation may provide a good opportunity for UMH to enhance its patient-oriented approach and, at the same time, increase nursing staff qualification. The fact that the nurses can be assigned with the tasks which they feel more comfortable to fulfill in TN provokes the risks that the model can become more task-oriented. Therefore, at least partial application of PN principles may result in better patient outcomes due to the refinement of communication patterns and the establishment of good nurse-patient-family relationships.


Cioffi, J., & Ferguson AM, L. (2009). Team nursing in acute care settings: Nurses’ experiences. Contemporary Nurse: A Journal For The Australian Nursing Profession, 33(1), 2-12.

Duffield, C., Roche, M., Diers, D., Catling-Paull, C., & Blay, N. (2010). Staffing, skill mix and the model of care. Journal Of Clinical Nursing, 19(15/16), 2242-2251. Web.

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Fairbrother, G., Jones, A., & Rivas, K. (2010). Changing model of nursing care from individual patient allocation to team nursing in the acute inpatient environment. Contemporary Nurse: A Journal For The Australian Nursing Profession, 35(2), 202-220. Web.

Finkelman, A. W. (2006). Leadership and management in nursing. Upper Saddle River, NJ: Pearson Prentice Hall.

Kerr, D., Klim, S., Kelly, A., & McCann, T. (2016). Impact of a modified nursing handover model for improving nursing care and documentation in the emergency department: A pre- and post-implementation study. International Journal Of Nursing Practice, 22(1), 89-97. Web.

Manthey, M. (2009). The 40th Anniversary of Primary Nursing: Setting the Record Straight. Creative Nursing, 15(1), 36-38. Web.

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