Primary or team nursing? Two conditions determine the choice.

The cost-benefit analysis of the primary nursing structure is contingent on the factors that affect the proper use of nursing skills. By reducing the problems of coordinating the work, primary nursing has the potential of greater professional nurse involvement with patients. However, in a unit with inefficient support systems, inappropriate use of professional skills in primary nursing render the primary nursing structure less cost-beneficial than the team nursing structure. We may postulate here that primary nursing will be more cost-beneficial than team nursing when the nursing support system requires very little of the RNs' time and the patients require highly skilled care. In a hospital that has inefficient nursing support systems and on nursing units that have mostly self-care to intermediate care patients, primary nursing will only diminish proper use of nursing skills without significant potential to improve the quality of care. On the contrary, with highly efficient nursing support systems and on nursing units that have mostly intermediate use to extensive care patients, primary nursing will have great potential to improve quality and to use nursing skills properly.