In recent years, healthcare delivery service has been steadily shifting out of acute care institutions, raising awareness of the importance of primary care and spurring discussions about how it can function more effectively and efficiently.
One of these discussions took place last summer in Atlanta at a conference focused on the role of registered nurses in primary care. The conference was convened by the Josiah Macy Jr. Foundation, an organization dedicated to improving the health of the public and committed to enhancing the education of health care professionals. The conference sparked renewed dialogue about the skill mix of providers and how they can best contribute to enhancing and advancing health care around the country.
At the conference, which was aptly titled “Registered Nurses: Partners in Transforming Primary Care,” leading experts concluded registered nurses who are properly prepared are uniquely suited to handle patient-centered duties, including the coordination and integration of care through team work, emotional support and sensitivity to non-medical needs.
In addition, nurses who work in primary care can assist in a variety of other services, such as assisting in the management of chronic diseases and improving transitional care.
But healthcare consumers are yet to start enjoying the full benefits of the presence of registered nurses in primary care settings because of the preponderance of patient triage responsibilities.
As a result, critically important work such as chronic care management, care coordination and preventive care receive less attention from RNs. As health care evolves and as the role of RNs rises in importance, more people are likely to seek primary care practices where a full range of services is available.
However, the greatest concern to me as a nurse educator is that registered nurses gain little or no primary care experience or training. Yet, educators can’t do it alone. The time is ripe for the healthcare industry and our nursing schools to team up to produce nurses who are prepared to work in primary care.
Currently, most nursing programs are designed to prepare nurses for careers in acute care–an understandable move given the fact that 60 percent of nurses work in acute care environments.
There are many challenges to preparing an RN workforce for primary care. First, the majority of nursing faculty are more comfortable working in acute care settings, in part because they lack experience working in primary care and also because of a lingering fear that students will not acquire the acute care skills necessary to make them competitive in the acute care marketplace which continues to face shortages. Secondly, nursing educators have learned from trying to place advanced practice students in primary care that the rapid pace and limited teaching time make primary care placements difficult.
A willingness to move faculty and students into primary care settings requires education leaders and practice partners. Universities and healthcare facilities could work out arrangements in which faculty members gain significant experience through working in a primary care practice and gaining knowledge and skills in the role of registered nurses.
In addition, because many primary care practices have a dearth of full functioning RNs, the presence of the faculty members will lead to the creation of a mutually beneficial partnership that enhances the practice and cultivates a nurturing environment for future students who will acquire invaluable experience at these practices. For example, the presence of nursing students can benefit practice partners as they step into roles that many of primary care practices may not have experienced, including home visits and a cross-disciplinary approach to care transitions. Such a collaboration will require a significant investment from institutions of higher education as well as from the providers, but in the end our nursing programs will be stronger, which in turn strengthens our health care facilities and their patient outcomes.
Because of the emphasis on the shifting role of registered nurses in health care and a need to prepare more of them to work in primary care, practice partners probably need to adjust the functions of other health staff who support the work of registered nurses, including licensed vocational nurses and nursing assistants. They, too, contribute to the skill mix of service in primary care.
The infusion of nursing students into a major segment of our care system will be a significant transformation in primary care itself. The enhanced emphasis on wellness, prevention and health promotion with RNs as providers as well as disease management specialists will allow physician providers, advanced practice nurses and other health care professionals to focus on their own full scope of practice.
Our health care system cannot gain the potential benefits of RNs practicing at their full scope unless health care partners welcome faculty and their students into the primary care setting. The time to begin this collaboration is now. Such a move will ultimately lead to a significant transformation of our health care system.
Our health care system will be dramatically transformed.
And tens of millions of patients will be better for it.
Anne R. Bavier is professor and dean of the College of Nursing and Health Innovation at the University of Texas at Arlington.