Functional Nursing Model

Posted: November 7th, 2023

Functional Nursing Model

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November 7, 2023

Functional Nursing Model

One of the overarching goals of contemporary nursing and primary care delivery is the continuous pursuit of safety, quality, and excellence while enhancing patient satisfaction. Decades of nursing research inform that healthcare institutions must implement care delivery models that align with their vision and mission to achieve such an objective. Organizations that employ The Functional Nursing Model of Care seek to improve operations efficiency through accurate and effective staff tasking. The underlying principle is that nurses are assigned individual roles, not patients. The approach was perceived as highly important in early 19^th-century medicine as it facilitated specialization and helped address staffing problems. This paper looks at Functional Nursing, its history, structure, relationships, and how the concept has evolved over time. Even though Functional Nursing is one of the oldest care models, it remains highly applicable in contemporary nursing care due to its ability to address the complexity of care, patient safety, care coordination, planning, and evaluation.

Description of the Nursing Model

            Functional nurse refers to a supervisory care model that assigns tasks to nurses and auxiliary personnel. The professional is expected to meet the needs of their delegated tasks to ensure the optimized flow of care. How well each member can perform their specific duty determines the effectiveness of the care provided to the larger group of patients (Parreira et al., 2021). Important to note is that the institution’s scope of practice will determine the number and nature of tasks assigned to care personnel. Functional nursing strives to transform nursing with the same principles applied in an assembly line, as seen in manufacturing. In 1909, Frederick Taylor made the argument that all organizations should be separated into distinct sections, with each line having a supervision manager (Parreira et al., 2021). Therefore, a supervising nurse coordinates all the care assignments and duties. The result is individuals becoming familiarized with patient needs and care challenges specific to their tasks.

The Licensed Practical Nurse (LPN) is assigned the duty of performing assessments and making reports associated with their task. Therefore, the LPN is responsible for collecting the data to be applied to the assessments (Yorder-Wise, 2019). Under functional nursing, the registered nurse is accountable for delivering intravenous medications and carrying out admission, but the LPN provides the treatment (Yorder-Wise, 2019). Another LPN can be assigned to provide oral medications, while a UNP may perform hygiene-oriented tasks. A charge nurse is responsible for coordinating care and assignments (Yorder-Wise, 2019). Therefore, the charge nurse might be the only individual in the chain of care with a comprehensive understanding of all the patient’s needs. The job duties and anticipations of nurses in the modern healthcare environment might be wide and varied, but within the confines of functional nurses, healthcare personnel have at least one or two core roles that they undertake throughout the entirety of their day.

Licensed Practitioner Nurse LPN

Registered Nurse

UNP (hygiene supplies)

Registered Nurse

The Charge Nurse

Fig 1: The Functional Nursing Care Model

The concept of organization in nursing care is rooted in the early 1930s as institutions sought methods to avert economic issues. Max Weber (1920) called for a clear distinction in areas of care competence (Parreira et al., 2021). Therefore, each individual was anticipated to specialize in distinct areas. The emergence of behavioural theories in the 1930s introduced the focus on group dynamics in organizations (Parreira et al., 2021). The theories highlighted the importance of collective motivation and leadership in enhancing organizational outcomes. Mayo (1880-1949) emphasized that managers should prioritize teamwork and collaboration instead of individuals without underplaying the single employee’s needs and points of satisfaction (Parreira et al., 2021). Mayo’s envision of the managerial role introduced new thinking in leadership, as leaders were not perceived as dynamic and active, causing change through people and not written policies and guidelines.

From this new understanding of leadership, functional nurses began experiencing the implementation of organizational norms focused on interrelationships and factors affecting group dynamics. The resultant organizational approach mirrored how individual workers, through teamwork, can coordinate and collaborate to be involved in the overall management process (Yorder-Wise, 2019). For example, the registered nurse who collects patient information contributes to the diagnostic process, which in turn is applied in the selection of treatments. The inclusion of behavioural theories had a big impact on functional nursing, as it led to the emergence of patient-centered techniques for primary care (Parreira et al., 2021). Throughout the 70s and the 80s, emerging forms of organizational management would strengthen the integration of team management principles in functional nursing. The development introduced primary nursing as a new approach to patient-centered care (Parreira et al., 2021). The new perspective considered modern organizations as comprised of individual and collective change agents.

