Health Care System and Primary Nursing Care

Primary Nursing Care and Health Care System

Primary Nursing,Historical View of Primary Nursing,Primary Nursing and Nursing Research,Cost Saving and Inpatient Hospitals

Primary Nursing

    Primary nursing is a nursing care delivery system that places the nurse-patient relationship at its center. One nurse is accountable and responsible for planning, management, delivery, and evaluation of a patient and his or her family's nursing care. 

    Primary nurses practice with a small group of associate nurses who care for the patient in their absence. Continuity between nurse and patient is essential. Primary nursing flourishes best in an environment that recognizes the unique contributions of the professional nurse and supports the various components of professional practice. 

    Typically, a decentralized approach to nursing management featuring a clinical nurse manager, participation in professional committees, and strong systems of accountability are present. Autonomy and authority over nursing practice are emphasized.

Historical View of Primary Nursing

    Primary nursing was initially conceived in the early 1970s by Manthey, Ciske, Robertson, and Harris (1970). Giovannetti (1980) extended this work, and Clifford (Clifford & Horvath, 1990) is widely recognized for expanding a nursing care delivery system into a professional practice model. 

    Historically, primary nursing has been anecdotally identified as a strong predictor of patient and nurse satisfaction. Research on primary nursing has been fraught with conceptual and methodological challenges. 

    Many studies lack conceptual and operational definitions, theoretical frameworks are not explicitly stated, instrumentation is frequently flawed, and research design less than rigorous.

Primary Nursing and Nursing Research

    Despite this lack of research rigor, primary nursing was widely implemented. Many of the original magnet hospitals, for instance, used a primary nursing model. 

    Lack of cost-benefit analyzes and measures of effectiveness contributed to a building sense in many hospitals that primary nursing was no longer affordable, and many of the myths associated with primary nursing were promulgated. 

    Many believed, for example, that a 100% RN skill mix was necessary for primary nursing.

Cost Saving and Inpatient Hospitals

    Recent pressures to decrease the cost of inpatient hospital care and wide spread adoption of reengineering principles have resulted in new patient care delivery models. Many of the patient focused care models herald a return to the team or functional nursing care delivery models of the past. 

    Concepts such as the nurse patient relationship, professional nursing practice, and continuity between nurse and patient are conspicuously absent in many of the new patient focused care models. 

    Rather than recognizing primary nursing as one of the earliest process redesigns in health care, elaborate new systems are being promoted that actually create numerous handoffs between team members. Clinical nurses are in jeopardy of being pulled further from patients to coordinate an increased volume of support tasks. 

    Interestingly, many of the methodological flaws present in the initial evaluation of primary nursing have returned to the evaluation of patient focused care models. 

    Instruments lacking validity and reliability, inappropriate sampling methods, and lack of operational definitions prevail. Once again, major decisions are being made about nursing care delivery without rigorous evaluation.

    Those institutions that have reaffirmed a commitment to primary nursing and professional practice models offer another opportunity to scientifically assess the outcomes of this nursing care delivery system. Rigorous qualitative and quantitative methods are required in this important area of research.