Collaborating With Rural Practice Partners to Provide a Primary Care Experience for Undergraduate Nursing Students

Background: Primary care in the United States is changing. There is a growing shortage of healthcare providers, increased prevalence of chronic disease, and a shift toward registered nurses practicing in the hospital setting away from primary care (Bauer & Bodenheimer, 2017; Flinter, Hsu, Cromp, Ladden, & Wagner, 2017). Registered nurses have been shown to be effective chronic disease care managers, yet they are often not present in many primary care practices (Bauer & Bodenheimer, 2017; Flinter et al., 2017). Research indicates there is a direct relationship between utilizing bachelor’s-prepared nurses and enhanced patient outcomes (American Association of Colleges of Nursing, 2008). However, reliance on associate degree nurses to meet staffing needs is the reality for rural facilities due to the lack of available bachelor’s-prepared nurses (Newhouse, