Nursing Care Delivery Model


Nursing care delivery models have a great influence on achievement of the desired patient outcomes. The models determine patient satisfaction, quality of care, and job satisfaction among nurses. This paper will focus on the total nursing care model. It will begin with a description of the model by highlighting its personnel requirements, coordination of work, and reporting relationships. This will be followed by a discussion on the model’s influence on cost, quality, and patient satisfaction. The last part of the paper will highlight the pros and cons of using the model.

Description of the Model

Personnel Requirements

The total nursing care model depends on registered nurses to deliver care services. The model utilizes a patient-centered approach to care where a dedicated nurse serves a patient for a specific period (Kelly & Tazbir, 2013). In this regard, the nurse must have adequate experience and knowledge to deliver the best care in order to achieve the desired outcome. Thus, the model uses registered nurses because they have adequate expertise. In addition, the model depends on nursing students to deliver care services. The model provides an excellent learning opportunity to nursing students since they are assigned to one patient who they can serve effectively.

Roles and Responsibilities of the Personnel

The assigned nurse is responsible for planning, organizing, and performing all the required nursing care activities in a given shift. The nurse is expected to identify the patient’s needs and to make decisions concerning the services that must be provided (Nagelkerk, 2008).

The nurses are also responsible for communicating the care services that they planned and delivered. This involves documenting the patient’s progress and expected outcome. In addition, the nurse or nursing student has to collaborate with managers, other nurses, and doctors to develop innovative ways of delivering the required services (Wolper, 2008). Generally, the assigned nurse is fully responsible for the entire nursing process.

Coordination of Work

Coordination of work is mainly done by the registered nurse who is in charge of the patient. However, in some hospitals a charge nurse who oversees specific areas such as the intensive care unit (ICU) does the coordination. The assigned nurse makes all the decisions concerning nursing activities, whereas managers and doctors provide advice occasionally to improve patient outcomes. Nursing assignments are allocated based on the needs of the patient. Direct communication between the nurse and other members of the healthcare team is utilized to coordinate work (McGillis & Doran, 2008). For instance, the nurse is allowed to consult a physician directly when necessary.

Reporting Relationships

The registered nurses who are in charge of one patient use a collaborative reporting relationship to perform their duties. Every nurse prepares a report on the patient’s progress at the end of his/ her shift to enable the nurse who is responsible for the next shift to plan and deliver the required care services (Fernandez, Maree, & Miranda, 2012). Nursing managers mainly act as facilitators and role models to the nurses who are responsible for serving patients. Thus, the relationship between the managers and nurses focuses on provision of technical support rather than supervision. In this regard, the nurses are accountable for the outcome of their nursing activities.

Educational Requirements

Registered nurses are required to have at least one of the three main academic qualifications namely, Diploma in Nursing, Associate Degree in Nursing (ADN), and Bachelor of Science in Nursing (BSN). Diploma programs are usually provided by healthcare facilities. ADN programs consist of classroom instructions and practical training in hospitals. The programs are administered in community colleges. BSN programs provide comprehensive training on advanced nursing and clinical practices.

Registered nurses are also required to pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) before being allowed to practice (Kelly & Tazbir, 2013). Nursing students, on the other hand, are expected to complete basic courses such as pharmacology, anatomy, and health assessment in order to be allowed to provide care services to patients.

Effects of the Model


The total nursing care model is associated with high operating costs because of the large number of registered nurses who are required to serve patients. Most registered nurses, especially, those who belong to labor unions demand very high salaries. This challenge is exacerbated by the limited availability of registered nurses (Shekelle, 2014). Consequently, hospitals have to offer very attractive remuneration packages in order to hire and retain registered nurses. This leads to high staff costs, which some hospitals cannot afford. The model also requires continuous training of nurses to equip them with adequate skills so that they can make independent decisions concerning nursing processes. Although the training programs improve productivity, they force hospitals to incur high operating costs.


The model facilitates provision of high quality healthcare services. The patient-centered approach used in the model enables nurses to provide tailor-made nursing care services that address the unique needs of each patient. One of the factors that improve quality is effective coordination among nurses (McGillis & Doran, 2008). In addition, the nurses have the opportunity to build positive relationships with patients. This facilitates improved understanding of patient’s needs, which in turn leads to provision of the best services.

