Nursing Care Delivery Model: Team Nursing I. Select Nursing Care Delivery Model from the literature: Team nursing as a care delivery model was developed in New York, NY in 1950s. This nursing care model consists of a group of nurses who work alongside as a team to provide patients’ care. The team shares responsibility and collaborates efficiently. The team leader is usually an RN (King, 2013). Describe Nursing Care Delivery Model: a) What personnel are utilized? In team nursing the care of the patient divided between team members- licensed and unlicensed personnel whose work is coordinated by the team leader, most of the times- RN appointed by the charge nurse. b) What are their roles/responsibilities? In team nursing the responsibilities usually divided in between the personnel, so that everyone’s has its own role in patient’s care. For example, RN might be assigned for patients’ assessments, LPN assigned for certain medication administration and nursing assistant helps with care/bathing and feeding patients. All this done under supervision of a team leader another RN (Currentnursing.com, 2015). c) How is the work coordinated? The appointed team leader is coordinating the flow of the work done. The team leader gives directions and instructions in details to team members, he/she is also schedules the care and assigns the tasks in between the team members. d) What are the reporting relationship? The team leader utilizes different methods to communicate with each team Care Delivery Models and Effective Nurse Administrators Essay Paper

In many areas of the developed world, contemporary hospital care is confronted by workforce challenges, changing consumer expectations and demands, fiscal constraints, increasing demands for access to care, a mandate to improve patient centered care, and issues concerned with levels of quality and safety of health care. Effective governance is crucial to efforts to maximize effective management of care in the hospital setting. Emerging from this complex literature is the role of leadership in the clinical setting. The importance of effective clinical leadership in ensuring a high quality health care system that consistently provides safe and efficient care has been reiterated in the scholarly literature and in various government reports. Recent inquiries, commissions, and reports have promoted clinician engagement and clinical leadership as critical to achieving and sustaining improvements to care quality and patient safety. In this discursive paper, we discuss clinical leadership in health care, consider published definitions of clinical leadership, synthesize the literature to describe the characteristics, qualities, or attributes required to be an effective clinical leader, consider clinical leadership in relation to hospital care, and discuss the facilitators and barriers to effective clinical leadership in the hospital sector. Despite the widespread recognition of the importance of effective clinical leadership to patient outcomes, there are some quite considerable barriers to participation in clinical leadership. Future strategies should aim to address these barriers so as to enhance the quality of clinical leadership in hospital care.Care Delivery Models and Effective Nurse Administrators Essay Paper

Keywords: management, hospital care, barriers, leadership, clinical leadership, discursive paper

Introduction

Globally, health care systems in the developed world continue to struggle with escalating demands for services and escalating costs. Service design inefficiencies, including outmoded models of care contribute to unsustainable funding demands.1 An example is the continuing practice in many settings to look to hospital emergency departments to provide what are essentially, primary health care services. While some progress and reforms have been achieved, numerous experts point to the need for further system change if services are to be affordable and appropriate in the future.2 They note that

[…] further change is still needed, despite years of progress in the quality of health care around the world. This transformation will require leadership – and that leadership must come substantially from doctors and other clinicians, whether or not they play formal management roles. Clinicians not only make frontline decisions that determine the quality and efficiency of care but also have the technical knowledge to help make sound strategic choices about longer-term patterns of service delivery.Care Delivery Models and Effective Nurse Administrators Essay Paper

Effective clinical leadership has been linked to a wide range of functions. It is a requirement of hospital care, including system performance, achievement of health reform objectives, timely care delivery, system integrity and efficiency, and is an integral component of the health care system.2–4 Though most people are provided with health care within the community setting, hospital care continues to garner the bulk of funding and attract considerable attention in relation to care quality and related concerns. Indeed, hospitals are very costly and diverse environments that vary in size and complexity, determined in part by their overall role and function within the larger health care system. The services provided by individual hospitals are determined and driven by a number of mechanisms, including government policy, population demographics, and the politics and power of service providers.Care Delivery Models and Effective Nurse Administrators Essay Paper

