Rebuilding Primary Care in Baccalaureate Nursing Programs

Purpose: The study purpose is to recruit and educate baccalaureate nursing students to practice to the full scope of their licensure in community-based primary care settings.

Background/significance: Baccalaureate registered nurses (RNs) are in pivotal positions to expand their practice role in primary care settings. Baccalaureate nursing programs are well positioned to integrate primary care and preventative services in their communities. Primary care nursing is a comprehensive continuum of collaborative care, coordinated sustained relationships, and access and navigation of health services and resources for patients, families, and communities. Thus, the advancing community oriented registered nursing (ACORN) program was proposed to recruit and educate baccalaureate nursing students to practice to the full scope of their licensure in community-based primary care settings.

Methods: The ACORN program was funded through a health resources and services administration grant and launched in July 2018 with select faculty, a community leadership advisory board, and research collaborations. In partnership with the veterans’ administration (VA) in San Antonio, students were placed in their primary care clinics throughout the city. Evaluative measures were focus group interviews, demographic and observational data collection, pre- and post-clinical experience comparisons, preceptor RN surveys, and reflective journaling. An external consultant assisted with the evaluative process.

Results: Three information sessions were held to recruit nursing students who were in their last year of nursing school. A rigorous interview process took place that ensured systematic objectivity and inter-rater reliability. A cohort of 5 nursing students was selected for year 1, 6 for year 2, and 7 for year 3. Students were provided with essential competencies and skill sets in population health, chronic disease prevention and management, team-based leadership and management, clinical judgment and reasoning, and culturally inclusive care coordination. Findings revealed students’ perspectives about primary care and preceptor insights about teaching. The VA served as the foundation for the ACORN program by hiring new graduates to work in their primary care settings.

Conclusions/implications: The ACORN program is an innovative model with a successful pathway for students to renew primary care nursing by generating educated RNs to deliver accessible healthcare services, supporting equity, diversity, and inclusivity for all.