Adapting a Primary Nurse Project to a Pandemic

Purpose: Within our clinical research center, ambulatory care primary clinical research nurses (PCRN) embrace a primary nursing model of care. Our goal is to expand and improve primary nursing in high-volume ambulatory care clinics. This goal is to support nurses in developing positive relationships through continuity of patient care and consistent meaningful interactions with research participants and their families.

Description: A literature review of evidence related to primary nursing using search terms “primary nurse,” “primary nursing,” “primary nursing clinic,” and “primary nursing model” was conducted. Based on our findings, a project plan was developed to identify relevant patient populations that could potentially benefit from our model of care approach. In January 2020, we began to utilize the primary nurse category in the electronic medical record (EMR) system. Working with our IT department, we established a secure method to maintain an active list of primary patient assignments, enabling each PCRN to independently maintain consistency between the EMR system and the secure drive. The nursing progress note in the EMR facilitates communication of pertinent information on primary patients. These improvements promote best practices through education, advancing care coordination and improving transition management when caring for complex research patients. Then COVID-19 happened…

Our original strategy was to implement this plan separately, in each of our three diverse ambulatory care clinics that specialize in conditions within neuro, endocrine, craniofacial and more. The pandemic changed the project dynamics and precipitated the question of “How do we keep our connection to primary nursing, to each other, move forward and socially distance during a decrease in patient census?” We had to adapt and work together, first by establishing WebEx accounts. To adjust, each PCRN selected a patient and created a presentation to include disease, nursing diagnosis, educational needs, and primary nursing impact. Our weekly WebEx presentations led to discussion and expanding our primary nursing process.

Evaluation: Discussion summaries were compiled and organized in SharePoint to include optimizing use of visit time; building team rapport; and maintaining excellent communication regarding education, intervention, and care needs. The team was surveyed to assess the project and determine continued direction. 12 of 15 responded, of which eight wanted to continue with a focus on patient conditions. Comments included “we gained better understanding of the varied processes and practices of our nurse colleagues on other clinics” and concluded that preparation for the project provided time to reflect on “how we can best serve our primary patients.”

Outcomes and implications: This project provided a sense of new community, a connection to nursing and each other during a time of pandemic imposed isolation. Using the WebEx venue provided inclusion, especially of those working from home. Additionally, the experience has inspired topics for future development. This professional learning activity proved to be a positive growth experience for all PCRNs, improving leadership skills, promoting staff integration, and increasing awareness of our unique individual clinic environments.