Is the Primary Nursing Model Right for Your Facility?

The primary nursing model is one of four foundational frameworks that guide how nurses do their jobs. Using this approach, each patient is assigned to a primary nurse, who serves as the point of contact, overseeing all aspects of care for the duration of the care episode.

Although this model is often associated with facilitating strong nurse-patient relationships and promoting person-centered care, it may not suit every facility’s requirements. To determine whether the primary nurse model fits your patient needs and staffing structure, use this overview to answer key questions about the model’s background, advantageous use cases, and specific benefits (in addition to possible dropbacks).

What Is Primary Nursing Care?

The primary nursing definition shares considerable overlap with that of the total nursing care approach. Both assign one nurse to the entirety of a patient’s care needs — with one nurse organizing, implementing, and evaluating all of a patient’s healthcare interventions.

The distinction lies in the duration of a primary nurse’s responsibility. With the primary nursing model (vs. total patient care), a nurse is responsible for their assigned patient(s) across the care journey — from admission until discharge. In total care, that responsibility is maintained only for the duration of the nurse’s shift.

This means that using the primary care model, nursing team members remain accountable for all therapeutic needs until the patient is discharged. If a nurse (under the primary model) goes off-shift while the patient is still admitted, they may temporarily delegate care tasks to another nurse, but maintain responsibility for decision-making and care outcomes, despite being away from the bedside. There’s an expectation that they’ll resume direct care as soon as they’re able to.

When Was the Primary Nursing Model of Care Adopted?

This model was pioneered by University of Minnesota hospitals in the late 1960s. It was developed in reaction to the era’s humanistic values and the growing desire of nurses for professional control and autonomy. Its use gained widespread traction — often replacing the functional nursing model which assigned tasks vs. patients to individual nurses — after Marie Manthey (and other contributors) furthered awareness through professional publications.

Growing complexity of care alongside increasing demand for nurses shifted popularity away from the primary nursing care model in the 1980s. However, some facilities still use this approach, particularly those that prioritize care continuity and the patient-nurse relationship.

Primary Nursing Model: Examples in Practice

Certain settings are more commonly associated with this nursing model of care. Examples range from outpatient clinics to inpatient oncological services, and may lead to healthcare experiences like the contextual examples below.

In a Hospice Setting

A nurse is assigned to a new hospice patient and will provide all the hospice-related care until the patient discharges or passes away. Using the provided symptoms to watch for, a family calls the nurse in the middle of the night because they think the patient may be actively dying. The nurse travels to attend to the patient, despite the irregularity of the hour.

In a Long-Term Care Setting

Upon admission, a new resident’s primary nurse designated that the patient can’t mobilize without assistance as a fall precaution. The resident is later frustrated with this decision and demands their mobility status be updated to independent ambulation. Because the patient’s primary nurse owns this decision, the night-shift nurse can’t amend the nursing care plan and must call the assigned nurse to relay the patient’s request.

What Is Primary Nursing Care Delivery Models’ Best Use Case?

The best use case depends on the needs and priorities of your patient population and facility requirements. Some considerations that may drive the adoption of this particular framework include:

• Need for continuity of care.
• Desire for personalization of patient experiences.
• Staff availability (and qualifications).
• Facility budget.
• Complexity of provisioned care.

To truly decide whether this approach would benefit your organization, consider weighing the model’s pros and cons (listed below).

Primary Nursing Model:Advantages and Disadvantages

Care needs vary by patient population and facility type. Here are the key advantages (and disadvantages) of the primary nursing care model that may help you decide whether it’s the best framework for your particular workforce.

Want to Strengthen Your Staff-Patient Relationships Without Stress?

The primary nursing model is one of many frameworks that prioritizes people-first healthcare. Use our wide range of expert-backed facility guides and best practice tips to maximize these approaches’ benefits without risking staff burnout or increased turnover.