From past paradigms to future frontiers: unique care delivery models to facilitate nursing work and quality outcomes

As healthcare processes were reengineered in response to managed care, traditional care delivery models were abandoned, resulting in nursing staff dissatisfaction, increased healthcare error, and eroding clinical outcomes. An aging patient population, chronicity of illness, the proliferation of new medical information and technology, severity of illness, and the focus of acute care to "stabilization and transition" necessitate the creation of systems that address changes in nursing work expectations while maximizing available resources. By evaluating unit-specific structure and process criteria and allocation of provider roles, unique, setting-specific care delivery models can be created to facilitate direct and nondirect patient care functions, resulting in improved financial and clinical outcomes.