Objective: In this presentation, we describe how we created and implemented an undergraduate educational experience around full RN collaboration in primary care visits (Funk & Davis, 2015, Sinsky, Jersak, & Hopkins, 2021). Specifically, we used telemedicine to train pre-licensure nursing students to practice to the full scope of license in the primary care setting.
Background: During the COVID-19 pandemic, several clinical sites shut down in-person services, resulting in a critical shortage of clinical placements for schools of nursing. To address this challenge, a pre-licensure nursing program in a Southeastern state collaborated with a small non-profit, community-based clinic to design an innovative approach using the RN co-visit model on a telemedicine platform, while giving nursing students real-life clinical experience.
In the RN co-visit model (Funk & Davis, 2015), an RN performs an initial assessment on a patient with an acute illness before engaging a provider and follows with post-visit follow-up In other literature, this concept has been called advanced team-based care (a-TBC) (Sinsky, Jersak, & Hopkins, 2021) with many of the same elements applied to telehealth.
Methods: Using the RN co-visit concept, nursing students, in groups of two under the supervision of the RN preceptor, who was also course faculty, reviewed the medical records for their assigned patients before the visit. At the appointment time, they connected with the patient via an approved telemedicine platform with video and multi-user capacity. They performed subjective assessment, including a history of present illness, past medical/surgical history, review of system, and any other pertinent issues brought up by the patient before texting the provider that they were ready.
When the provider logged on to the platform, the students reported their findings under the RN preceptor’s supervision and with the patient’s presence on video. The provider then conducted objective assessment under the limitation of the virtual environment, established the diagnosis and treatment and left the call, leaving the students and the RN preceptor to provide patient education, answer patient questions, assist the patient with resources if needed, and close out the visit.
In each visit, students rotated the roles of primary interviewer or scribe (making notes of the encounter). The RN preceptor/faculty provided students with feedback, assisted them in writing a SOAP (subjective, objective, assessment, plan) note, and entered the note into the electronic health record. The visit generally took between 20-30 minutes.
Outcomes: Students overwhelmingly reported satisfaction and improved confidence in several areas such as communication, assessment, critical-thinking skills, and patient education. The clinical practice also reported satisfaction with the partnership because the providers could see more patients with the flip visit model while improving patient's access to care during the COVID pandemic. Patients also reported satisfaction as they could spend more time with a trusted person: the nurse.
Conclusion: Using RN co-visit model and telemedicine in primary care to train pre-licensure nursing students is an innovative approach to training students in full-scope practice of nurses in primary care and improving patient access.