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Originated in 1969 by staff nurses at the University of Minnesota, primary nursing is a system
of nursing care delivery which emphasizes continuity of care and responsibility acceptance by
having one registered nurse (RN), often teamed with a licensed practical nurse (LPN) and/or nursing
assistant (NA), who together provide complete care for a group of patients throughout their stay in a
hospital unit or department.[1] For the duration of a patients episode of care, the primary nurse
accepts responsibility for administering some and coordinating all aspects of the patients nursing
care. When RNs supervise LPNs and NAs in the care of patients, costs associated with labor and
other resources typically decrease while more attentive, well-coordinated care is provided for
patients, increasing patient satisfaction and safety.
This is distinguished from the practice of team nursing, functional nursing, or total patient care, in
that primary nursing focuses on the therapeutic relationship between a patient and a named nurse
who assumes responsibility for a patients plan of care for their length of stay in a particular area.
Marie Manthey, one of the originators of this care delivery system and the author of The Practice of
Primary Nursing (2002), asserts that a nursing system can enhance and facilitate either professional
or bureaucratic values as it either focuses on caring for people or tending to the needs of an
organization. From The Practice of Primary Nursing, Primary Nursing is a delivery system for
nursing at the station level that facilitates professional nursing practice despite the bureaucratic
nature of hospitals. The practice of any profession is based on an independent assessment of a
clients needs which determines the kind and amount of service to be rendered: services in
bureaucracies are usually delivered according to routine pre-established procedures without
sensitivity to variations in needs.[2]
A delivery system is a set of organizing principles that is used to deliver a product or service and
generally consist of four elements: decision-making, work allocation, communication, and
management.The following table illustrates the similarities and differences between the four most
common nursing care delivery systems:
Element
Functional
nursing
Team nursing
Total patient
care
Primary nursing
RN makes
Decision-making
occurs over a
Decisionmaking
single shift;
decisions usually
made by nurse
manager or
charge nurse.
Decision-making
occurs over a
single shift;
largely by team
leader or nurse
manager.
Decision-making
occurs over a
single shift
either by an RN
caring for the
patient or by a
charge nurse.
decisions for
individual patients
based on their
therapeutic
relationship, which
is sustained for the
length of stay of
the patient on the
unit.
Nurse
Nursing
assignments are
Nursing
assignments are
patient-based to
assignments are
largely patient-
ensure continuity
based on level of
based, with RN
of care. An RN is
Nursing
complexity and
providing
assigned to a
assignments are
commensurate
activities of care.
patient and
Work allocation
task-based,
level of expertise;
Nursing
remains that
and/or patient
nurses are
focus is on tasks
assignments may
patients primary
assignment
assigned to tasks
to be
vary by shift
rather than
accomplished;
based on
as the patient
patients.
assignments
geography and
change based on
patient acuity,
(unless
without
circumstances
work complexity.
supporting
continuity of care.
primary nurse is
assigned).
Communication Communication is
Communication is
Communication is
Communication is
hierarchical; task
hierarchical; the
direct. However,
direct. Patient
completion is
care provider
in some Total
information is
documented and
reports to the
Patient Care
solicited by the
communicated to
systems, RNs
team leader
may be required
communicates
directly and
the charge nurse
to communicate
pulls information
together for all
reports to
patients and
physicians and/or
communicates
with other
team members.
members of the
with physicians
and other
members of the
health care team
through a charge
nurse.
proactively with
team members,
physicians, and
other colleagues.
The primary nurse
is responsible for
integrating
information and
coordinating care.
Managers promote
the nurse-patient
Nurse manager
Management of
the unit or
environment of
care
assuring that
is responsible for
tasks are
supervising other
accomplished.
staff in the
delivery of care.
relationship and
Managers serve
the professional
as a resource and
promote nurses
They influence
having a stronger
care by creating a
role in care
healthy work
decisions.
environment and
empowering the
staff to remove
barriers to care.
From the book Relationship-Based Care: A Model for Transforming Practice (2004), Mary Koloroutis,
editor. Used by permission.
[3]
Contents
[hide]
2 History
3 See also
4 References
From the book Relationship-Based Care: A Model for Transforming Practice (2004), Mary Koloroutis,
editor. Used by permission.[3]
History[edit]
Marie Manthey tells this story about the origins of primary nursing in the book Relationship-Based
Care: A Model for Transforming Practice:
Primary Nursing was implemented in 1969 on Unit 32 at the University of Minnesota Hospital. This
radical change in care delivery came about when a colleague, Pat Robertson (nursing supervisor)
and I (assistant director of nursing) held an evening meeting with nursing staff and leaders at [my]
home. This was an unprecedented and radical actionto invite staff nurses and leaders to come
together to figure out how to improve patient care and the work environment itself. The nurses told
stories about attempts to implement [care delivery systems like] Primary Nursing elsewhere in the
United States, and we discussed how it could happen in our organization. Our message to the staff
that night was that they have the ability to influence their own practice and how it will lookand step
one was that it was okay for them to make patient assignments. (p. 170)
The first seminar presenting primary nursing to the nursing community took place in 1970, and the
first article, "Primary nursing: a return to the concept of 'my nurse' and 'my patient', co-authored by
Marie Manthey, Karen Ciske, Patricia Robertson, and Isabel Harris was published in January 1970 in
the journal Nursing Forum.[4] A second article, "A Dialogue on Primary Nursing," written by Marie
Manthey and Marlene Kramer, was published in the journal Nursing Forum in October 1970.
[5]
Throughout the 1970s, interest and development were steady, but never well-organized; however,
several hospitals quickly realized the benefits of a primary nursing care delivery system to patients
and nurses. The nursing staffs at Boston Beth Israel led by Joyce Clifford and Evanston Hospital led
by June Werner were early adopters of primary nursing and were recognized for their outstanding
work in fully implementing this professional nursing model.
See also[edit]