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. For the duration of a patient’s episode of care, the primary nurse accepts responsibility for administering some and coordinating all aspects of the patient’s 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.
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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 patient’s 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 client’s 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.”
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:
From the book Relationship-Based Care: A Model for Transforming Practice (2004), Mary Koloroutis, editor. Used by permission.
Myths and facts about primary nursing
From the book Relationship-Based Care: A Model for Transforming Practice (2004), Mary Koloroutis, editor. Used by permission.
History
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 action—to 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 look—and 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. 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.