Significance of the Nursing Model

            Medical research has long found that functional nursing has numerous advantages to hospital operations. The approach improves task completion within the shortest time possible as each division of labour has specialized personnel and leadership. The speed of response is often cited as crucial in acute care as the time taken to deliver quality care directly influences recovery rates (Norful et al., 2017). Since each nurse is responsible for a particular task, organizations benefit from skill specialization. Improved knowledge and competence facilitate the integration of registered nurses into primary care. The RN can supplement some of the providers’ workload, reducing work-related physical, cognitive, and emotional stress (Norful et al., 2017). Given that skill specialization improves response time, it can also be hypothesized that it reduces the number of nursing work hours. The enhanced team ethic magnifies the impact of individual contributions, resulting in nurses working for fewer hours, which enhances their work satisfaction due to reduced exhaustion.

            Iterative work or repetitive tasks result in brain imprints, meaning nurses work instinctively. The focus on one or two core tasks results in skill development at a faster rate (Norful et al., 2017). Some of the skills center on team dynamics, suggesting nurses under the functional nursing model are better positioned to learn interpersonal, communication, and management skills. Early skill development contributes positively to career progression, which is associated with increased commitment and engagement with the employer organization due to improved satisfaction levels (Wu & Liu, 2022). In another benefit, the improved efficiency under the model will be economical. The integration of registered nurses into other nursing duties negates the need to hire external professionals or consultants (Norful et al., 2017). Such a development translates into reduced operational costs. Functional nursing will also promote and enhance teamwork. Collaborations are known to improve personal experiences, trust, and confidence levels, which are prerequisites for nurse work satisfaction.

            The functional nursing model has particular drawbacks that leadership must be attentive and innovative to address. Foremost, patient care becomes fragmented, which could result in the depersonalization of care delivery (Cherry & Jacob, 2018). Since there is reduced contact between one nurse and the patient in favour of the collective, individual nurses might not become able to comprehensively outline a single patient’s needs. The focus on one or two core functions can impede the career progression of nurses (Cherry & Jacob, 2018). The approach limits the extent to which nurses can exhibit their skills, knowledge, and competencies in the workplace.

The functional nursing model might enhance nurse work satisfaction but negatively affect patients’ perceived quality of care. Care fragmentation implies that only the charge nurse has the full knowledge to answer patient inquiries (Yorder-Wise, 2019). Therefore, the patient can become frustrated and disappointed when registered nurses do not provide holistic answers. The patient might perceive that they are being overlooked when they encounter two or three nurses during the course of their treatment. The transition in shifts might result in changes in the patient’s health condition going unnoticed (Yorder-Wise, 2019). One cause of the patient’s condition going unrecognized is lapses in communication associated with nurse transitions. However, the practice gaps in the functional nursing model can be addressed by the introduction of electronic health records and nursing informatics (Cherry & Jacob, 2018). The ready access to processed clinical information can assist in answering patient questions while enhancing nurse knowledge of individual patient needs. The functional nursing model is one of the main beneficiaries of the integration of EHR in primary care.

Conclusion

            In summary, the functional nursing model is one of the oldest and most utilized systematic approaches to care delivery since the onset of the 20^th century. The practice framework presents an effective way of organizing care and embedding evidence-based practice into primary care. The method separates work to individual healthcare personnel under the supervision of a senior nurse. It represents the best approach to use when a healthcare organization has staffing challenges. However, the functional nursing model is suitable only for short-term care delivery. Its extensive use will result in care fragmentation, negatively impacting nurse and patient satisfaction. Due to numerous nurse transitions, the approach does not support a holistic approach to patient-centered care. Electronic health records have to be integrated into patient care to ensure the model achieves consistent high efficiency and patient satisfaction.

References

Cherry, B. & Jacob, S. (2018). Contemporary nursing e-book: Issues, trends and management. Elsevier Health Sciences.

Norful, A., Martsolf, G., Jacq, K. & Poghosyan, L. (2017). Utilization of registered nurses in primary care teams: A systematic review. International Journal of Nursing Studies, 74, 15-23. http://dx.doi.org/10.1016/j.ijnurstu.2017.05.013

Parreira, P., Santos-Costa, P., Neri, M., Marques, A., Queirós, P., & Salgueiro-Oliveira, A. (2021). Work methods for nursing care delivery. International Journal of Environmental Research and Public Health, 18(4), 2088. https://doi.org/10.3390/ijerph18042088

Wu, H., & Liu, Y. (2022). The relationship between organizational support for career development, organizational commitment, and turnover intentions among healthcare workers in township hospitals of Henan, China. BMC Primary Care, 23(1), 136. https://doi.org/10.1186/s12875-022-01753-4   

Yorder-Wise, P. S. (2019). Leading and managing in nursing [7^th Ed]. Elsevier.