However, regardless of the differences, the clinical areas of the hospital are critical to all health care organizations, given that it is at this level where consumers principally engage with the hospital system. It is at this point where consumers are recipients of hospital care and where they witness and experience how the system functions, observing the strengths and inefficiencies of the health care system and conflict and collegiality between and among groups of health professionals. It is also at this point that clinicians, defined as any frontline health care professionals, have opportunities to fulfill leadership roles. For consumers of health care to achieve optimal health outcomes and experience optimal hospital care, many believe effective clinical leadership is essential.

In this paper, we discuss clinical leadership in contemporary health care, definitional issues in clinical leadership, roles of hospitals in contemporary health care, preparation for clinical leadership roles, and the facilitators and barriers to effective clinical leadership in the hospital sector.

Clinical leadership in contemporary health care

The importance of effective clinical leadership in ensuring a high quality health care system that consistently provides safe and efficient care has been reiterated in the scholarly literature and various government reports.6–8 Recent inquiries, commissions, and reports have promoted clinician engagement and clinical leadership as critical to improving quality and safety.9 As one Australian example, a key priority nursing recommendation of the Garling Report was that Nurse Unit Manager (NUM) positions be reviewed and significantly redesigned “to enable the NUM to undertake clinical leadership in the supervision of patients […] to ensure that for at least 70% of the NUM’s time is applied to clinical duties.”8 The remaining time could be spent on administrative and management tasks. In the more recent Francis report7 from the UK, a recommendation was made for similarly positioned ward nurse managers to be more involved in clinical leadership in their ward areas. In the United States, clinical leadership has also been identified as a key driver of health service performance, with the Committee on Quality of Healthcare suggesting considerable improvements in quality can only be achieved by actively engaging clinicians and patients in the reform process.10Care Delivery Models and Effective Nurse Administrators Essay Paper

However, leadership in health care is often very complex, and some authors claim it faces unique contextual challenges. For example, Schyve5 claims aspects of governance are sui generis in health care, noting

healthcare organizations also have a rather unique characteristic. That is, the chief executive is not the only part of the organization’s leadership that is directly accountable to the governing body. In healthcare, because of the unique professional and legal role of licensed independent practitioners within the organization, the organized licensed independent practitioners – in hospitals, the medical staff – are also directly accountable to the governing body for the care provided. So the governing body has the overall responsibility for the quality and safety of care, and has an oversight role in integrating the responsibilities and work of its medical staff, chief executive, and other senior managers into a system that that achieves the goals of safe, high-quality care, financial sustainability, community service, and ethical behaviour. This is also the reason that all three leadership groups – the governing body, chief executive and senior managers, and leaders of medical staff – must collaborate if these goals are to be achieved (Schyve 2009:35).Care Delivery Models and Effective Nurse Administrators Essay Paper

While nursing is not specifically named in the above quote, we believe nursing to be implicit and integral to leadership in hospitals. There is recognition of the challenges associated with health care governance, evidenced by significant investment internationally in building systems for leadership development in health care.5,11 For example, the UK advanced leadership programs have been instituted and run for clinical leaders since 2001 by the National Health System Leadership Centre,12 and there are some similar innovations in other countries (see, for example, Ferguson et al13). This points to the realization that the cost and consequences of poor clinical leadership greatly outweigh the costs and potential benefits of provision of formal programs to enhance clinical leadership capacity ideally in a multidisciplinary health care team context.Care Delivery Models and Effective Nurse Administrators Essay Paper

Indeed, across the health care sector, evidence exists of the need for clinical leadership to optimize care delivery. In addition to challenges associated with resources and demand, episodes of poor patient outcomes, cultures of poor care, and a range of workplace difficulties have been associated with poor clinical leadership,8,9,14 and these concerns have provided the impetus to examine clinical leadership more closely. Care Delivery Models and Effective Nurse Administrators Essay Paper