Marie Manthey
Marie Schuber Manthey (born July 17, 1935) is an American nurse, author, and entrepreneur. She is recognized as one of the originators of Primary Nursing, an innovative system of nursing care delivery. Manthey was named a Living Legend of the American Academy of Nursing in 2015. The Living Legends designation honors individuals with "extraordinary contributions to the nursing profession, sustained over the course of their careers." Education. Manthey received a diploma in nursing from St. Elizabeth Hospital in Chicago, Illinois in 1956. After passing the Illinois State Boards, she joined the University of Chicago Medical Center as a  staff nurse, and then became an assistant head nurse and then head nurse on a twenty-bed surgical floor there. She received her Bachelor of Science in Nursing Administration in 1962 and her Master of Science, Nursing Administration in 1964, both from the University of Minnesota School of Nursing in Minneapolis. Manthey was awarded an honorary doctorate from the University of Minnesota in 1999. Primary Nursing. Primary Nursing emphasizes continuity of care and acceptance of responsibility for care over a period of time by the patient's Primary Nurse - usually a registered nurse (RN). The care team consists of the  Primary Nurse and additional staff - a licensed practical nurse (LPN) and/or nursing assistant (NA) - and together they provide complete care for a group of patients within a hospital unit or department. While serving as Assistant Director of Nursing at the University of Minnesota Hospital, Manthey was head of a team of nurses that implemented Primary Nursing in 1968-1969 on Unit 32, an acute medical care ward. Manthey was later named Associate Director of Nursing at the University of Minnesota. In 1968 Primary Nursing evolved from the work of a team of direct care providers on Unit 32 at the  University of Minnesota Medical Center who were experiencing extreme frustration with their chaotic work environment. The result was a nursing delivery system that was "too fragmented and diffuse -- one in which 'everybody's responsible for everything and nobody's responsible for anything'." At the time, it was quite revolutionary to allow the nurse providing care for the patient to determine the amount and type of nursing care the patient would receive. Nurses had been expected to follow policies and orders rather than making decisions based on their own professional judgment. Nurses providing direct care also did not generally communicate with  physicians. Instead, patient information was communicated by the unit manager or nurse in charge. These individuals served as a go between, transmitting patient information/messages and orders between the nurses providing patient care and the patient's physician. "The change to primary nursing eliminated one level of nursing supervision, the traditional team leader, and flattened the well-worn hierarchical structure. Each registered nurse on Station 32 assumed 24-hour responsibility and accountability to plan nursing care for a small group of patients. The results were positive, totally unplanned and nearly palpable. The staff nurse instantly earned, and claimed, the power  to make nursing decisions. Almost overnight, communication changed to a direct, person-to-person pattern; physicians discussed patients with the nurse caregiver, not the head or charge nurse." The Primary Nursing model, which emphasizes 'relationship-based care' is based on 'one nurse taking responsibility for one small group of patients, delivering individualized care for the duration of the stay.' "The essence .. is that primary nursing is really a generic term that simply means one nurse accepting responsibility for managing the care of a small number of patients. Who delivers the care, what the ratio mix is, what the skill level  is, what the staffing level is, what the care plans look like, none of those things make a difference. What makes a difference is whether the nurse accepts responsibility for managing the care of the patients." At the core of Primary Nursing is an empowered staff led by empowering leaders. "It [Primary Nursing] not only put a relationship focus on the nurses' role, it also had the effect of decentralizing power and empowering the individual at the bedside... Nurse managers and directors and vice presidents had to really make a considerable shift in their job focus -- from control to development ." The principles of Primary Nursing were later expanded to include people in all health care disciplines and departments, and clinicians seeing themselves as the "primary" caregiver or service provider to each patient and family became the core of the Relationship-Based Care Model of care delivery (Koloroutis, 2004). Marie Manthey's leadership has allowed the work started by the nurses on Unit 32 at the University of Minnesota Medical Center to be expanded and shared worldwide. Later career. After leaving the University of Minnesota, Manthey became Assistant Administrator and Director of Nursing at Miller Hospital as it merged with St.  Lukes to become United Hospitals of Saint Paul, Minnesota. Manthey moved to New Haven, Connecticut in January 1976, and served as the Vice President of Patient Services at Yale New Haven Hospital. During that time in Connecticut she also served as associate professor at the University of Connecticut and associate clinical professor at Yale School of Nursing. In 1978, she founded a consulting firm specializing in the organization and delivery of health care services. Originally named Creative Nursing Management, now known as Creative HealthCare Management since 2002, headquartered in Eden Prairie, Minnesota, USA. Manthey provided technical guidance to the U.S.  Department of Health and Human Services for their study of Primary Nursing, published in 1983. Manthey has also remained active with the University of Minnesota School of Nursing, including serving as the President of the Nursing Alumni Society from 1999 to 2003. Throughout her career, Manthey has continued to nourish and support the profession of nursing as it continues to evolve. "The profession of nursing must continue to define itself. .. Nurses must ask themselves some important questions.. in short, what is the nursing imperative? I would ask you to mount your own inquiry, and come up with your own answers . Here are mine: "The nursing imperative is a two-sided coin. On one side there is the imperative to be clinically competent in both technical skills and clinical judgement. The other side is the willingness to step in to "being with" the human being for whom the nurse in caring. In healthcare, people experience vulnerability at every level of their being: mental, emotional, physical, and spiritual. The privilege of nursing is having the knowledge and skill, the position and relationship, to interact with a vulnerable human being in a way that alleviates pain and increases mental, emotional, physical, and spiritual  comfort. This is the privilege of nursing -- the "being with" a vulnerable human being. If this privilege is ignored or overlooked, nursing isn't happening. No matter what is happening in a care environment, authentic human connection with the vulnerable human beings in our care can and must happen. That, to my mind, is the nursing imperative."