Primary Nursing is a relationship-based with therapeutic presence, autonomous, evidence-based, and collaborative delivery care model. Primary Nursing is a system for delivering nursing care that is based upon the four elements:
- Responsibility for Relationship and Decision-making
- Work Allocation and Assignments
- Communication with the Health Care Team
The Primary Nursing role is based upon responsibility, accountability and authority: the responsibility to develop a therapeutic relationship, the accountability to the patient, family and members of the health-care team and the authority to develop and implement an individualized plan of care for the patient.
The Bridge of Primary Nursing
Rebecca Billing, R.N.-C, B.S.N.
CN III, Pediatric Infusion Center
As a nurse in the Inpatient Pediatric Unit, I learned the value of the Primary Nursing Delivery Care Model when it was first introduced at UC Davis in the mid nineties. Like many departments, we tried to practice consistency in nursing and developing a Primary Nursing Model gave us the framework and tools to move forward. Since then, the benefits have been consistently demonstrated over the years to enhance patient and family satisfaction. In addition, it has improved both our clinical practice outcomes and given us greater autonomy. When I transferred to the Pediatric Infusion Center in 2005. I, once again, saw the benefits of primary nursing and the importance of using this model in the outpatient setting. One major advantage is the bridge it has built for the patient and family who has to transition back and forth in the inpatient and outpatient setting. The continuity of care is more efficient when the primary nurses and teams are involved. All nurses work towards a common goal of giving the best care to the patient and they are assured that it is occurring in all settings of nursing practice.
Currently, I take care of a 13 year old boy who is battling bone cancer named David. He was diagnosed in October 2010 and since then has undergone weekly chemotherapy as well as tumor resection and limb salvage surgery this past February. He generally starts his infusions in the Pediatric Infusion Center and then transfers to the Pediatric Unit. Over the course of his therapy, I have gotten to know him well so I know what works and what doesn't to help ease the stress of his disease and treatment such as controlling his nausea. Knowing when to push him in certain directions and when to back off is an art and a major advantage of consistency in practice. In establishing a sound relationship with his family to help with the fear of having a child with cancer, we have become a team, working together to battle his cancer. Having a child with a life threatening disease is tremendously stressful for any family. As a pediatric nurse, it is a huge challenge clinically and emotionally caring for a child with cancer.
When I asked David's mother, Rebecca how she felt about the care that David had been receiving, she said, "Going through chemotherapy has been very difficult for my son. However, UC Davis has made the process a lot easier. David has a great team of doctors and nurses committed to getting him better. It has been very comforting for David to have the same nurses taking care of him because they have gotten to know him so well. His primary nurses know his needs and also when he is sad, scared or angry and know how to care for him."
David has been both brave and courageous during his illness. As one of his nurses, it is a honor and privilege to take care of him. His family had bracelets made that say David verses Goliath. He is up against a giant and one that we, as his family and treatment team, battle with him.