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Primary nursing is a system of nursing care delivery that 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.[1] While the patient is on the nurses' unit, the primary nurse accepts responsibility for administering some and coordinating all aspects of the patient's nursing care, with the support of other members of the nursing staff.[2][3] This results in the nurse having greater insight into the patient's condition, both medical and emotional.[4]

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.[5] The patient is aware of who their nurse is in primary nursing, and can communicate to the entire hospital staff through that nurse.[6] The nurse accepts responsibility for the patient's care.[2]

It originated in 1969 by staff nurses at the University of Minnesota.

Primary nursing description

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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. Primary nursing moves decision-making to the primary nurse, giving the primary nurse responsibility for the care of the patient. Results include shorter hospital stays, increased patient satisfaction, fewer medical complications, and less staff absenteeism.[7][8] Work is allocated by the primary nurse to other staff in their absence, accountability remains with the primary nurse.[9] Communication between the patient, the physician and the nurse is improved because the primary nurse is the central hub, and responsible for all communications.[6] "All a good phsysician wants is quality care for his patient, and if primary nursing is the way to get it they are all for it", says Lawrence J. Donnelly, RN, Director of Nursing at Glendale Memorial Hospital.[10]

Effect on Nursing Retention

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Shortages of qualified nurses and nursing retention issues are long-standing challenges for hospitals. Reasons for nursing turnover including dissatisfaction with the way they are required to practice nursing, in team nursing environments.[note 1] Primary nursing grew out of a group of nurses and nurse supervisors working together to address that dissatisfaction. [note 2] Charlotte Dison of Baptist Hospital of Miami stated that primary nursing increased nursing retention because "the nurse is more satisfied with her environment. Absenteeism tends to be less, and there is a greater commitment to the patient."[8] Dick Otswald, Vice President Nursing at Wausau Hospitals, believed that returning nurses to direct patient care versus administrative duties would increase retention because the reason people go in to nursing is to give patient care.[3]

Patient experience

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In team nursing, "the tasks got done, but patients often went home poorly taught (to take care of themselves) and the caring aspect of nursing wasn't carried out" said Karen Ciske, a former staff nurse and nursing instructor and a member of the University of Minnesota Hospitals' primary-nursing project. Ciske said that the one-to-one communication between nurse and patient is .. "where you form a relationship and patients open up to you. Not back with the charts and the pills."[12] Patients reported satisfaction with the system because care is personalized to them.[6] The trust relationship between the nurse and the patient is critical. "Gaining a patient's trust means they will tell me about any discomfort to changes going on in their body that the monitors might not pick up."[2]

That patient-nurse relationship carries over to the family, and helps the nurse with discharge planning, as they're able to assess the patient's support system outside of the hospital.[2] The patient-focused continuity of care of primary nursing also affects the patient's family. Penni Weston, primary nursing project coordinator at St. Alexius explained, "The family knows which nurse to talk to" when they have questions or anxiety about the patient's recovery.[13] In a University of Michigan study, two groups of kidney-transplant patients were compared, one under primary nursing, the other under team nursing. The patients under team nursing experienced an average of four complications after the operation. The patients under primary nursing experienced an average of one complication after the operation, and so were able to be discharged from the hospital sooner.[4]

Comparison between nursing care delivery systems

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The following table illustrates the similarities and differences between the four most common nursing care delivery systems:[11]

Element Functional nursing Team nursing Total patient care Primary nursing
Decision-making Decision-making occurs over a single shift; decisions usually made by nurse manager or charge nurse. Decision-making occurs over a single shift; largely by team leader or nurse manager. Decision-making occurs over a single shift—either by an RN caring for the patient or by a charge nurse. RN makes decisions for individual patients based on their therapeutic relationship, which is sustained for the length of stay of the patient on the unit.
Work allocation and/or patient assignment Nursing assignments are task-based, nurses are assigned to tasks rather than patients. Nursing assignments are based on level of complexity and commensurate level of expertise; focus is on tasks to be accomplished; assignments change based on patient acuity and work complexity. Nursing assignments are largely patient-based, with RN providing activities of care. Nursing assignments may vary by shift based on geography and patient acuity, without supporting continuity of care. Nurse assignments are patient-based to ensure continuity of care. An RN is assigned to a patient and remains that patient's primary nurse for as long as the patient remains on the unit (unless circumstances require that a new primary nurse is assigned).
Communication Communication is hierarchical; task completion is documented and communicated to the charge nurse; the charge nurse pulls information together for all patients and communicates with other members of the health care team. Communication is hierarchical; the care provider reports to the team leader; the team leader reports to physicians and/or other health care team members. Communication is direct. However, in some Total Patient Care systems, RNs may be required to communicate with physicians and other members of the health care team through a charge nurse. Communication is direct. Patient information is solicited by the primary nurse who communicates directly and proactively with team members, physicians, and other colleagues. The primary nurse is responsible for integrating information and coordinating care.
Management of the unit or environment of care Managers function as overseers, assuring that tasks are accomplished. Nurse manager supervises the team leader who is responsible for supervising other staff in the delivery of care. Managers serve as a resource and promote nurses having a stronger role in care decisions. Managers promote the nurse-patient relationship and the professional role of the nurse. They influence care by creating a healthy work environment and empowering the staff to remove barriers to care.

