Primary Care Certificate Program:
Primary Care Nurses
Spencer Revels and Judy Neubrander
The healthcare climate in the United States is currently in a state of transformation, and as a result the roles of many healthcare workers are in flux. One approach to strengthening this new healthcare system is to evaluate and improve the function of valued healthcare providers such as primarycare nurses (PCN). Nurses working in the primary care sector already play a vital role in providing quality care to patients in the United States. A new model of healthcare has been emerging in the U.S, which has spurred new amendments to the Affordable Care Act and the Patient Protection Act. These new healthcare mandates called for an expansion in access to healthcare and to provide a more patient centered medical home, thus increasing the demand for primary care providers. This shift in the healthcare delivery model should be reflected in the academic curriculum preparing nurses for the primary care sector. Other countries such as Australia and Canada have been in the process of creating primary care certificate courses in order to prepare their nurses to be more successful on the job (Oandasan et al., 2010). There is an inherent responsibility of nurse educators in the U.S. to anticipate and prepare for this change in the healthcare delivery system. Therefore, it has been imperative to examine the current role of the PCN as well as explore new functions that will aid in delivering efficient and quality care under this new model.
Current research in primary health care has called for a change in the academic curriculum for nursing education (Berg & Dickow, 2014, Baxley & Cunningham, 2014, Drummond, Abbott, Williamson, & Somji, 2012, Oandasan et al., 2010). Primarily, the type of care in which the PCN delivers has been vastly different from the care delivery of one in an acute setting (Oandasan et al., 2010). When examining care delivery of the family practice nurse, Oandasan et al.’s (2010) stated that these nurses “played an important role in gathering information from the patients to develop a holistic understanding, which included lifestyle, familial, and socioeconomic circumstances” (p. e379). PCN’s have been treating patients in an individualized and unique manner, therefore their education should also reflect that specificity.
In addition, Drummond et al.’s (2012) study and others encouraged nursing educators to reevaluate the curriculum for nurses going into primary care because in their careers, nurses have been fulfilling roles in which they have not explicitly been trained for (Berg & Dickow, 2014). Nurses have beenworking in these roles not only because it wasdefined to be in their scope of practice, but also because these roles were a crucial need within the primary care office. One such role was communicating and coordinating with other professionals to meet patient needs (Haas, Swan, & Haynes, 2013). Nurses in the primary care sector have been undoubtedly working within an interdisciplinary team comprised of doctors, additional nurses, office staff, practice managers, and other professionals. Current research has indicated that although it is common practice for the PCN to work within a team, nurses have not been explicitly trained for interdisciplinary teamwork (Baxley & Cunningham, 2014, Drummond et al., 2012). Drummond et al.’s (2012) completed a study on inter-professionalism in primary care facilities within Canadian family medicine clinics; the researchers asserted that nurses need to be better educated on interdisciplinary teamwork because few nurses are prepared to work in these teams when they arrive on the job. Although working optimally within a team comes with experience, explicitly training nurses on teamwork skills could better prepare them for the primary care environment. Specifically, further educating nurses on the roles within their own scope of practice as well as the responsibilities and limitations of other professionals within the team could aid the interdisciplinary team to function more productively and efficiently to maximize quality patient care (Banner, MacLeod, & Johnston, 2010, Baxley & Cunningham, 2014). The hallmark function of the PCN has been coordination of patient care, yet the success of that job depends primarily on communication within an interdisciplinary team. Therefore, it is imperative that nurses be trained for interdisciplinary teamwork.
Nurses have had a steadfast history of being a vital member of primary care office by fulfilling roles from patient advocacy to providing efficiency within the office (Haas et al., 2013). A primary role of the PCN has been care coordination or case management, which involves facilitating communication between the doctor, other providers, the patient, and the patient’s family (Haas et al., 2013, Yang & Meiners, 2014). Many studies have shown that PCN in the role of care coordinator is the most patient centered model (Haas et al., 2013). Yang and Meiners (2014) stated that nurses are best equipped at care coordination because they take initiative in patient care, while also knowing their patient’s personal and medical needs; PCN have met these needs by sharing information with not only efficiency, but also accuracy due to their advanced medical training. Similarly, a study by Oandasan et al. (2010) in Canada, showed that successful PCN had a relationship centered approach to care delivery, in which good patient care was founded upon a trusting nurse-patient relationship that was established over time. A study conducted by Haas et al. (2013) also confirmed that “coaching and counseling of patients and families” was an important role of the PCN in care coordination because it built long term relationships with the patients as well as their families (p.46).
In addition to the previously stated nursing roles, a study by Haas et al. (2013) further defined patient-centered roles of PCN that they recommend as core competencies and associated activities for care coordination. The researchers included previously mentioned roles such as “education and engagement of patient and family,” “cross setting communication and transition” from one facility to another, “teamwork and collaboration”, “patient centered care planning,” and patient advocacy for preventative care (Haas et al., 2013, p.46). An additional dimension was the PCN’s role in support for self-management of a patient’s chronic disease management, which involved providing educational materials and medication sheets. Another competency presented was the overall nursing process, which included assessment, planning, implementation and intervention, and evaluation, as a result of procedures such as asking open ended questions to the patients to assess their knowledge of their illness. The researchers also cited “decision support and information systems” as related to population health management as a strong role of the PCN in care coordination (Haas et al., 2013, p.46).
