whats primary care nursing?

itsmyturn · Apr 21, 2009

We call primary care nurses office nurses.

I have on average 7-8 pts and this is rough.

Sounds to me like they are wanting to get rid of CNAs and have the nurses perform full scope.

Lord, if I did not have my CNA buddy, I would never get everything done.

Thanks CNAs you are the greatest!

rnffemtguy, BSN, RN · Apr 21, 2009

Primary care is just that, you are the primary nurse responsible for all nursing care for the patients you are assigned to, assessments, meds, personal care, the whole nine yards. There are variations of primary care, some units will use UAP's to assist within the scope of practice of the aide/tech.

Team nursing uses a blend of nurses (RN's & LPN's) and UAP's to care for the patients, usually an RN is assigned as team leader with either one or two LPN's or RN's, and some aides/techs, and assigned a group of patients to care for. In this instance it is up to the team leader to assess aquity of the patients and which members of the team will perform which tasks within their scope of practice, this is where delegation skills come into play....

10-12 patients for primary care? Is it feasible?, well, anything is feasible, but is it realistic/safe? NO!!!!!!! At least not on an acute care unit/floor......JMHO........

I'm sure others will chime in with their views on this and insights on primary vs team care nursing, looking forward to the replies.......

Atlas09 · Apr 21, 2009

Holy crap! 10-12 on primary care? My wife does primary care nursing... no techs, EVERYTHING is done by the nurse, she has 3 patients. Her last hospital was primary care with 4 patients but that was rough, 3 is doable. In my honest opinion anything more than 3-4 primary care is unsafe period. If your hospital is saying 10-12 patients on primary care a piece in acute care setting... run, run now.

nwanne7 · Apr 21, 2009

This use to be the way we did nursing care many years ago...(I date myself) in some hospitals.

I worked on medical floor and had 9 patients all on the same wing where I did their total care. I absolutely loved it. I got to know the patients very well, and their families. I knew the vital signs were done and accurate because I took them. Having the extra time with the patients while doing back rubs, meds, helping them at meal time etc.. you get to spend more time teaching them and discussing any concerns and stress issues. You also get a good assessment of the patients when you are bathing them and turning them. The physicians loved it when they made rounds or called in since you could give them a more accurate evaluation of overall how they were doing.

Of course, we always had a few wonderful CNAs to help with some of the care, especially on the day shift.

I know things are more complex now, and more time is spent on charting, but if it can be done right, the continuity of care is excellent.

Saifudin · Apr 21, 2009

"This use to be the way we did nursing care many years ago...(I date myself) in some hospitals."

Your not alone and not so dated. I started on a med-surg floor back in 1978. 36 patients on each side of an H-shaped unit with a central station facing the elevators.

As I recall, we were usually two RN's, an LPN and a nurses aid on the AM shift, then 3 of us (RN, LPN, NA) on evenings and nights for each team so we split the patients with each RN caring for 13 patients on the morning shift. Of course, we didn't have the same level of technology and things were very much hands on. Most of the day was spent in patient rooms. Also, we functioned as at team with each looking out for the other. It was a great experience fresh out of school.

Primary care, as it was then meant total patient management, which was direct care and coordinating functions for tests, procedures, etc. It was very hectic and busy depending on the level of care required but I was much younger then and could tolerate it.

I remember that nurses were close with their patients and we had few problems with family and friends 'camping out' or creating problems. There was a very high level of control from the hospital on visiting and the number of visitors, while patients and visitors were very respectful of staff.

llg, PhD, RN · Apr 21, 2009

The are many variations of primary care. In some, the RN does all of the care and there is minimal use of assistants. However, in others, there are still CNA's, LPN's, etc. and the key element is that a single RN oversees that patient's care from admission to discharge. She may not give all the hands-on care herself, but she is planning all of the care and coordinating it. She is responsible for developing and documenting a plan of care and then following up to see that it is being carried out appropriately.

Like most other things ... whether or not it is feasible depends on the details of how it will be defined and implemented.

Saifudin · Apr 22, 2009

"our hospital is trying to come up with a plan to have solely primary care nursing, instilling the thought that nurses SHOULD TOTALLY CARE the asigned patients, including meds, carrying orders, vital signs taking, and other request peratining to their assignment. Added, to that, the load to be given includes 10-12 patients."

This sounds more like the Total Patient Care Model. In this model the nurse is responsible for what you are describing, total care, and is often referred to as primary care. This model is best in areas that require a higher level of expertise with patients with high acuity. This model only works with limited numbers of patients like in a critical care 1:1 or 1:2 setting.

If your facility wants a true primary care system 10-12 is too many patients. I believe a team approach would work better. Realistically, a mix of approaches is what many do and according to various factors, staffing, types of available staff, census, acuity, etc. In my experience primary nursing is planning, managing and coordinating a patients care with off-shift nurses carrying out your plan of care. True, the primary nurse is direct care and closely linked to the patient but other care needs can and are done by other staff (i.e., LPN, CNA). But, perhaps it was more of a modified approach. No need to be to rigid.

emjay86 · Apr 23, 2009

thank so much for the posts. it reallly helped a lot knowing about nursing care, even including those of your experiences.

karenG · Apr 23, 2009

thats interesting.

over here, primary care refers to patients seen outside of a hospital setting. I work in primary care, we are seen as the first port of call for any patient so its primary care! patients cared for in hospitals are in secondary care.

Interesting how we use the same language but the terminology is different!

loriangel14, RN · Apr 23, 2009

We pracitice what we call primary care where I work. Usually you have 4 pts on days and 6 on evenings and you are responsible for them comp[letely. We have no techs or aids. I enjoy working like this because I can assess as I am doing all cares.

emjay86 · Apr 24, 2009

would that be the maximum load? 4? and 6?

our hospital lets us on with 10-12 though..huhu