Hi everyone! I am new here. I work in a level III NICU in Texas. I have been there 4 years, I am a RNC and a member of the transport team. My hospital does not do primary care nursing other than having the same patient assignment for the two or three days we are there. I am trying to start up primary care nursing, but don't know where or how to start.
How does your hospital do it? How does one become the "primary"? Are there shift primaries? What about "associates", do they fill in when the primaries aren't there? How do you keep track of who is primary and associate? Any other tips or suggestions?
I think this is very important to the patients and thier families, and to help in preventing errors or things missed, unfortunately if you want something changed you have to do it yourself. I am hoping to come up with a thorough and convincing plan to change "our ways" in my NICU.
I work at a level III NICU in Sioux Falls, SD. We are currently in the process of developing our Relationship Based Care that involves primary nursing. It has been a work in progress and we have met a lot of resistance. Even so we are moving forward because it is the best thing for our babies and their families. As for our structure, we have a voluntary sign up sheet for each infant with 5-6 slots underneath their name where RN's can sign up to be part of their primary "team". We decided not to do just 1 primary nurse because we work 12hr shifts and there wouldn't be a primary assigned for 4 days out of the week. Even though our primary is on a voluntary basis, each nurse must be assigned to at least 1 infant but no more than 3. We have been trialing this for a few weeks now and it seems to work out well for us. We will be going live in about 1 month and every infant will have a primary!
I am in a similar situation of trying to implement primary nursing in our level 3 NICU - along with that we are hoping that by enhancing mother-nurse relationship we will be able to improve breast feeding rates as well. Has anyone been able to find an actual protocol that I can present to my supervisor for implementing primary nursing care in the nicu?
It's voluntary where I'm at and pretty much follows what people have said.
One of the problems I see is that when a baby has many primaries and the patient is particularly complex, the one day or so a week or month that there isn't a primary available, the nurse taking care of that baby is at odds with the parents who come to expect a certain level of care and intimacy. As nurses, voluntarily signing up for a kid means that you generally like the kid a lot and will probably find the time regardless of how busy you might be to spend the extra 10 minutes to do more with the patient, whether it be playing or brushing hair, etc etc.
It's not to say that any other nurse wouldn't do it, of course, but the parents come to expect it, when it should be considered more of as an extra thing when the nurse has time versus if she has multiple kids assigned or a particularly acute case next door. And then the parent might think that you aren't a good nurse if you aren't spending enough time with their child, even though you've done your thorough assessment, made sure they were clean and comfortable.
That being said, I think they are a good idea. I've signed up for three in my two years so far and I've enjoyed my time with each of them, along with the families.
Hi, I work at a level 3 NICU in California. At our facility we do primary nursing. We do not have a protocol. It is generally after a relationship has been formed between the family and to promote family centered care. Some of our patients have 1 or 2 primaries or several depending on the patient. We try to promote primary nursing for the patients who are long term, and or will go home with: trach-vent, g-tube, TPN/Lipids, Broviac, apnea monitor. I find primary nursing wonderful I think that whatever I can do to help one of our babies move to the goal to go home in the best shape possible I want to help with. There are some draw backs, you are with the same patient for sometimes a long period of time so it limits your ability to have varying patient assignments. Also as the patient down grades in acuity the rn to patient ratio increases, so the 1 on 1 attention the family is used to is not as abundant. Some of the problems I have noticed: Some personal it is hard to say goodbye. Some interpersonal. Sometimes there are conflicts that arise. But all in all it is a wonderful experience, and helping a precious life is a one of a kind experience.
harklehm
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I work at a level III NICU in Sioux Falls, SD. We are currently in the process of developing our Relationship Based Care that involves primary nursing. It has been a work in progress and we have met a lot of resistance. Even so we are moving forward because it is the best thing for our babies and their families. As for our structure, we have a voluntary sign up sheet for each infant with 5-6 slots underneath their name where RN's can sign up to be part of their primary "team". We decided not to do just 1 primary nurse because we work 12hr shifts and there wouldn't be a primary assigned for 4 days out of the week. Even though our primary is on a voluntary basis, each nurse must be assigned to at least 1 infant but no more than 3. We have been trialing this for a few weeks now and it seems to work out well for us. We will be going live in about 1 month and every infant will have a primary!