Objective: Preparing community-based primary care registered nurses (RNs) to practice to the full scope of their license will require a comprehensive professional development approach. The Community-Academic Partnership for Primary Care Transformation (CAPACITY) project, funded by the Health Resources & Services Administration involves an academic-clinical partnership between a research university, and a federally qualified health center (FQHC) in an urban setting serving vulnerable populations in Atlanta, GA. In this presentation, we describe how we are leveraging this partnership to create a professional development program customized to support expanding nursing practice of RNs to the full scope of license within a primary care setting.

Approach: To guide the focus of the professional development program for RNs, a needs assessment was conducted to identify areas of interest and importance for practicing to the full scope of their nursing license. A mixed-methods and phased approach was used for this needs assessment. The needs assessment design included an online survey and an in-person discussion (similar to a focus group) held with registered nurses (RNs) at the FQHC. The needs assessment was built using the patient-centered medical home assessment (PCMH-A) as the foundation and was supplemented by additional questions regarding soft skills and the organizational and environmental context of the setting. The sample included 11 FQHC clinic RNs, representing three FQHC clinic locations.

Outcomes: The results indicated the areas where the FQHC clinic would benefit from professional development in order for RNs to expand their nursing practice. Of the eight PCMH-A domains, “quality improvement strategy” (mean=3.52) was the highest scoring domain, and “empanelment” (mean=2.73) was the lowest scoring domain. Other domains identified for improvement were “continuous and team-based healing relationships” (mean=3.12), “organized, evidence-based care” (mean=3.13), and “enhanced access” (mean=3.13). When asked about topic areas to gain more knowledge and skill, participants prioritized substance abuse, behavioral health, diabetes/prediabetes, dermatology, and wound care. Lastly, participants identified managing complexity (64%), managing conflict (55%), and communicating effectively (55%), as areas where they need further improvement. A curriculum model for the professional development program has been developed based on these results and initial deployment of these modules began in April 2019.

References:
1. American Academy of Ambulatory Care Nursing. (2010). The role of the registered nurse in ambulatory care position statement.
2. Bauer, L. & Bodenheimer, T. (2017). Expanded roles of registered nurses in primary care delivery of the future. Nursing Outlook, 65, 624-632. doi: 10.1016/ j.outlook.2017.03.2011.
3. Bodenheimer, T. &, Bauer, L. (2017). The Future of Primary Care: Enhancing the registered nurse role. In Bodenheimer, T. & Mason D. (Eds.), Registered Nurses: Partners in Transforming Primary Care: Proceedings of a Conference on Preparing Registered Nurses for Enhanced Roles in Primary Care (pp. 57-86). New York, NY: Josiah Macy Jr. Foundation.
4. Daniel, D. M., Wagner, E. H., Coleman, K., Schaefer, J. K., Austin, B. T., Abrams, M. K., ... & Sugarman, J. R. (2013). Assessing Progress toward Becoming a Patient‐Centered Medical Home: An Assessment Tool for Practice Transformation. Health services research, 48(6pt1), 1879-1897.

Chimora Amobi MD, MPH

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