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Primary Nursing

is a system for the distribution of nursing care in which care of one patient is managed for the entire 24-hour day by one nurse who directs and coordinates nurses and other personnel; schedules all tests, procedures, and daily activities for that patient; and cares for that patient personally when on duty. In acute care the primary care nurse may be responsible for only one patient; in intermediate care the primary care nurse may be responsible for three or more patients. Nurse midwives and other nurse practitioners practice primary nursing. Some advantages are continuity of care for the patient; accountability of the nurse for that care; patient-centered care that is comprehensive, individualized, and coordinated; and the professional satisfaction of the nurse.

From Mosby’s Medical Dictionary, 8th edition.

What are the objectives of Primary Nursing and Team Nursing?

What are the objectives of Primary Nursing and Team Nursing?

Primary Care Nursing: to promote autonomy and competency on a single nurse as all duties and responsibilities in taking care of a patient for his or her duration of stay is delegated entirely on a single nurse. It also aims to produce a nurse that is specialized in an area or a given setting to further improve the nursing practice and patient care.

Team Nursing: to provide the best patient-centered care.  Since other minor duties are delegated to UAP’s, LPN’s and Nurse Aids, the nurse gets to spend more time by the patient’s bedside doing delicate nursing care that cannot be given to any other members of the team.  Another goal is to train the nurse to be flexible.  As the nurse is not confined in the care of a single patient, he or she will be able to learn to adjust accordingly to different needs of different patients.   Team nursing is also a training ground for nurses to become nurse leaders and nurse managers of a team; this can be useful as a preparation for professional advancement.

FUNCTIONS of a Primary Care Nurse and a Team Nurse

What are the respective functions of a Primary Care Nurse and a Team Nurse?

The functions and responsibilities of a primary care nurse are:

1)     The primary nurse is responsible for collaborating with other health care professionals assigned to care for the medical needs of the client.

2)     Physical assessment.

3)     Administration of medication

4)     Creating nursing care plans

5)     Charting medications, I&O, and other pertinent findings related to the care of the client

6)     Provides patient teaching as well as discharge planning.

7)     Evaluates the plan of care given to the patient as well as creating and implementing necessary adjustments for patient’s improvement.

Any perceived problems are consulted with the nurse manager by the primary care nurse for guidance and approval of any plan of action.  This is to ensure the safety of both client and primary care nurse since total accountability and responsibility is on the primary care nurse.

On the other hand, functions and responsibilities of a team nurse are:

1)     The team nurse is the figure of authority within the team, and responsible for coordinating the team members’ actions with respect to implementing total patient care.  The team leader in this way serves as a role model for each member.

2)     Performs any delicate tasks that have to be done to the patient outside the scope of a team member’s knowledge and capability.

3)     The team leader is responsible in planning the care of a patient by coordinating with the team through nursing conferences and formulating nursing care plans.

4)     Fill in for any team member who is unavailable (i.e. breaks, conference)

5)     Coordinate each action done by the members of the team.  The team leader then observes the implementation done by the members of the team, takes note of the method of implementation by noting both strengths and weaknesses of each member.  The notations are then relayed to the members of the team either at the end of the shift or on the next day’s scheduled conference.

6)     Schedule a 10-15 minute conference each day to promote communication and continuity of care.  The team nurse is responsible for arranging the time and venue of the conference.  The physical set up is also the responsibility of the team leader which includes but not limited to: temperature of the room, adequacy of space and seats, arrangement of necessary devices such as projectors or sound system in order to communicate better with the members of the team.

Team Nursing

is a decentralized system in which the care of a patient is distributed among the members of a group working in coordinated effort. The charge nurse delegates authority to a team leader who must be a professional nurse. This nurse leads the team-usually of 4 to 6 members-in the care of between 15 and 25 patients. The team leader assigns tasks, schedules care, and instructs team members in details of care. A conference is held at the beginning and end of each shift to allow team members to exchange info and the team leader to make changes in the nursing care plan for any patient.

From Mosby’s Medical Dictionary, 8th edition.

CHANNELS OF COMMUNICATION

What is the channels of communication in Primary Care nursing and Team Nursing?

The primary care nurse directly reports and communicates to all health personnel responsible for the care of the patient.  Communication is done through:

1)     Nursing care plans

2)     Charting

3)     Direct reporting

In team nursing, the nursing leader coordinates with the Nursing Coordinator or Unit Nurse Manager with regards to the condition of the patient, as well as problems of team members and in the ward through submitting a summary report or through conference.  As for the team members, the team leader communicates with each member by:

1)     Nursing care plans

2)     Charting

3)     Reporting

4)     Conference: this may happen at the beginning and at the end of the shift.  The team leader will lead the discussion about:

a.       Delegation of duties.

b.       Any change in the number of patient, or change in the plan of care.

c.       Summary of each team member about the wellbeing of their respective patients, as well as their duties and responsibilities.

d.       Planning on the next day’s activities.

