Development of a Learning Module on the Legal Implications in Primary Care Nursing

Despite a high need for registered nurses in the primary/ambulatory health care system, colleges of nursing across the country generally have limited teaching and clinical opportunities for pre-licensure nursing students focused in these care settings. A southeastern college of nursing aimed to change this when they received a Health Resources and Services Administration grant to support an innovative program, “Rebalancing the Curricula to Advance Primary Care Nursing (ReCAP),” that introduces traditional BSN nursing students to additional learning experiences in primary and ambulatory care settings.

In the ReCAP program, BSN students learn about important primary and ambulatory care nursing topics and concepts. Students spend anywhere from 45 to 150 hours in the primary/ambulatory care clinical setting in addition to didactic course requirements. Students are also able to take independent study hours to further study primary care topics of interest. One student taking independent study hours researched the topic of important legal aspects to primary care nursing. This led to the development of a ReCAP program module that participating ReCAP students will study. Modules include learning objectives, select readings, lecture slides, and an associated learning activity based on the learning objectives. This module is appropriate for primary care registered nurses (RNPCs).

The module reveals that in the U.S. primary health care system, RNPCs are seeing an increase in the acuity of patients seeking care, an increasingly diverse population that presents with multiple chronic conditions, an increased focus on pay-for-performance, and the associated increase in documentation requirements, and changes in insurance coverage requirements. There are legal considerations for each of these issues.
With the complexity seen in this environment, primary and ambulatory care leaders find it essential to work within the academic-practice partnership model to adequately prepare nurses for positions in the primary/ambulatory care environment. An important component of this preparation is to ensure that RNPCs are aware of their legal responsibilities.

Special care must be taken by all health care team members to ensure that legal guidelines are considered when delivering and documenting care provided to patients. In the primary/ambulatory care setting, the patient’s holistic care is in part coordinated by registered nurses. The primary care office, a contact point for patients experiencing symptoms and illnesses, is seeing an increase in the use of registered nurses. It is the primary care registered nurses’ (RNPCs) responsibility to assess the patient, plan, and lead care coordination efforts, initiate necessary treatments and referrals, provide education to the patient and their support systems, and document this care. All of these responsibilities fall within the scope of practice for RNPCs and can open the registered nurse up to legal liability if rules, regulations, laws, and standards of practice are violated. As primary care patient acuity continues to climb, the registered nurse in this care setting should know these rules, regulations, laws, and standards to ensure that they are practicing within the appropriate guidelines and scope of practice, particularly related to delegation to non-licensed caregivers in these settings. This poster presentation provides a review of key legal concepts/implications.