Primary Nursing Care

I fully expect that RN burn out will gain momentum in the next few years due to the increased pressure felt by our nurses. Rn's continue to leave the profession, recruitment is tight and hospitals have to tighten their budgets to reflect the current economical crisis. Whilst we all acknowledge that our priority is high quality patient care, we have to question what cost?

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Where I used to work, 8 nurses have left in the recent months and not 1 nurse has been employed to fill in the gap. The work load has increased, expectations remain the same and the clients are getting sicker.

We all know despite the current nursing job freeze and the effects this is having on our new nursing graduates, we do face in our near and distant future a increased nursing shortage with the 'baby boomers' getting older, generations are living longer and RN's who are in their 60's and 70's working because they cannot afford to retire.

Is Primary Nursing Care being seen by some as the new way forward? If you said yes then you would be correct, there is current a new wave of thinking that we must revert to the old in order to move forward to the future. We must always think first and foremost about pt satisfaction, because financially this means pts will return to our facility time and time again, and will recommend the hospital to others, which in turn increases our revenue. In recent surveys at my hospital patients said what helped to improve their stay in hospital was lots of interaction with their RN. The least satisfied Pt's were the ones who said they hadn't seen enough of their nurse and some could not even remember the name of any RN's who had cared for them.

What happened recently in my hospital, they closed 6 beds because there were not enough nurses but then they open up 3 beds because ER was full as there were no more beds in the hospital. Did the floor get another nurse no they had to flex up. This added pressure and stress on the already overworked RN now they have 1 more pt which means 3 more daily assessments and all the work which comes with a new admission that I don't need to explain at this time.

So somebody came up with a brilliant idea to do Primary Nursing Care where all pts will be more actively involved with their RN. The aim of this is that RN's will spend 70% of their working day at the Pt's bedside, the goal increased pt satisfaction. Is this ambitious? Who can say it is early in the experiment, and RN's are going through the typical problems change brings.

It is important to stress at this time that management did not get any floor RN's on board before commencing this trial and the only documentation the RN saw was a piece of paper which stated their new role. There was however a meeting once a week for a month, and staff were encourage to attend one session this allowed the staff to hear what was happening and an opportunity to ask questions.

They are still waiting to see the patients satisfaction levels to see if this way forward was the right way to go. Sometimes I think health care management are just fumbling in the dark and are so far removed from the shop floor they are unable to think critically. Management just don't seem to comprehend what is happening, the tools they use to measure are old and antiquated and need to be revamped by asking the regular nursing staff to be more on board. Maybe primary nursing care is the way forward all I know is it didn't work in the 80's and 90's so why should it work now?

The disadvantage of involving the floor nurses is again cost. Cost of what cost of time, self, responsibility, education, the list is endless.

Baby boomers - Wikipedia

Primary nursing

Quote

Primary nursing is a method of nursing practice which emphasizes continuity of care by having one nurse (often teamed with a nursing assistant) provide complete care for a small group of inpatients within a nursing unit of a hospital. The "primary nurse" is responsible for coordinating all aspects of care for the same group of patients throughout their stay in a given area.

This is distinguished from the practice of team nursing or functional nursing by dividing duties by patient rather than by function (I.e. passing medications, doing treatments, etc.)

RN with 26 years of experience many of those years spent in dialysis. I have worked in acute care, home, ICHD as a CN, FA, and currently a director.

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littleneoRN

459 Posts

Specializes in NICU. Has 6 years experience.

The problem is that if I spend 70% of my time at the bedside, there simply will not be enough minutes left in that 30% left for the level of documentation expected, the phone calls, the hunting down of this or that thing the patient needs, communication with physicians, and helping out co-workers where a second set of hands is needed. Not unless you decrease the number of patients we are responsible for, and I think there is a fat chance of that. I would LOVE to spend more than 70% of my time with patients and their families!

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU. Has 19 years experience.

I have done primary nursing. I would advocate for it with the following caveats:

Will I get the support I need when the time comes that I need that support.

Patients are sicker, families more demanding, 25 hours needed in a day...

CaLLaCoDe, BSN, RN

1,174 Posts

Specializes in Cardiology, Oncology, Medsurge.

Patients are sicker, families more demanding, 25 hours needed in a day...

And then there's this customer service huey that detracts us from doing our job and that is nursing, not making sure the a tiny bloody spot on a patient's bed be changed stat, but saving lives!

I was fired recently for a customer service related incident. Corporate interest is in having us all mimic the party (corporate) compliance line and not to listen to our voice of reason.

We're being thwarted in our vested interest to serve the needs of the patient. I can recall attending a lecture at a hospital which the speaker, who was not a nurse but a businesslady, stated that we aught to be looking at work as those who work at the Seattle Fish Market or Disneyland. Excuse me, I don't work to entertain the public, but to save lives!

John20

190 Posts

I don't want to spend 70% of my time with my patients, they're sick.

Ginger's Mom, MSN, RN

1 Article; 3,181 Posts

Has 41 years experience.

