Primary Care Nursing

When I first came out of Nursing school the CCU I worked at was Primary care along with every job I held after that up until about 1992. I loved primary care!! We staffed with RN's, LPN's and had 1 CNA. Everyone worked together when needed but ultimately the Primary Care Nurse delegated and followed that particular pt throught thier entire hospitalization in our unit. The RN's/LPN's did the assessments, meds, bathing, feeding, I&O's, dressing changes, dealing with families. The CNA floated between everyone assisting with bathing etc when asked to do so. This was a 13 bed CCU. We did the same thing in the 29-bed Telemetry Unit with 2 CNA's to float amonst the RN/LPN in assisting with baths etc. RN/LPN were responsible for all vitals also. On ocassion the CNA would be asked to double check the vitals if there was a question of the results or the RN/LPN was running late with another pt. I enjoyed it as I knew pretty much who and what type patient I was dealing with everytime I came into work until that pt was discharged from our unit. Care was consistent and also the pt was able to build a relationship usually on a first name basis during thier time there. I'm sure others have more to add but this is just the basics of how I felt about primary care.

I did primary care on a sub acute rehab floor for a year. It is very hard work. After a year management changed back to having cna's as they found it was too expensive to staff all nurses for 24 hrs a day. We were only to take care of 6 patients each, but the number would creep up to 8 to 10 on some days. If you had a sick pt or a demanding family, you could really get behind and hope you could find a nurse to help bail you out. I really liked the fact that I new everything about my pts though.

i am also a big fan of primary nursing for several reasons:

1) you really get to know your patients. on the floor where i work be have been having 8-10 high needs patients per rn. this creates a major problem when trying to make sure that all tasks are completed for that patient on the given shift. a lot of times i only have time to see my patients one time maybe two in a 12 hour shift. this is not very safe nursing practice but that is what we have to work with for the time being. i would really like to be able to really get to know my patient instead of trying to rush through their assessment and literally throw their meds at them while rushing right back out of the room.

2) with primary nursing it is all about you and you can ensure that everything was done for that patient. if something is not right then it is up to you to fix it. the problem i see with primamry nursing is i have encountered several nurses (at my facility and others) that think they are "above" doing vitals, baths and tending to "code browns."

i think that if staffing is appropriate then primmary nursing is the way to go to ensure adequate patient care.:roll