Coordination of Care

What does “coordination of care” mean and what is the RN’s role?

• RNs coordinate care when they identify the health needs of clients and organize the required care to ensure continuous, safe care (1).
• As coordinators of care, RNs are team leaders in their practice environments. They coordinate the health care team to analyze and organize complex health challenges into manageable components. They perform assessments and create care plans, provide care, make decisions about assignments to other care providers and communicate with other care providers as they oversee and evaluate the ongoing care of clients (2, 3 & 4).
• Assignment of care is part of the coordination of care; a decision that identifies the most appropriate care provider for the provision of a client’s care. Assignment of care occurs not only at the beginning of the shift but throughout the shift as client care needs change.
• The registered nursing process is comprised of an assessment of the client, development of the nursing care plan, care plan implementation and evaluation of the nursing care provided. This is part of the coordination of care and therefore the responsibility of RNs. The RN is responsible and accountable for all these components (5).
• When resources are not available to provide appropriate or safe care, RNs collaborate with others to adjust priorities and minimize harm. RNs keep the clients receiving the care informed about potential or actual plans regarding the delivery of care. RNs inform employers about potential threats to the safety and quality of health care (6).

The RNs in my organization are reporting there are not enough RNs to meet the needs of our clients. What does this mean as we have an RN/client ratio of 4:1?

The RNs are bringing this concern forward based on the complexity of the care required for the clients for which they are responsible. As coordinators of care, the RN must consider the needs of each client and determine which care provider is best matched to provide the required care. It is possible the staff mix may not be at an optimal level and requires evaluation and action to resolve.

One of the new RNs says that at her former workplace, the RNs who were coordinating care simply assigned patient care by room blocks (e.g., rooms 1-6, 7-12). Is this a practice we should consider implementing?

What you are describing is geographic assignment and is not best practice. When RNs coordinate and assign patient care, decisions should be based on an assessment of client factors, nurse factors and environmental factors. Depending upon the model of care, a block of rooms may be consistently assigned to a team that might include LPNs, RNs and/or RPNs. Client care needs are then determined by the team, including which provider is best able to meet those client care needs, and when care needs are appropriate to transfer to another provider taking into account environmental factors such as other supports and resources. However, when a primary care model is in place, geographic assignment is not supported because this assignment model does not intentionally match client care needs with the best provider to meet client needs safely and consistently. It also does not consider client predictability and acuity changes that may occur over time.

CRNS Resources

CNA Code of Ethics for Registered Nurses (2017)

Registered Nurse Practice Standards (2024)

The Registered Nurses Act (1988)

External Resources

CNA Staff Mix Framework