Primary nursing is very expensive. I was working in Boston when Joyce Clifford who implemented at Beth Israel, the nurses were deliriously happy. Then BI hit budget cuts and Primary Nursing went out the window. I love Primary Nursing but it requires nurses to work 8 hour/five days a week. It also requires 24 accountability.

My current hospital is over 90% in patient satisfaction and we do not use primary nursing.

As a professional, I loved primary nursing when staffed correctly and the nurse is empowered to make change.

We have been slowly doing away the the "tech (nursing assistant)" role in our hospital. So what will happen is that one tech on a floor of 20 or so patients will choose a couple patients from each nurses assignment as their own. The tech is now getting vitals/I&O's bathroom lights on 1-2 of my 5 patients. I am responsible for the rest. It gets downright confusing. You have to be constantly reminding yourself of which patients vitals and accu checks to get, who needs bathed, yada yada.

Well I hate it. Techs are very valuable to the nursing role and I have seen patient satisfaction decline as a result (pt feedback as my only basis). Its embarrassing to say "I'm sorry Mr. Jones that we didn't get your bed changed today. We'll try our best to get it done on the next shift." What can you say? Oh, staffing sucks, sorry you had to wait 15 minutes before I could get to your room, I was in an isolation room in poo up to my elbows!"

I just think that primary nursing is a positively bad idea. I don't see it working in my hospital and my personal job satisfaction is going down the toilet too.

WeS-RN

6 Posts

Specializes in MedSurg/Geropsych so far. Has 1 years experience.

I've tried primary nursing care and believe that it would be awesome if staffed correctly. As a RN that has also been an aide, I can tell you what the aide does is a full time job some days depending on the type of patients you have. The LPN's job can be a full time job some days when you have patients with 10 or more PO meds, plus IV and AC/HS blood sugar checks and insulin. The RN, yeah, even as a new RN that has only worked a little over 6 months I have come to understand how much stress the RN is under. Not only do we have to do our own assessments and all the paperwork that is involved (btw, my hospital still does paper charting, not much computing done here), we are also responsible for the jobs the LPN's and aide's are supposed to be performing. If you work in a hospital where the people in those positions are doing their jobs right, be proud. It isn't always that way and when the RN has to come behind them it makes the job MUCH harder than it should be.

If we are to go to primary nursing, it will only work if the nurse to patient ratio is reduced accordingly. Say, just doing the RN job, you take up to 10-12 patients with the LPN and aide doing their jobs... and you change to primary nursing it should be 1/3 of what you normally take, which in most cases would be 3-4 patients to 1 RN. That will never happen. It is just not cost effective for a hospital to hire another RN when they could hire a LPN and at least one aide for the same cost.

doubleplay

50 Posts

I guess we do primary nursing care. We do all the work, no LPN or tech on staff. I think our patient satisfaction scores are in the 70 to 74 percent range. The problem is that everyone hates to work there. They call me all the time to work extra hours but I don't want to be there the hours that I am supposed to be there. If the economy wasn't so bad people would leave there left and right. The manager walks around and tries to figure out new ways to slow everyone down and make the job even harder than it already is. I love it when I am in the middle of giving insulin and the unit clerk tells me that someone needs to go to the bathroom.

keba

18 Posts

Specializes in Trauma and emergency, Orthopedic, ENT,.

I congratulate you for voicing something that i have long been pondering; the practicality of our nursing practice and theory. We know our realistic client to nurse ratio and we know what is the ideal client to nurse ratio however the bosses of our health institutions who claim that they are in the business of helping people be healthy are knowingly ignoring the fact that in order to fulfill their dream of providing quality client care, they need to know and understand the dynamics in the system.:uhoh3: Nurses need to stop compromising because they are the ones that end up sick, alone, and financially broken after they have to pay for care at these very same health institutions.:smackingf

ryanthomas

1 Post

During my stint in primary nursing care i spent way too much time trying to figure out ways to get info sorted. My mum told me that I should consider the Skyscape Pearson Nurse's Guide drug -2010, at first I was wondering how it would work on my droid, but tech savvy mum was actually right! I'm so happy with this I just had to share it! It actually provides safe, comprehensive and effective drug information which is in an easily accessible format. It's been recently revised fully. It actually has all the latest drugs approved by the FDA. You can actually see the effects, dosages, forms and all sorts of additional details as well as how to administer them - via oral/I.V. etc. It's pretty cool!

It lists all the drugs in Alphabetic order (- with the Generic drug names!!) - I can actually access an index that identifies the generic, the trade, prototype as well as combination drugs. This guide has also the prescribed dosages for neonates, infants, adolescents, adults as well as certain patients with renal, hepatic impairment or obesity (- could you seriously ask for more info?). This guide even offers the various side effects as well as family/patient training information for every drug.

(I can't believe mum was right - and I'm not going to admit it to her, but god this is a great guide!! )

littleneoRN

459 Posts

Specializes in NICU. Has 6 years experience.
I don't want to spend 70% of my time with my patients, they're sick.

What is this supposed to mean? What are you wanting to spend your time doing?