The team nursing model is where the RN gives the patient a pill, the practical nurse changes the patient's bed linens, and the nurses' aide brings the bed pan - the RN only saw the patient that one time, when they gave the patient the pill. In primary nursing, the primary nurse gives the pill, teaches the patient about what the effects of the medication are, and monitors the patient's reaction to the medication. On discharge, the primary nurse can recommend the best time of day for the patient to take the pill, based on what they've seen during the patient's hospital stay. The primary nurse is also more alert to medication errors, because of their greater awareness of patient medication outcomes.[8]

In the total patient care system (or modified primary nursing), the responsibility aspect of primary nursing is not implemented. However RN's do still provide more patient care than under team nursing, and have less supervisory duties over other caregivers.[14]

Myths and facts about primary nursing

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The following table explores contrasting perspectives on primary nursing[15]

Myths about primary nursing Facts about primary nursing
Primary nursing requires an all-RN staff. Primary nursing can be implemented with the available staff—it does not require special staff, nor does it require an all-RN staff. Licensed practical nurses, nursing assistants, and other team members play vital roles in meeting the needs of the patient and their family.
The primary nurse does all of the bedside care. The essence of the primary nurse's role is the acceptance of responsibility, authority, and accountability for decisions about patient care. It is not about the primary nurse “doing it all.”

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. Primary nurses doing all of the bedside care are not be able to assume responsibility for planning and coordinating the patient's care.

Primary nursing eliminates teamwork. Everyone works individually and therefore is not aware of patients other than their own. In a primary nursing model, care providers do not help each other. Teamwork is critical to the primary nursing care delivery system. It has been demonstrated that the best utilization of ancillary staff is in relationship with one RN—(at least within a given shift)—not assigned to help many. However, a general culture of “helpfulness” based on a shared commitment to all patients and team members is necessary to achieve consistently safe, quality care.

Primary nursing supports collaborative interdisciplinary practice through communication and coordination.

Complex scheduling requirements prohibit continuity of the nurse-patient relationship central to the primary nurse model. Clinical staff report a 25% reduction in work redundancy due to day-to-day continuity of care. They also report a perceived increase in productivity through more consistent co-worker assignments. The key to achieving these results is to find creative methods to schedule nurses with continuity of care as the priority. For example, if a patient's anticipated length of stay is three days, schedule nurses three consecutive days.

History

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Primary nursing is a return to the relationship between the nurse and patient being primary, with the nurse bringing all of her professional knowledge and expertise to her care of the patient.[16]

In the 1920s and earlier, nearly all nursing was home care nursing, in which the nurse alone managed the patient's care. Hospitals trained nurses, and those student nurses provided the care in hospitals. Once the student nurse graduated and became a professional nurse, they would be on their own professionally, managing themselves as a business with clients who required care at home.[6][16] In World War II, registered nurses (RN's) were drawn into care of the wounded. The staffing available to hospitals was limited to Licensed Practical Nurses (LPN's) and Nurses Aides, so the functional model of nursing was implemented. In functional nursing, each person is assigned tasks limited by their qualifications.[3] After the war, hospitals were built all over the US to continue to provide care to the wounded, and expand the health of the population. Functional nursing remained in place as demand for nurses constantly was greater than the supply of nurses, so the work was assigned out to various roles: orderlies, technicians, nursing assistants, practical nurses, and aides - and the Registered Nurse had oversight over all of them, rarely seeing a patient themselves.[12] Nursing dissatisfaction and turnover was a continual problem throughout the 1950s and 1960s. The return of primary nursing started in 1969 on Unit 32 at the University of Minnesota Hospital.[6]

The first seminar presenting primary nursing to the nursing community took place in 1970, and the first article was published that same year in Nursing Forum.[17] A second article, "A Dialogue on Primary Nursing", was published in the journal Nursing Forum in October 1970.[18] Throughout the 1970s, hospitals started to see the benefits of a primary nursing care delivery system to patients and nurses. In the Twin Cities, hospitals that implemented primary nursing in the 1970s included Hennepin County Medical Center, United Hospital, Bethesda Lutheran Medical Center, the Veterans Administration hospital and the University Hospital.[12] St. Alexius implemented primary nursing in the early 1980s, crediting it with improved outcomes.[13] 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.[5][19][20]

Hospitals' attempts to implement primary nursing were hindered by the initially-higher costs of a more professional staff. Some hospitals initially implemented a modified version in which responsibilities are moved toward a patient focus.[8]

Implementation

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As implementation of primary nursing continued, patients reported satisfaction with the system because care is personalized to them.[6] Hospital-level resistance to primary nursing comes from the difficulty of integrating the primary nursing process within usual hospital processes.[7] Changes required may include the nurse-doctor relationship, staffing patterns and nursing supervision practices.[21] Changes are also required to the technical support systems underlying nursing practice.[22] Marie Manthey asserts that a nursing system can support either professional (nursing) values or bureaucratic (hospital) values as it either focuses on caring for people or tending to the needs of an organization. “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.”[23] Manthey also stated that primary nursing is sometimes rejected because the nursing leader is afraid of losing authority.[4]

