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Best Practices: Professional Practice
Many scholars believe that one of the best forms of nursing — as well as one of the most rewarding and therefore most effective at encouraging retention — comes under the general rubric of "primary nursing." A recent analysis explains that from its inception, primary nursing has involved the following:
- a nurse assuming 24-hour responsibility for a designated patient caseload;
- accountability for a patient's care by one nurse from time of admission to discharge, with direct care by that nurse whenever he or she is present;
- case management of patients by primary nurses who use written plans that have a multidisciplinary approach; and
- the use of associate nurses who work in partnership with the primary nurses.212
The American Hospital Association similarly supports an "attending RN" model, urging hospitals to adopt this "model of care [that] gives the nurse the responsibility and related authority for patient care."213
Indeed, the belief in the nurse-patient relationship as the foundation of professional nursing practice has been consistently cited as a central principle by nurses at magnet hospitals.214 "I have found primary nursing to be the most satisfying part of my job," explained one nurse. "I would not work anywhere that did not practice primary nursing."215 Nursing directors in magnet hospitals likewise have expressed strong support for primary nursing. One administrator maintains this practice only in select departments; she reports that "where there is primary nursing there is very good retention."216
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