Overall, Team nursing is better to implement than primary nursing in several ways.  The team will be able to give patient-centered care according to their specialties and abilities without causing too much stress.  Proper implementation will ensure that the team will be able to take care of the needs of several patients without the need to extend hospital hours, or worrying about going behind schedule.  It is also cost-effective for a team of 4-6 members can take care of a group of clients comprising of 15-20 patients while.  This ratio will ensure less confusion and less errors in rendering patient care.  Proper communication will ensure that all tasks done in team nursing will be done in the right time and ensure patient satisfaction.

Team Nursing vs Primary Care Nursing, with an emphasis on Team Nursing. It should include

1 Definitions of Team Nursing and Primary Care Nursing

2 Objectives of team nursing and Primary Care Nursing

3 Lines of organization of team nursing and Primary Care Nursing

4 Functions of all Team Nurses and Primary Care Nurses

6 Channels of communication in Team Nurses and Primary Care Nurses

6 Summary on why Team Nursing is better than Primary Care Nurses

NURSING MANAGEMENT: TEAM VS. PRIMARY

NURSING MANAGEMENT: TEAM VS. PRIMARY

Hospitals address nursing care of ward patients in several ways. The two most common nursing management styles are Team Nursing and Primary Care Nursing. Each type of nursing care management has its own pro’s and con’s with respect to both nurses and patients. Both systems were devised in order to improve the quality of care given to patients, while considering the abilities, capabilities, and limitations of nurses and other health care providers in the ward.

WHAT IS PRIMARY NURSING AND TEAM NURSING?

Primary Care Nursing is a system in which one nurse is caring for all the needs of a patient or more within a 24 hour from admission to discharge. He or she is responsible for coordinating and implementing all the necessary nursing care that must be given to the patient during the shift. If the nurse is not available, the associate nurse responsible for filling in for the nurse’s absence will provide hospital care to the patient based on the original plan of care made by the nurse. This type of nursing care can also be used in hospice nursing, or home care nursing.

o The advantage of promoting primary nursing in hospital practice is that the patient is able to build trust and confidence on the abilities of the nurse assigned to him. This in turn can lead to fast recovery and improved nurse-client relationship.

o The disadvantage of promoting primary nursing is the high cost setting, especially in specialized units such as the ICU where one nurse is assigned to the total care of a single patient. It is also important that the assigned nurse will be highly knowledgeable about the patient’s condition and how to properly plan and implement the right nursing care. Also, if the right patient-nurse mix is not achieved, the patient may deteriorate in condition and even reject the nurse totally.

Team Nursing, on the other hand, is a system developed in the 1950’s to answer the need of more nurses in a hospital. This is where one nurse is in charge of leading group comprising 4-6 different members such as nursing aids and unlicensed assistive personnel to care for a group of patients equating to 15-20. Patient care is delivered through the coordination and cooperation of each team member through delegation of assignments with respect to the team member’s level of responsibility and accountability. Delegation of patients and duties are done at the beginning of the shift, while a summary of care given and outcomes resulting from patient care is conveyed at the end. Any action that is done by unlicensed assistive personnel, nursing aid or nurse volunteer is the responsibility and accountability of the team leader, the registered nurse.

o The advantage of team nursing is that the total number of absences and leaves related to over-work and medical conditions related to stress and fatigue is lessened. This is due to the sharing of workload between each team members, enabling them to do a huge amount of work in such a short time without undue exertion. This delegation of duties will also enable team members to hone their skills in different nursing tasks, and also improve their ability to communicate and coordinate. Each can also learn from each other during team conference while discussing on ways how to go about in caring for different patients. Once the team has established themselves as members and not as individuals each would feel that they belong thereby increasing nurse morale. This in turn would improve the quality of care each would give to the clients, leading to better patient satisfaction. Each will realize each team member’s role in caring is important for the client, minimizing the barrier between each profession.

o One major disadvantage of team nursing is lack of team effort and inability to communicate. Pooling people together in order to work does not necessarily equate that each team will work as a group. Time must be given in supervising the team to help each member act as part of a group. Communication barriers may cause some problems in rendering patient care. If team members are constantly being re-shuffled, the continuity of care can be interrupted, leading to patient dissatisfaction.

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