Nursing Care Models for Better Acute Care Outcomes
NR447 Nursing Care Models Paper
Assignment Instructions and Guidelines
Purpose
This assignment requires you to identify nursing care models used in contemporary health care settings and deepen your understanding of how these models affect care management and delegation practices. You will evaluate the effectiveness of an observed model and determine how to collaborate with a nurse leader to identify improvement opportunities that safeguard quality, safety, and staff satisfaction.
Course Outcomes
Completion of this assignment enables the student to meet the following course outcomes:
- CO1: Apply leadership concepts, skills, and decision making in the provision of high quality nursing care, healthcare team management, and the oversight and accountability for care delivery in a variety of settings. (PO2)
- CO2: Implement patient safety and quality improvement initiatives within the context of the interprofessional team through communication and relationship building. (PO3)
- CO3: Participate in the development and implementation of imaginative and creative strategies to enable systems to change. (PO7)
- CO6: Develop a personal awareness of complex organizational systems and integrate values and beliefs with organizational mission. (PO7)
- CO7: Apply leadership concepts in the development and initiation of effective plans for the microsystems and/or system-wide practice improvements that will improve the quality of healthcare delivery. (PO2, and 3)
- CO8: Apply concepts of quality and safety using structure, process, and outcome measures to identify clinical questions as the beginning process of changing current practice. (PO8)
Directions
- Read your text, Finkelman (2024), pp. 111-116.
- Observe staff in delivery of nursing care provided. Practice settings may vary depending on availability.
- Identify the model of nursing care that you observed. Be specific about what you observed, who was doing what, when, how, and what led you to identify the particular model.
- Write a 5-7 page paper that includes the following components.
Paper Requirements
- Review and summarize two scholarly resources (not including your text) related to the nursing care model you observed in the practice setting.
- Review and summarize two scholarly resources (not including your text) related to a nursing care model that is different from the one you observed.
- Discuss your observations about how the current nursing care model is being implemented. Be specific.
- Recommend a different nursing care model that could be implemented to improve quality of nursing care, safety, and staff satisfaction. Be specific.
- Provide a summary and conclusion about this experience and what you learned about nursing care models.
- Write your paper using APA format using Microsoft Office 2010 or later.
Grading Rubric and Marking Criteria
| Criteria | Exemplary (100%) | Proficient (85%) | Developing (70%) | Unsatisfactory (0-55%) |
|---|---|---|---|---|
| Observed Model Literature Review (30 points) |
Two scholarly sources summarized with clear connection to observed model; analysis demonstrates depth of understanding of model’s evidence base. | Two scholarly sources summarized; connection to observed model established but analysis remains somewhat surface-level. | One or two sources present but summaries lack depth; connection to observed model is vague or incomplete. | Sources absent, non-scholarly, or unrelated to the observed nursing care model. |
| Alternative Model Literature Review (25 points) |
Two scholarly sources on a different model summarized thoroughly; clear contrast with observed model articulated. | Two sources summarized; contrast with observed model addressed but lacks specificity. | Sources present but analysis of the alternative model is superficial; contrast poorly developed. | Alternative model section missing or sources are non-scholarly. |
| Implementation Observations (20 points) |
Specific, detailed observations addressing who did what, when, and how; rationale for model identification is evidence-based and precise. | Observations are specific but lack full detail; model identification rationale is reasonable but could be stronger. | Observations are general; rationale for model identification is weak or unclear. | Observations absent or too vague to evaluate; no clear model identification. |
| Recommendation for Improvement (15 points) |
Specific alternative model recommended with clear justification tied to quality, safety, and staff satisfaction; implementation considerations addressed. | Model recommended with justification; connection to quality and safety is present but could be more explicit. | Recommendation is vague; justification lacks connection to stated outcomes. | No recommendation provided or recommendation is unsupported. |
| APA Format and Writing Quality (10 points) |
APA 7th edition formatting is correct throughout; writing is clear, concise, and free of grammatical errors; paper meets 5-7 page requirement. | Minor APA or grammatical errors present; paper meets length requirement; writing is generally clear. | Multiple APA or writing errors that detract from readability; paper may be slightly under or over length. | Significant formatting and writing issues; paper does not meet length requirement. |
Why This Matters in Practice
Nursing care models determine how patient assignments are structured, how RNs delegate tasks to LPNs and UAPs, and how accountability flows within a unit. A unit operating under team nursing will experience different communication patterns and delegation challenges than one using primary nursing or a patient-centered care model. Understanding these structural differences prepares you to diagnose workflow breakdowns, propose evidence-based staffing adjustments, and advocate for models that reduce missed care and improve nurse retention; skills that directly translate into nurse manager and clinical leader competencies evaluated by the ANCC and AONL.
