The Nurse Manager’s Role in the Primary Nursing Care Model: A Review of Clinical and Management Aspects

Abstract

Implementation of the primary nursing care model requires a change in the role of the nurse manager from “a collector of information and responses” to a nurses’ trainer in care planning and related decision-making and support. To describe the experience of introducing the primary nursing care model in a surgical setting; to describe methods designed to change the nurse manager’s role; and to provide organizational elements and data based on practical experience. In order to apply the four cornerstones of primary nursing to a surgical setting, the staff was given full assistance by creating the necessary organizational and relational conditions and promoting the transition from “being a primary nurse” to “feeling a primary nurse” in their provision of care to, and relationship with patients, as well as in their experience with their respective families and social environment. The transition from a team nursing to primary nursing model was prepared by defining care standards, reshaping organizational processes, mapping nursing competencies, defining materials and resources, building instruments such as clinical care pathways, and administering a questionnaire for nurses and patients as both a fact-finding survey tool preceding the introduction of the model and an impact-assessment tool at one year’s distance of such introduction. The application of the primary nursing model created a positive environment in professional relationships where nurses could test their accountability; in addition, patients’ satisfaction with the care provided was higher; their perception of dignity improved with regard to privacy, autonomy and relational aspects; and, finally, pain perceived at rest and on movement dropped. The manager’s satisfaction does not derive from knowing anything about his or her patients and controlling the situation at any time, but rather from seeing patients recognize and seek care from their attending nurses, who are closely involved in care provided to patients and feel comfortable about what they are doing and their own professional growth. The primary nursing model implies a necessary renewal in the cordinatoor’s role to include clinical and managerial components in its leadership activities at the patient’s bedside. When the model is applied, a nurse manager becomes a clinical manager who works out standards for the care practice, assesses the performance of his or her staff, teaches nurses, supports them in decision-making, oversees care, coordinates care activities, and has a direct experience in the relationship that a nurse establishes with a patient.