Sample Nursing Paper on Analysis of Functional Nursing as a Care Delivery Model

Abstract

There are a handful of care delivery models in the field of nursing. These include team nursing, total patient care, functional nursing, and primary nursing. Whatever model an organization chooses to incorporate is dependent on factors such as costs and the number of patients. This paper seeks to analyze the functional nursing model of care delivery. It examines its history, personnel requirements, advantages and disadvantages, and impact on various satisfaction metrics. It concludes with recommendations on possible areas of improvement.

 

 

Analysis of Functional Nursing as a Care Delivery Model

History of Functional Nursing

Functional nursing came about in the late 1930s as a result of the effects of the Second World War and the Great Depression. These factors led the American government to reconsider its approach to healthcare in the sense that there was a need for the training of more nurses. The war had led to a decrease in the number of qualified nurses, and most of the hospitals in the country were experiencing a severe personnel shortage. Doctors alone were not capable of treating patients and offering pre and post-op care. Due to this scarcity of nurses, the American Red Cross in conjunction with the Department of Civilian Defense was forced to train up to 200,000 aides as the war went on. A significant part of the training constituted of non-nurse related tasks. Later on, the trainees were qualified to receive further training on basic nursing duties. The crisis that the country was facing after the war was the reason behind the formation of the Hill-Burton Act of 1946 (Fox & Grogan, 2018). This statute aimed at the provision of reserves to fund the reconstruction of the destroyed hospitals and the building of new ones. Before the end of the war, there was a demand of nurses by the armed forces, both of whom were stationed away from American territory. Back home, the depleted supplies caused a change in the arrangement of the nursing staff. Both the semi-professionals and the UAPs (Unlicensed Assistive Personnel) had to be hired to fill the void left by the nurses that had left for Europe. Priorities of the patients were prorated according to the volume of tasks per inpatient department. Each worker was then assigned a duty according to the job description he best fit.

Due to a large number of patients per hospital, nurses who had been deployed to serve the armies at war were forced to take up more responsibilities that were previously authorized to be conducted by trained doctors only. It was also at this point that the government acknowledged the fact that registered nurses possessed specialized skills, and there was room for the advancement of these skills. Public awareness was thus created to encourage young women to enter the nursing profession. In 1943, the Bolton Act introduced the Cadet Nurse Corps, which was among the first subsidized programs for nursing schools and their students (Rushton, 2016).

Personnel Utilized in the Functional Nursing Model

The two main types of personnel utilized in the functional model are the unlicensed assistive personnel (UAP), and the licensed practical nurses (LPN).

 

Licensed Practical Nurses (LPN)

Roles and Responsibilities of Licensed Practical Nurses

A licensed practical nurse usually works under the supervision of a registered nurse (RN) or a qualified doctor. One of the duties s of an LPN consists of collecting fluid samples. This may be to determine the type of infection that the patient is suffering from. He may also administer medication, but only under the doctor’s supervision. This also depends on the type of medication as the more complex ones can only be administered by the doctor himself. An LPN has to maintain records of the patient for future reference. Such records include allergies and the exact time that the patient received his last medication. Some patients may also have trouble performing basic tasks such as bathing or eating, and it is at this point that the LPNs come in. The LPN will also update the doctor on the status of the patient by keeping track of his vital signs. Finally, an LPN dresses the patient’s wounds and changes the bandages as often as required.

 

Educational Requirements for an LPN

LPN training typically takes an average of 12 months, although some may be seven months long. In a few instances, the training may go for up to 24 months. The basic courses in LPN training are nursing math, nutrition, general nutrition, nursing fundamentals, pediatric nursing, and geriatric nursing,

 

Licensing of LPNs

Once the nurse successfully finishes the training, she must apply for the nursing license, whereby she will sit the NCLEX-PN test that is administered by the ANCC. For one to be granted the license, he must pass all sections of the exam. They include Psychosocial Integrity, Physiological Integrity, Safe Care Environment, and Health Maintenance. Afterward, the nurse will be awarded a permit that allows him to practice his expertise in hospitals, nursing homes, government facilities, military bases, physician’s offices, and in-home healthcare provisions.

 

Unlicensed Assistive Personnel (UAP)

The term ‘unlicensed assistive personnel’ refers to healthcare providers who are not licensed but have been trained and certified to perform various nursing duties. The difference between UAPs and LPNs in that the former have a certificate while the latter have licenses.  UAPs often work under the direct supervision of a registered nurse (RN). It is the role of the Registered Nurse to delegate tasks to the unlicensed assistive personnel. If a UAP performs a task that has not been delegated to him, this action shall be regarded as ultra vires. Ultra vires is a doctrine whereby a person is treated as acting beyond his powers. In such scenarios, the UAP may be suspended or let go depending on the gravity of the situation.  Before the Registered Nurse delegates tasks to the unlicensed assistive personnel, the factors discussed below need to be considered.

For starters, there is the potential for causing harm. UAPs do not have in-depth training and experience as compared to registered nurses. As such, any task assigned to them must lack the potential for causing harm. If such a duty is given to them, it should be done in the presence of the RN or any other superior.

The complexity of the task is crucial. Complex tasks are rarely delegated to unlicensed assistive personnel. Tasks that are outside the threshold of what the UAP was trained in are supposed to be delegated to the more qualified healthcare providers.

Level of critical thinking or problem solving required. Critical thinking is an essential skill that all healthcare providers must possess regardless of their rank. However, some tasks will require more application of critical thinking than others. Such tasks should not be delegated to UAPs, as it may turn out to be disastrous.

