CHAPTER 14

coordinates, monitors, and

evaluates options and services

ORGANIZING PATIENT CARE

to meet an individual's health

needs through communication

The five most well known means

and available resource to

of organizing care for patient

promote quality, cost-effective

care delivery are total patient

care, functional nursing, team
and modular nursing, primary

MANAGEMENT integrated

nursing and case management.

TOTAL PATIENT CARE, utilizing

utilization management and

discharge planning functions

the case method of assignment,

and may be unit based,

is the oldest form of patient care

assigned by patient, disease

organization and still widely

used today.
TOTAL PATIENT CARE NURSING
is sometimes referred to as

based or primary nurse case

individual patient, the case

because patients were assigned

manager employed in a

as cases, much like

DISEASE MANAGEMENT

contemporary private-duty

PROGRAMS plans the care for

nursing is carried out.

FUNCTIONAL NURSING

populations or groups of

organization requires the

patients with the same chronic

completion of specific tasks by

illness.
In POPULATION BASED HEALTH

different nursing personnel.

TEAM OR MODULAR NURSING

CARE, the focus is on "covered

organization uses a leader who

lives" or population of patients,

coordinates team members in

rather than on the individual

the care of a group of patients.

PRIMARY CARE NURSING also

patient.
DIFFERENTIATED NURSING

known as RELATIONSHIP-BASED

PRACTICE delineates different

NURSING is organized so that

roles for nurses based on their

the patient is at the center of

skill, knowledge, educational

the structure; one nurse has 24-

level and motivation.

The two basic differentiated

hour responsibility for the

managed.
While the focus historically for
case management has been the

CASE METHOD OF ASSIGNMENT

outcomes.
ACUTE-CARE CASE

nursing care plan.

CASE MANAGEMENT is a

practice models are

EDUCATIONAL MODEL- role

collaborative process that

differentiation based on type of

assesses, plans, implements,

educational preparation

(AND,BSN, and MSN) and

skills necessary, employee

COMPETNECY MODEL- role

evaluation, and communication

differentiation based on

patterns are often affected by

individual nurse skill level,

work redesign.

expertise, experience, etc.

The care MAP
(MULTIDISCIPLINARY ACTION
PLAN) is a combination of a
critical path and a nursing care
plan, except that it shows times
when nursing interventions
should occur as well as

variances.
A new role sometimes termed
CLINICAL NURSE-LEADER, an
experienced nurse possessing a
baccalaureate or higher degree
will facilitate care for patients in

the future.
Delivery system may have
elements of the various designs
present in the system in any

organization.
Each unit's care delivery
structure should facilitate
meeting the goals of the
organization, be cost-effective,
satisfy the patient, provide role
satisfaction to nurses, allow
implementation of the nursing
process, and provide for
adequate communication

among health care providers.

When work is redesigned, it
frequently has personal
consequences for employees
that must be considered. Social
interactions, the degree of
autonomy, the abilities and

CHAPTER 15

actively seeking out or

EMPLOYEE, RECRUITMENT,

attracting applicants for existing

SELECTION, PLACEMENT, AND

INDOCTRINATION

positions, and it should be an

adequate workforce depends on

the management process. In

many variables, including

staffing, the leader-manager

financial resources, and

recruits, selects, places, and

adequate nursing pool,

indoctrinates personnel to

competitive salaries, the

accomplish the goals of the

organization's reputation, the

organization. It is and especially

location's desirability, and the

important phase of the

status of the national and local

management process in health

economy.
Effective recruiting methods

organizations are usually labor

include advertisements, career

intensive.
The first step in staffing process

days, literature and the informal

is to determine the type and

organization as examples of

number of personnel needed.

A number of factors have

satisfies employees.
An INTERVIEW may be defined

use of members of the

contributed to a severe nursing

as verbal interaction between

shortage, particularly in acute

individuals for a particular

care hospitals, in the early 21st

century. These factors include a
nationwide downsizing of
hospitals in the 1990s, the aging

purpose.
The major defect of the

interview is subjectivity.
Interview research helped
managers to develop strategies

of the nursing workforce,

for overcoming its limitations

accelerating demand for

these are: 1.) prepare for the

professional nursing services,

interview, 2.) use a team

and inadequate enrollment in

ongoing process.
Successfully RECRUITING and

STAFFING is the third phase of

care organizations because such

RECRUITMENT is the process of

approach and lastly, 3.) develop

nursing programs of study.

The current shortage is caused
by both inadequate short-term
and long-term supply of human
resources as well as a projected
long-term rise in demand for
nursing services.

a structures interview format for

each job classification.

Despite their limitations,
interviews are widely used as a
method of selecting employees
for hire.

The interview should meet the

goals of both the applicant and

employees on units,

the manager.
Managers must be skilled in

departments, and shifts where

they have the best chance of

planning, conducting and

controlling interviews.
Due to numerous federal acts

seekers, managers must be

socialization of employees.
INDUCTION, the first phase of

cognizant of the legal

indoctrination, takes place after

constraints on interviews.
SELECTION should be based on

the employee has been selected

the requirements necessary for

role.
ORIENTATION provides the

the job; these criteria should be

succeeding.
INDOCTRINATION consists of
induction, orientation, and

that protect the rights of job

Managers should place new

but before performing the job

developed before beginning the

employees with more specific

selection process.
Managers should seek to

information for the position.

A well-prepared and executed

proactively recruit and hire staff

orientation program educates

that represents age, gender,

the new employee about the

cultural, ethnic, and language

desired behaviors and expected

diversity in response to the

goals of the organization and

rapidly increasing diversity of

actively involves the new

the communities that they

employee's immediate

serve.

supervisor.