Primary Nursing

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.

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.

It is simply not practical for the primary nurse to complete all aspects of care. Obvious barriers to singular care by a primary nurse include shortened length of patient stay; escalating patient acuity levels; complex, multifaceted care requirements, and the cyclical nursing shortage. If the primary nurse were doing all of the bedside care, he or she would not be able to assume responsibility for planning and coordinating the patient’s care.

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