Implementing Primary Nursing in a Clinical Research Ambulatory Setting

Subject: At our facility, a primary research environment, ambulatory clinical research nurses instituted a primary nursing model of care. Our goal in implementing primary nursing is to support nurses in developing positive relationships between nurse and patient through continuity of care and consistent positive interactions.

The purpose of this endeavor is to provide an overview of the nurses’ role in implementing a primary nursing model of care in an ambulatory care setting by promoting best practices through education, advancing care coordination, and improving transition management when caring for complex patients.

Methods: A literature review was conducted of evidence related to primary nursing. A project plan was developed to identify patient populations that will have primary nurses based on established criteria which included: 1) assigning patients based on continuity of nursing care and nurses’ preferences, 2) introduction and establishing rapport with both patient and research team, 3) providing a list to charge nurse for daily assignments which lists each nurses’ primary patients, 4) educating the staff on roles and expectations of being a primary nurse, 5) placing of a red asterisk to identify primary patients on the assignment board, 6) developing a nursing progress note to communicate pertinent information on primary patients in the electronic record, and 7) weekly audits to maintain compliance of primary nurse documentation.

Outcomes: Because many patients are transitioning to an ambulatory environment, primary care nurses take on leadership roles to develop nursing strategies for coordination and management of patient care to prevent inpatient hospitalization. Primary nurses, working in collaboration with interdisciplinary team, implement a plan of care to identify what is working effectively and change what is ineffective to meet patient’s satisfaction and care. The primary nurse will serve as the core person that connects the dots to various aspects of patient care as well as improves the nurse and patient relationship.

Analysis and implications: Based on our audit and patient satisfaction survey, implementing primary nursing in a research ambulatory care setting improves patient outcomes. A primary nurse can advocate for patients to improve their lives by teaching them how to use patient portals for information, procedures, care, and community services. A primary nurse can assess the need for counseling and coaching of patients and families. They help guide the patient and family about telecommunication with their providers.