Patient Satisfaction

The total nursing care model improves patient satisfaction due to the following reasons. First, the model promotes personalization of care services. This strategy is based on the fact that patients have unique needs that require special attention. Thus, personalization of services facilitates achievement of the desired patient outcomes, thereby improving patients’ satisfaction (Wolper, 2008). Second, the model ensures compassion through strong relationships between the nurses and patients. Compassion motivates nurses to provide emotional support to enable patients to cope with their situations. As a result, patients become satisfied as they recover or accept their medical conditions.

Resource Availability

The availability of resources is taken into account by considering three factors namely, patient needs, staff satisfaction, and organizational needs. The patient needs that determine adoption of the model include the number of patients, the intensity of care required, and the expertise of the personnel. The model is usually adopted in situations where the required intensity of care is high and the nurses have adequate expertise. Since nurses are the most important resource in the nursing process, their satisfaction must be taken into account during the implementation of the model (Shekelle, 2014). Undoubtedly, satisfied nurses deliver the best care and contribute to cost reduction through low labor turnover. A high nurse retention rate coupled with cost reduction enable hospitals to use the total nursing model. Organizational needs such as availability of funds, profitability, and maintaining high customer satisfaction must also be considered. Given the high cost of the model, healthcare facilities usually adopt it only if they have adequate financial resources to implement it in a profitable manner.

Job Satisfaction

The total nursing care model is associated with high job satisfaction among registered nurses because of the following reasons. First, the nurses have great autonomy in their work. They directly participate in decision-making processes that determine the outcome of their work. As a result, nurses feel that they are making important contributions in the nursing process and their effort is appreciated (Nagelkerk, 2008). Second, the collaborative reporting relationships between nurses and managers reduce opportunities for conflicts. The resulting improvement in work relationships improves job satisfaction. Finally, the model reduces the workload that nurses have to manage within a given shift. The nurses are usually assigned to one or a few patients to prevent burnout and exhaustion. In this case, nurses become satisfied because their workload is manageable.

Pros and Cons of the Model


The total nursing care model has the following advantages. First, the model allows healthcare providers to achieve the desired patient outcomes by providing comprehensive care services that are aligned to patients’ needs. Second, roles and responsibilities are clearly defined in the model. This helps in preventing conflicts among nurses and duplication of responsibilities, which often lead to fragmentation of care services. Third, the model promotes accountability among nurses by allowing them to oversee the entire nursing process. In this regard, nurses are likely to improve their productivity and commitment to avoid receiving negative feedback from patients and managers. Fourth, the high job satisfaction associated with the model stimulates motivation, which in turn promotes creativity among nurses (McGillis & Doran, 2008). Creative nurses are likely to develop improved nursing methodologies to reduce operating costs and to improve patient outcomes. Finally, the model improves the competitiveness of hospitals through high patient satisfaction. Satisfied patients are likely to become regular customers. In addition, they are likely to refer their friends to the hospitals that provide excellent services through the total nursing care model.


First, the use of the model is limited due to its high operating costs. Hospitals are likely to shift the high costs to patients, thereby preventing access to healthcare services. Second, the shortage of registered nurses discourages the use of the model (Wolper, 2008). Specifically, hospitals have to use their scarce resources for talent acquisition and staff development purposes, rather than investing in modern technologies and medical supplies. As a result, the quality of healthcare services is likely to be compromised. Finally, the model is often ineffective if nurses have different approaches to care. In this case, there will be inconsistencies in the type and quality of the services received by patients.


The total nursing care model facilitates provision of patient-centered care services. The services are often provided by dedicated registered nurses and nursing students. The main advantage of the model is that it improves patient outcomes. It also leads to high satisfaction among patients and nurses. However, the model is not cost-effective due to its reliance on a large number of registered nurses. In addition, it can lead to poor patient outcomes if nurses have varying perceptions concerning the approach that should be used to deliver care services. Thus, the healthcare facilities that have adopted the model should focus on cost reduction and developing a shared understanding of the recommended nursing methodologies.


Fernandez, R., Maree, J., & Miranda, C. (2012). Models of care in nursing: A systematic review. International Journal of Evidence Based Healthcare, 10(4), 324-337.

Kelly, P., & Tazbir, J. (2013). Essentials of nursing leadership and management. New York, NY: McGraw-Hill.

McGillis, L., & Doran, D. (2008). Nurse staffing, care delievry model, and patient care quality. Journal of Nursing Care Quality, 19(1), 27-33.

Nagelkerk, J. (2008). Leadership and nursing care management. New York, NY: John Wiley and Sons.

Shekelle, P. (2014). Effect of nurse-to-patient staffing ratios on patient morbidity and mortality. Web.

Wolper, L. (2008). Healthcare administration: Planning and implementing. London, England: Elsevier.

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