The implementation of primary nursing outside of the U.S. started in England, where the term 'named nurse' was used in the National Health Service. John Major announced the Patient's Charter in 1991, one component of which was that "a named qualified nurse, midwife, or health visitor .. will be responsible for your nursing or midwifery care." In making this policy change, he stressed that Nursing was being recognized as a key component of medicine, that well-trained nurses' greater responsibilities were a benefit for the health system and for patients. While the Royal College of Nursing supported this greater role for nursing, cost challenges were also acknowledged.[24] Stephen Wright at Tameside promoted primary nursing's benefits, while also acknowledging the challenges. The benefits Wright identified of primary nursing include reduced patient complaints, fewer medical complications, and less staff absenteeism. The discomfort of doctors working with different primary nurses, rather than one specific head nurse/ward sister is a challenge. Also, for the primary nurse, taking responsibility for the patient's care from admission to discharge requires an adequate support system. Wright said, "It can be pretty scary if you are totally responsible for a patient's care. The bus stops with you." Wright also stressed the need for adequate funding of the new system.[7] Imperfect conditions meant that at times the ward sister (similar to Head Nurse in the U.S.) was treated as a primary nurse in some cases, meaning that Patient was given her name as their nurse. The Royal College of Nursing stated that since the named nurse concept meant "qualified staff having responsibility for designated patients", the ward sister assignment as named nurse was not realistic.[25] Possible cost savings to support the hiring of additional qualified nurses were identified to include reducing shift change from two hours down to one, reducing supervision costs, and moving clerical and housekeeping tasks from nursing to other hospital staff members.[26]

In the 1990s, industry consultants led a movement of hospitals into restructuring and re-engineering in the name of cost-cutting, that had the effect of reducing professional nursing autonomy and judgment by use of multi-skilled team members. The term primary nursing fell out of use, and the concepts were modified.[27] Other changes included de-emphasis of the nurse-patient relationship.[14] This had a negative effect on nursing satisfaction with the care they were able to provide to patients.[28]

In the UK, hospital restructuring had the effect of spreading skilled work among a wider variety of staff. This 'changing skill mix' had the effect of increasing the managerial, medical and therapeutic work of nursing, and assigning bedside care to non-nursing staff. This grew out of 'total patient care' which involved nurses taking on additional clinical roles such as occupational therapy tasks, their work load increased accordingly. Nurses reported being concerned about qualitative differences in patient care that weren't being measured, as well as increased pressure and uncertainty due to extensive changes.[29]

Current terminology for this practice model - 'Relationship-Based Care' - applies the original concepts of Primary Nursing to all functions and relationships within the hospital setting.[30]

See also

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Further reading

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Notes

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References

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Revisions and contributorsEdit on WikipediaRead on Wikipedia

Primary nursing

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from Grokipedia
Primary nursing is a model of nursing care delivery in which a designated assumes primary responsibility for coordinating and providing comprehensive care to a small group of patients from admission through discharge, ensuring continuity and personalization of treatment. This approach emphasizes building trust-based relationships between the nurse and patient, with the primary nurse assessing needs, developing individualized care plans, and delegating tasks as needed while remaining accountable for overall outcomes. Originating in the at the Hospitals under the leadership of nurse Marie Manthey (1935–2024), primary nursing was developed as an alternative to fragmented team-based systems, aiming to restore professional autonomy and holistic patient focus to practice. First formally described in print in 1980 through Manthey's book The Practice of Primary Nursing, the model gained widespread adoption in settings during the late . At its core, primary nursing operates on principles of responsibility, , and , where the primary nurse serves as the central coordinator, integrating evidence-based practices and collaborating with interdisciplinary teams to promote patient healing and wholeness. It fosters a relationship-based framework that recognizes patients as unique individuals, prioritizing therapeutic presence and patient-centered decision-making over task-oriented routines. Unlike modular or team nursing models prevalent in the mid-20th century, primary nursing minimizes care handoffs, reducing errors and enhancing communication, which aligns with broader philosophies of and . Empirical evidence highlights primary nursing's benefits, including reduced rates of adverse events such as pressure ulcers and falls, shorter lengths of stay, and higher satisfaction scores. Systematic reviews of studies from 2000 to 2022 demonstrate its positive impact on -sensitive outcomes like care quality and functional recovery. Despite challenges like staffing demands in modern healthcare, the model continues to influence professional standards, underscoring its enduring role in advancing patient-centered care.

Overview

Definition

Primary nursing is a care delivery model in which a single , designated as the primary nurse, assumes full responsibility for a patient's comprehensive care throughout their stay, encompassing assessment, , , and evaluation of interventions. This approach ensures that the primary nurse coordinates all aspects of the patient's care, often delegating specific tasks to associate nurses during off-shifts while retaining overall accountability. At its core, primary nursing emphasizes three key components: continuity of care, , and the development of a therapeutic nurse-patient relationship. Continuity is achieved by assigning the same nurse to a from admission to discharge, minimizing care fragmentation and allowing for consistent monitoring and adjustment of the care plan. places the primary nurse in charge of and outcomes for their assigned caseload, fostering professional autonomy and responsibility around the clock. The therapeutic relationship, built through ongoing , enables personalized care that addresses the 's holistic needs, including emotional and aspects. Unlike general nursing roles that often involve task-based assignments or team coordination, primary nursing prioritizes holistic, individualized care delivered by one nurse who serves as the central point of contact for the patient and their family. This model shifts away from fragmented duties, such as those in functional nursing where tasks are divided by , toward a patient-centered structure that enhances nurse empowerment and care personalization.

