How unit level nursing responsibilities are structured in US hospitals

J Nurs Adm. 2007 Oct;37(10):452-8. doi: 10.1097/01.NNA.0000285147.87612.96.


Objectives: To describe (1) the extent to which acute and intensive care units use the elements of nursing models (team, functional, primary, total patient care, patient-focused care, case management) and (2) the deployment of non-unit-based personnel resources.

Background: The lack of current data-based behavioral descriptions of the extent to which elements of nursing models are implemented makes it difficult to determine how work models may influence outcomes.

Methods: Nurse managers of 56 intensive care units and 80 acute care adult units from 40 randomly selected US hospitals participated in a structured interview regarding (1) day-shift use of patient assignment behaviors associated with nursing models and (2) the availability and consistency of assignment of non-unit-based support personnel.

Results: No model was implemented fully. Almost all intensive care units reported similar assignment behaviors except in the consistency of patient assignment. Non-intensive care units demonstrated wide variation in assignment patterns. Patterns differed intra-institutionally. There were large differences in the availability and deployment of non-unit-based supportive resources.

Conclusions: Administrators must recognize the differences in work models within their institutions as a part of any quality improvement effort. Attempts to test new work models must be rigorous in the measurement of their implementation.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Case Management / organization & administration
  • Delegation, Professional
  • Hospital Units / organization & administration*
  • Humans
  • Intensive Care Units / organization & administration*
  • Models, Nursing*
  • Nurse Administrators
  • Nurse's Role*
  • Nursing Administration Research
  • Nursing Assistants / organization & administration
  • Nursing Staff, Hospital / organization & administration
  • Nursing, Practical / organization & administration
  • Nursing, Team / organization & administration
  • Outcome Assessment, Health Care
  • Patient-Centered Care / organization & administration
  • Personnel Staffing and Scheduling / organization & administration
  • Philosophy, Nursing
  • Primary Nursing / organization & administration
  • Professional Autonomy
  • Surveys and Questionnaires
  • Total Quality Management / organization & administration
  • United States
  • Workload