Primary Care

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    I know I have asked questions about this in the past but.....
    Two years ago we stopped doing primary care. It was being abused by people wanting to stay in the intensive part of the unit, the babies with the best parents, or just sign up while your on your stretch.
    In the last two years none of the resident nurses have been able to follow a baby through the process of a stay. While we strive for continuity primaries were always give top priority. I think it has been harder for these newer nurses to get organized and learn the cause and effect of a disease process.

    Our unit has changed a little. Now babies are admitted throughout our four rooms and our units have separated. Stable babies move to the ICN to work on growing/feeding. Primaries used to follow thier pts. if they wanted but now they have a core staff.

    So what works in your unit or what do you think could be done better.....
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  3. 6 Comments so far...

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    We have primary nursing and MOST follow the baby through their whole stay, including when they go to level 2. There are exceptions for some staff (some have weight restrictions, so they have to give up a baby when it gets big, and we do have some core level 2 staff, so if they are on a primary sometimes gets bumped to the NICU). It works well for us. Personally, I don't really care why a nurse chooses a primary and don't think it's important at all.
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    i believe whole heartedly in primary care in the nicu. the way our unit is set up we have 3 levels icn-intesive care level iii, ccn- level ii continuing care for feeding & growing babies nicu grads, and imc- intermediate care (pt usually ther <1week). these are in sepparate areas. a primary usually only follows the pt through thier home unit stay. i rarely am without a primary pt. there is a satisfaction in bonding with a family and making this difficult time a little easier for them.
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    Does anyone have a guideline or policy or is it just one those this is how it is?
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    I work in a large Level III unit that has no actual step-down - we have a separate area for growers/feeders, but sometimes it's closed due to low census so we mix those babies in with the sicker ones. We don't have designated staff for each area - everyone works everywhere. We follow our primary patients from admission to discharge. It's very frowned upon to take your name off a baby for any reason, especially if the reasoning is that you like sicker kids and that one is now a grower/feeder or chronic. It's upsetting to the parents too - because like I said we're one big unit so you'll still be seeing the family every time you work.

    Don't have a policy about it. I think I posted something about how we do our assignments in an earlier thread - we have a pretty good system so that nurses get their primaries 95% of the time. Let me look for it...
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    We just started primary care in our unit and I have a primary care baby and im also an associate care nurse for another baby.....in the unit....I enjoy it because I basically get to know the babies I am working with and the parents like it as well. In primary nursing we are responsible for all the discharge paperwork and all the things that need to be done to prepare the baby for discharge meaning we oversee and make sure if the baby had an eye exam the dates are documented and the hearing screens are done ...PKU and all that stuff....so it also helps us to really dig deep into the baby's care and read up on our babies so we basically know what has been going on with the baby even when we are not at work working with the baby.


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