Key Principles

Primary nursing is grounded in philosophical underpinnings that place at the center of care delivery, emphasizing relationship-based practice, , and the power of . This model promotes nurse and empowerment, fostering therapeutic relationships built on trust to avoid fragmented care and enhance overall quality. These foundations, as articulated by Marie Manthey, the model's pioneer, underscore the nurse-patient dyad as the core unit of care, integrating humanistic elements with clinical expertise to support holistic . The primary nurse assumes full accountability for a patient's care from admission through discharge, including comprehensive assessment, individualized care , coordination with multidisciplinary teams, and of outcomes. This role extends to discharge , where the primary nurse ensures seamless transitions by anticipating post-hospital needs and collaborating with community resources. By delegating routine tasks while retaining oversight, the primary nurse maintains continuity and , acting as the central to align all interventions with the patient's unique goals and preferences. Complementing this, the associate nurse provides support during the primary nurse's off-shifts, implementing the established care plan without assuming primary accountability. This ensures 24-hour continuity while preserving the therapeutic bond formed by the primary nurse, allowing associates to report observations back for plan adjustments. Such role delineation reinforces the model's efficiency without diluting the primary nurse's authority. Central to primary nursing is a strong emphasis on , where nurses champion rights, safety, and informed decision-making, often serving as liaisons between patients and other providers. Family involvement is integral, with primary nurses engaging relatives in care discussions, education, and coaching to build supportive networks that enhance recovery and adherence. Documentation standards prioritize individualized care plans that detail assessments, interventions, and progress, promoting transparency, legal protection, and interdisciplinary communication tailored to the model's relational focus.

Historical Development

Origins

Primary nursing originated in the mid-1960s at the Hospital, where Marie Manthey, serving as associate director of nursing, collaborated with colleagues including staff nurses to develop the model as a direct response to the fragmented care prevalent in hospital settings. This fragmentation arose from task-oriented practices that divided responsibilities among multiple staff members, often leading to disjointed patient experiences and diminished accountability. Manthey and her team sought to restore continuity by assigning a single primary responsibility for a small group of patients throughout their hospital stay, fostering a more holistic and professional approach to care delivery. The initial motivations for primary nursing were rooted in addressing widespread dissatisfaction with existing models amid escalating challenges in the healthcare environment of the . Nursing shortages, exacerbated by postwar demands and an aging , strained resources, while rising acuity—driven by advances in technology and treatments—required more coordinated, individualized care that task-based systems could not adequately provide. These factors, combined with a growing emphasis on , prompted Manthey and her colleagues to innovate a system that empowered nurses as autonomous practitioners responsible for planning, implementing, and evaluating care, thereby improving both outcomes and nurse satisfaction. Early publications by Manthey and collaborators in the late and articulated the theoretical foundations and practical applications of primary nursing. A seminal work, "Primary Nursing," co-authored by Manthey, Karen Ciske, Patricia Robertson, and Irene Harris, appeared in Nursing Forum in 1970, outlining the model's structure and benefits in detail. This was followed by "A on Primary Nursing" in the same journal later that year, which explored implementation challenges and philosophical underpinnings through discussions between Manthey and Marlene Kramer. The first implementations occurred as pilot programs in U.S. hospitals during the late , beginning with Unit 32—an acute medical-surgical ward—at the Hospital in 1969. These pilots extended to psychiatric units in other institutions, testing the model's adaptability across specialties and demonstrating its potential to reduce care fragmentation while aligning with broader reforms aimed at enhancing professional autonomy.

Evolution and Modern Adoption

Building on the foundational principles established in the 1960s by Marie Manthey at the , primary nursing expanded in the as a hallmark of exemplary hospitals during a period of nursing shortages. The American Academy of Nursing's landmark study identified primary nursing as one of 14 key characteristics of "" hospitals, which excelled in recruiting and retaining nurses through professional autonomy and patient-centered care. This recognition spurred widespread adoption in U.S. hospitals, where the model promoted and continuity amid quality improvement initiatives. In the 1990s, the formalized the Magnet Recognition Program in 1990, further incentivizing primary nursing implementation as a benchmark for excellence and . Adoption spread to European hospitals, with British and other nurses adapting the model to local contexts, influenced by similar drives for and efficiency. Studies in countries like the and explored Magnet attributes, including primary nursing, to enhance care delivery in systems. During the , primary nursing evolved to integrate with emerging technologies and evidence-based frameworks, aligning with broader shifts in healthcare informatics. As electronic health records (EHRs) proliferated, the model was adapted to facilitate primary nurses' centralized , care coordination, and data-driven decision-making, as evidenced in analyses of hospitals from 1998 to 2007 where EHR adoption intersected with primary nursing structures to influence staffing and care quality. This period also saw primary nursing reinforce by emphasizing individualized care plans grounded in , supporting its role in multidisciplinary teams. The COVID-19 pandemic from 2020 onward highlighted challenges for primary nursing amid global staffing crises, with many settings adapting the model through hybrid approaches to maintain care continuity in high-turnover environments. Globally, primary nursing has seen implementation in non-Western contexts by the 2020s.

