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.
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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
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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
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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
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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
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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
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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
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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,
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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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