Primary nursing in the NICU

EricJRN, MSN, RN · Mar 29, 2006

Our unit does some primary nursing. Nurses usually request to be primary on the younger, sicker kids who we know will be there a long time. Often a kid will end up with an AM primary and a PM primary. There can be some scheduling circumstances where the kid doesn't get assigned to their primary, but it's rare. Most of the nurses on our unit like it because your assessments, MAR's, etc tend to go faster once you know the baby.

futuregaspasser · Mar 29, 2006

Yes and no. We do primary in a perfect world. Usually though it is more like you get your same babies for the three days you work (if your days are in a row). Primary works better on the younger babies for us. By the time they are to the grower feeder stage, they are up for grabs (as we are short on NICU nurses and often have labor or PP nurses helping on our unit).

**canoehead, BSN, RN** · Mar 29, 2006

I can remember floating to the NICU and getting the feeder/grower room. It seemedlike I was racing to beat the clock to get those feeds in all night. It never faileed that a child would have to take 45cc Q3h and they'd conk out with 10cc left. Enough to make a difference, but just one good swallow for anyone bigger. It was SOO frustrating.

I also noticed that some parents would come in and notice a "new" nurse had their child and they'd give you the 3rd degree about the long term plan for their child and what did this test mean, or that. I'd explain about floating, but I'd answer the best I could, but still they'd freak if I said something that didn't jive with what NICU staff had told them. Shhesh...I told them I really didn't know!

BittyBabyGrower, MSN, RN · Mar 29, 2006

Yes we do. Each baby has a primary and an associate on each shift. If it is a night primary, then they co-primary with a day shifter so that someone is there for rounds. For the chronics, we can have more than the usual 3 associates and can have co-primaries as it does get tiring sometimes taking care of these kids and you need a break. The only problem we have is when 4 of the same shift people sign up for the kids in the same room and then they squabble about who gets their kids. We usually assign them by acuity or d/c needs. Gotta play nice.

Gompers, BSN, RN · Mar 29, 2006

If you search the NICU forum, there are quite a few threads about this...

I'm just cutting and pasting my reply from one of those threads:

We use primary nursing and really love it. It's entirely voluntary, and "dropping" a baby once it's not sick anymore is really really looked down upon, so it doesn't happen very often. We try to make sure each baby has a primary nurse (any shift), and then we can also sign up to be associate nurses to take care of the baby when the primary isn't there. Some babies have up to 8 associates!

We have a big board where all the babies are listed, with the primary nurse's name next to it and then the associates after that. The charge nurse takes the assignment sheets for the next day to the board and pencils in primary and associate babies next to the nurses' names. Of course they try to assign all the primary nurses to their babies first. Then they pencil in the associates, and these are given second priority. If there are multiple associates on for a single baby, the one whose name is further up the list (signed up earlier) gets first dibs. If a baby's primary won't be in until evening or night shift, the baby is assigned to someone who will be leaving when the primary comes on. It works out really well, considering that we do 4, 8, 12, and 16 hour shifts.

Primary nursing works really well for us, as we enjoy continuity of care and feel that it really does help in terms of picking up little changes from day to day. The parents really love it too, especially because we do associate nursing as well. It seems that some babies almost always have the same nurses, day after day, and the parents have said that it makes them feel so much more comfortable. Of course, there is a downside here - it makes parents really wary of "strangers" sometimes. You have to explain that it's an ICU and that they won't always get "their" nurses but that everyone is very qualified even if they don't "know" their child.

For me, it makes me excited to go to work to see "my" babies and how they're doing. Because we've bonded with these babies and their families, it makes such a lasting impact on them. Parents say it intensifies their rollercoaster ride in the NICU to have someone familiar to celebrate with or to greive with. They know that we spend more time with their children than anyone.

futuregaspasser · Mar 29, 2006

I can remember floating to the NICU and getting the feeder/grower room. It seemedlike I was racing to beat the clock to get those feeds in all night. It never faileed that a child would have to take 45cc Q3h and they'd conk out with 10cc left. Enough to make a difference, but just one good swallow for anyone bigger. It was SOO frustrating.
I also noticed that some parents would come in and notice a "new" nurse had their child and they'd give you the 3rd degree about the long term plan for their child and what did this test mean, or that. I'd explain about floating, but I'd answer the best I could, but still they'd freak if I said something that didn't jive with what NICU staff had told them. Shhesh...I told them I really didn't know!

As I mentioned in my post we have nurses float to our unit a lot and work with our grower feeders. I have had parents of my previously "primary" assignments comment to me about this, and how they seem to have a "new" (different) nurse every day. I tell them this is a good thing, meaning their baby is getting better and will be going home soon. This makes them feel a lot better about not having a consecutive nurse anymore. Of course we always check on "our" babies, and visit with the parents on their progress when we can. This comment also works when parents are upset their baby no longer has a one on one nurse, and now their babie's nurse has a 3:1 assignment (i.e. your baby is getting much better and no longer requires one on one)

NicuNightRN · Mar 29, 2006

We do primary nursing, which is great for the nurses who sign up for a primary...but it's a pain for nurses who don't or can't take a primary. I have a primary now, but before, I would end up filling in on nights off, meaning my assignments weren't the same even when I had my nights in a row. I love having a primary now...it makes report so much easier when there is a complicated medical or social history, and I think it's a lot easier to pick up on subtle changes when you know the baby. Not every baby has a primary, but the second we get a micropreemie, people fight to be primary! Parents really like it because the same person is taking care of their child.