How Primary Nurses Operationalize Accountability

Abstract

Primary nursing has been suggested as a method of nursing care delivery that promotes individualized care (Marram, Schegel & Bevis, 1979), higher quality patient care (Felton, 1975), continuity of nursing care, professional practice and accountability (Ciske, 1980; Zander, 1980). The authors suggest that 24-hour accountability is the essence of care in primary nursing. However, the concept of accountability has not been clearly defined; hence, this study was conducted to determine what 24-hour accountability means to primary nurses and how they operationalize it in their practice. Background research in primary nursing The concept of primary nursing is not new. It was developed at the University of Minnesota Hospital in the early 1960s and was introduced in the literature by Manthey, Ciske, Robertson and Harris, (1970) from the University of Minnesota. In an extensive literature review it was found that only 21% of more than 150 articles on primary nursing were classified as research (Giovanetti, 1982). The majority of the articles (56%) contained no emperical data and 23% were classified as descriptive-evaluative. Most of the research studies have evaluated the effectiveness of the primary nursing care system when compared to functional or team nursing. These studies focused on several variables: patient-centered variables including patient satisfaction and patient-outcome criteria; process-outcome criteria related to the quality of patient care; cost effectiveness; and, job satisfaction.