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Team Nursing in a Medical-Surgical Unit: Assignment Example
A medical-surgical unit at a Midwestern community hospital utilized a team nursing model during the morning shift observation. The charge nurse assigned one RN and two certified nursing assistants to a group of twelve patients; the RN retained full accountability for assessment, care planning, intravenous medication administration, and discharge teaching while the CNAs performed vital signs, hygiene, ambulation, and intake/output documentation. Huddle communication occurred at 0700 and 1400, reinforcing task allocation based on acuity. The model became evident through the consistent pairing of the same RN-CNA team across four consecutive shifts and the clear hierarchical delegation patterns documented in the unit’s assignment sheet. Ball, Doyle, and Oocumma (2023) noted in Nursing Management that team nursing can reduce missed care episodes when the RN-to-assistive personnel ratio remains at or below 1:4, a threshold this unit maintained. The RN verbalized comfort with delegation but identified incomplete CNA documentation of fluid balance as a recurring patient safety concern during handoff.
Team Nursing Outcomes and Staffing Thresholds
Research from a multisite cross-sectional study involving 76 medical-surgical units found that team nursing units reported 18% fewer omitted care events than total patient care units when skill-mix ratios favored registered nurses by at least 55% (Härkänen et al., 2022, Journal of Advanced Nursing). The unit described above operated with a 50% RN skill mix, which may explain the documentation gaps the observed RN identified. Skill mix influences team nursing effectiveness more than total staffing hours because registered nurses must possess sufficient time to supervise and verify tasks delegated to assistive personnel; without that buffer, accountability diffuses. The Agency for Healthcare Research and Quality (AHRQ) links dedicated supervision time to reductions in patient falls and medication errors in team-based models. Students analyzing similar observations should calculate the RN-to-patient and RN-to-UAP ratios as objective indicators of model fidelity, not rely solely on the charge nurse’s label for the care delivery system.
Distinguishing Team Nursing from Total Patient Care
A common student misstep involves confusing team nursing with total patient care when RNs perform most bedside tasks. The distinction hinges on intentional delegation structure. In total patient care, the RN assumes sole responsibility for all aspects of care for an assigned patient group without routinely delegating core functions to consistent assistive personnel partners (Fairbrother, Jones, & Rivas, 2021, Journal of Clinical Nursing). Team nursing, by contrast, depends on a deliberate dyad or triad that persists across shifts, with formal delegation of specific recurring tasks such as bathing, feeding, and mobility. If the unit schedule rotates CNAs randomly across RN assignments every shift, the model shifts toward total patient care regardless of what the unit policy manual states. Students should audit three consecutive shift assignment sheets to determine whether consistent team configurations exist or whether task distribution is ad hoc; this operational detail often reveals the true model in practice rather than the model described in organizational documents.
Frequently Asked Questions
What is the difference between team nursing and primary nursing care models?
Team nursing assigns an RN leader to supervise a group of assistive personnel who together care for a larger patient cohort; the RN delegates tasks while retaining accountability. Primary nursing assigns one RN total responsibility for a smaller patient caseload across the entire care episode, with minimal delegation to unlicensed staff.
How do I identify which nursing care model my unit uses?
Examine the assignment sheet, observe delegation patterns, and track whether the same RN-CNA pairings persist across shifts. Document specific examples of who performed what tasks, the communication structure, and the RN’s span of control over assistive personnel.
What scholarly databases should I use for this NR447 paper?
CINAHL Complete, PubMed, and the Cochrane Library provide peer-reviewed nursing and health systems research. Limit searches to publications within the past five years and use MeSH terms such as “Nursing Care Delivery Models,” “Personnel Staffing and Scheduling,” and “Quality of Health Care.”
Write a 5-7 page APA-formatted paper identifying a nursing care model observed in clinical practice, summarizing scholarly literature on both observed and alternative models, and recommending evidence-based improvements for quality and safety outcomes.
Assignment: NR447 Week 5 Discussion Post – Delegation and Prioritization in Nursing Care
This discussion requires you to analyze a delegation scenario from your clinical setting using the five rights of delegation framework. Identify a situation where an RN delegated a task to an LPN or UAP, evaluate whether the delegation aligned with state nurse practice act guidelines and organizational policy, and discuss the prioritization rationale the RN employed. Post a 300-500 word initial response by Wednesday and reply substantively to two peers by Sunday, integrating course readings on supervision and accountability from Finkelman (2024) chapters 8 and 9.
References
Ball, J. E., Doyle, N., & Oocumma, N. I. (2023). Nursing shortages and the impact on care delivery models: A systematic review. Nursing Management, 30(4), 22-29. https://doi.org/10.7748/nm.2023.e2076
Fairbrother, G., Jones, A., & Rivas, K. (2021). Changing nursing care delivery models in acute medical units: A longitudinal qualitative study. Journal of Clinical Nursing, 30(15-16), 2283-2294. https://doi.org/10.1111/jocn.15770
Finkelman, A. (2024). Professional nursing concepts: Competencies for quality leadership (5th ed.). Jones & Bartlett Learning.
Härkänen, M., Vehviläinen-Julkunen, K., Murrells, T., Rafferty, A. M., & Franklin, B. D. (2022). Medication administration errors and mortality: Incident reports as a source of patient safety data. Journal of Advanced Nursing, 78(3), 823-833. https://doi.org/10.1111/jan.15002
Needleman, J., Liu, J., Shang, J., Larson, E. L., & Stone, P. W. (2020). Association of registered nurse and nursing support staffing with inpatient hospital mortality. BMJ Quality & Safety, 29(1), 10-18. https://doi.org/10.1136/bmjqs-2018-009219