Primary care is the base of the U.S. healthcare system and essential in both reducing healthcare disparities and ensuring access to care. RNs are a key to effective primary care, and in recent years, RNs have begun performing complex care such as chronic disease management, preventative care, and care coordination. Few RNs work in primary care offices, and most nursing students do not have a clinical experience in the primary care setting, perpetuating the problem. In the 2017 National Council of State Boards of Nursing Practice Analysis, most newly licensed RNs (74.9%) reported working in hospitals, while only 2.5% of RNs reported working in office settings. These same new RNs reported competence in skills essential for the primary care setting, such as care coordination, patient education, health promotion, chronic disease management, referral processes, and screening assessments.
The HRSA-funded undergraduate primary care and rural education (UPCARE) project is a community-based academic-practice partnership created to bridge primary care and nursing education to enhance services/programs to a rural, medically underserved community. This grant created evidence-based primary care RN preceptor roles tailored to the needs of federally designated rural health clinics (RHCs) in one rural county and then filled these roles with two RNs who work as both full time primary care RNs and BSN student preceptors. Nursing students participated in a practicum in the primary care clinics for 150 hours over four semesters through this primary care-based program. These RNs are the only RNs in primary care in that county and focus on nursing interventions which both increase care access and quality. Students (n = 48) actively participated in patient care alongside the RNs, providing annual wellness visits, care coordination, chronic disease management, telehealth, triage, and home visits. Overwhelmingly, student surveys indicate that this was an overall positive clinical learning experience. Anecdotally, students indicate that through their primary care-based experiences, they have a better understanding of comprehensive patient care and care complexities.
The strategies used to prepare students can easily be adapted for primary care staff professional development. To prepare for home visits, students were instructed in the use of screening tools and assessment to identifying care gaps to share with the interdisciplinary team to contribute to the care plans, and post-visit debriefing was used to enhance learning and future practice. Additionally, staff could benefit from the telehealth primary care simulations that used standardized patients to develop student competence in aspects of the primary care RN role.
This innovative pilot program has been embraced by students, staff, and patients, demonstrating the possibilities of clinical immersion of RN students into primary care environments as well as the strength of a strong RN role in primary care. The UPCARE project has also established community-oriented nursing interventions that are sustainable, flexible, and responsive to community health needs. This is of critical importance to the continued strengthening of primary care in the U.S. health system.
Learning objective: Discuss the importance of partnerships between academia and practice to develop nursing students’ competence in primary care and create a pipeline of new RNs into this setting.
MSN, RN, CNL,
James Madison University