Comparison to Other Models

Functional and Team Nursing

Functional nursing is a task-oriented care delivery model in which nursing responsibilities are divided into specific functions, such as administering medications, taking vital signs, or performing hygiene tasks, with individual nurses or aides specializing in one duty across a group of patients. This approach emphasizes efficiency through specialization and was particularly dominant in hospitals before the 1960s, emerging prominently during World War II to address acute nursing shortages by maximizing the use of available staff with varying skill levels. Key characteristics include a mechanistic structure with minimal coordination between staff members, leading to fragmented patient care where no single nurse oversees the entirety of a patient's needs. Major limitations of functional nursing involve the lack of continuity and personalization in care, which can dehumanize the patient experience, increase the risk of errors due to poor communication, and diminish nurse satisfaction by reducing opportunities for holistic involvement. Team nursing, developed in the as a collaborative response to ongoing nursing shortages and dissatisfaction with task-based systems, involves a (RN) leading a small group of healthcare providers, including licensed practical nurses (LPNs) and aides, to deliver care to a defined set of patients. Pioneered by Eleanor Lambertson at , this model was intended as a compromise to integrate diverse staff roles while promoting shared accountability under the team leader's coordination. Characteristics include an emphasis on communication, , and , with the RN assessing needs, planning care, and supervising task distribution to ensure comprehensive coverage. However, limitations arise from the absence of a consistent primary for each , potential fragmentation if delegation reverts to task division, and the need for strong to avoid inconsistencies in care quality and reduced individual accountability among team members. These models' emphasis on division of labor and , while addressing staffing constraints, highlighted gaps in continuity that primary nursing later sought to resolve through individualized .

Patient-Centered and Hybrid Models

Patient-centered care represents a foundational in modern healthcare, prioritizing the integration of patients' preferences, needs, and values into all clinical decisions to foster respect and responsiveness. This approach, articulated in the Institute of Medicine's 2001 report Crossing the Quality Chasm, emphasizes shared decision-making between patients and providers, enabling collaborative choices informed by evidence and individual circumstances. Unlike primary nursing, which assigns a single nurse for ongoing , patient-centered care operates as a broader system-wide principle that may incorporate various delivery models without mandating a dedicated primary nurse, allowing flexibility across multidisciplinary teams. Hybrid models in have emerged prominently in the as adaptive combinations of traditional primary nursing with modular assignments and integration, addressing staffing shortages and enhancing flexibility in high-turnover environments. For instance, OU Health's 2025 hybrid model pairs in-person nurses, who handle direct bedside care akin to primary nursing responsibilities, with virtual nurses managing education, medication reviews, and coordination via platforms like Nexus Bedside, thereby distributing tasks to optimize workforce efficiency. These models promote scalability by leveraging technology to support overburdened units, such as , without requiring full-time primary nurse assignments for every patient. Relationship-based and partnership nursing models, gaining traction in the 2010s, build on continuity principles similar to primary nursing but shift toward greater interdisciplinary , involving nurses, physicians, and other providers in shared power dynamics to address complex care needs. As outlined in the World Health Organization's 2010 framework and subsequent works like Potter's 2012 analysis, these models emphasize interprofessional partnerships to mitigate global nursing shortages, fostering team-based relationships that enhance holistic patient support. Emerging from efforts to recover collaborative threads in nursing history, they prioritize mutual accountability across disciplines over individual nurse ownership. Key differences between primary nursing and these hybrid or partnership approaches lie in accountability and scalability: while primary nursing maintains full individual responsibility for a patient's care trajectory, hybrids dilute this by modularizing tasks among virtual and in-person roles, improving adaptability in resource-constrained settings but potentially fragmenting continuity. Partnership models further distribute accountability interprofessionally, enhancing team coordination for diverse patient populations yet requiring robust communication to preserve relational depth.

Implementation

Strategies and Steps

The preparation phase for adopting primary nursing begins with assessing unit readiness through structured evaluations of current workflows, staffing levels, and staff attitudes toward the model. This involves conducting surveys or focus groups to gauge buy-in and identify gaps in knowledge or resources. Following assessment, staff training on primary nursing roles is essential, typically delivered through education programs lasting 4-6 weeks that cover principles such as , continuity of care, and care coordination. These programs, often led by nurse educators or external consultants, include workshops on developing individualized care plans and collaborating with multidisciplinary teams. The assignment process requires matching primary nurses to based on factors like patient acuity, length of stay, and the nurse's clinical expertise to ensure effective care continuity. A primary nurse is designated as the accountable provider for a consistent group of throughout their hospitalization, with associate nurses supporting during off-shifts. Typical caseloads range from 4-6 per primary nurse, allowing for comprehensive assessment and without overwhelming the provider. Assignments are reviewed daily by unit to accommodate changes in patient needs or staff availability. Rollout steps emphasize a phased approach starting with a pilot implementation in one unit to test the model on a small scale. During the pilot, which may last 3-6 months, primary nursing is introduced gradually, beginning with select cohorts. Evaluation focuses on metrics such as the rate of care plan completion and adherence to assignment protocols, using tools like checklists or audits to track fidelity to the model. Successful pilots inform adjustments before scaling to additional units. For example, a 2023 quasi-experimental pilot in a Portuguese hospital's unit, lasting 6 months, demonstrated feasibility and positive impacts on care quality. Support structures include regular multidisciplinary huddles, typically held daily or shift-based, to facilitate communication among nurses, physicians, and other providers about statuses and care transitions. These brief meetings, lasting 10-15 minutes, promote coordinated planning aligned with primary nursing principles of holistic . Additionally, documentation tools tailored to primary nursing, such as templates for individualized care plans and progress notes, streamline record-keeping and ensure visibility of the primary nurse's responsibilities.

