Seattle University, USA
Danuta, PhD, RN, FAAN is an Associate Professor and Department Chair, Seattle University College of Nursing, Seattle, WA. She completed the project on Registered Nurses roles in Primary Care as a member of the Leadership Action Learning group along with six other RWJF Executive Nurse Fellows.
Background: Healthcare delivery in the United States requires fundamental redesign to become effective, sustainable, and less costly. Early and consistent utilization of primary health care services is associated with improved patient health outcomes, reduced health disparities, and more efficient spending of health care dollars. Nurses have a long and distinguished career of improving population health through service in primary health care. Still, with swiping changes in how care was delivered in the 20th century, nursing education and practice has moved to acute care and currently only about 10% of RNs are employed in primary health care. Purpose: This presentation will explore the scope of practice, current role, and economic implications of RNs in the delivery of primary health care and offer recommendations for policy, education, and practice to optimize the use of the RN skill set and knowledge in the context of interprofessional team-based care delivery. Methods: The authors interviewed RNs, physicians, and other members of interprofessional teams, employed within a variety of exemplar primary health care practices across the country. We selected 10 practices identified previously as models of quality primary care delivery. The unique roles for RNS in these primary health care settings that improved care outcomes, costs of care, and patient and care team’s job satisfaction included: Episodic and preventive care delivery, chronic disease management, and care coordination. Discussion: RNs are well positioned to contribute to direct care delivery, care coordination, and leadership of interprofessional teams in primary health care. There is a compelling need to expand the contribution and optimize the scope of practice of RNs in primary health care to address a rapidly expanding primary health care access crisis, promote the creation of healthy and satisfying work environments for RN’s and interprofessional team members, and to enhance the health of our nation. Recommendations: Findings from the literature review and interviews of exemplary practices we recommend: Creating incentives for clinicians, provider organizations, payers, states, and the federal government to adopt primary health care delivery models. Expansion of RN’s role in primary care; revising nursing curricula and expanding educational opportunities in primary health care for nursing students; and lastly, preparing workplaces in primary health care, and clarifying and optimizing the roles of all professionals on the healthcare delivery team.