Nurse-Led Care: Capturing Quality Nursing Care in Primary Care

Introduction: As the healthcare industry pivots its focus from acute care to ambulatory care, it is significant to better understand the nursing workforce and the contributions that licensed nurses have in primary care. The growing demand for management of chronic illnesses requires interdisciplinary collaboration within primary care, yet registered nurses are underutilized members of the primary care team. Nurse-led interventions, particularly for chronic illness management, provides opportunities to better utilize registered nurses in primary care and improve the quality of care.
Purpose: The purpose of this discussion is to describe how nurse-led primary care interventions in ambulatory care are measured and examine the implications for the nursing workforce.
Background: Value-based payment models are a revenue generating form of compensation for the delivery of quality health care in primary care. To date, primary care has not capitalized on registered nurses’ ability to contribute to quality and payment. Although there is evidence of nurse-led interventions in the primary care setting, no synthesis of these interventions and their effect on patient and organizational outcomes has been conducted.
Methods: A literature review with searches done in PubMed, CINAHL, Google Scholar, and a university database for peer-reviewed articles. Inclusionary criteria included being published within the last 5 years, written in the English language and article abstract/title included keywords "payment for RNs," "unique nurse identifier," "primary care," "nursing," "payment model," "alternative payment models," "value-based payment," "nurses," "healthcare," "nurse-led," "ambulatory care," "chronic care model," "patient teaching," and "outcomes." International research articles and non-English language articles were excluded. Results presented in narrative form.
Results: We identified six studies, enrolling 3,284 participants, that met the inclusionary criteria measuring nursing care/interventions in the primary care setting in the United States. Five studies evaluated nurse-led interventions for different chronic disease and a sixth study focused on advanced care planning. Results were mixed with four studies finding improved outcomes and two studies finding no difference from standard care. Two themes were identified in this review. First, adequate training and organization support for nurse-led primary care interventions can improve the quality of patient outcomes and decrease the cost of care. Second, appropriate selection and utilization of measurement tools to evaluate nurse-led interventions supports assessment and valuation of nurses’ role in primary care delivery. Limitations of these studies were absence of assessment of nurse-led interventions using nurse-sensitive outcomes and lack of diverse patient populations, majority of the study participants were white males.
Conclusion: Registered nurses provide high-quality, cost-effective primary care given appropriate training and the opportunity to lead interventions in chronic disease management. However, future research is needed on the role of nurse-led interventions in diverse populations. Greater utilization of nurse-sensitive outcomes to examine nurse-led interventions is needed as a mechanism to standardize the assessment of primary care nursing. Payors can drive integration of nurse-sensitive indicators in primary care settings through reimbursement policies. When quality nursing care is recognized and valued, licensed nurses will be seen as a financial viability of practices contributing to the expansion of registered nurses in primary care.