Barriers and Facilitators

Implementing primary nursing encounters several organizational barriers that can impede adoption. Staffing shortages, particularly in registered nurses (RNs), limit the model's emphasis on individualized and continuity, as inadequate personnel disrupts consistent nurse-patient assignments and increases reliance on less specialized support staff. High nurse-patient ratios exceeding 1:5 further exacerbate this, straining the primary nurse's ability to coordinate comprehensive care and leading to fragmented responsibilities. Resistance often arises from entrenched task-oriented cultures, where staff accustomed to modular or team-based approaches view the model's increased and 24-hour as overwhelming or incompatible with existing workflows. Facilitators for successful include strong support, which fosters a prioritizing relationship-based care and provides resources for model integration. Adequate RN staffing at an ideal ratio of 1:4 enables primary nurses to maintain oversight without overload, enhancing care coordination. Integration with (EHR) systems supports continuity by allowing seamless documentation and access to patient information across shifts, reducing errors and empowering primary nurses in . Systemic issues also pose challenges, such as cost implications in underfunded healthcare systems, where perceive the RN-heavy of primary nursing as a high-cost endeavor, prompting substitutions with lower-wage aides that undermine model . Regulatory hurdles in non- settings, including scope-of-practice restrictions, complicate adaptation beyond environments, limiting broader applicability. Mitigation strategies have proven effective in recent pilots, including phased training programs that build competencies gradually through in-service education and on-the-job mentoring.

Outcomes and Evidence

Patient Experience and Satisfaction

Primary nursing enhances experience by providing continuity of care through a dedicated primary nurse, fostering trust and improving communication between patients and healthcare providers. This allows patients to build with a consistent , which studies have shown leads to higher perceptions of care quality, with 96.5% of patients reporting high nursing care in settings implementing primary nursing. Continuity reduces fragmentation compared to team nursing models, where multiple nurses handle care, resulting in more personalized interactions and reduced patient anxiety. For instance, primary nursing interventions have been associated with significant relief in negative emotions, including anxiety, by offering emotional support and consistent reassurance during hospitalization. Personalized elements of primary nursing, such as tailored on , individualized assessment, and ongoing emotional support, contribute to greater patient satisfaction. indicates medium effect sizes in satisfaction improvements following primary nursing adoption, with scores rising from an average of 193.57 to 210.21 on standardized scales. Patients experience care as more responsive and individualized, with over 90% reporting positive outcomes in these areas, enabling the primary nurse to address specific needs like symptom monitoring and strategies. Key metrics underscore these benefits, including improved adherence to treatment plans through primary nurse-led follow-up, which enhances abilities such as medication management among hospitalized patients. In multimorbid older adults, primary nursing led to greater gains in scores (mean increase of 0.48 versus 0.21 in controls), particularly in recognizing symptoms and managing therapies. This continuity also links to lower readmission rates, as the model's emphasis on discharge planning and ongoing coordination supports sustained recovery. Vulnerable populations, such as those with chronic illnesses, derive amplified benefits from this coordination, with enhanced self-management reducing the burden of ongoing care needs.

Nurse Retention and Job Satisfaction

Primary nursing enhances nurses' by granting greater in care planning and fostering meaningful, ongoing relationships with patients, which contribute to a of fulfillment and reduced burnout. In a 2023 of quantitative studies, implementation of the primary nursing model led to higher reported among nurses, particularly in areas of and overall work environment, with one included study showing reduced scores post-adoption compared to baseline levels from prior years. This allows primary nurses to make independent decisions on patient care, aligning their work with personal values and diminishing feelings of fragmentation often experienced in modular nursing approaches. The model's emphasis on and promotes retention by boosting and encouraging long-term career commitment within the . Nurses in primary nursing units report stronger identification with their roles, leading to higher and lower intentions to leave; for instance, a 2020 study cited in the found that 94.8% of nurses had no plans to depart their positions following model adoption. This sense of cultivates a supportive team dynamic and professional pride, which sustains even amid demanding healthcare environments and supports extended tenure in nursing roles. Primary nursing also facilitates professional development by providing opportunities to build skills in care coordination, leadership, and holistic patient management. Through direct responsibility for patient trajectories, nurses enhance competencies in areas such as diagnostic functions and flexible thinking; quantitative data from a 2018 implementation study showed significant improvements, with helping role scores rising from 18.11 to 19.85 (p=0.0001) and diagnostic functions from 18.88 to 20.11 (p=0.0007). These experiences empower nurses to advance in leadership capacities, contributing to progression and overall professional growth within the model. While generally beneficial, primary nursing can present drawbacks such as potential overload for primary nurses if levels are inadequate or fluctuate, which may strain resources and increase fatigue. However, when supported by sufficient and , the model yields net positive effects on retention and .

