What DON'T you like about primary nursing?

[ceecel.dee]

Please bear with me...we are from the "stix", and are still doing team nursing.

Almost all of "the team" want primary nursing.

We know many of the positives......

Will anyone share some of the negatives? :) :) :) :)

[llg, PhD, RN]

I sat on my first committee to implement "Primary Nursing" as a staff nurse back in 1978 -- and I have worked in many hospitals with variations of "Primary Nursing" since. Primary Nursing as I have known it, is always modified to fit the specific setting. People throw the term around a lot -- with each person meaning something a little different. In my experience, that is where some of the biggest problems develop.

As people try to make Primary Nursing work in their setting, they encounter some problems and then they make adjustments. As time goes by, the system is adjusted more and more to accommodate the specifics of the setting. That is all well and good. However, as the practical day-to-day issues get addressed, there are rarely discussions of the deep-down issues that underlie the model. As each individual has differing views of these deep-down issues, people can end up being unsatisfied with the resulting system because those differing views of the underlying issues were never brought to light and resolved.

For example:

Take the issue of "continuity," one of the hallmarks of Primary Nursing. How does your staff really feel about this? Do your current scheduling/staffing practices promote continuity or not? If it is a core value of your staff, are those people willing to make some sacrifices in their personal lives to provide true continuity? If your staff sees Primary Nursing as a way to "fix" current problems with continuity, are they going to be disappointed when they realize that Primary Nursing won't fix all of the problems? On some units, having high percentage of part time staff members and staff working three or four 12-hour shifts per week actively works against continuity (and Primary Nursing won't fix that?) On other units with quick patient turnover, 12-hour shifts may promote continuity. In other words, if continuity is an issue on your unit, your unit should be discussing the specific details of continuity on your unit -- not relying on Primary Nursing to fix it.

Another, even thornier issue is "accountability." Are nurses willing to be accountable for things that happen when they are not there? -- or for the care that other nurses give when they are not there? Is the Primary Nurse willing to write out detailed plans of care to be followed when she is not present? Are the rest of the staff members willing to follow that plan? If the Primary Nurse is NOT accountable, then it's really a team of people who accountable, is it not? --- then why not call it a variation of Team Nursing?

These are just a few, quick thoughts -- that might not make a lot of sense at first. I hope you can see what I am getting at, though.

llg

[ceecel.dee, MSN, RN]

llg,

Thank you for the info. The continuity issue is something we will have to discuss, as I am predicting quite differing views on this too!

Any other thoughts?

[ceecel.dee, MSN, RN]

llg,

Thank you for the info. The continuity issue is something we will have to discuss, as I am predicting quite differing views on this too!

Any other thoughts?

[mattsmom81]

I trained with team nursing and was fortunate to have good team members and a strong system of accountability for all levels of team members.

I moved to Texas where we did primary care...it's OK EXCEPT the PTB tend to overstretch the RN in the same way as team nursing...seems we're short staffed 99% of the time.

Personally, I prefer primary nursing because I prefer to be responsible for myself vs a team I may not be sure of ..or a short staffed team. JMHO. Guess that's why ICU is my niche. :)

[mattsmom81]

I trained with team nursing and was fortunate to have good team members and a strong system of accountability for all levels of team members.

I moved to Texas where we did primary care...it's OK EXCEPT the PTB tend to overstretch the RN in the same way as team nursing...seems we're short staffed 99% of the time.

Personally, I prefer primary nursing because I prefer to be responsible for myself vs a team I may not be sure of ..or a short staffed team. JMHO. Guess that's why ICU is my niche. :)