Abstract

Nursing as a profession has seen the loss of large numbers of practitioners through job dissatisfaction. In addition, recent studies testing professional growth among new graduates have demonstrated negative findings. Lack of responsibility and accountability have been indicated as potential causes of these problems which confront professional nursing.

In nursing modalities such as functional, case method and team nursing the lack of autonomy in providing care is visible. The team nursing approach fragments patient care; a nurse in this system is responsible for team members rather than directly for patients. The registered nurse does not have enough personal contact in this fragmented setting setting to plan care with the patient, and so does not have the opportunity to practice professional nursing.

Patients also experience dissatisfaction with the fragmentation of the team nursing system. The patient is not involved in his care planning. Frequently patients receive care from nonprofessional ancillary nursing personnel. The patient's questions are often unanswered and his needs inadequately assessed.

Primary nursing was developed to deal with the problems of decreasing professionalism as well as with the dissatisfaction with fragmented care. The goal in primary nursing is to improve patient care by establishing a trust relationship and allowing greater contact between the professional nurse and the patient. This allows the nurse to assess, plan, and deliver care. The concept of "my patient, my nurse" is portrayed. One registered nurse plans care for a group of approximately five patients. This primary nurse works one eight-hour shift and two associate nurses cover the two remaining shifts. They collaborate with the patient in planning care. The primary nurse and the associate provide all the nursing care for the patient.

Sixty-one patients and seventy nursing employees, of which forty eight were registered nurses, participated in this study. The purpose of the study was to determine the effect of primary nursing on job satisfaction among nurses and satisfaction with nursing care among patients. The problem was to establish whether the nurses and patients on the primary nursing unit did experience greater satisfaction than those on the control unit. This was stated in two nondirectional hypotheses:

1. Patients who experience primary nursing will demonstrate a significant difference (α=0.05) in scores on the Risser Patient Satisfaction Scale from those of patients on team nursing units.

2. Registered nurses employed on the primary nursing unit will demonstrate a significant difference (α=0.05) in scores on the Brayfield and Roth Job Satisfaction Scale from those of registered nurses working on the team nursing units.

The study was nonexperimental, comparative, and correlational in nature. Three nursing units were involved in the study. Unit A, the primary nursing unit; Unit B, the unit most like Unit A at baseline; and Unit C, the unit most like Unit A at the end of the study period. For test of hypothetical significance Unit A was compared to Unit C. Unit B was included to establish baseline data.

The study was conducted over a six-month period with data collected at the beginning, after three months, and at the end of the six month period. The primary nursing unit was the only unit tested at three months. Consents were obtained from patients as well as employees of the units.

The criteria for selection were designed to eliminate those patients who were unable to communicate in English, were critically ill or in physical distress, under the effects of anesthesia or narcotics, or involved in any litigation against the medical center. Patients who met the criteria during the selected testing periods were given the opportunity to participate in the study.

The data were analyzed using Chi square and Mann Whitney U tests. Chi square tests were used to compare groups on individual questions and Mann Whitney U tests were used to compare the groups on total test scores. The results of this analysis are included in the following paragraphs. Where significance is indicated, it is always in favor of the primary nursing unit, Unit A.

At baseline there were only two questions from the Brayfield and Roth Job Satisfaction Scale that showed a significant difference between Units A and B using Chi square. This reflected the likeness in the units at that point in time.

At the end of the study, hypothesis one, patient satisfaction with patient care, showed statistically significant differences between Units A and C using Chi square. Over half of the questions on the Risser Patient Satisfaction Scale showed a significant difference in favor of the primary nursing unit.

Although not calculated to determine the hypothetical findings, Unit A, when compared to Unit B, also demonstrated significant difference in patient satisfaction at the end of the six-month period. Patient satisfaction was also reflected by use of the Mann Whitney U test where Unit A was compared to Unit B. However, when Unit A was compared to Unit C using this test, no significant difference in patient satisfaction was demonstrated between the two units.

Hypothesis two, registered nurses' job satisfaction with primary nursing, was again tested at time three between Unit A and Unit C. Based on the Mann Whitney U test there was a significant difference in nurse job satisfaction between Unit A and Unit C and on Unit B. Nurses on Unit A also showed significantly higher satisfaction scores when compared to Unit B.

Both hypotheses one and two were found to show significant difference in satisfaction in favor of the primary nursing unit. The results demonstrated the potential of primary nursing and its effect on the registered nurse in providing responsibility and accountability as satisfiers. The results demonstrated the potential of primary nursing to benefit patients by making their nurse more visible and the quality of their care more individualized.

LLU Discipline

Nursing

Department

Nursing

School

Graduate School

First Advisor

Evelyn L. Elwell

Second Advisor

Ruth Weber

Third Advisor

Grenith Zimmerman

Degree Name

Master of Science (MS)

Degree Level

M.S.

Year Degree Awarded

1979

Date (Title Page)

6-1979

Language

English

Library of Congress/MESH Subject Headings

Primary Nursing

Type

Thesis

Page Count

viii; 111

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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