Healthcare System Structure & Organization
Understand how healthcare is organized, including levels of care, unit types, scope of practice for healthcare team members, interprofessional roles, healthcare delivery models, and patient rights.
Levels of Healthcare
Primary through quaternary care
Healthcare is organized into levels based on the complexity of care provided. Understanding these levels helps nurses appreciate where their role fits within the broader system and how patients move through the continuum of care.
Levels of Care
Hospital Units & Care Settings
ICU, med-surg, step-down, and beyond
Different hospital units serve patients with varying acuity levels. Understanding unit types helps nurses prepare for the type of patients they will encounter, the nurse-to-patient ratios, the monitoring capabilities, and the pace of care delivery in each setting.
Intensive Care Unit (ICU/CCU)
Highest acuity patients requiring continuous monitoring and life-sustaining interventions. Nurse-to-patient ratio typically 1:1 or 1:2. Features: continuous cardiac monitoring, mechanical ventilation, vasoactive drips, invasive hemodynamic monitoring (arterial lines, central venous catheters). Types include: Medical ICU, Surgical ICU, Cardiac Care Unit (CCU), Neuro ICU, Pediatric ICU (PICU), Neonatal ICU (NICU). Patients are critically ill and unstable.
Step-Down/Progressive Care Unit (PCU)
Intermediate level between ICU and med-surg. Patients are stable enough to leave ICU but still need closer monitoring than a general floor. Nurse-to-patient ratio typically 1:3 or 1:4. Features: continuous telemetry monitoring, may have non-invasive ventilation (BiPAP/CPAP). Patients may be weaning from ICU-level interventions or at risk for decompensation requiring close observation.
Medical-Surgical (Med-Surg) Unit
The most common inpatient unit. Cares for patients with a wide range of medical and post-surgical conditions. Nurse-to-patient ratio typically 1:4 to 1:6. Patients are generally stable but require nursing care including medication administration, wound care, education, and discharge planning. This is where most new graduate nurses begin their careers.
Other Settings
Emergency Department (ED): acute, undifferentiated patients requiring triage and stabilization. Operating Room (OR): surgical procedures with specialized perioperative nursing. Post-Anesthesia Care Unit (PACU): immediate post-surgical recovery. Labor & Delivery (L&D): obstetric care. Rehabilitation: recovery of function after illness/injury. Long-term care (LTC): chronic care for those unable to live independently. Home health: nursing care delivered in the patient's home. Community/public health: population-focused care.
Scope of Practice & Interprofessional Team
Who does what, and why it matters
Modern healthcare is delivered by interprofessional teams. Each member brings unique expertise, and effective collaboration improves patient outcomes. Understanding roles prevents scope-of-practice violations and optimizes delegation. The nurse is often the coordinator of the care team at the bedside.
Nursing Roles
RN: Full assessment, care planning, medication administration, IV therapy, patient education, delegation, and evaluation. LPN/LVN: Focused assessment, stable patient care, medication administration (varies by jurisdiction), data collection. Works under RN/provider supervision. CNA/PCA: Basic care, vital signs, hygiene, ambulation, feeding, I&O recording. Cannot assess, plan, or administer medications. NP: Advanced practice, diagnoses, prescribes, orders tests, manages care independently or collaboratively.
Allied Health Team Members
Physical Therapist (PT): Mobility, strength, gait training, rehabilitation. Occupational Therapist (OT): Activities of daily living (ADLs), fine motor skills, adaptive equipment. Respiratory Therapist (RT): Airway management, ventilator settings, breathing treatments, ABG collection. Registered Dietitian (RD): Nutritional assessment, therapeutic diets, tube feeding. Social Worker: Discharge planning, community resources, psychosocial support, insurance navigation. Pharmacist: Medication safety, interactions, dosing, patient education.
Scope of Practice — Know Your Boundaries
Scope of practice defines the legal boundaries of what each healthcare professional is authorized to do based on their education, certification, and licensure. Working outside your scope is a legal and ethical violation. RNs can assess, plan, implement, and evaluate care, administer medications, and delegate to LPNs/CNAs. LPNs/LVNs provide direct care under RN or physician supervision, administer certain medications, and perform focused assessments. CNAs/PCAs perform basic care tasks (bathing, feeding, vital signs, ambulation) under nurse supervision. NPs have advanced practice authority including diagnosis, prescribing, and autonomous practice (varies by state/province). PAs practice medicine under physician collaboration. The key principle: always practice within YOUR scope and delegate appropriately within THEIR scope.
Healthcare Delivery Models & Patient Rights
How care is organized and what patients are entitled to
Healthcare delivery models shape how care is financed, accessed, and coordinated. Understanding these models helps nurses navigate the system and advocate for patients. Equally important, patient rights form the ethical and legal foundation of all nursing care, nurses serve as the primary advocates for these rights.
Chain of Command
The chain of command provides a structured process for escalating patient safety concerns. If a nurse identifies a safety issue: first notify the charge nurse, then the nursing supervisor, then the nurse manager, then the medical director/chief nursing officer. The chain exists to protect patients, nurses have an ethical and legal obligation to escalate concerns even when met with resistance. Document all communication and responses.
Advance Directives
Legal documents expressing a patient's healthcare wishes when they cannot communicate. Living will: specifies desired or refused treatments (e.g., mechanical ventilation, tube feeding, CPR). Healthcare power of attorney (proxy): designates a decision-maker. Do Not Resuscitate (DNR): specifies no CPR if cardiac/respiratory arrest occurs. POLST/MOLST: medical orders based on patient wishes for seriously ill patients. Nurses must verify and honor advance directives.
Healthcare Delivery Models
Healthcare delivery models determine how care is organized, financed, and delivered. Fee-for-service: providers are paid for each service rendered, can incentivize volume over quality. Managed care (HMOs, PPOs): organizations manage cost and quality by requiring referrals, using networks, and implementing utilization review. Accountable Care Organizations (ACOs): groups of providers jointly accountable for quality and cost of care for a patient population. Patient-Centered Medical Home (PCMH): coordinated primary care model with a team approach, emphasizing prevention and chronic disease management. Value-based care: reimbursement tied to patient outcomes rather than volume of services, the direction healthcare is moving globally.
Patient Rights — A Core Nursing Responsibility
Patient rights are legally protected and include: the right to informed consent (understanding risks, benefits, alternatives before treatment), the right to refuse treatment (even life-saving treatment for competent adults), the right to privacy and confidentiality (HIPAA in the US, PIPEDA in Canada), the right to access medical records, the right to be informed of diagnosis and treatment options, the right to participate in care decisions, the right to be treated with dignity and respect regardless of background, the right to file grievances without retaliation. Advance directives (living will, healthcare power of attorney) extend these rights to situations when patients cannot speak for themselves. Nurses are patient advocates, protecting these rights is a core nursing responsibility.
Match the Healthcare Role
Terms
Definitions
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