Nursing Care Assignment
*Definition:
Nursing care assignment is a sheet used to indicate total nursing
care needed b y patients in the ward. Assignment specifies the role of
each nurse in the provision of whole patient care. It covers the twenty-
four hours period of the day and the seven days of the week.
**Purposes of Assignment:
-Serves as a work plan for provision of nursing care.
-Provides for giving comprehensive nursing care to all patients in the
ward at all times.
-Increases the skills of nursing personnel.
-Identifies responsibility of each staff member.
-Provides for teaching of staff nurses and nursing students.
-Prevents overlapping of nursing functions.
**Characteristics of Good Assignment:
-Should be done according to personnel and patients' needs.
-Should be written clearly, concisely and legibly.
-Should be posted in a place easily accessible.
-Should be related to previous assignments, in order to provide
for progressive learning experience.
-Done on weekly basis and adjusted daily to meet changes in
patients' needs or changes in nursing personnel.
**Methods of Assignment:
There are five different methods of assignment used by the
nursing departments/units as follow:
Case Method:
The case method of assignment enables one worker to give all
the care that a patient need. In this method no gaps exist because
the nurse knows what have been done and what should be done for
the patient. However, very often little continuity of care exists from shift
to shift. The hospital needs all registered staff nurses to use this method
of assignment. It may be used to advantages in coronary and intensive
care units.
Advantages:
-Patient centered method.
-The patient feels more secure.
-The nurse develops good relationship with the patient/consumer.
-The nurse feels more satisfaction. She can observe progress in
patient condition as a result of her care.
-She can practice all tasks involved in the patient care.
Disadvantages:
-One-to-one ratio is sometimes unrealistic.
-This method is expensive (nurses' salaries).
-It needs frequent supervision.
-It needs more equipment and supplies.
-It results in crowd-ness in certain areas such as medication and
dressing rooms.
The Functional Method:
The functional method is called efficiency method of assignment. In
this method the nursing care is divided into separate tasks. These are
performed by the varied levels of nursing personnel, depending upon the
complexity of each task in terms of judgment and technical knowledge
and the preparation of the individual staff member is responsible for only
the task done during a given tour of duty.
Advantages:
-Each nurse becomes highly skillful; she develops speed and efficiency
in doing her assigned task.
-She become more independent and needs less supervision.
Inexpensive method e.g. nurses are from different categories.
-Small number of nursing staff can provide care to relatively large
number of patients.
-Less equipment and supplies are needed.
Disadvantages:
-Functional centered method.
-Fragmentation and depersonalization of patient care. No-one nurse
knows or evaluates patient care.
-It is difficult to define responsibility for errors in patient care. Some
aspects of patient care are omitted e.g. health teaching.
-Poor nurse/patient communication.
-Monotony in doing the one task.
-The nurse becomes less skillful in other tasks; their abilities are not
fully utilized.
The Team Method:
This method utilizes a heterogeneous team of nursing personnel to
deliver nursing care to a group of patients. The team leader is given the
responsibility for planning, continuity and evaluation of the nursing care
of all patients cared for by the team. She supervises the team members
in the implementation for nursing actions. She also evaluates the results.
Advantages:
-Total effort of the group is better than that of each individual
member.
-Professional staff members devote their time and energy to the care of
critically ill patients.
-The method includes nurses in a group process.
- It promotes nurses' sense of belonging.
-All nurses have contact with the patient; they share in the planning
and supervision of his care.
Disadvantages:
• Most nursing programs do not prepare nurses for leadership roles.
• Nurses are more interested in developing clinical patient care skills
than leadership abilities.
• With staff shortage it is difficult to properly apply this method.
• It needs more time by the team leader to meet and share ideas and
coordinates efforts.
• Needs more supplies and equipment's.
*The Primary Nursing Method:
Primary nursing features a registered nurse who gives total patient
care to four to six patients. She remains responsible for the care of
those patients 24hours a day throughout the patient's hospitalization,
does the admission interview and develops the nursing care plan,
including teaching, and discharge plan. The staff nurse is expected to
contact the primary nurse regarding in the care.
Advantages:
It decreases the number of people in the chain of command
Reduces the number of errors.
Mobile use auxiliary workers.
Increases satisfaction of the nurse and the patient.
Patient is secure.
Nurse identifies the patient's outcome as a result of their work.
Patients have fewer complications and a shorter hospitalization.
Disadvantages:
-Primary nursing confines a nurse's talent to a limited number of
patients.
-Time consuming.
-Its success depends on the quality of nursing staff and administrative
support.
**The Modular, or District Nursing Method:
Is a modification of team and primary nursing method? It is
sometimes used when there are not enough registered nurses to practice
the primary nursing method. Each registered nurse, assisted by the Para-
professionals, delivers as much care as possible. The registered
nurse plans the care, delivered as much of it as possible, and directs the
Para- professionals for more technical aspects of care. The registered
nurse's role is closer to that of coordinator and information processor.
Advantages:
-It decreases the sense of isolation and unrealistic expectations. It
increases continuity and quality of care.
-More time may be spent in direct care. Nurses' morale is improved.
Disadvantages:
It needs physical changes to be implemented.
- Medication chart m u s t be placed in the hall instead of
nursing medication room.
- Kardex must be kept on the medication cart.
- Charts must be moved to the patient's
References:
1. Marquis, B., L., and Huston, C., J. (2017): leadership roles and
management functions in nursing: Theory and practice. 9th ed.,
Lippincott Philadelphia.
2. Sullivan, E. (2017): Effective Leadership and Management in
Nursing'. 9thed, Pearson Prentice Hal.
3. Motacki,K and Burke, K.,(2017):Nursing Delegation and
Management of patient care,2nd ed., Eliseverst, Louis,Missouri.
