Primary nursing facts for kids
Primary Nursing is a special way that nurses give care in hospitals. It started in 1969 at the University of Minnesota. In this system, one main nurse, called the primary nurse, takes charge of a patient's care. This nurse often works with other helpers, like a licensed practical nurse (LPN) or a nursing assistant (NA). Together, they look after a group of patients during their whole stay in the hospital.
The primary nurse is responsible for planning and guiding all the nursing care for their patients. This helps the nurse understand the patient's health and feelings much better. It's different from other nursing styles where many different nurses might care for a patient each day. With primary nursing, patients know who their main nurse is. They can talk to this nurse about their needs, and the primary nurse helps communicate with the rest of the hospital team.
Contents
What is Primary Nursing?
Primary nursing is a way to organize how healthcare is given. It focuses on four main things: making decisions, sharing work, communicating, and managing care.
- Making Decisions: The primary nurse makes important decisions about a patient's care. This means they are responsible for how the patient is looked after. This approach can lead to shorter hospital stays and happier patients. It can also mean fewer health problems for patients and less time off for nurses.
- Sharing Work: Even if the primary nurse isn't there, they still guide the care. They can ask other staff members to help, but the main nurse remains responsible.
- Better Communication: Communication between the patient, doctors, and nurses gets much better. The primary nurse is like the main contact person. They make sure everyone knows what's happening. A nursing director named Lawrence J. Donnelly once said that doctors want good care for their patients, and primary nursing helps achieve that.
Why Nurses Like Primary Nursing
Hospitals often face challenges finding enough qualified nurses and keeping them. One reason nurses might leave their jobs is being unhappy with how they have to work. Primary nursing was developed to help with this problem.
Charlotte Dison from Baptist Hospital of Miami said that primary nursing helps keep nurses because they are "more satisfied with their environment." This means nurses are happier at work. When nurses are happier, they tend to be absent less often. They also feel a stronger connection to their patients. Dick Otswald, a nursing vice president, believed that letting nurses focus more on direct patient care, instead of just paperwork, would make them want to stay. This is because many people become nurses to help patients directly.
How Patients Benefit
In older nursing systems, like team nursing, tasks might get done, but patients sometimes went home without knowing how to care for themselves. Also, the caring part of nursing wasn't always as strong. Karen Ciske, a former nurse and instructor at the University of Minnesota Hospitals, explained this. She said that the one-on-one talks between a nurse and patient are where a real connection forms. Patients feel comfortable opening up and sharing more.
Patients have reported being very happy with primary nursing. This is because their care feels more personal. Building trust between the nurse and patient is very important. Nurses say that when patients trust them, they are more likely to share details about their discomfort or changes in their body. These details might not be picked up by medical machines.
This strong patient-nurse relationship also helps with the patient's family. It makes it easier for the nurse to plan for when the patient leaves the hospital. They can understand what kind of support the patient will have at home. Penni Weston, a primary nursing coordinator at St. Alexius, said that families know exactly which nurse to talk to if they have questions or worries.
A study at the University of Michigan looked at two groups of kidney transplant patients. One group had primary nursing, and the other had team nursing. The patients with team nursing had about four problems after their surgery. The patients with primary nursing had only about one problem. This meant they could leave the hospital sooner!
Different Ways Nurses Provide Care
Here's a look at how primary nursing compares to other common ways nurses give care:
| What's Different? | Functional Nursing | Team Nursing | Total Patient Care | Primary Nursing |
|---|---|---|---|---|
| Making Decisions | Decisions are made for one shift, usually by a manager. | Decisions are made for one shift, mostly by a team leader. | Decisions are made for one shift by the nurse caring for the patient. | The main nurse makes decisions for their patient based on their relationship, which lasts the whole hospital stay. |
| Sharing Work | Nurses are given tasks, not specific patients. | Tasks are given based on how complex they are; assignments change often. | Nurses care for patients, but assignments might change each shift. | Nurses are assigned to patients to make sure care is continuous. One nurse stays the main nurse for a patient's whole stay. |
| Communication | Communication goes up the chain of command; tasks are reported to a manager. | Communication goes up the chain of command; nurses report to a team leader. | Communication is direct, but sometimes nurses report to a manager. | Communication is direct. The main nurse gathers information and talks directly with doctors and other team members. |
| Managing Care | Managers make sure tasks are done. | Managers supervise team leaders who supervise other staff. | Managers help nurses have a bigger role in care decisions. | Managers help the nurse-patient relationship grow. They create a good work environment for nurses. |
Let's look at an example. In team nursing, one nurse might give a patient a pill. Another nurse might change the bed sheets. A third person might bring a bedpan. The nurse who gave the pill might only see the patient that one time.
In primary nursing, the primary nurse gives the pill. But they also teach the patient about the medicine's effects. They watch how the patient reacts. When the patient leaves the hospital, the primary nurse can suggest the best time for them to take the pill at home. This is based on what they learned during the patient's hospital stay. The primary nurse is also more likely to notice if there's a mistake with medication. This is because they know the patient's health much better.
In a system called "total patient care," nurses do provide more direct patient care than in team nursing. However, they don't have the same level of responsibility for the patient's entire stay as in primary nursing.
