chapter 9 | Delegation of Client Care 127delegation and communication skills are essential to
successfully follow through with any given model of
care delivery.
Functional Nursing
Functional nursing or task nursing evolved during
the mid-1940s due to the loss of RNs who left
home to serve in the armed forces during the
Second World War. Prior to the war, RNs com-
prised the majority of hospital staffing. Because of
the lack of nurses to provide care at home, hospitals
used more LPNs or licensed vocational nurses and
UAP to care for clients.
When implementing functional nursing, the
focus is on the task and not necessarily holistic
client care. The needs of the clients are categorized
by task, and then the tasks are assigned to the “best
person for the job.” This method takes into consi-
deration the skill set and licensure scope of practice
of each caregiver. For example, the RN would per-
form and document all assessments and administer
all IV medications; the LPN or LVN would
adminster treatments and perform dressing
changes. UAP would be responsible for meeting
hygiene needs of clients, obtaining and recording
vital signs, and assisting in feeding clients. This
method is efficient and effective; however, when
implemented, continuity in client care is lost. Many
times, re evaluation of client status and follow-up
does not occur, and a breakdown in communication
among staff occurs.
Team Nursing
Team nursing grew out of functional nursing; nurs-
ing units often resort to this model when appropri-
ate staffing is unavailable. A group of nursing
personnel or a team provides care for a cluster of
clients. The manner in which clients are divided
varies and depends on several issues: the layout of
the unit, the types of clients on the unit, and the
number of clients on the unit. The organization of
the team is based on the number of available staff
and the skill mix within the group.
An RN assumes the role of the team leader. The
team may consist of another RN, an LPN, and UAP.
The team leader directs and supervises the team,
which provides client care. The team knows the con-
dition and needs of all the clients on the team.
The team leader acts as a liason between the
clients and the health-care provider/physician.
Responsibilities include formulating a client plan
of care, transcribing and communicating orders and
treatment changes to team members, and solving
problems of clients and/or team members. The
nurse manager confers with the team leaders,
supervises the client care teams and, in some insti-
tutions, conducts rounds with the health-care
providers.
For this method to be effective, the team leader
needs strong delegation and communication skills.
Communication among team members and the
nurse manager avoids duplication of efforts and
decreases competition for control of assignments
that may not be equal based on client acutity and
the skills sets of team members.Total Client Care
During the 1920s total client care was the original
model of nursing care delivery. Much nursing was
in the form of private duty nursing, in which nurses
cared for clients in homes and in hospitals. Schools
of nursing located in hospitals provided students
who staffed the nursing units and delivered care
under the watchful eyes of nursing supervisors and
directors. In this model, one RN assumes the
responsibility of caring for one client. This includes
acting as a direct liason among the client, family,
health-care provider, and other members of the
health-care team. Today, this model is seen in high
acuity areas such as critical care units, postanesthe-
sia recovery units, and in labor and delivery units.
This model requires RNs to engage in non-nursing
tasks that might be assumed by individuals without
the educational level of an RN.Primary Nursing
In the 1960s nursing care delivery models started
to move away from team nursing and placed the
RN in the role of giving direct client care. The cen-
tral principle of this model is to distribute nursing
decision making to the nurses caring for the client.
As the primary nurse, the RN devises, implements,
and is responsible for the nursing care of the client
during the time the client remains on the nursing
unit. The primary nurse along with associate nurs-
es gives direct care to the client.
In its ideal form, primary nursing requires an
all-RN staff. Although this model provides conti-
nuity of care and nursing accountability, staffing is
difficult and expensive. Some view it as ineffective
as many tasks that consume the time of the RN
could be carried out by other personnel.