Flex-primary: an ED nursing care delivery and communications systems.

Abstract

I n November 1982 a task force of ED clinical nurses was commissioned by the ED clinical director at St. Vincent Medical Center, a 655-bed, acute-care teaching facility in urban Toledo, Ohio, whose emergency department logs approximately 36,000 annual patient visits. The goal of the task force was to identify and propose solutions to departmental problems. Many staff members were dissatisfied with the quality of patient care, primarily because of taskoriented, fragmented nursing care and unequal distribution of the work load. Another contributing factor was dissatisfaction with communication, which was thought to be inefficient, insufficient, and at times erroneous. Thus two major areas were targeted to resolve departmental problems: the nursing care delivery system and intradepartmental communications. The ED nursing staff had previously tried several nursing systems, including the “team” concept with charge nurses, “side” (medical-surgical) assignments, and the “catch as catch can” system. All had some major drawbacks and proved to be unsuccessful and unpopular with the ED staff. In researching nursing care systems, the task force found a great deal to recommend the concept of primary nursing. Since its inception in the 1960s and the first documented application in 1963 at the Loeb Center of the Montefiore Hospital and Medical Center in New York, primary nursing has gained wide acceptance as a preferred mode for nursing care delivery. Various authors describe the essential elements of primary nursing to include (1) accountability, (2) autonomy, (3) comprehensiveness, (4) coordination, and (5) continuity.‘-6 Marram et a1.3 assert that clinical nurses find individualized, patientcentered, personalized primary nursing to be reward-