The unpredictability of the task’s outcome. Functions that are likely to result in unpredictable consequences must not be assigned to the unlicensed assistive personnel. The reason for this is that the result may be life-threatening, and if a Registered Nurse is not present, the patient may lose his life.

 

Roles and Responsibilities of Unlicensed Assistive Personnel

Unlicensed Assistive Personnel collects patient data such as the intake of medication and any change in vital signs. It is also his responsibility to assist the patient to eat, and bath. Most unlicensed assistive personnel will also perform typical clerical duties that take place in an office setting. The UAP will, therefore, answer phone calls at the ward’s reception and enter the relevant information into the spreadsheets. Registered nurses usually perform therapeutic procedures on patients. However, the unlicensed assistive personnel may assist if the task cannot be handled by one person. It should be noted that the unlicensed assistive personnel cannot perform this duty without delegation. While the patient is in hospital, the UAP will assist the physician in coming up with the patient’s plan of care for as long as he is in admission, and even after discharge. Unlicensed assistive personnel may also respond to certain emergency services as directed by his supervisor.

 

Educational Requirements for Unlicensed Assistive Personnel

Since unlicensed assistive personnel only require a certificate and not a license, their educational requirements are not as complex as those of licensed practical nurses. They must have the ability to read and write English, possess a high school diploma or its equivalent, have certification in basic First Aid and CPR, skills in office management, and any other pre-employment training as required by the employer.

 

How Work is Co-ordinated in Functional Nursing

In functional nursing, duties are assigned according to the level of training per nurse. Each task shall be given to a specified worker. For instance, a registered nurse may be assigned the task of giving medication while another may be responsible for admitting patients. Other nurses may take up the role of discharging patients. For a discharge to be legitimate, it must be authorized by a qualified doctor from that center of treatment.

Some nurses are also stationed to provide hygienic care for their patients. This includes cleaning patients who are too fragile to clean themselves and changing bedpans at specific intervals.

 

How Functional Nursing Influences Cost, Quality Care, Patient, and Family Satisfaction

Functional Nursing is cost-effective since each nurse only performs the specific task in which he or she was trained. If a single nurse had to perform a variety of functions, more stipends would have to be allocated to her. However, the fact that they only perform specified tasks means that fewer funds are allocated to them.

This model of nursing promotes quality care since each nurse focuses only on that which he was trained. The patient may not pick functional nursing as his best model since he is unable to regard only one nurse as ‘his’ nurse. However, the results offer more satisfaction to the family and the patient himself.

How the Availability of Resources is taken into Consideration when Adopting this Model

The hospital must consider whether its funds are enough to cater for the salaries of each nurse. Furthermore, since functional nursing incorporates the skills of different nurses to perform specific functions, more nurses will be required to be stationed at a hospital. The size of the hospital must, therefore, accommodate all these nurses without the need for some to feel like they lack space during their shift breaks.

Advantages of Functional Nursing

Functional nursing ensures that a large volume of work can be done in a short period. Each patient is normally regarded as a task that awaits delegation and completion.

The nurses perfect the art of working very fast. Since each patient must be completely dealt with before moving on to the next, workers have learned to work efficiently as they know that the lives of other patients are at risk.

Under functional nursing, the nurses are delegated tasks according to what they are specifically trained for. As such, they can perfect their skill because they do the same task repetitively among different patients.

Functional nursing is also cost-effective. The concept of saving comes about from the fact that each nurse performs a specific task. Fewer stipends will be allocated to a nurse that performs a specific duty all year round as compared to a nurse that performs a variety of tasks.

 

Disadvantages of Functional Nursing

This model of nursing is highly fragmented, and it is impossible to achieve holistic care. Nurses in functional nursing must perform a specific task. One would, therefore, find that a single patient is attended to by different nurses instead of having one nurse attend to all his needs.

Another demerit is that accountability is diminished. When a single nurse cares for a patient, it is easy for him or her to be held accountable for the patient’s complaints or compliments. However, having multiple nurses attend to one patient diminishes responsibility and accountability, and it would be difficult to track the one who is responsible for interfering with the patient’s progress.

Further, with functional nursing, the relationship between a patient and his caregiver does not develop fully. It would be easier for a patient to strengthen his bond with a nurse if only one nurse were attending to him. Having multiple nurses makes it difficult to form a strong bond with just one of them.

Finally, there is a risk of the patient being unaware of the identity of the person attending to them. Patients often like to identify Person X as their nurse. However, the fact that so many nurses attend to him during his stay at the hospital makes it impossible for him to know who his designated nurse is.

 

Conclusion

The Second World War was the reason behind the shortage of nurses all over America. The government, together with the Red Cross and Department of Civilian Defense, therefore, saw the need to train aides to decrease the gap left by the shortage of nurses. Ranks had to be expanded to allow more nurses to be able to be delegated tasks which they were previously not allowed to perform. However, this shortage still went on even after the war since the government faced limitations from the accrediting agencies for the renovation of old hospitals and the building of new ones. However, when these challenges were overcome, the concept of functional nursing provided an opportunity for the transition in the nursing world, which remains relevant to date. Thanks to functional nursing, multiple levels of the profession were introduced, including the unlicensed, professional, and semi-professional levels. It differs from the model of total nursing in significant ways. For instance, it focuses more on completing tasks as compared to total nursing, which is based on meeting all the needs of a patient at once. In functional nursing, the relationship between a patient and his caregiver is not a top priority since each patient is treated as one of the duties that have to be performed.

 

 

 

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