Nursing Care Delivery Models: Overview
Nursing care delivery models provide research-backed frameworks to guide how nurses can best manage their workload and deliver patient care. By standardizing therapeutic practices through a structured approach, organizations can optimize care quality, consistency, and efficiency across nursing teams.
There are several well-recognized frameworks employed to help healthcare staff meet clinical demands, but the efficacy of each can vary by facility and clinical practice. With the right care delivery model, nursing-related process improvements become a streamlined aspect of care delivery, driving quality and excellence without risking disruptive change. This article provides a brief outline of the four primary models, with key takeaways to help you decide which works best for the specific needs of your facility.
What Are the Nursing Care Delivery Models’ Purposes?
Better patient outcomes are the ultimate objective of nursing. Delivering consistently beneficial outcomes requires a strong organizational approach. Individual staff strengths may improve the outcomes for a few patients, but they won’t shape systemwide results. That’s why standardization is essential. The use of a particular model offers a well-vetted (and research-backed) method for achieving standards that benefit most (if not all) patients.
The primary differences among different nursing care models include:
- Clinical decision-making
- Work allocation
- Communication methods
- Management styles
The decision of which model best suits your particular healthcare needs often comes down to facility-specific social and environmental factors. Here’s a look at more detailed distinctions among the most well-known (or popular) models in use.
What Are Four Popular Nursing Care Delivery Models?
There are four primary models popularly associated with patient care provisioned by nurses, although some argue there are as many as 5 nursing care delivery models (if you include the advanced practice provider (APP) approach). The four frameworks listed below cover the delivery of general, clinical-based nursing care.
1. Functional Nursing Model
Widely adopted during World War II, the functional nursing model is designed to accomplish the most work with the least amount of staff possible. In this model, a head nurse assigns tasks (rather than patients) to individual nurses — meaning, one nurse performs the same task for all the patients who require that specific intervention.
Example:
For nurses working under the functional model, one nurse may be assigned the role of medication passer. That means that the assigned staff member would administer medications to every patient on the unit, while another handles wound care, for example.
| This model optimizes different skill sets, driving workplace efficiency. Maximizing the workforce (potentially reducing staff requirements), can decrease the cost of care. Staff often become more adept at certain tasks, increasing the quality of the delivered care because of specialization. | Less personalized care can lead to a disease- rather than person-based approach. It’s more difficult to achieve the caring relationships that often nurture staff’s (and patients’) ability to cope with stress. Because scope becomes limited to a single task, it may be harder for staff to spot issues that affect a patient’s total wellbeing. |
2. Primary Nursing Model
Established in the 1960s, this model assigns a primary nurse to each patient for the duration of their care journey, from admission to discharge. If that nurse isn’t available for the entirety of the care experience (within hospital environments with multiday stays, for example), the primary nurse is able to delegate to an associate, but remains ultimately responsible for decision-making and clinical outcomes.
Example:
A nurse is assigned to an end-stage renal disease patient as soon as they’re admitted to an outpatient dialysis center. They enact the ordered treatment plan, overseeing the organization, delivery, and evaluation of care until the patient discharges (even staying past their designated clock-out when the treatment extends past the clinic’s normal business hours).
| This model offers the maximum continuity of care per patient journey. Nurses and patients have the ability to develop deep, meaningful relationships that can help with navigating stress. Care is more personalized to the individual needs of the patient, becoming more person-centered and holistic. | Because responsibilities are broader, nurses are less able to specialize in particular tasks, (potentially reducing efficiency or effectiveness).This model is staff-intensive, requiring enough personnel to provide adequate coverage. It can force staffing frameworks to prioritize registered nurses, driving costs and impacting workplace (licensure) diversity. |
3. Team Nursing Model
Although the team model isn’t widely used, many facilities did transition to this approach during the COVID-19 pandemic. It works by assigning a team of nursing professionals to a single patient. The team is led by a senior (often registered) nurse who assigns each member certain tasks (based on scope, skillset, and expertise). It parallels the intent of the functional model, while using team assignments to maintain some relational aspects of other (patient-centered) nursing care delivery models.
Example:
An RN, LPN, and CNA team are assigned a group of patients on a med-surg unit, including an elderly, walker-dependent patient, admitted for a gastrointestinal bleed. Based on scope and strengths, the RN delegates the frequent toileting assistance to the CNA, serial lab draws to the LPN, and assumes responsibility for blood product administration and monitoring. The patient sees the same group of staff for the entirety of their shift, developing a relationship with each — while the staff manage tasks that maximize their personal/professional strengths.
| This approach encourages teamwork, optimizing interprofessional collaboration on behalf of the patient. Staffing efficiency is often maximized by assigning team members tasks according to their specialties and strengths. Care costs may be reduced by the emphasis on a diverse workforce, with less reliance on exclusively RNs. | Overreliance on RNs (or senior staff) to work as leaders while also providing patient care may increase their workload, leading to burnout. Because care is overseen by multiple caregivers at once, opportunities for miscommunication (especially during busy or stressful moments) may risk medical errors or care lapses. Efficiency may be compromised due to the amount of time it takes to coordinate care with a team-based approach. |
4. Total Patient Care Model
The total patient care model is sometimes used interchangeably with the primary care model. Indeed, these nursing delivery care models share many similarities. A nurse is assigned to a patient and is expected to carry out the planning, delivery, and evaluation of all associated nursing care. The difference rests in the length of time they’re responsible for the patient. In the total care model, the nurse is responsible for the patient’s care until the end of their shift (rather than the duration of the patient journey).
Example:
An inpatient orthopedic nurse is assigned to a patient as soon as they arrive from the post-operative care unit. The nurse assumes all hip-replacement post-operative monitoring duties and care measures until their shift ends two hours later. During shift hand-off, they update the oncoming nurse to the patient’s status, effectively relinquishing clinical responsibility for the surgical patient.
| This model often facilitates strong patient-nurse relationships, improving environmental satisfaction for both. Studies demonstrate that this framework often leads to decreased length-of-stay for patients, saving care costs. Total patient care increases continuity of care, often defragmenting the therapeutic experience. | By requiring more licensed staff to satisfy safe staffing requirements, this can lead to higher healthcare costs. Focus is narrowed to individual patient assignments, encouraging less teamwork and collaboration across staff. Depending on assignments, this can increase the nursing burden by requiring them to support the entirety of many patients’ highly complex needs. |
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Nursing care delivery models, examples, and best practices can help your organization standardize patient care to achieve better, more consistent outcomes. Don’t miss our latest facility guides and resources to keep your facility at the cutting-edge of innovative quality improvement.