Structure vs. people in primary nursing: an inquiry

This paper raises the question, "Is it the structure or the competency of the nursing staff that improves the quality of primary nursing over team nursing?" In the study an all-RN model of primary nursing was compared to a team nursing care system. The nursing competency scores of registered nurses on the two units were equalized through six months of continuing education and staff development programs, and the nursing competencies and the quality of patient care were measured by Slater and Qualpac scores, respectively. Although the primary nursing unit scored higher than the team unit on five out of six subscales, the scores were statistically significant (p = .06) only on one, the communications subscale. Results of this study were compared to Felton's study, which found primary nursing units had a more competent nursing staff and higher Qualpac scores. The comparison suggests that nursing competencies may be a stronger contributing factor to the quality of care than is the structure of primary nursing.