Published Jan 11, 2004
A year ago we stopped doing primary care. Since then we had a burst of 23-26 weekers that are now 4-6 months old and chronic everything. It is very sad because there are a few that do not have parents that have bonded either! I am looking for GOOD research to take to our CD to bring back primary care.
We have three residencies that have not experienced taking care of a pt from admit to discharge, no matter what. Now they are scared to death to take care of the huge baby with all the crap. For me it has also taken alot from my job satisfaction. There is nothing compared to seeing a child at 5 and the parent saying this is the nurse that took care of you!
So how is it done in your units??
Are they assigned? By choice??
Does everyone do it or just a few??
What is the best reasoning to give our CD to return to primary care?
(we stopped because some were using it as a way to remain in the unit with the highest accuity baby then dumping it after the moving started and signing up for your stretch to the baby with the nice parents just for the same assignment for those few days)
rush presbytirian st lukes medical center in chicago is a magnet nursing research center and has a great premie follow up program as well as primary care for its babies from admit to d/c.
they have a website and i'm sure you'll get follow up for research and answers to your questions.
we have primary care nurses sign up and are held accountable to there patients thru d/c.(kids cannot be dumped after leaving icu to intermediate unless picked up by another nurse)
if a nurse does'nt have a primary they are given one.
we allow 1 nurse to a primary a shift as well as 2 associate nurses to a primary. per shift(xtra coverage if a primary nurse is off)
we have a premie party for our kids after d/c every year sponsored by our suppliers..it's great karma!
Being a primary is completely voluntary here (and it SHOULD be as far as I am concerned). Some nurses are not suited to being primaries, and forcing them to be will only lead to problems. We just sign up for a baby we want, and there are certain conditions (they must be less than a week old when you sign up, etc). We tried forcing primaries to keep their babies when they went to the intermediate nursery, but we found that nurses who didn't like that area just wouldn't pick up a primary. So now, primaries are allowed to sever that relationship with the baby when they are transferred as long as they told the parents they would not follow the baby there when they signed up and the parents were ok with it. Few do this though....
and it should be as far as im concerned.....some nurses are not suited...old school if you ask me!
it certainly is harder to handle a kid once it goes from nicu to intermediate...some people like the tubes and lines and rn to pt ratio...however when there is 3-4 kids in your care and all the teaching that goes with as well as the constant eye to keep the kid back out of the nicu THATS WHERE THE REAL CHALLENGE COMES IN.....as far as not being suited... the nicu is a choice to be a part of...if not suited then DONT BE A PART!
That's fine if you have unlimited staff. We don't, so a "take it or leave it" attitude would not really fly. In addition we have MANY staff on work restrictions for injuries with very specific restrictions (nurses from other areas of the hospital are often trained for the NICU after an injury because of the fact that it doesn't involve lifting). There are nurses who can not look after infants over 2000g and some who can't look after babies over 1500g. It makes no sense to try to force them to the intermediate nursery where a good number of the kids are big and have to try to get an appropriate assignment for them. It's just not practical. There is also the issue of less experienced staff. We allow them to primary at 6 months, but not to leave the NICU because the managers want new staff to get experience there for at least a year before they go to level 2 for months. Plus, if we have an unsual number of kids on jets and oscillators with lines in the NICU, an experienced nurse with a primary in level 2 will get pulled anyways.
I like being primaried, but I don't see any reason to force people if they don't. There is nothing worse than making people miserable at work for no good reason. People who don't want to go to level 2 generally just don't pick primaries up. That may be preferable to you, I don't know. But I don't have a problem with the rare primary who is upfront about not wanting to go there from the very beginning.
I guess some people rise to the level of expectation...and some can't..point taken.
It would be nice if things were ideal.... I'll keep dreaming....
I also forgot to mention that we have some staff who can only work in level 2, and agency can only work there. So if I have a primary there and we need to use agency, I can get kicked out into the NICU.... Or sometimes 2 nurses have the same primary and when we work the same shift we get to fight over who gets to work with them..... You get the idea.... Staffing is an insane mess, and I don't envy the charge nurses when they make up the assignments.
Personally, I like the break in level 2 on occasion. It's always busy with 4 or 5 babies, but it is soooooo much quieter without the alarms always going off! So even though I work just as hard down there, I feel like it's a little vacation.
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