Primary nurses' performance: role of supportive management

Background. Most studies examining primary nursing focus on outcome variables such as enhanced patient and staff satisfaction with care, perceived autonomy and quality of care, whereas only limited research has examined processes of implementing and maintaining primary nursing. In addition, the few studies that have explored process variables discuss only direct relationships between the design of the primary nursing care-delivery system, process and nurse outcomes, and disregard how such variables interact. Aim. This study sought to address previous inconsistent findings about the impact of primary nursing care-delivery models on the performance of nurses by incorporating the moderating role of supportive management practices. Method. Three hundred and sixty-eight nurses from a variety of wards completed questionnaires that assessed the degree of primary nursing on their unit, the support practices of their direct supervisor and their perceptions of the cost of seeking support from their supervisor. In addition, the direct supervisor evaluated the nurse's performance in the unit. Results. Primary nursing did not exert a direct impact on nurses' performance. Rather, the interaction of primary nursing with supervisor support was more predictive of performance: if supervisor support was high, performance was substantially higher than if supervisor support was low. In addition, nurses' perceptions of the costs of seeking support had a detrimental impact on their performance. Conclusions and limitations. The study was cross-sectional and relied on self-report data only. Nevertheless, the findings show that supportive management practices are crucial to the success of implementing primary nursing.