An Exceptional Case of Undergraduate Student Nurse Learning in Primary Care

Purpose: To explore the contextual and relational elements in one case of undergraduate student nurse learning in primary care.

Background/significance: Healthcare reform, changing demographics, and the swell of chronic disease have amplified the nation’s healthcare workforce demands in primary care. Nursing is responding to the call, and the American Academy of Ambulatory Nursing (AAACN) is leading the charge to redesign the role of registered nurses (RNs) in ambulatory and primary care settings (AAACN, 2017). The AAACN’s transformational leadership in expanding the role of RNs urges schools of nursing and nurse educators to reexamine curricula and redesign clinical learning experiences to prepare students to lead and to practice at the top of their license across the continuum of care. Preparing student nurses to be “practice ready” RNs in primary care will require, in most instances, strategic curricula revision and development of dynamic academic-practice partnerships.

When one student learning experience stands out there is a curiosity and desire to understand why and how this particular case may be different. This presentation will highlight the critical contextual and relational elements in one exceptional case of undergraduate student nurse learning in primary care to “grab the nuances of real-life experience” (Sandelowski, 1996, p. 527). The case was situated within a larger primary care training program and research study aimed at educating undergraduate nursing students, nurses, and community partners about the role of RNs in primary care.

Methods: A single-case study design was used to explore the contextual and relational elements in one exceptional case of undergraduate student nurse learning in primary care. The case comprised the student, faculty, curricula, course assignment(s), and academic-practice partner model of care and preceptor. Data were collected via interviews, survey, and written documents and analyzed descriptively. A case study approach is appropriate when the focus of inquiry is to answer why or how questions and when the contextual conditions are relevant to the phenomena of interest (Yin & Campbell, 2018).

Results: Spiraling curricula (e.g. health promotion, population health) introduced the student to the basic concepts of promoting and managing health across the lifespan and care continuum. Community-based assignments (e.g., community assessment, service-learning projects) promoted the application of knowledge and the development of community-based nursing skills in non-traditional settings. Faculty developed and delivered concept-based learning activities (CBLAs) targeting primary care concepts (e.g., health equity, population health management) deepened context-specific knowledge. A clinical learning experience where the model of care supports top of license practice revealed in “real time” the many roles of RNs in primary care (e.g., triage, referral, complex care coordination/management, transitional care management, interprofessional networking, patient advocacy across different systems) and mobilized the preceptors’ desire to teach, lead, and learn.

Conclusion/implications: The synergistic combination of spiraling curricula, community-based assignments, focused CBLAs, and academic-practice partners that support top of license RN practice enhanced student learning beyond the “usual” and provided valuable input to a training program and research study aimed at educating undergraduate nursing students, nurses, and community partners about the role of RNs in primary care.