Purpose: To create an enhanced primary care nurse role, practicing at the full scope of license in community-based primary care, resulting in sustainable solutions to address the primary care nursing workforce shortage in Indiana, enhance the health and well- being of our patients, address social determinant factors, and recruit and train nursing students in community-based primary care.
Background/significance: Currently, there is no defined role for an enhanced primary care RN. According to the Indiana Data Report 2015, only 8.9% of all RN’s (n=6,009) who completed their survey work in an ambulatory care setting (Vaughn et al, 2015). By creating this enhanced role, population health, social determinants of health, chronic disease management, care coordination, transitional care management, mental health, and pain management can be addressed to increase quality care and prevent hospital admissions.
Methods: In addition to creating a new top of license role for the registered nurse, a primary care curriculum for pre-licensure baccalaureate nursing students and post-licensure RN-BSN students was created. The current state of curricula does not involve education in primary care nursing. In partnership with The University of Indianapolis School of Nursing (UIndy), a primary care overview course, and subsequent primary care nursing classes were developed and are currently being implemented with 19 credit hours and 150 clinical hours, resulting in the first minor in primary care nursing in the country. With these implementations, a pipeline was created for entry into primary care which will increase patient access to primary care services and improve population health outcomes. To successfully train students to be effective primary care nurses, an ambulatory care preceptor training course was initiated.
Result: Nine students were enrolled in the first primary care overview course at UIndy. Three enhanced RNs in seven clinical sites were secured in clinical rotations, and seven preceptors were trained. Standardized instruments are being utilized to measure student perceptions of their curriculum and preceptors, preceptor perceptions of their training, and patient perception of their care rendered in the primary care sites. These tools include The Self-Efficacy and Performance in Self-Management Support tool (SEPSS-36, Duprez et al, 2016), Nursing Preceptors’ Attitudes and Perceptions Questionnaire (Kalischuk et al, 2013), The Preceptor’s Perception of Benefits Rewards Scale (PPBR) (Dibert, 1993), and The Clinical Learning Environment, Supervision and Nurse Teacher Scale (CLES+T) (Saarikoski et al, 2008). Data is currently being evaluated to identify trends in patient perception and team cohesiveness via standardized survey instruments. Conclusions: An enhanced RN role in primary care nursing is necessary to improve access to health care, yet it is not implemented in primary care settings, where nurses are typically used in triage roles. The challenge remains that while this is needed in practice, it has not been a part of curricula in nursing. A minor in primary care nursing in an undergraduate nursing program, along with an enhanced RN role in six practice settings were developed to revolutionize the role of primary care nursing, create a pipeline for new nursing graduates to enter primary care nursing, and improve patient outcomes.