Primary Nursing Care

The problem is that if I spend 70% of my time at the bedside, there simply will not be enough minutes left in that 30% left for the level of documentation expected, the phone calls, the hunting down of this or that thing the patient needs, communication with physicians, and helping out co-workers where a second set of hands is needed. Not unless you decrease the number of patients we are responsible for, and I think there is a fat chance of that. I would LOVE to spend more than 70% of my time with patients and their families!

I have done primary nursing. I would advocate for it with the following caveats:Will I get the support I need when the time comes that I need that support. Patients are sicker, families more demanding, 25 hours needed in a day...

Quote from JoPACURNPatients are sicker, families more demanding, 25 hours needed in a day...

I don't want to spend 70% of my time with my patients, they're sick.

Primary nursing is very expensive. I was working in Boston when Joyce Clifford who implemented at Beth Israel, the nurses were deliriously happy. Then BI hit budget cuts and Primary Nursing went out the window. I love Primary Nursing but it requires nurses to work 8 hour/five days a week. It also requires 24 accountability.My current hospital is over 90% in patient satisfaction and we do not use primary nursing. As a professional, I loved primary nursing when staffed correctly and the nurse is empowered to make change.

We have been slowly doing away the the "tech (nursing assistant)" role in our hospital. So what will happen is that one tech on a floor of 20 or so patients will choose a couple patients from each nurses assignment as their own. The tech is now getting vitals/I&O's bathroom lights on 1-2 of my 5 patients. I am responsible for the rest. It gets downright confusing. You have to be constantly reminding yourself of which patients vitals and accu checks to get, who needs bathed, yada yada. Well I hate it. Techs are very valuable to the nursing role and I have seen patient satisfaction decline as a result (pt feedback as my only basis). Its embarrassing to say "I'm sorry Mr. Jones that we didn't get your bed changed today. We'll try our best to get it done on the next shift." What can you say? Oh, staffing sucks, sorry you had to wait 15 minutes before I could get to your room, I was in an isolation room in poo up to my elbows!" I just think that primary nursing is a positively bad idea. I don't see it working in my hospital and my personal job satisfaction is going down the toilet too.

I've tried primary nursing care and believe that it would be awesome if staffed correctly. As a RN that has also been an aide, I can tell you what the aide does is a full time job some days depending on the type of patients you have. The LPN's job can be a full time job some days when you have patients with 10 or more PO meds, plus IV and AC/HS blood sugar checks and insulin. The RN, yeah, even as a new RN that has only worked a little over 6 months I have come to understand how much stress the RN is under. Not only do we have to do our own assessments and all the paperwork that is involved (btw, my hospital still does paper charting, not much computing done here), we are also responsible for the jobs the LPN's and aide's are supposed to be performing. If you work in a hospital where the people in those positions are doing their jobs right, be proud. It isn't always that way and when the RN has to come behind them it makes the job MUCH harder than it should be. If we are to go to primary nursing, it will only work if the nurse to patient ratio is reduced accordingly. Say, just doing the RN job, you take up to 10-12 patients with the LPN and aide doing their jobs... and you change to primary nursing it should be 1/3 of what you normally take, which in most cases would be 3-4 patients to 1 RN. That will never happen. It is just not cost effective for a hospital to hire another RN when they could hire a LPN and at least one aide for the same cost.

I guess we do primary nursing care. We do all the work, no LPN or tech on staff. I think our patient satisfaction scores are in the 70 to 74 percent range. The problem is that everyone hates to work there. They call me all the time to work extra hours but I don't want to be there the hours that I am supposed to be there. If the economy wasn't so bad people would leave there left and right. The manager walks around and tries to figure out new ways to slow everyone down and make the job even harder than it already is. I love it when I am in the middle of giving insulin and the unit clerk tells me that someone needs to go to the bathroom.

I congratulate you for voicing something that i have long been pondering; the practicality of our nursing practice and theory. We know our realistic client to nurse ratio and we know what is the ideal client to nurse ratio however the bosses of our health institutions who claim that they are in the business of helping people be healthy are knowingly ignoring the fact that in order to fulfill their dream of providing quality client care, they need to know and understand the dynamics in the system. Nurses need to stop compromising because they are the ones that end up sick, alone, and financially broken after they have to pay for care at these very same health institutions.:smackingf

During my stint in primary nursing care i spent way too much time trying to figure out ways to get info sorted. My mum told me that I should consider the Skyscape Pearson Nurse's Guide drug -2010, at first I was wondering how it would work on my droid, but tech savvy mum was actually right! I'm so happy with this I just had to share it! It actually provides safe, comprehensive and effective drug information which is in an easily accessible format. It's been recently revised fully. It actually has all the latest drugs approved by the FDA. You can actually see the effects, dosages, forms and all sorts of additional details as well as how to administer them - via oral/I.V. etc. It's pretty cool! It lists all the drugs in Alphabetic order (- with the Generic drug names!!) - I can actually access an index that identifies the generic, the trade, prototype as well as combination drugs. This guide has also the prescribed dosages for neonates, infants, adolescents, adults as well as certain patients with renal, hepatic impairment or obesity (- could you seriously ask for more info?). This guide even offers the various side effects as well as family/patient training information for every drug. (I can't believe mum was right - and I'm not going to admit it to her, but god this is a great guide!! )

Quote from John20I don't want to spend 70% of my time with my patients, they're sick.

I am a charge nurse in a hospital that uses "primary nursing" meaning an RN takes 3-4 pts without a tech or LPN and they also use "team nursing" where an RN is paired with an LPN or tech and has 6 pts. Depending on how many pts we have and what the magical staffing matrix calls for dictates how much staff we have. We give the "primary" nurse the "best" pt assignment meaning the pts that can get up with minimal assist, need little PRN, etc. The problem is making sure that nurse is able to get to all the call lights. In addition we have hourly rounding where the staff is to go in to every pt room once an hour to check pain, potty, position. Thats not going great so we have not seen too much reduction in call light usage. Primary nursing can be good if its assigned correctly. Even if not assigned correctly pairing 2 nurses who can work well together with 7-8 pts can work well. It's all an theory of what is best. I think both ways can work well if people can work well together and help each other when in need. I do think we rely on "patient satisfaction" scores way too much. My floors scores are like a rollar coaster. We have tried everything from customer service rounds, discharge call backs, manager rounds, etc. I work with a great bunch of nurses and can not understand why we vary so widely month to month. Pt's are sicker, nurses have lots of responsibilities, and life as a nurse is difficult. We may not get the blood off the sheet "stat" but we gave the pt with a hgb of 5 the life saving blood they needed "stat." Whats more important?