Since its inception in the late 1960s, primary nursing has been the subject of much misinterpretation, as well as healthy adaptation. Over the last 15 years, the first generation of primary nursing users have shown that professional nursing is ultimately enhanced, not through changes in staffing patterns, but in the locus of accountability. The second generation primary nursing users face the challenge of developing a culture that integrates the realities of care delivery with the evolving professional status of nursing.