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Primary Nursing Paves the Way for Safer, More Rewarding Care

By Janet Weaver, MSN, RN, NE-BC, Consultant at Creative Healthcare Management

I have to admit that I am dumbfounded by the resistance I’ve encountered from direct care providers, right up to the CNO, to Primary Nursing. The first time I heard a colleague share an example of a Primary Nurse explaining his or her role to a patient, I remember thinking, “This is great; I would really feel safe as a patient or family member if my nurse spoke those words.”

It sounded something like this:

Hello, my name is Janet Weaver, and I am your Primary Nurse. I will be responsible for you during your stay in this department [episode of care]. I will listen to what is important to you and communicate with others what we agree on for how best to deliver your care. I will make sure you understand how to care for yourself before you go home.  

I once had the good fortune to have a nurse speak very similar words to a family member of mine. She was my mother’s hospice nurse. I had total trust in her because it was evident that she was making an authentic effort to know my mother, that she would ensure that my mother’s needs were met, and that my mother would not experience harm from anyone’s lack of knowing.  This nurse had my mother’s back. Why would any nurse not want to provide this type of care for patients and their loved ones? 

The Primary Nurse Becomes a Care Partner

Primary Nursing is a care delivery system that puts the responsibility for decision-making for a set of patients in the hands of one nurse for the patient’s episode of care. The Primary Nurse partners with the patient to develop a plan of care that will best meet the patient’s needs, and communicates this plan with others caring for the patient. The Primary Nurse may delegate some tasks as appropriate, but the Primary Nurse coordinates all care provided to the patient. 

Safe quality care is on the mind of everyone delivering healthcare these days. Primary Nursing provides the necessary structure for RNs to function to the height of their licensure and education. What better way could there be to positively impact Nurse Sensitive Indicators (NSI), those components of care for which nurses have direct control, than a Primary Nurse coordinating and following a patient’s care?

Improved Patient Care Experiences

Adopting Primary Nursing is not an easy transformation to implement; it challenges staff on many levels. They must become skilled at managing their interpersonal relationships, establish trust and respect with one another, and open lines of honest communication. Accepting responsibility for the development and management of a patient’s care can concern nurses for a variety of reasons. Still, what I have repeatedly experienced is that nursing staff members, despite their initial misgivings, find that Primary Nursing makes possible a higher degree of professional nursing practice, and they witness patients having an improved experience of care. 

In discussions I have with organizations contemplating a change to Primary Nursing, along with the inevitable resistance, I’ve also seen people’s faces soften as they begin to get a clearer vision of what Primary Nursing makes possible. As they experience the rewards of a responsibility relationship, they realize that Primary Nursing has little in common with the often unsatisfying way they currently practice; instead, it puts a structure in place that makes it possible for them to practice in the way they’ve always hoped to. Nurses engage and become enthusiastic when they’re shown the vision of an infrastructure that actually makes room for knowing the patient as a person and really being able to tailor care to his or her unique needs and circumstances. 

With the support of an expert guide, staff creatively (and often eagerly) overcome the initial challenges and misgivings and successfully implement Primary Nursing. Staff I have worked with have shared improved patient outcomes, such enhanced patient communication and partnerships when in the role of a Primary Nurse. I suspect and hope that you’re now thinking of the ways you too will impact patient care as you implement Primary Nursing. 

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). jweaver@chcm.com

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