Functional Nursing

It is a care model that uses the division of labor according to specific task and technical aspects of the job. It has been defined as work assignment by functions or tasks, such as passing medicines, doing dressing changes, giving baths, or taking vital signs. Under functional nursing, the nurse identifies the tasks to be done for a shift. The work is divided and assigned to personnel, who focus on completing the assigned task. Functional nursing has the advantage of being efficient for taking care of the tasks related to handing a large number of clients.

Functional nursing was the norm in US hospitals from the late 1800s through the end of World War II. Functions such as increases in clients’ acuity, greater complexity of care delivery, and expansion of the number of paying clients increased demand for hospital nursing services. As hospitals searched for ways to improve efficiency and service yet control labor costs, the functional division of tasks was instituted to get the work done. Cyclical shortages of nursing labor, exacerbated during times of war, accelerated staffing shortages and the demands of work. This organization of work, combined with frequent understaffing, forced nurses to be task-oriented rather than client oriented. It was a major reason why graduate nurses dislike staff nursing as compared with private duty.

In the early 1900s, business and industry concepts of “scientific management” emphasized efficiency. The efficiency was gained by breaking down a work process into its component task steps and then analyzing and timing the steps, establishing standards, and determining the best way to perform each task. Thus managerial control over the planning and execution of work could be established. Assembly lines in factories were one result. Functional nursing was developed as a result of this concern for task analysis and proper division of the nursing workload. Under this model, there might be a “temperature nurse”, a “medication nurse”, a nurse for the right side of the ward, and a nurse for the left side of the ward.

Functional nursing was less oriented to individualized and holistic care and more oriented to task accomplishment. One advantage was that there was little confusion about roles and duties. When applied to nursing, this method was efficient and cheap, but nurses and clients hated it. Client satisfaction dropped under this kind of care delivery system. Clients felt that they could not identify who was their nurse caretaker.

Care Delivery System:

  • Task and activity oriented
  • Each person is assigned specific functions performed for all patients in a given unit, and all report to the head nurse (E.g. typical division of labor for RNs would be medication nurse or treatment nurse).
  • Head nurse or charge nurse does the decision making
  • One registered nurse may be responsible for giving medications, another nurse for admission and discharges while nursing attendants change linen, provide hygienic care or do simple procedures for which they have trained.
  • This method divides the work to be done with each person being responsible to the Head or Senior Nurse.

Advantages Disadvantages It is the best system that can be used when there are many patients and professional nurses are few.Each patient’s care is fragmented and it does not support the RN’s professional practice responsibilities It allows most work to be accomplished in the shortest time possible.It is suitable only for short-term use. If continued, it fragments the care of patients to tasks only. Workers learn to work fastHolistic care is not achieved.

Workers gain skill faster in a particular task because of repetitive task.Nurses accountability and responsibility are diminished. Greater control over work activities and it is aimed at conservation of workers and cost.Patient’s cannot identify who their “real nurse” is. Efficient and the least costly because it requires few RNs.Nurse-patient relationship is not fully developed.

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