Primary Nursing (relationship based care)

**canoehead, BSN, RN** · Jul 1, 2007

I have seen primary nursing- but if you were the primary you took that patient whenever you had a shift scheduled. Otherwise how could you assess them, or build the relationship?

What's up with being a primary for someone who isn't your patient? It makes no sense.

Nurse032006 · Jul 1, 2007

My point exactly....the assignments are made by the charge nurse of the previous shift, and there have been numerous times that I have not had that patient on my assignment...I don't see how it is going to work if the primary nurse does not get her patient either, also, if we only have one nursing assistant for the whole unit, how is it possible to do primary nursing for all 7-8 patients???? Can you see why I am frustrated????

icie rn, ADN, RN · Jul 4, 2007

It is possible to be a primary nurse for 7 to 8 patients, acuity is the key, but Canoe is right, IF you are the primary nurse you do it all, no one else assesses, no one else plans care, gives meds or treatments unless the CN jumps in to help. Oh yeah, like that happens.

nursenpnk, RN · Jul 4, 2007

hmmm this doesn't sound like the primary nursing I am familiar with. The general concept, I thought anyways was to improve continuity of care. Meaning you would take care of pts that you have had in previous days and be providing all aspects of care for these individuals. I suppose each hospital molds this form of nursing into their own version

anniemac470 · May 10, 2008

Primary nursing can work and is dependant on how it is implemented. It depends on your units length of stay, number of RN staff and whether you choose to have both RN's on days and eves be primary RN's Say your unit is 32 beds, if you have a mix of full time and part time RN staff you might choose to have only staff who work 7 -8 or more shifts a pay period be primary RN's. If both day and eve RN's each took 2-3 patients as primaries you would care for your own primaries each time you worked plus other patients that belong to another primary when they are not there. You need to consider how long your patients are there, whether you work 8 or 12 hour shifts. For units with longer lengths of stay like Rehab 8 hour shifts work better, for mother baby units 12 hour shifts work better. There are many ways to look at it, but the ultimate goal is consistency for the patients and the staff. And yes it can work very well with Relationship Centered care, as the relationships you establish with your primary patients, being able to set shift goals, working together to reach outcomes set by the RN and patient is greatly enhanced when you are primary nurse. good luck

RN1989 · May 10, 2008

From what is being described, primary care and relationship centered care are two different things that someone is trying to merge into one type of care. I've never heard of relationship centered care. From the posts, it sounds like relationship centered care is very involved. Perhaps the reason I have never heard of it is because it is not a reasonable care model in today's system of shortstaffing and lack of everything to do a job.

MISTY BODINE · Jun 30, 2008

Management need a fall guy, primary care is a very hard job. You are held accountable for all the needs and care of a patient and do the math. If you have 6 patients 7 hours of patient care, duties are all iv's,docotrs orders,meds,vital signs,labs, monitoring ect ect. No consideration for no breaks or meals. Mandatory overtime comes in to play because you must stay till your done. God help us all.........

JustaNurse0214 · Dec 18, 2008

Misty...have you considered a career in real estate? WOW! Someday you will advance in your career to management and then, and only then, will you "get it". Best of luck to your patients....again...WOW!

heron, ASN, RN · Dec 18, 2008

I remember when primary nursing was first introduced. It seemed wonderful, then. The primary remained responsible for the nursing care for the length of the admission ... up to and including writing nursing orders according to her/his plan of care in order to provide continuity during those times the primary wasn't on hand.

It's become code for "you're on your own, toots ... you get to do it all with no help whatsoever". Admin. loves it because they get to dispense with workers like LPNs and techs. Great for the bottom line.