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Nursing Excellence

The Online Newsletter for Children's Nurses
e-Edition, Issue 11 

Patricia Lindsey

Care Delivery

The application of the nursing process to the provision
of patient care within a defined model of care.

By Patricia Lindsey, MSN, RN, CNS, CPN

L.E.G.A.C.Y. and the Interdisciplinary Team.


In Children’s Hospital’s L.E.G.A.C.Y care delivery model (Leadership, Excellent Patient/Family Care, Growth, Accountability and Autonomy, Collaboration, Your Professional Practice), the registered nurse (RN) functions as coordinator of patient care. The most familiar application of the nursing process is how the RN utilizes it to affect the patient’s and family’s care. The RN also leads the interdisciplinary team in the development, implementation and evaluation of an individualized plan of care for the patient. The RN is responsible for the professional development of the team members. Therefore, it is the RN’s accountability to apply the nursing process, not only to the patient’s care, but to the team’s improvement as well.

The RN collaborates with other interdisciplinary care providers to gather data and assess the patient, and the team determines goals for the patient’s treatment. The RN then formulates a plan of care and communicates this to the team who, with individual responsibilities, works together toward a common goal. The RN monitors the plan to assure its implementation via delegation and supervision. The defined roles and accountabilities enhance the expectations for excellent care. The RN is constantly evaluating the progress of the goals and the plan of care. As new information is gathered or the patient’s condition changes, the RN modifies the plan of care and sets new goals, collaborating with the team to help meet them. Thus, the evaluation step of the nursing process is brought full circle to identifying new problems and new goals. With the RN at the lead of interdisciplinary consultation and coordination, information for patient care is centralized and integrated into the plan of care.

Under the L.E.G.A.C.Y. model, the RN functions as an expert and resource for the ongoing professional development of the team. The RN provides opportunities for growth of team members, resulting in an environment of continuous learning. The RN in L.E.G.A.C.Y. is responsible for the development of the team members. The RN, as the coordinator of care, is responsible for mentoring the team members while maintaining a high quality of care for the patient. The experienced RN is a resource for the new RN, the float RN or the traveler RN to coach them in potentially unfamiliar aspects of care. For example, the new RN may be focused on tasks to perform for patient care while in need of support in some aspects of delegation, supervision and interdisciplinary collaboration. The RN, as coordinator of care, works alongside the float RN to assist in the specific needs of a particular patient population. For instance, perhaps the float RN is not familiar with the routines of chemotherapy administration or unique care requirements of a short gut patient. The RN also works next to the traveler, who may need guidance to provide patient care according to Children’s Hospital policies and procedures. In these instances the RN consistently evaluates, plans and implements the coaching of the individual, enriching his/her experience, while providing a consistent level of care for the patient and family.


L.E.G.A.C.Y. Consistency of Care Diagram



The RN coaches the unlicensed assistive personnel (UAP), providing delegation, supervision and feedback to help them grow in their abilities and knowledge. The RN is knowledgeable of scope of practice of the individuals on the team in order to optimize their performance. As a coach, the RN evaluates the professional development of the individual, and delegates and supervises accordingly to coach him/her in new experiences and enhance his/her growth.

The nursing process guides the provision of patient care and creates a framework for interdisciplinary collaboration, care planning and mentorship of colleagues. The RN assesses, plans, implements and evaluates for the patient and the patient care team. Using expertise, leadership and the nursing process, the RN guides the provision of patient care ensuring the best possible care.


In This Issue

Professional Practice

Professional Values

Theoretical Framework

Professional Practice


Collaborative Relationships

Care Delivery


Research / Evidence-Based Practice

Professional Development

Reward and Recognition