Research Findings

Empirical evidence on the effectiveness of primary nursing has been synthesized in recent s, which indicate improvements in key quality indicators such as reduced adverse events, including pressure ulcers, falls, and infections, as well as higher satisfaction scores akin to HCAHPS metrics. For instance, a 2023 of quantitative studies from settings across multiple continents found consistent associations between primary nursing implementation and decreased length of stay, with odds ratios for high satisfaction ranging from 1.52 to 1.705 in included trials. These findings build on foundational research from the to that established primary nursing's potential for continuity of care. Recent quasi-experimental trials from 2021 to 2024 further support these outcomes, demonstrating practical reductions in care omissions. A 2024 single-group quasi-experimental study in a Portuguese internal medicine department involving 48 nurses reported significant decreases in missed care across all measured dimensions (p < 0.005), alongside enhancements in and post-implementation. Similarly, an influential 2020 quasi-experimental trial in a Brazilian hospital showed a 78.5% reduction in missed care following primary nursing adoption, with associations to staff satisfaction and job roles. Though such studies remain preliminary. Despite these advances, gaps persist in the evidence base, particularly regarding long-term outcomes beyond acute settings, such as in or facilities where primary nursing adaptations are less studied. Projections post-2025 highlight challenges amid ongoing nursing workforce shortages, with limited on in non- contexts potentially exacerbating care discontinuities. Methodologically, the is dominated by observational and quasi-experimental designs due to implementation complexities, with study quality varying from weak to strong; experts call for more randomized controlled trials to establish and generalizability.

Challenges and Misconceptions

Common Challenges

One significant challenge in sustaining primary nursing is the increased and resulting borne by individual nurses due to their heightened responsibility for care coordination. In understaffed environments, this model amplifies , as primary nurses must manage comprehensive oversight without adequate support, leading to mental strain. For instance, a found that nurses in primary nursing systems experienced higher emotional stress (self-negativity) compared to those in paired systems, indicating greater mental from sole . Post-COVID staffing shortages have intensified this issue, with global nursing deficits pushing ratios beyond sustainable levels and contributing to exhaustion among primary nurses. As of 2025, surveys indicate that 8 in 10 nurse leaders are piloting new care models to address chronic shortages and burnout in traditional systems like primary . Scalability presents another ongoing difficulty, particularly in high-acuity or short-stay units where patient turnover disrupts continuity of care essential to the model. Primary nursing relies on stable nurse- assignments, but rapid acuity fluctuations and brief stays make it hard to maintain dedicated relationships, often requiring shifts to more flexible team-based approaches. During the crisis, this limitation became evident as critically ill overwhelmed systems, revealing a supply-demand mismatch with insufficient specialized nurses to scale effectively. Such environments highlight the model's rigidity, limiting its application in dynamic settings like intensive care or units. Interdisciplinary tensions frequently emerge in primary nursing, with conflicts over in care between nurses, physicians, and aides. Physicians often position themselves as primary decision-makers, fostering hierarchical dynamics that marginalize nurses' input despite their central in ongoing care. This can lead to misunderstandings and fragmented , as aides are seldom integrated into , exacerbating role conflicts and hindering holistic . Tensions arise from differing professional perspectives, where nurses' relational focus clashes with physicians' directive . Equity concerns arise from the uneven application of primary nursing across diverse settings, disproportionately affecting minority and rural patients. The underrepresentation of racial/ethnic minority nurses—comprising approximately 23% of the U.S. nursing workforce as of 2024—limits culturally competent care delivery, as primary relationships require tailored understanding of patients' backgrounds to address disparities effectively. In rural areas, geographic isolation and chronic staffing shortages further impede consistent implementation, resulting in fragmented continuity and poorer outcomes for underserved populations. Research underscores these issues as barriers to equitable care in primary nursing.

Myths versus Facts

One prevalent myth surrounding primary nursing is that it is only feasible in small, low-acuity units due to constraints. In reality, the model is adaptable to larger settings through hybrid approaches that integrate primary nursing with or virtual elements, as evidenced by studies in environments during the 2020s. Another misconception is that primary nursing significantly increases operational costs compared to other models. However, it yields long-term savings through improved nurse retention and a reduction in adverse events, with associated healthcare expenditures from shorter stays and fewer readmissions. A common belief is that primary nursing excludes teamwork by isolating the primary nurse from others. To the contrary, it enhances by establishing clear, defined roles for the primary nurse as a care coordinator alongside associate nurses and interdisciplinary teams, fostering better communication and coordinated care. Finally, some view primary nursing as outdated in the post-digital era, incompatible with modern tools. In fact, it complements technologies like by maintaining nurse- continuity across virtual and in-person interactions, enabling seamless care transitions as shown in recent nurse-led telehealth implementations. These myths often trace back to early criticisms in the and during initial adoptions amid varying skill mixes and acuity levels.

