Page 454 - Encyclopedia of Nursing Research

PRIMARY NURSING n 421

in 1968. The overall project goal was to formal definition, many leaders in both edu-
improve the delivery of support services to cation and practice have assumed that to be a
nursing units, and Station 32 was the pilot requirement. In the first wave of implementa- P
unit. In the course of multiple changes in tion of primary nursing in the United States
a wide variety of services, frustration with in the 1970s and 1980s, some nurse leaders
team nursing led the staff to innovate in used it as a way to increase the RN ratios in
organizing their own work. As their prac- their skill mix, thus perpetuating the myth of
tice changed, it became apparent that a new the all-RN staff. However, by the 1990s, staff
delivery system was being created. The reductions across the United States forced
result of that innovation became primary reintroduction of larger numbers of support
nursing. It is important to note that this staff, with the result that many nurse man-
development was initiated by the nursing agers felt they had to give up primary nurs-
staff of an operating unit. ing. To this day, these misconceptions about
The year l970 saw the first seminar pre- resource requirements for primary nursing
senting primary nursing to the nursing com- are believed by many health care industry
munity and the first published article about leaders.
it, Primary Nursing: A Return to the Concept of Abbreviated lengths of stay, 12-hour
“My Nurse” and “My Patient” (1). Throughout shifts and part-time positions have all con-
the 1970s, interest in primary nursing was tributed to a commonly held belief that pri-
steady but had not yet led to an organized mary nursing does not work in short-term,
movement. Several hospitals quickly real- high-acuity situations. However, recent
ized the benefits to patients and nurses. The innovations in implementing the fundamen-
nursing departments at Boston Beth Israel tal delivery system principles have resulted
Hospital, led by Joyce Clifford, and evanston in changes in both role expectations and role
Hospital, led by June Werner, were early management. The simple notion of short-
adaptors and were recognized as outstand- term goals for short-term patients has freed
ing models of full implementation of a pro- nurses to achieve implementation that is
fessional practice model. pragmatically appropriate for the fast pace
The concept continued to spread gradu- of today’s hospitals. The understanding
ally across the United States and then to other that a responsibility relationship enhances
countries. The Practice of Primary Nursing (1) patient care and creates a more professional
was published in 1980. Articles on the sub- role for RNs is reemerging in today’s prac-
ject appeared in American nursing journals tice settings.
throughout the 1970s and 1980s. The wide variety of settings in which
There was a continuous call for research nurses practice today has also resulted in
to prove the benefits of primary nursing. recognition that primary nursing works in
The challenge of conducting well-designed any setting. It is about establishing a respon-
research projects within the context of oper- sibility relationship between a nurse and a
ating patient care units has consistently been patient—whether in the patient’s home, a
recognized. Despite these difficulties, hun- long-term care setting, an ambulatory cen-
dreds of studies and articles have been pub- ter, or an acute-care setting. Primary nurs-
lished globally. ing is a responsibility relationship that
A misconception that has plagued pri- enhances patient care and the profession of
mary nursing is the myth that more RNs and/ nursing.
or more staff in general are required for its Although changes in the health care sys-
implementation, making it more expensive tem seem to frequently negatively impact pri-
than other care delivery systems. Although mary nursing, the experience of more than
an all-RN staff has never been part of the 40 years demonstrates that after a period