Question about care managers

[waded]

Hi! I'm trying to redo our NICU's care manager/primary nurse program, and we've been unsuccessful in the past trying to keep the program consistant. I was wondering if some of you could tell me about how your units do care managers or primary nurses? For example--does every single baby get a primary nurse or just those over a certain gestational age? Is it voluntary or is each baby assigned to a nurse if no one signs up for it? What about if a nurse had the baby for the past 2 days and on her third day the baby's primary nurse is working--who gets the baby? The nurse who's been there the past two days or the primary nurse? (This has actually been a huge problem/complaint amoung our staff. Many feel they should keep their assignment on their third day in a row, regardless of if the primary nurse is working, which of course negates the whole concept of having care managers).

Any other information you could share with me would be greatly appreciated!

Thanks in advance!

[SteveNNP, MSN, NP]

We do primary nursing in our unit. Each FT/PT/PRNIII nurse chooses a baby as a primary and signs their name in INK next to who they want. Only one or two nurses from each shift may pick the same infant. If infants do not have a primary nurse, and there are nurses without primaries, they are automatically assigned. If the baby's primary nurse is working, he/she gets their baby, no ifs ands or buts. However, if the nurse is precepting and needs a specific assignment for her orientee's needs, she won't necessarily get her baby. We had a lot of complaints at the beginning, but almost all the rns love it now, and love really bonding with a baby and their family. We have just gotten to the point that while we would like the same assignment 3 days in a row, we also respect that it's a primary nurse's right to have her baby. We just got over it, I guess..... it's working out great now.

[Sweeper933]

We have had primary nursing on our unit for over 20 years - we all love it! It is not mandatory that each nurse has a primary - but most of us do. We also have what we call "associates" as well. In each room on our unit, we will have either 2-3 assignments, depending on our acuity and our census. For example, if my primary baby is in a room, I might sign on to be an "associate" nurse for the other baby(s) in that same assignment. This way, almost every baby ends up with at least one primary or associate.

As far as how many people are allowed to sign up for each baby, it varies. For the most part, we allow one nurse from each shift (day, night, sometimes pms, weekend nights...). That way each baby has their own "team" of nurses that are consistently taking care of them. We have no problem switching assignments after 2 days if a primary comes in for their shifts - primary nurses get priority over anything else. The only problems we run into are when there are more primary nurses on during a shift than there are assignments in the room. But for the most part, we're pretty good at sharing the assignments. Each of the nurses know the babies in that room, so the babies still get pretty consistant care.

We aren't allowed to start taking associates until you have been off orientation for at least 3 months, that way you still get a variety of experiences. And you can start taking primaries about 6 months after you are finished with orientation.

The parents also enjoy having a consitent team of nurses taking care of their babies. We get to build great relationships w/ the parents - a lot of us continue to keep in touch with our primary baby's families years after discharge. Sometimes though, parents will get a little "concerned" if a nurse who doesn't know their baby is taking care of them. But we just explain that every nurse is qualified to take care of all the babies... it works out just fine!

For the most part, we all love having primaries. One of the downsides, is when you end up w/ a primary who is here for months and months... sometimes you get a little sick of taking care of them. But if that happens, you can always take a few shifts off of taking care of your baby... And sometimes after taking care of a "chronic" for a long time, a lot of us will take a break from having a primary - just to take a breather...

Hope this helps!