Nurses' Evolving Role in Primary Care
While policy-makers in Washington and in state capitals across the nation have been embroiled in a debate over health care reform, many aspects of the health care system have been evolving in response to economic and demographic pressures. The latest issue of the Robert Wood Johnson Foundation’s ongoing Charting Nursing’s Future (CNF) series of policy briefs highlights a number of examples of that evolution, all related to nurses’ changing role in primary care.
The Institute of Medicine’s landmark report, The Future of Nursing: Leading Change Advancing Health, noted that nurses “are poised to help bridge the gap between coverage and access, to coordinate increasingly complex care for a wide range of patients, to fulfill their potential as primary care providers to the full extent of their education and training, and to enable the full economic value of their contributions across practice settings to be realized.” In fact, as the CNF brief points out, “Nurses are already leading the way in keeping patients healthy, managing their diseases, and reducing their use of costly hospital care by increasing the availability and scope of primary care services.”
As evidence, the brief points to specific examples of nurses’ expanded role in primary care in a variety of settings, including:
- Empowering Primary Care Nurses to Serve Patient Needs. In Minnesota, the nonprofit health care organization HealthPartners empowers primary care nurses to serve their patients. As part of an overall collaborative approach, registered nurses (RNs) and licensed practical nurses (LPNs) collaborate with other professionals to anticipate patient needs, treat some acute conditions with standard protocols, and make sure patients have supports in place to implement care plans successfully. Another noteworthy innovation: HealthPartners has established a popular service that employs nurse practitioners (NPs) to diagnose and treat common conditions via the Internet.
- Leveraging Nursing’s Contributions to Primary Care. The “Prescription for Pennsylvania,” a series of reforms launched in 2007 in response to concerns about the cost and quality of care for patients with chronic conditions, included relief from state restrictions on NPs’ scope of practice, leading to dozens of NP-staffed convenient care clinics opening around the state. The state also began offering financial incentives to primary care practices to implement the widely respected Wagner Chronic Care Model, which relies on nurses to provide coordinate patient care.
- Supporting Primary Care with Community-Based Nurse Care Coordination. Vermont’s Blueprint for Health program deploys nurse care coordinators in clinics and private practices across the state, where they collaborate with social workers, behavioral health counselors and others to transform the delivery of primary care. Nurses often serve as team leaders, and they and other members of the teams meet with patients to make sure they receive the preventive and coordinated care they need. The state also changed its nurse practice act to mitigate physician shortages by allowing experienced advanced practiced registered nurses (APRNs) to engage in solo practice.
- Connecting Nurses with Patients to Strengthen Continuity of Care. At Veterans Administration hospitals, where the equivalent of 8,500 full-time nurses are on duty, nurses provide continuous, coordinated primary care to the nation’s veterans, playing multiple roles as part of Patient-Aligned Care Teams (PACTs). Each PACT includes a primary care provider (an NP, physician, or physician assistant), a nurse care manager (an RN), a clinical associate (an LPN or nursing assistant), and a clerical associate. Each veteran has a PACT RN responsible for coordinating care over the long term, in person or via telehealth technology. This continuity of care over an extended period of time, the VA believes, serves to create strong bonds between nurses, patients, and their families.
Such efforts aimed at taking better advantage of nurses’ training and skills are helping provide high-quality care to patients at lower cost across a variety of settings.
- Read the CNF brief, Implementing the IOM Future of Nursing Report–Part III: How Nurses Are Solving Some of Primary Care’s Most Pressing Challenges