Background: Currently primary care is characterized by many distinct providers and services leading to fragmented, uncoordinated care where follow-up appointments and important interventions are easily missed, challenging the ability of healthcare professionals to provide high quality, efficient, and cost-effective care. Under the Affordable Care Act, providers are held accountable for engaging patients, working in teams, and sharing decision-making. As healthcare evolves into an interdisciplinary model, registered nurses (RNs) are well positioned to re-engineer processes that can improve patient outcomes. Registered nurses are pivotal in quality patient care and achieving patient-centered healthcare goals. Primary care is at the center of population health and is crucial for the prevention of illness and chronic disease management. Only 60% of RNs are employed in acute care, yet education in nursing programs across the United States (US) is geared toward inpatient hospital care with approximately 4% of nursing programs in the US boasting a comprehensive population-focused curriculum.
Methods: A midwestern university recently redesigned their curriculum to embrace population health and to extend clinical experiences into primary care. Faculty were awarded a 2 million dollar grant from the Health Resources and Services Administration to provide longitudinal clinical experiences in primary care and to expand the scope of RN practice to full extent of licensure. One key factor of the grant was evaluation of the curriculum for inclusion of primary care. To ensure incorporation of the primary care focus, courses were evaluated for content and objectives and adjustments were made to align with the care coordination and transition management (CCTM) model competencies. Clinical evaluation tools were created to include the competencies outlined in the CCTM model. The CCTM model parallels well with the quality and safety education for nurses competencies (QSEN). The knowledge skills and attitudes of the QSEN competencies are integrated in the CCTM model as well as in the baccalaureate nursing program objectives. The course curriculum and evaluation alignment with the CCTM model will be presented.
Implications for practice: With the inclusion of primary care in the nursing program, baccalaureate nursing students will be offered a clinical experience most programs do not. During the longitudinal clinical experience of up to 192 hours, nursing students will work alongside RNs in the primary care setting. Students will deliver care, provide disease management education, assess patient resources, and manage all aspects of patient care coordination. Students will gain an appreciation for the scope of practice of all members of the interdisciplinary primary healthcare team. The overarching goal of the project is to integrate the role of the primary care RN in the curriculum, offer practice opportunities during the undergraduate nursing program to foster a population-focused approach to healthcare, and explore opportunities beyond acute care.
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