1. Copyright © 2006 Elsevier, Inc. All rights reserved Chapter 15 The Health Care Organization and Patterns of Nursing Care Delivery

2. Copyright © 2006 Elsevier, Inc. All rights reserved What Are Some Important Challenges Currently Facing Health Care? Increase in costs  Health care costs too much Strategy used to reduce costs can be described in broad terms as managed care Shortage of nurses Patient safety

3. Copyright © 2006 Elsevier, Inc. All rights reserved How Does Managed Care Change Reimbursement Patterns? Trend is to pay for health care at a prearranged rate rather than as billed Health Maintenance Organization (HMO) plans have become very popular as a form of insurance The Preferred Provider Organization (PPO) is another type of insurance plan designed to meet the goals of managed care

4. Copyright © 2006 Elsevier, Inc. All rights reserved What Is the Impact of Managed Care On Health Care Entities? Individual hospitals or physicians’ offices merging into large-scale organizations Nonprofit hospitals changing to for-profit status Work environment is likely to involve corporate culture

5. Copyright © 2006 Elsevier, Inc. All rights reserved How Does Case Management Support Managed Care? Ensures coordination of care while reducing costs By assessing, planning, implementing, coordinating, monitoring, and evaluating options and services to meet person’s health needs Effective in providing care, but not all patients need this intensity of interaction

6. Copyright © 2006 Elsevier, Inc. All rights reserved What Tools Are Used to Support Case Management? Clinical pathways  Also known as Care Maps Disease management Both generally based on clinical guidelines incorporating nationally acceptable ways to care for specific disease

7. Copyright © 2006 Elsevier, Inc. All rights reserved What Tools Are Used To Support Case Management? (cont’d) Clinical pathways—essential elements  Timeline outlining when specific care given  Categories of care/activities and interventions  Intermediate and long-term outcomes to be achieved  Variance record

8. Copyright © 2006 Elsevier, Inc. All rights reserved What Tools Are Used To Support Case Management? (cont’d) Disease management  Supports physician/patient relationship and plan of care  Emphasizes prevention; uses evidence-based practice guidelines; empowers patients  Evaluates clinical, humanistic, and economic outcomes—goal to improve overall health

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10. Shortage of Nurses The most recent shortage began in 1998 Nurses are retiring Wider range of career options now available to young people A survey found that the average RN turnover rate in U.S. hospitals was 15.5% and the vacancy rate was 13.9%

11. Copyright © 2006 Elsevier, Inc. All rights reserved What Can Be Done to Recruit Nurses to the Profession? Interactive advertising Recruitment materials distributed to hospitals, high schools, nursing schools Improve work environment for nurses

12. Copyright © 2006 Elsevier, Inc. All rights reserved How Can Health Care Organizations Retain Nurses? Adequate compensation Flexible staffing Allow professional autonomy Good communication and interpersonal relationships Work recognition Adequate benefits Professional practice Follow magnet hospital programs

13. Copyright © 2006 Elsevier, Inc. All rights reserved Patient Safety To improve health care quality, care must be  Safe  Effective  Patient-centered  Timely  Efficient  Equitable

14. Copyright © 2006 Elsevier, Inc. All rights reserved What Is the Total Patient Care or Private Duty Model? When one nurse assumes responsibilities for the complete care of a group of patients on a 1:1 basis, providing total patient care during the shift Many nurses prefer this method

15. Copyright © 2006 Elsevier, Inc. All rights reserved What Is Functional Nursing? Breaks nursing care into a series of tasks performed by many people  LPN, CNA  Can result in fragmented, impersonal kind of care  Can lead to lack of accountability for the total patient

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17. What Is Team Nursing? Groups of patients are assigned to team headed by a team leader (usually RN) Success of team nursing centers on good communication among team members Team conference plays vital role

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19. What Is Primary Nursing? Nurse plans and directs care of patient over 24 hour period Relationship-based practice is new name for primary nursing—RN manages and coordinates patient’s care in hospital and the patient’s discharge plan

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21. What Is Patient-Focused Care? Traditional nursing interventions handled by ancillary workers under direction of RN Moves RNs to higher level of functioning

22. Copyright © 2006 Elsevier, Inc. All rights reserved What Is the Impact of Staffing Patterns on the Quality of Care? Lower levels of hospital nursing staffing associated with more adverse outcomes Patients in hospitals today more acutely ill than in the past, yet skill levels of nursing staff have declined Higher acuity patients have added responsibilities increasing nurse workload

23. Copyright © 2006 Elsevier, Inc. All rights reserved How Are Nursing Work Assignments Determined? Vary with individual institutions Patient acuity fluctuates dramatically from day to day and from season to season Can be based on budgeted nursing hours per patient per day Establish a hospital-specific written staffing plan Identify and mandate fixed staffing ratios

24. Copyright © 2006 Elsevier, Inc. All rights reserved What About Scheduling Patterns? 10 hour days 4 days a week Two 12 hour weekend shifts for 36 hours of pay  Use of overtime can cause job stress, accidents, absenteeism, poor job productivity  Mandatory overtime should only be used in emergency situations