Understanding the Primary Nursing Care Model

Although it’s been around for close to 50 years, primary care nursing is often misunderstood or overlooked as a model for effective nursing care. To deal with any uncertainty about where it could be deployed, or where it might not be of value, let’s look at the basics of what the primary nursing model is and does.

First, realize that in addition to primary care nursing, other nursing-delivery models include:

• Team-based nursing: Pairing nurses for individual patient care
• Modular nursing: Similar to the team-based approach, where the unit is divided into quadrants and teams are assigned to each.
• Functional nursing: Nurses are each assigned specific care tasks and have a single-source direct report nurse.
• Float nursing: Nurses move from unit to unit on a set schedule, or are stationed in a permanent float pool

Each has its adherents, and each can and should be evaluated to see if it would work in the particular healthcare setting under review.

Primary Care Nursing Model Definition

Primary care nursing is when a single nurse is identified as the point of contact and primary caregiver for a patient during his or her particular hospital stay or other episode of care. As envisioned by staff nurses at the University of Minnesota in 1969, the primary care nursing team is composed of that lead nurse, who directly supervises the engagement of a licensed practical nurse and/or nursing assistant in that patient’s care. Further, the primary care nurse acts as care partner, serving as communications liaison between the patient and his or her doctor and other care team members. (In many facilities and systems, the position of nurse practitioner has been created to fulfill this role.)

The Primary nursing model is hailed by proponents as creating a better bond and trust relationship between patients and caregivers, thanks to that single-source relationship. They say that the patient’s care is elevated by having that single nurse overseeing its delivery, and that its structure empowers the nurse to utilize managerial abilities as well as deploy their best bedside care.

Adapting the Primary Nursing Care Model Has Challenges

Even so, it’s not an easy system to put into place for a variety of reasons. For one, the nurses who engage in it must have strong interpersonal skills. Nurses are known for their empathy, certainly, but large patient loads and nurse shortages mean that many if not most are working with many time constraints, and so may have seen those skills atrophy somewhat.

What’s more, becoming a primary care nurse means accepting responsibility for that patient’s outcome, to a degree. The nurse is acting as both caregiver and care manager, and that can be a difficult balance to maintain.

Resistance to Change

And lastly, there’s the usual resistance to change. It’s natural to be wary of a new system, even if it promises to solve many vexing problems that nurses face in today’s hospital and other care settings. Their chief goal is almost always to spend more time with patients and  grow those interpersonal relationships with patients and their friends and families. Done properly, primary care nursing provides the setting for those interactions to take place, and also can do much to improve patient safety and better outcomes, not to mention staff satisfaction and improved retention.