Models of care in nursing: a systematic review

Abstract

Based on the available evidence, a predominance of team nursing within the comparisons is suggestive of its popularity. Patient outcomes, nurse satisfaction, absenteeism and role clarity/confusion did not differ across model comparisons. Little benefit was found within primary nursing comparisons and the cost effectiveness of team nursing over other models remains debatable. Nonetheless, team nursing does present a better model for inexperienced staff to develop, a key aspect in units where skill mix or experience is diverse.

Nursing stress and satisfaction outcomes resulting from implementing a team nursing model of care in a rural setting

“…[1,2] In Australia, registered nurses find themselves in a position of supervising other registered (including new graduate) and enrolled Nurses [3][4][5] as well as other unregulated and non-credentialed health care workers. [5][6][7] In order to manage the increased demands of responsibility and supervision of this range of varied staff classifications, team nursing as a model of care was introduced in five clini-cal units medical/surgical in a rural region in Australia as a way to address this varied skill mix. A team nursing model of care in this context refers to all levels of nurses who contributed to the direct nursing care (NC) of patients including registered and unregistered staff.…”

“…[10] This overall ratio is similar to data from previous years. [11] Adopting models of care that capitalise on the skill mix of staff available is a feature of global contemporary nursing workplaces largely resulting from workforce shortage [4,6] and desire to contain health care costs. [5,12] In Australia, there are two levels of regulated nurses; registered and enrolled nurses.…”

“…[11] Increasingly, the nursing workforce is being supplemented by non-regulated nurses, nursing assistants as a method for ensuring appropriate staffing levels within a fiscally constrained environment. [4,6] Health Workforce Australia [2014] presented options for reconfiguring the nursing workforce to ensure sustained NC. They suggested that unregulated nurses could represent 5% of the acute care sector and 70% of aged care workforce without a significant change in quality of care delivery.…”

“…Any change to the nursing workforce skill mix however requires changes to work practices namely the models of care utilised to ensure quality care is upheld and public safety maintained. [4,6,14] Ferdandez et al [6] and You et al [15] highlighted evidence that indicates best patient outcomes are achieved when the nursing workforce is primarily registered nurses. They conclude that registered nurses are the most highly qualified and are more likely to detect and respond to patient deterioration.…”

“…It is therefore logical to suggest that in controlling health expenditure, that reconsidering models of care is inevitable. [5,6,11] Health Workforce Australia [11] temper Governments fiscal constraint commentary as a driver of health care change with a positive outcome for regulated nurses (registered nurses [RNs] and enrolled nurses [ENs]). They highlight scenarios that incorporate greater numbers of unregulated nurses which will improve opportunities for registered nurses and enrolled nurses to take on more complex practice activities that may support increased JS and reduce leakage from the system.…”