An Innovative Training Program to Build the Community-Based Primary Care Registered Nurse Workforce

Purpose: In 2018, the Health Resources and Services Administration (HRSA) implemented a four-year training program, Nursing Education, Practice, Quality and Retention – Registered Nurses in Primary Care (NEPQR-RNPC). The purpose of this program is to recruit and train nursing students and current registered nurses (RNs) to practice at the full extent of their license in community-based primary care settings. By strengthening the capacity for basic nurse education and practice, NEPQR-RNPC aims to develop a sustainable primary care nursing workforce equipped with the skills needed to address pressing national health issues. The program also seeks to improve the distribution of the nursing workforce in rural and underserved areas, enhance access to care, and promote population health outcomes.

Background/significance: Traditional nursing education has primarily focused on training nurses to practice in acute care settings. Recent changes in the US healthcare system, including the increased complexity of health care in community settings and health workforce shortages, have led to an increased need to train nurses to work at the full extent of their practice in community settings. Having all the members of the care team, including RNs, work to the full extent of their practice helps to enhance patient experiences, improve population health outcomes, reduce health costs, and promote the well-being and resilience of healthcare providers – addressing the goals of the quadruple aim.

Methods: Representatives from HRSA and the 42 NEPQR-RNPC award-recipient developed an evaluation team. This team met several times over a nine-month period to brainstorm on appropriate evaluation measures to assess the program’s impact, particularly on increasing the supply and expanding the distribution of a RN workforce equipped to deliver quality comprehensive primary care services in rural and underserved community-based primary care settings.

Results: HRSA identified six measurement domains – curriculum enhancement, training, provider experience, patient experience, partnerships, and healthcare access and cost. The evaluation team collaboratively identified the respective shared evaluation measures, measurement tools, target groups, and the frequency of collecting the data. The recipients began implementing the evaluation measures in the second year of the program.

Initial anecdotal findings indicate that many RN graduates from NEPQR-RNPC are choosing to practice in the rural and underserved settings where they trained. In addition, the care settings have increased the use of RNs and expanded their roles, reducing the burden on the other higher-level clinicians and increasing access to care. By implementing nurse-led care coordination and case management services, patients are better able to manage their health conditions, reducing health costs because of lower utilization of the emergency department and less hospital readmissions.
Conclusion/implications: By the end of the four-year program period, we anticipate that NEPQR-RNPC will contribute to a cultural shift in how RNs are educated and trained to practice in community-based primary care settings. Other anticipated outcomes include expanded roles of RNs as part of interprofessional teams; improved provider competency, efficacy, satisfaction and retention; improved patient outcomes, experiences and satisfaction; stronger and valuable academic-practice partnerships; and improved quality of care and health outcomes at a lower cost.