Most importantly, research suggested that higher levels of care coordination leads to better healthcare outcomes, therefore, PCN’s being the optimal care coordinators could improve healthcare outcomes overall and ultimately reduce healthcare cost (Berg & Dickow, 2014, DiCicco-Bloom et al., 2007, Yang & Meiners, 2014). However, as one study underlined, “care coordination involves skills that are…not traditionally emphasized in most advanced-practice nurse training” (Yang & Meiners, 2014, p.98). Furthermore, the Nurse Role Exploration Project: The Affordable Care Act and New Nursing Roles out of California, stated that alterations to nursing education is key to implementing new nursing roles in the primary care sector such as care coordination (Berg & Dickow, 2014). Clearly, there has been a demand for nursing education to embrace care coordination into the PCN’s curriculum.
California’s Institute for Nursing and Health Care (CINHC) has sought to create a new model for primary health care in anticipation of the transformation of our health care system. Through this, Berg and Dickow (2014) defined five new nursing roles that met the changing health care climate in California. One role already discussed was care coordination, however, they further identified this role to extend to supervising team members and advising entire communities as a means to population health management. Another role defined a PCN as a faculty team member, which called for PCN to “take the lead in creating interdisciplinary teach teams” to educate others on interdisciplinary approaches to care (Berg & Dickow, 2014, p.10).
Also, Berg and Dickow (2014) added the role of informatics specialist, advising nurses to design software and interpret data. They called for PCN to be nurse and family cooperative facilitators, to encourage the use of tele-health application for “connecting people where they live and work to understand and adjust elements that will result in healthier, more successful outcomes;” in this role, they identified the PCN as taking responsibility for early intervention and prevention (Berg & Dickow, 2014, p.11). Finally, the CINHC distinguished PCN’s as primary care providers. According to the authors, PCN’s have met the criteria of a primary care provider because they have been proven valuable in the community; they delivered support to individuals and families for prevention of illness and helped them maintain overall wellness as well as assisted management of chronic illness. In essence, PCN could fill the role of primary care provider in order to increase access to health care in areas without immediate access (Berg & Dickow, 2014).
Looking at roles of PCN in today’s health care system, it was clear that PCN’s are not only necessary, but valued in the primary health care sector. PCN are currently providing care coordination, case management, patient advocacy, as well as holistic and patient centered care. The anticipated PCN will take on larger roles such as interdisciplinary team leader, primary care provider, and informatics specialists; the care coordination position will grow to providing community education and planning for preventative care, individual support and planning for chronic illness management, and population health management. As suggested by current research and new health care legislation, it appears that the PCN will become an even more essential in the health care model. To aid in this metamorphosis, it imperative that nursing educators thoughtfully prepare nurses by providing them with a relevant and innovative curriculum specific to primary care.
References
Banner, D., MacLeod, M. L. P., & Johnston, S. (2010). Role transition in rural and remote primary health care nursing: A scoping literature review. Canadian Journal of Nursing Research, 42(4), 40-57.
Baxley, E. G., & Cunningham, P. R. (2014). Meeting North Carolina’s health care needs through interprofessional education and practice. North Carolina Medical Journal, 75(1), 65-67.
Berg, J. G., & Dickow, M. (2014). Nurse role exploration project: The affordable care act and new nursing roles.Nurse Leader,12(5), 40-44. doi:10.1016/j.mnl.2014.07.001
Drummond, N., Abbott, K., Williamson, T., & Somji, B. (2012). Interprofessional primary care in academic family medicine clinics: Implications for education and training. Canadian Family Physician, 58, e450-e458.
DiCicco-Bloom, B., Frederickson, K., O’Malley, D., Shaw, E., Crosson, J. C., & Looney, J. A. (2007). Developing a model of social capital: Relationships in primary care. Advances in Nursing Science, 30(3), E13-E24.
Haas, S., Swan, B. A., & Haynes, T. (2013). Developing ambulatory care registered nurse competencies for care coordination and transition management.Nursing Economic$,31(1), 44-43. Retrieved from ac58-45bc-ba41-9b24e020c8d9%40sessionmgr4002&vid=10&hid=4113
Oandasan, I. F., Hammond, M., Conn, L. G., Callahan, S., Gallinaro, A., Moaveni, A. (2010). Family practice registered nurses: The time has come. Canadian Family Physician, 56. e375-e382.
Yang, Y. T.,Meiners, M. R. (2014). Care coordination and the expansion of nursing scopes of practice.Journal of Law, Medicine & Ethics,42(1), 93-103. Retrieved from eds.a.ebscohost.com.wncln.wncln.org/eds/pdfviewer/pdfviewer?sid=fdae6d3b-ac58- 45bc-ba41-9b24e020c8d9%40sessionmgr4002&vid=5&hid=4113