Background: As the complexity of patients in primary care increases and the move towards value-based care payment structures expands, registered nurses (RNs), working to the fullest extent of their licensure and expertise, have been identified as key primary care team partners for improved and cost-effective chronic disease prevention and management, improved quality of the care experiences, and decreased clinician burden and burnout.
Despite powerful drivers to transform primary care settings to include registered nurses there still remains a significant workforce shortage of nurses prepared to fulfill those roles. Baccalaureate nursing programs have historically emphasized acute care; however, primary care transformation demands increased primary care content and experiences so that new RNs are prepared to be full team partners focusing on wellness, providing patient- and family-centered care, population health, care coordination, and data analytics.
Undertaking: Our HRSA nurse education, practice, quality and retention program aims to prepare students and community RNs for transformed primary care roles. We developed 13 online modules that were integrated into baccalaureate programs of study and placed online for access by community RNs free of charge. The content focuses on how foundational nursing knowledge can, and is, applied to primary care. Students and community RNs were awarded digital badges and nursing contact hours upon module completion demonstrating their primary care knowledge to current and future employers. Digital badges are a new form of engaged learning. Additionally, we worked with rural primary care RNs to be prepared to precept students for 150 hours, including preceptor training and the development of standard protocols for RN-led encounters.
Outcomes: Over 2,000+ badges have been awarded to baccalaureate students and community RNs. We have developed relationships with primary care clinics serving rural and underserved populations that have RNs committed to working at the top of their licensure. To support clinics developing these enhanced roles, we delivered 8 online webinars (open to students and community RNs) on the topics of nursing to the top of their licensure such as advanced care planning, transitional care management, chronic care management, and annual wellness visits. The number of nursing students participating in longitudinal primary care clinical placements during their capstone semester has risen from zero to 4,200 hrs.
Conclusions: Nurses have been called out to work to the fullest extent of their licensure as full partners within interprofessional primary care teams. While not new, these roles need to be enhanced and better defined. As healthcare faces the full transformation, there will be more demand for primary care RNs. Therefore, it is imperative that innovative curricula teaching and clinical placements work to prepare RNs for these enhanced roles.
Learning objectives
1) Define nursing roles in transformed primary care and developing nursing content for baccalaureate curriculum.
2) Describe the roles and responsibilities of ‘nurse to the top of their licensure’ including billing for RN-led patient encounters.
3) Describe what a digital badge is and their psychological dimensions.
4) Describe developing clinical sites where nurses work in these enhanced roles.
Present benefits and barriers found during implementation.