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Primary nursing

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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:



Team nursing

Total patient

Primary nursing

RN makes
occurs over a

single shift;
decisions usually
made by nurse
manager or
charge nurse.

occurs over a
single shift;
largely by team
leader or nurse

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
relationship, which
is sustained for the
length of stay of
the patient on the


assignments are


assignments are

patient-based to

assignments are

largely patient-

ensure continuity

based on level of

based, with RN

of care. An RN is


complexity and


assigned to a

assignments are


activities of care.

patient and

Work allocation


level of expertise;


remains that

and/or patient

nurses are

focus is on tasks

assignments may

patients primary


assigned to tasks

to be

vary by shift

nurse for as long

rather than


based on

as the patient



geography and

remains on the unit

change based on

patient acuity,


patient acuity and



work complexity.


require that a new

continuity of care.

primary nurse is

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

team leader; the

systems, RNs

primary nurse who

the charge nurse;

team leader

may be required


directly and
the charge nurse

to communicate

pulls information
together for all

reports to

patients and

physicians and/or


other health care

with other

team members.

members of the

with physicians
and other
members of the
health care team
through a charge

health care team.

proactively with
team members,
physicians, and
other colleagues.
The primary nurse
is responsible for
information and
coordinating care.

Managers promote
the nurse-patient
Nurse manager
Management of
the unit or
environment of

Managers function supervises the

as overseers,

team leader who

assuring that

is responsible for

tasks are

supervising other


staff in the
delivery of care.

relationship and
Managers serve

the professional

as a resource and

role of the nurse.

promote nurses

They influence

having a stronger

care by creating a

role in care

healthy work


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.


1 Myths and facts about primary nursing

2 History

3 See also

4 References

Myths and facts about primary nursing[edit]

Myths about primary nursing

Facts about primary nursing

Primary nursing can be implemented with the available

Primary nursing requires an all-RN

staffit does not require special staff, nor does it require

an all-RN staff. Licensed practical nurses, nursing
assistants, and other team members play vital roles in
meeting the needs of the patient and his or her family.

The essence of the primary nurses role is the acceptance

of responsibility, authority, and accountability for decisions
about patient care. It is not about the primary nurse doing
it all.
The primary nurse does all of the
bedside care.

It is simply not practical for the primary nurse to complete

all aspects of care. Obvious barriers to singular care by a
primary nurse include shortened length of patient stay;
escalating patient acuity levels; complex, multifaceted care
requirements, and the cyclical nursing shortage. If the
primary nurse were doing all of the bedside care, he or she
would not be able to assume responsibility for planning and
coordinating the patients care.
Teamwork is critical to the primary nursing care delivery

Primary nursing eliminates

teamwork. Everyone works
individually and therefore is not
aware of patients other than their
own. In a primary nursing model,
care providers do not help each

system. It has been demonstrated that the best utilization

of ancillary staff is in relationship with one RN(at least
within a given shift)not assigned to help many. However,
a general culture of helpfulness based on a shared
commitment to all patients and team members is
necessary to achieve consistently safe, quality care.
Primary nursing supports collaborative interdisciplinary
practice through communication and coordination.

Complex scheduling requirements

Clinical staff report a 25% reduction in work redundancy

prohibit continuity of the nurse-

due to day-to-day continuity of care. They also report a

patient relationship central to the

perceived increase in productivity through more consistent

co-worker assignments. The key to achieving these results

is to find creative methods to schedule nurses with
primary nurse model.

continuity of care as the priority. For example, if a patients

anticipated length of stay is three days, schedule nurses
three consecutive days.

From the book Relationship-Based Care: A Model for Transforming Practice (2004), Mary Koloroutis,
editor. Used by permission.[3]

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.

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]