Discussion: Conceptualized Primary Nursing Discussion: Conceptualized Primary Nursing
Discussion: Conceptualized Primary Nursing
Discussion: Conceptualized Primary Nursing
Discussion: Conceptualized Primary Nursing
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The disadvantage of this system is that RNs spend some time doing tasks that could be done more cost-effectively by less skilled persons. This inefficiency adds to the expense of using a total patient care delivery system.
Primary Nursing Conceptualized by Marie Manthey and implemented during the late 1960s after two decades of team nursing, primary nursing (Figure 3-4) was designed to place the registered nurse back at the patient’s bedside (Manthey, 1980). Decentralized decision making by staff nurses is the core principle of primary nursing, with responsibility and authority for nursing care allocated to staff nurses at the bedside. Primary nursing recognized that nursing was a knowledge-based profes- sional practice, not just a task-focused activity.
In primary nursing, the RN maintains a patient load of primary patients. A primary nurse designs, implements, and is accountable for the nursing care of patients in the patient load for the duration of the patient’s stay on the unit. Actual care is given by the primary nurse and/or associate nurses (other RNs).
Primary nursing advanced the professional practice of nursing significantly because it provided:
● A knowledge-based practice model ● Decentralization of nursing care decisions, authority, and responsibility to the staff nurse ● 24-hour accountability for nursing care activities by one nurse ● Improved continuity and coordination of care ● Increased nurse, patient, and physician satisfaction.
Primary nursing also has some disadvantages, including:
● It requires excellent communication between the primary nurse and associate nurses. ● Primary nurses must be able to hold associate nurses accountable for implementing the
nursing care as prescribed. ● Because of transfers to different units, critically ill patients may have several primary care
nurses, disrupting the continuity of care inherent in the model. ● Staff nurses are neither compensated nor legally responsible for patient care outside their
hours of work. ● Associates may be unwilling to take direction from the primary nurse.
Although the concept of 24-hour accountability is worthwhile, it is a fallacy. When primary nursing was first implemented, many organizations perceived that it required an all–RN staff. This practice was viewed as not only expensive but also ineffective because many tasks could be done by less skilled persons. As a result, many hospitals discontinued the use of primary nurs- ing. Other hospitals successfully implemented primary nursing by identifying one nurse who was assigned to coordinate care and with whom the family and physician could communicate, and other nurses or unlicensed assistive personnel assisted this nurse in providing care.
Patient
Other health care providers
Primary nurse Charge nurse
Associate nurse Associate nurse
Figure 3-4 • Primary nursing.
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