Primary Vs. team Nursing – patient safety

Studies evaluating the effect of nursing models on staff satisfaction have provided conflicting evidence on the method that bears the greatest benefit in enhancing staff satisfaction. Makinen et al. (2003) for instance evaluated how organization of care determined job satisfaction using a sample of 26 ward sisters and 568 nurses drawn from 35 medical and surgical wards of various hospitals in Finland. Nurses satisfaction was assessed through a job diagnostic survey that was informed on an earlier study (Odham, 1975 as cited in Makinen et al. 2003, p. 3001); the survey instrument is comprised of items evaluating nurse satisfaction with supervisors (e.g. ward sisters), satisfaction with co-workers and satisfaction with the personal growth.  The models assessed included primary and team nursing. The study’s results indicated that increasing nurse satisfaction levels were noted as the model of care approached a primary nursing set-up for all the categories (supervisory, co-worker, and personal growth) of job satisfaction evaluated. For instance, the opportunity to write patients’ nursing notes, a core feature of primary nursing, was found to enhance nurses’ satisfaction with their supervisors and the opportunity for growth that their jobs provided.

Sellick, Russell and Beckmann (2003) examined how primary nursing impacts on patient and staff satisfaction using patients and nurses in a surgical hospital in Melbourne. A comparison was made using two wards; one comprised of the experimental group (where primary nursing had been introduced three months prior to the start of the study), and the other a control group where functional nursing was practiced. The sample size was 59 patients and 47 nurses with 28 patients and 17 nurses being assigned to the experimental group and the remainder of the patients and nurses being assigned to the control group. Patient satisfaction was assessed via an 11-item questionnaire whereas nurses’ job satisfaction was evaluated using the staff satisfaction scale comprised of 23 items. Both measurement instruments were specifically designed for the study but pretested using pilot samples. Results of the study indicated that primary nursing was associated with enhanced levels of patient and staff satisfaction. For the nurses, the higher satisfaction levels were noted particularly with regard to items that were in line with the philosophy of primary nursing such as the opportunity to participate in decision-making. The study’s findings are however limited by its use of measurement instruments whose validity and reliability are untested. Additionally, limitations imposed by the sample (e.g. failure to use random assignment) prevent the generalization of the findings to other settings.

In contrast to the above studies, other studies have had favourable findings for team nursing with respect to job satisfaction. For instance, Fairbrother, Jones and Rivas (2010), evaluating a change from individual patient allocation, a primary-nursing-informed model, to team nursing, found out that introduction of team nursing in the acute inpatient wards improved staff satisfaction and retention at Sydney’s Prince of Wales Hospital. Such benefits were especially noted for new graduate nurses for whom the model provided opportunities to learn under the guidance of experienced RNs. Other studies (e.g. Giovannetti 1980, as cited in Tiedeman & Lookinland, 2004, p. 295) have implied that team nursing offers greater job satisfaction when compared with primary nursing, with such benefits being enhanced by assignment to a fixed team (Tiedeman & Lookinland, 2004). Continue to cost and conclusion.

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