Building Capacity for RN-Led Medicare Annual Wellness Visits in a Federally Qualified Health Center: A Story of an Academic-Clinical Partnership in Ohio

Background: The need for registered nurses (RNs) in primary care settings has never been greater. Despite the growing body of evidence on the importance of the role of RNs in primary care, educational programs for RNs at the ADN and BSN level have not integrated in curriculum enhanced and expanded roles in primary care. It is imperative that RNs practice to the full scope of their license in community-based primary care teams to increase access to care, with an emphasis on chronic disease management, including mental health and substance use conditions.

In 2018, our college of nursing (CON) responded to a call, and was awarded funds, from the Health Resources and Services Administration (HRSA) to educate a sustainable primary care nursing workforce equipped with the competencies to address pressing national public health issues, improve access to care, and improve population health outcomes by strengthening the capacity for registered nursing education and practice. Furthermore, addressing national nursing needs under three priority areas: education, practice, and retention. Through an academic-clinical partnership with a rural federally qualified health center (FQHC) in southern Ohio, primary care registered nurses were enrolled in our CON certificate and residency programs over the course of 2 years (2020-2022). This poster presentation will explore our academic-clinical partnership through the RN residency and how the 2020 cohort developed and implemented an evidence-based quality improvement RN-led Medicare annual wellness visit (AWV) program.

Program purpose: Developed using the ambulatory care registered nurse residency program (2017) from the American Academy of Ambulatory Care Nursing (AAACN), the RN residency program at the CON was designed to meet the program aims of HRSA as outlined above. Additionally, the residency builds confidence and competence of the primary care nurse through a structured, professional transition-into-practice experience that creates and enhances professional networks while sharpening leadership and change agent proficiencies.

Description: This HRSA-funded program provided salary support to hire and train RNs to work in a rural FQHC providing chronic disease management, care coordination and transition in care, and population health management. The nine-month residency program is comprised of 4 modules (foundations, communication, professional practice, and systems). At the end of the residency, each resident is required to complete an evidence-based quality improvement capstone project that will offer a substantial change of practice in their organization. The 2020 residency cohort used an evidence-based practice (EBP) model to develop and implement a plan for a RN-led AWV program.

Program outcomes: As a result of the RN residency and academic-clinical partnership, the RNs were able to successfully implement the practice of RNs conducting AWVs beginning July 2021. This practice change has led to increased value-based quality visits by delivering health education and promoting health screenings with Medicare beneficiaries. This academic-clinical partnership successfully met the aims of the program by expanding the role of the RN and increasing access to care.