References

  1. https://pmc.ncbi.nlm.nih.gov/articles/PMC9915435/
  2. https://www.nursing.upenn.edu/nhhc/nursing-through-time/1960-1989/
  3. https://nursing.umn.edu/news-events/distinguished-alum-nursing-trailblazer-marie-manthey-passes-away
  4. https://pubmed.ncbi.nlm.nih.gov/19343849/
  5. https://health.ucdavis.edu/nurse/practicemodel/index.html
  6. https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-021-00712-1
  7. https://onlinelibrary.wiley.com/doi/full/10.1155/2024/5549115
  8. https://www.researchgate.net/publication/338585771_The_practice_of_Primary_Nursing_Theoretical_framework_and_experience_from_the_US
  9. https://doi.org/10.3390/ijerph20032391
  10. https://journals.lww.com/ajnonline/fulltext/2025/04000/reflection_on_marie_manthey.5.aspx
  11. https://ahc-ohp.lib.umn.edu/2012/07/13/interview-with-marie-manthey/
  12. https://www.sagepub.com/explore-our-content/blogs/posts/sage-perspectives/2025/01/23/honoring-the-legacy-of-marie-manthey-a-pioneer-in-primary-nursing
  13. https://onlinelibrary.wiley.com/doi/10.1111/j.1744-6198.1970.tb00442.x
  14. https://onlinelibrary.wiley.com/doi/10.1111/j.1744-6198.1970.tb01048.x
  15. https://ahcarchives.lib.umn.edu/category/nursing/
  16. https://ahc-ohp.lib.umn.edu/wp-content/uploads/2012/07/MManthey.pdf
  17. https://urresearch.rochester.edu/fileDownloadForInstitutionalItem.action?itemId=5126&itemFileId=7921
  18. https://www.wolterskluwer.com/en/expert-insights/history-of-the-magnet-recognition-program
  19. https://www.sciencedirect.com/science/article/abs/pii/S0020748909004088
  20. https://www.researchgate.net/publication/43200449_Electronic_Medical_Records_Nurse_Staffing_and_Nurse-Sensitive_Patient_Outcomes_Evidence_from_California_Hospitals_1998-2007
  21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924841/
  22. https://www.researchgate.net/publication/8517542_Traditional_Models_of_Care_Delivery_What_Have_We_Learned
  23. https://www.ncbi.nlm.nih.gov/books/NBK222274/
  24. https://www.ouhealth.com/blog/2025/august/ou-health-launches-groundbreaking-hybrid-nursing/
  25. https://www.who.int/hrh/resources/framework_action/en/
  26. https://journals.sagepub.com/doi/10.1891/1078-4535.18.2.50
  27. https://www.freshrn.com/primary-nursing-vs-team-nursing/
  28. https://www.aha.org/aha-center-health-innovation-market-scan/2023-02-28-5-imperatives-scale-virtual-nursing-program
  29. https://pmc.ncbi.nlm.nih.gov/articles/PMC12523961/
  30. https://journals.lww.com/nursingmanagement/fulltext/2015/12000/establishing_a_primary_nursing_model_of_care.3.aspx
  31. http://medcraveonline.com/NCOAJ/NCOAJ-04-00101.pdf
  32. https://pmc.ncbi.nlm.nih.gov/articles/PMC8129221/
  33. https://doi.org/10.1111/jocn.14135
  34. https://journals.lww.com/naqjournal/fulltext/2025/04000/a_non_inferiority_mixed_methods_pilot_study.7.aspx
  35. https://www.mdpi.com/1660-4601/20/3/2391
  36. https://pubmed.ncbi.nlm.nih.gov/31433878/
  37. https://www.aacnnursing.org/news-data/fact-sheets/nursing-shortage
  38. https://doi.org/10.21203/rs.3.rs-5107994/v1
  39. https://www.wolterskluwer.com/en/expert-insights/crisis-response-leads-to-promising-new-care-delivery-models
  40. https://www.wolterskluwer.com/en/news/eight-out-of-ten-nursing-leaders-are-piloting-new-nursing-care-models-cites-wolters-kluwer-survey
  41. https://www.researchgate.net/publication/274086506_Interdisciplinary_Communication_and_Collaboration_Among_Physicians_Nurses_and_Unlicensed_Assistive_Personnel
  42. https://www.journalofnursingregulation.com/article/S2155-8256(25)00047-X/fulltext
  43. https://www.ruralhealthinfo.org/topics/rural-health-disparities
  44. https://pmc.ncbi.nlm.nih.gov/articles/PMC9583196/
  45. https://pubmed.ncbi.nlm.nih.gov/1902557/
  46. https://pmc.ncbi.nlm.nih.gov/articles/PMC8655582/
  47. https://www.healthstream.com/resources/understanding-the-primary-nursing-care-model?type=Blogs
  48. https://pmc.ncbi.nlm.nih.gov/articles/PMC10655287/
  49. https://pmc.ncbi.nlm.nih.gov/articles/PMC10784421/
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