A delivery system is a set of organizing principles that is used to deliver a product or service and generally consist of four elements: decision-making, work allocation, communication, and management.
Results include shorter hospital stays, increased patient satisfaction, fewer medical complications, and less staff absenteeism.
"[2] That patient-nurse relationship carries over to the family, and helps the nurse with discharge planning, as they're able to assess the patient's support system outside of the hospital.
The patients under primary nursing experienced an average of one complication after the operation, and so were able to be discharged from the hospital sooner.
However RN's do still provide more patient care than under team nursing, and have less supervisory duties over other caregivers.
[3] After the war, hospitals were built all over the US to continue to provide care to the wounded, and expand the health of the population.
[8] As implementation of primary nursing continued, patients reported satisfaction with the system because care is personalized to them.
[7] Changes required may include the nurse-doctor relationship, staffing patterns and nursing supervision practices.
The practice of any profession is based on an independent assessment of a client’s needs which determines the kind and amount of service to be rendered: services in bureaucracies are usually delivered according to routine pre-established procedures without sensitivity to variations in needs.”[23] Manthey also stated that primary nursing is sometimes rejected because the nursing leader is afraid of losing authority.
The benefits Wright identified of primary nursing include reduced patient complaints, fewer medical complications, and less staff absenteeism.
The discomfort of doctors working with different primary nurses, rather than one specific head nurse/ward sister is a challenge.
Also, for the primary nurse, taking responsibility for the patient's care from admission to discharge requires an adequate support system.
[25] Possible cost savings to support the hiring of additional qualified nurses were identified to include reducing shift change from two hours down to one, reducing supervision costs, and moving clerical and housekeeping tasks from nursing to other hospital staff members.
[26] In the 1990s, industry consultants led a movement of hospitals into restructuring and re-engineering in the name of cost-cutting, that had the effect of reducing professional nursing autonomy and judgment by use of multi-skilled team members.
This 'changing skill mix' had the effect of increasing the managerial, medical and therapeutic work of nursing, and assigning bedside care to non-nursing staff.
This grew out of 'total patient care' which involved nurses taking on additional clinical roles such as occupational therapy tasks, their work load increased accordingly.
Nurses reported being concerned about qualitative differences in patient care that weren't being measured, as well as increased pressure and uncertainty due to extensive changes.
[29] Current terminology for this practice model - 'Relationship-Based Care' - applies the original concepts of Primary Nursing to all functions and relationships within the hospital setting.