Organisation of Care
The division of workload in nursing and midwifery can be managed on a shift by shift basis via number of different models. All models are based on the development of person-centred plans of nursing and midwifery care, as a result of assessment and identification of needs. A broad overview of the four main identified models is:
- Total patient care: one registrant is responsible for providing all care to a particular patient on a shift
- Team nursing: a team is responsible for providing all care to a group of patients on a shift
- Primary nursing: one nurse is responsible for planning all the care for a particular patient over the whole episode of care
- Task allocation: individual members of the team have particular tasks to all patients on the ward each shift.
There is a lack of systematic, evaluative research on the various models of care delivery and their impact on the quality of care outcomes, the choice of model used on a ward being described as a ‘philosophical’ decision determined by the professional team lead or manager. Whilst there is also little or no evidence of direct comparison between the different models, the key appears to be ensuring appropriate delegation and ensuring that work that should be carried out by registered nurses (RNs) or midwives is not delegated to the non-registered workforce.
The evidence would suggest, however, that when low ratios of RNs to patient are unavoidable, task orientation may be the safest model of providing nursing care particularly.
During these periods, and in times of large numbers of temporary staff, it may be helpful to consider this model of organising care, matching delegated tasks and duties with the skills of individuals in the team, who have self-identified their abilities through the group outline. It may also be helpful to organise the clinical environment, where possible, to co-locate people with similar levels of care needs, who are then matched with small teams of people who have the relevant skills base. A helpful tool to assist with that is the Safer Nursing Care Tool  and the descriptors outlined in it.
For additional information specific to particular care settings e.g. Private Nursing Homes, please see below.
 Shelford Group. (2014). Safer Nursing Care Tool: Implementation Resource Pack. Available on request from: https://shelfordgroup.org/safer-nursing-care-tool/
Currently there is no freely available validated tool for attributing acuity and dependency levels in Private Nursing Home settings in Northern Ireland. In the context of this microsite, the ability to identify the acuity and dependency of people in nursing home care enables cohorts of staff to be deployed relative to their skills as appropriate, for acutely ill and/or increasingly dependent people.
Tools currently available include:
- Assessment of acuity through the use of NEWS2 or the RESTORE2 model found at: https://wessexahsn.org.uk/projects/329/restore2
- Assessment of dependency using e.g. the Rockwood Frailty scores: https://www.bgs.org.uk/sites/default/files/content/attachment/2018-07-05/rockwood_cfs.pdf