primary care teams

RN4Little1s · Oct 22, 2009

We do more along the lines of what you were thinking. When a baby is admitted, nurses sign up to be the day shift, night shift, and weekend primary (because we have several straight weekenders). Whenever that nurse is working, they will have that baby - trumping whoever had them the previous day, etc. You can also sign up to be an associate, which is great when you are in between primaries and lets you have a break for awhile. The associates take care of the baby on days the primary is not there.

soprano3 · Oct 22, 2009

Thank you for your reply. Do you put the sign up sheet away from the bedside? Are people pretty good about signing up or do you have to hound them? What if 2 people who have signed up are there on the same day? Don't mean to be a pest, but you know us NICU RN's tend to be sticklers for details.

Music in My Heart · Oct 22, 2009

From the parent's perspective, I wanted to invite nurses to be primaries, not simply have them assigned. It's about forming relationships, not just continuity of care.

I'm definitely in the "have the nurses sign up for it" camp rather than having them be assigned.

Do all your nurses end up as primaries? I've known a number of nurses who always refuse primary assignments... they just don't like it.

soprano3 · Oct 24, 2009

All our regular part time nurses are on Primary Care Teams, it is expected in our unit. Only the per diems are alternates. I like the idea of admitting a baby & following that family thru it's stay in the ICN, I think most of our nurses would agree. My manager says we can do a trial for 2-3 months to see if this works. So, I may try this system.

RN4Little1s · Oct 24, 2009

We post have a large dry erase board divided into sections. Next to bedspot and pt name there is a spot for primaries labeled with "Day," "Night," and "Weekend." Then there is another block next to that for Associates to sign up. You can only have one primary, but you can be an associate for up to 3. We keep a binder with all of this information in it on a paper chart so that it can be taken to staffing meetings to make assignments. Everyone should at least be signed up for a couple of associates, but they do not have to be a primary if they don't want to. However, within 24 hours of admission, the infant must have a primary list stated - i.e. someone should sign up for this infant to have some continuity.

I understand what you are saying from a parent's perspective, but part of the reason we started this was because our parents started thinking they could hand pick the RN on the next shift who would have their baby. They got grumpy if they couldn't. They would flat out refuse a nurses. It was ridiculous and it was not culitvating relationships. Parents always have their favorites, but this was out of control. I don't feel like parents new to the NICU know to "invite nurses" to be their primaries. Nurses that choose to primary a baby usually tell them that they will be their primary RN and take care of them whenever they are here.

Nurses choose to sign up for which babies they want in our system, and it is usually because they meshed well with the family on the couple of shifts they started caring for them. So it works out that way.

Let's say it's day shift. Let's say the infant's true day shift primary is not there. If 2 associates are there and one had the baby the previous day, they would keep the assignment. If 2 associates are there and neither had the baby the day prior, you would have to look at all the assignments and see which RN had another one of their associates available. It's a puzzle - it takes about 10 minutes to figure out using the primary RN binder and staffing list each shift. But you get used to it! Let me know if you have any more scenarios you have questions about.

NeoNurseTX, RN · Oct 25, 2009

We have a list of the babies at the charge desk where we can sign up. If they have 2 primaries that are there at the same time, the primary that was there the day before gets them back.

soprano3 · Oct 25, 2009

We keep our primary care teams at the Charge Nurse desk & she/he makes the assignments for the next shift using that matrix as a guide, but sometimes your primary is paired with someone else's primary which causes problems. Also, some fill in charge nurses don't follow the matrix & just go by who the nurse had the day before so there's not as much consistency.

NicuGal, MSN, RN · Oct 29, 2009

We use the dry erase board method also...it is divided into our pods with each bedspace lined out. Babies can have 2 primaries, one on days, one on nights and one associate for each shift. We do not let parents pick nurses...that leads to many problems and can cause a rift in the staff. I understand what you are saying, but we can't allow that to happen.

We always try to give out primaries, but if you have 3 day primaries in one room and they are all there at the same time, then the sickest kid gets the primary, or if a primary is going home, then he/she is assigned their primary. We play pretty nice with each other and share.