|NEWSRoom | Source: Robert Wood Johnson Foundation|
New RWJF Brief on Nurses' Role in Primary Care
Among the many recommendations from the groundbreaking 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, was a call for an expanded role for nurses in primary care. The latest policy brief in the Robert Wood Johnson Foundation’s (RWJF’s) Charting Nursing’s Future (CNF) series explores systems and institutions that have taken on the challenge, creating innovative models to provide patient-centered, coordinated, and cost-effective care by taking advantage of nursing’s strengths.
The IOM report noted that as the largest and most flexible component of the healthcare workforce, nurses are “poised to help bridge the gap between coverage and access, to coordinate increasingly complex care for a wide range of patients, to fulfill their potential as primary care providers to the full extent of their education and training, and to enable the full economic value of their contributions across practice settings to be realized."
The new CNF brief spotlights innovative models now in place in Nebraska, Minnesota, Pennsylvania, Vermont, the District of Columbia, and at Veterans Administration (VA) hospitals across the nation. The specific approaches vary, but each redefines nursing roles to extend access, improve care, and contain costs. They emphasize the care coordination at which nurses excel, employ interprofessional teams that share responsibility for health outcomes, and exploit information technology to enhance patient communication, track care, and improve clinical decision-making. Some change the way care is paid for, and allow nurses, physicians, and others to practice to the full extent of their knowledge and skills. For example:
· In Minnesota, the nonprofit healthcare organization HealthPartners empowers primary care nurses to serve their patients. As part of an overall collaborative approach, NPs diagnose and treat common conditions in person and via the internet. Meanwhile, RNs and licensed practical nurses (LPNs) collaborate with these other professionals to anticipate patient needs, treat some acute conditions with standard protocols, and make patients have the supports in place to implement care plans successfully. The approach has helped HealthPartners provide a standard of care that exceeds state averages as measured by specific quality measures, at a cost 10% lower than the state average.
· The “Prescription for Pennsylvania,” a series of reforms launched in 2007 in response to concerns about the cost and quality of care for patients with chronic conditions, included relief from state restrictions on NPs, allowing them to practice to the full extent of their training. That, in turn, led to dozens of NP-staffed convenient care clinics opening around the state. The state also began to offer financial incentives to primary care practices to implement the widely respected Wagner Chronic Care Model, relying on nurses to provide care management.
· Vermont’s Blueprint for Health program deploys nurse care coordinators in clinics and private practices across the state, where they collaborate with social workers, behavioral health counselors and others to transform the delivery of primary care. Nurses often serve as team leaders, and they and other members of the teams meet with patients to make sure they receive the preventive and coordinated care they need. The state also changed its nurse practice act to mitigate physician shortages by allowing experienced APRNs to engage in solo practice.
· At Veterans Administration hospitals, where the equivalent of 8,500 full-time nurses are on duty, nurses provide continuous, coordinated primary care to the nation's veterans, playing multiple roles as part of Patient-Aligned Care Teams (PACTs). Each PACT includes a primary care provider (an NP, physician, or physician assistant), a nurse care manager (an RN), a clinical associate (an LPN or nursing assistant), and a clerical associate. Each veteran has a PACT RN responsible for coordinating care over the long term, in person or via telehealth technology. This continuity of care over an extended period of time, the VA believes, serves to create strong bonds between nurses, patients, and their families.
You can download the full brief, Implementing the IOM Future of Nursing Report–Part III: How Nurses Are Solving Some of Primary Care’s Most Pressing Challenges, at http://www.rwjf.org/files/research/cnf20120810.pdf. Past editions of Charting Nursing’s Future series are available at http://www.rwjf.org/humancapital/product.jsp?id=38074.
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