Nurse-Driven Protocols Leverage Nursing Expertise and Expand Access to Marginalized Populations

Traditional physician-centered healthcare settings are structured such that there are long wait times for appointments and complex approval processes. These structures hinder the provision of straight-forward medical care and intimidate those who are often marginalized due to financial, social, and racial factors. A well-written, well-implemented nurse-driven protocol has the potential to streamline processes, reduce redundancy, and hasten the provision of care. Culturally sensitive nurses are well positioned to provide care that is patient-centered and unbiased, further reducing barriers.

Robust nurse-driven protocols leverage nursing assessment and critical thinking while remaining within the scope of nursing practice, but they can be challenging to create. Nursing must collaborate with advanced providers, physicians, and leadership and orient the team to the protocol to ensure understanding, accurate implementation, and realistic expectations. The outcomes can be beneficial on multiple levels. The healthcare team gains mutual respect, and communication and collaboration is strengthened. Patient care is expedited and access to care is expanded.

Our urban clinic strives to reduce healthcare disparities among traditionally marginalized populations, including the LGBTQ+ community, recently incarcerated and/or homeless individuals, and the uninsured. The clinic is situated in a neighborhood where 80% of residents are of low socioeconomic status and the overwhelming majority are African-American and Latinx. Because they often have healthcare-related trauma, many have not accessed care in years and have complex unmet healthcare needs and they are at a higher risk of contracting HIV, STI, hepatitis C, and COVID-19.

The Future of Nursing 2020-2030 report calls for the nursing profession to take an active role in ensuring expanded access to “care that is safe, effective, person-centered, timely, efficient, and equitable.” Coupled with the strategic placement of our clinic, the development and implementation of nurse-driven protocols has had a major impact on opening access to timely and fiscally sound healthcare services. Because of the protocols, walk-in services are available for STI, HIV, and COVID-related screening, vaccination, and treatment. Low-barrier entrance for these services has led patients to engage further with healthcare at our clinic, as evidenced by repeat appointments and conversion to primary care. Specifically, we have experienced a three-fold increase in access to STI (sexually transmitted infection) services from April 2021 to October 2021 with a 20% conversion of high-risk individuals to PrEP (pre-exposure prophylaxis against HIV) therapy and a 22% conversion to primary care. When told “you are welcomed, the door is open,” people will seek services that lead to better health.

A review of the key elements in structuring an effective nurse-driven protocol will be shared, along with a blueprint for an effective protocol implementation plan. A quantitative and qualitative review of the positive outcomes of implementing such protocols on both the clinical team dynamics and the patients that interact with the healthcare team will be illustrated. After viewing the poster presentation, participants will be able to identify key elements of an effective nurse-driven protocol and develop an implementation plan to ensure successful adoption and compliance in their area of clinical care.