Primary Nursing Improves Outcomes

April 1, 2021
April 1, 2021
By Janet Weaver, MSN, RN, NE-BC, Consultant at Creative Health Care Management

There have been times in my career when a change has been introduced, and I cannot for the life of me figure out why the decision was made to alter how we were currently doing things—why we’re changing structures or processes that seemed to be effective and working fine. Sometimes my immediate manager would have an explanation, a hope that this change would effect, and other times…well, there was no good explanation of the why. Still, there was always an assurance that we would have improved outcomes if we would embrace the proposed change and put forth our best efforts into making it work.

When I work with clinical nurses and those supporting the RN to assist them in determining how to implement Primary Nursing, I’m often asked, “Why?” Why should we change our care delivery system to Primary Nursing? What will be different? What about it will be better than how we currently provide care to the patients?

Every essence of my being tells me having a Primary Nurse partnering with patients, their loved ones, and colleagues WILL positively influence all types of outcomes. Sounds pretty strong, I know, but I’ve experienced it first hand from both sides of the bed, and I know the difference of when there is a Primary Nurse and when there is not one. 

What I will do is share with you outcomes of Primary Nursing, from my personal perspective and from evidence, both qualitative and quantitative, of how Primary Nursing improves patient/family and staff outcomes.

There are many types of outcomes; a few general categories include:

  • Patient satisfaction
  • Patient safety
  • Staff satisfaction and professional fulfillment

Patient Satisfaction

In one organization patient satisfaction increased from the 89th to the 94th percentile for nurse attention to personal preferences; patient satisfaction for having their emotional needs met increased from 86.3th to the 96.2th percentile; patient perception for nursing response for their concerns improved from 86th to the 96.2th percentile and patient satisfaction for being kept informed went from the 89th to the 93rd percentile in a two year period after implementing Primary Nursing.

Patients have a better perception of the healthcare experience when a registered nurse takes the time to get to know them, to find out what is most important to them, and to plan and communicate that plan to others.

Patient Safety

The Joint Commission and the IHI have increased awareness about the importance of teamwork and colleague communication as it relates to patient safety and improved patient outcomes. One organization reported improved patient and family perceptions of how staff worked together from the 91st percentile prior to the organization implementing Primary Nursing, and three years later survey results showed they were at the 96.3rd percentile for the same question. Staff also stated an improved perception of communication with one another as well as a general impression of improved colleagueship.

An acute psychiatric facility stated that since implementing Relationship-Based Care and Primary Nursing they now rarely make calls to law enforcement or security. They stated that the primary care giver takes responsibility to connect with the patient and other care team members in such a way that violent outbreaks have all but ceased.

Staff Satisfaction and Professional Fulfillment

Nurses repeatedly report that when they state out loud that they are responsible for coordinating care and communicating the patient preferences that they discover by creating a therapeutic relationship with the patient, they experience a sense of great professional satisfaction.

One nurse shared her excitement about several experiences she had with patients following five minute “sit downs” as part of her Primary Nurse role. She shared:

"It feels like a partnership, jointly working on optimizing hospital stay and recovery. Even sitting at the bedside and really looking the patient in the face establishes a feeling of true connection. A surprising variety of responses is generated by questions such as 'What is most important to you that we need to accomplish this shift? I am here until 11:30 p.m.' or  'What is a central concern about your hospitalization that we can address?' or 'What key questions are on your mind that you want answered?' I am using these questions interchangeably with my patients."

A couple of the patient responses she reported in her email include:

  • “Where is my Prilosec? I take it every day but haven’t had it yet here.” [Investigated; pharmacy oversight that got corrected… patient happy and understands]
  • “This bed is killing my back [ant/post spinal fusion]; it’s like it has a hole in it, and I’m afraid it’s going to hurt my incision.” [changed beds; still no-go; got a hard plastic transfer slider for under the mattress, which made for  one happy patient and wife, who asked where to report “going the extra mile.”]

And my personal experiences:

  • As a family member I felt seen and safe and that the nurse really cared for my family member and for me. I felt confident that everything we needed would be tended to and we would all experience the care we desired.
  • As the nurse providing care, I knew in no uncertain terms that I was meeting every expectation of my patient and his family. I felt a sense of accomplishment that comes from seeing and knowing those needing care and meeting not just their physical but also their emotional needs.

I challenge and encourage you to experience the professional satisfaction and the improved patient satisfaction and outcomes possible when you say to your patient, “Hello, my name is _____ and I’m your Primary Nurse.”

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As a clinical nurse, Janet connected with her patients and felt great compassion for them. As her career evolved and she moved into leadership roles, something she’s done for nearly 30 years, Janet brought that same sensitivity to her teams. As a consultant for CHCM, Janet’s areas of focus include Primary Nursing, orchestrating the implementation of Relationship-Based Care (RBC) and facilitating Re-Igniting the Spirit of Caring (RSC).