Common Ideas vs. Facts About Primary Nursing
Here are some common misunderstandings about primary nursing, and the real facts:
| What Some People Think | What is Actually True |
|---|---|
| Primary nursing needs only Registered Nurses (RNs). | Primary nursing can work with the nurses and staff already available. It doesn't need only RNs. Licensed practical nurses, nursing assistants, and other team members are very important in helping patients and their families. |
| The primary nurse does all the bedside care. | The main idea of the primary nurse's job is to be responsible for decisions about patient care. It's not about doing every single task. It's not practical for one nurse to do everything. Patients often stay for a short time, their needs can be very complex, and there can be nurse shortages. If the primary nurse did all the bedside care, they wouldn't have time to plan and coordinate the patient's overall care. |
| Primary nursing means nurses work alone and don't help each other. | Teamwork is very important in primary nursing! It has been shown that it's best when other staff members work closely with one RN. A general feeling of "helpfulness" among all staff is needed to give safe, good care. Primary nursing helps different healthcare professionals work together through good communication and planning. |
| It's too hard to schedule nurses to keep the same nurse with the same patient. | Nurses have reported that they do 25% less repeated work because of the continuous care. They also feel more productive when they work with the same co-workers. The key is to find creative ways to schedule nurses so that keeping the same nurse with the same patient is a top priority. For example, if a patient is expected to stay three days, schedule their primary nurse for three days in a row. |
The History of Primary Nursing
Primary nursing is a return to an older idea: that the relationship between the nurse and patient is the most important thing. The nurse uses all their professional knowledge to care for the patient.
In the 1920s, most nursing happened at home. Nurses worked for themselves, managing their own patients. Hospitals trained student nurses, who provided care there. After World War II, many Registered Nurses (RNs) were needed to care for wounded soldiers. Hospitals then relied more on Licensed Practical Nurses (LPNs) and Nurses Aides. This led to "functional nursing," where each person was given specific tasks based on their training.
After the war, many new hospitals were built. Functional nursing continued because there were always more patients than nurses. Work was divided among many roles: orderlies, technicians, nursing assistants, and aides. The RNs often oversaw everyone but rarely saw patients themselves. This led to nurses being unhappy and leaving their jobs throughout the 1950s and 1960s.
Primary nursing began in 1969 on Unit 32 at the University of Minnesota Hospital. The first public talk about primary nursing happened in 1970. Articles about it were published that same year. Throughout the 1970s, hospitals started to see how primary nursing helped both patients and nurses. Hospitals in places like the Twin Cities and St. Alexius started using it. Nurses like Joyce Clifford in Boston and June Werner in Evanston were praised for fully using this professional nursing model.
At first, some hospitals found primary nursing more expensive because it needed more professional staff. So, some started with a slightly changed version.
How Primary Nursing is Used Today
As primary nursing continued to be used, patients kept saying they were happy because their care was personal. Sometimes, hospitals found it challenging to fit primary nursing into their usual ways of working. This could mean changes to how nurses and doctors work together, how staff are scheduled, and how nurses are supervised.
Marie Manthey, a nursing expert, said that primary nursing helps nurses practice their profession even in big hospitals. She explained that a profession means a nurse looks at a patient's needs and decides what care is best. This is different from just following set hospital rules. Manthey also suggested that sometimes nursing leaders might not want to use primary nursing because they are afraid of losing their power.
Primary nursing also spread outside the U.S., especially in England. There, it was called 'named nurse' in the National Health Service. In 1991, John Major announced a "Patient's Charter." One part of this was that a "named qualified nurse" would be responsible for a patient's care. This showed that nursing was being seen as a very important part of medicine. It meant that well-trained nurses taking on more responsibility would help both the health system and patients.
While the Royal College of Nursing supported this, they also knew there would be cost challenges. Stephen Wright, a supporter of primary nursing, pointed out its benefits like fewer patient complaints, fewer medical problems, and less staff absence. However, he also noted challenges. Doctors might find it different to work with many different primary nurses instead of just one head nurse. Also, for the primary nurse, taking full responsibility from when a patient arrives until they leave needs a lot of support. Wright said, "It can be pretty scary if you are totally responsible for a patient's care. The bus stops with you." He also stressed that the new system needed enough money.
Sometimes, the head nurse was wrongly assigned as the "named nurse," which wasn't realistic. The Royal College of Nursing said that a "named nurse" means a qualified nurse is responsible for specific patients. They suggested ways to save money to hire more qualified nurses. This included reducing the time spent on shift changes and moving office or cleaning tasks away from nurses to other staff.
In the 1990s, some hospitals tried to cut costs by changing how they worked. This often reduced how much freedom nurses had to make their own decisions. The term "primary nursing" was used less, and some of its ideas were changed. The focus on the nurse-patient relationship became less important. This made nurses less happy with the care they could give.
In the UK, hospital changes meant that skilled nursing work was spread among more types of staff. This meant nurses took on more management, medical, and therapy tasks. Bedside care was often given to non-nursing staff. This came from the "total patient care" idea, where nurses took on extra clinical roles. Nurses felt worried about the quality of patient care, which wasn't being measured. They also felt more pressure and uncertainty because of all the big changes.
Today, the ideas of primary nursing are often called 'Relationship-Based Care'. This applies the original concepts of primary nursing to all parts of the hospital and all relationships within it.
