Primary nursing is a care delivery model where one registered nurse assumes 24-hour accountability for planning, directing, and evaluating the care of a specific group of patients from admission right through to discharge. Unlike team nursing or functional nursing where tasks are fragmented among various staff members, primary nursing establishes a direct, continuous link between a single nurse and the patient. Even when the primary nurse is off duty, an associate nurse follows the established care plan to maintain consistency. This model aims to restore personalized care, foster therapeutic nurse-patient relationships, and enhance professional autonomy. Nigerian nursing students must note that accountability rests squarely on the primary nurse, demanding sound clinical judgment and effective communication.
The primary nurse performs comprehensive health assessments upon admission and formulates an individualized care plan. They communicate directly with doctors, pharmacists, and physiotherapists to coordinate the multidisciplinary treatment regimen. Education forms a major daily duty, ensuring both the patient and their family understand the disease process, medications, and home care requirements. When away from the ward, the primary nurse hands over detailed updates to ensure associate nurses execute the plan accurately. Discharge planning starts on day one, guaranteeing a smooth transition from the hospital back to the community.
| Model | Primary Focus | Communication Flow | Accountability |
|---|---|---|---|
| Functional Nursing | Task-oriented (e.g., meds, dressing) | Fragmented among many task workers | Shared across the whole shift team |
| Team Nursing | Group of patients managed by a led team | Through the team leader | Shared among the assigned team |
| Primary Nursing | Comprehensive, holistic individual care | Direct nurse-to-patient and team | Single registered nurse 24/7 |
Functional nursing breaks care down into separate chores, which saves time but often leaves patients feeling like strangers to the staff. Team nursing relies heavily on delegation from a team leader, which can dilute individual accountability. Primary nursing eliminates these gaps by placing total responsibility on one registered professional.
Patients cared for under the primary nursing model typically report higher satisfaction because they build a trusting relationship with a familiar face. Nurses also experience greater job satisfaction due to increased autonomy and clear accountability. However, the model demands a high ratio of registered nurses, making it costly and difficult to staff in resource-constrained environments. Burnout can occur if a primary nurse carries a heavy caseload of complex patients without adequate backup during off-hours.
Applying primary nursing in Nigerian tertiary or secondary hospitals faces notable hurdles, including severe nurse shortages, high patient-to-nurse ratios, and heavy reliance on task-oriented functional nursing. When one nurse is assigned to twenty or more patients in a crowded ward, maintaining 24-hour accountability becomes nearly impossible. Yet, adapting elements of primary nursing—such as assigning specific patients to individual nurses per shift or improving bedside handover—can greatly enhance care quality. Nurse managers must advocate for policy changes and better staffing structures to make true primary nursing achievable in public health institutions.