The author illustrates how the tensions between primary and secondary care issues are generally expressed and potentially balanced in the daily work of child and youth care staff, who are described as serving two masters: the students and the organization. The author contends that while the provision of primary (personal) care within a secondary (organizational) care context is inherently challenging, it also presents interesting opportunities. An ecological perspective regarding care in everyday life is outlined that takes into account the major influence exerted on a child’s life by secondary life systems, such as parents’ employment and even the wider political and economic environment. The author illustrates these points through an analysis of a typical 1.5 hour staff meeting at a prestigious residential child care agency serving 40 severely disturbed elementary and high-school aged clients. The author illustrates how the exchanges observed in the meeting often expressed the dominance of administrative concerns over immediate child and youth care concerns. The dominance of secondary care issues is described as the typical expression of the tension between the primary and secondary care domains. Only when particular subsystems are able to muster sufficient thrust to counteract organizational necessities are primary care concerns likely to take precedence. Bureaucratic and clinical issues involving group care work are explored followed by a conceptual examination of primary (clinical) and secondary (bureaucratic) care systems, including their history, their sociological manifestations, and their variations in emotional demands. How the tensions between primary and secondary care issues impact care workers is considered before potential solutions to these inherent tensions are offered, which include the advice to standardize clinical and organizational processes. Closing comments include the observation that effective group care practice may require an expansion of the theoretical orientations and practice procedures of the two care domains. Notes, references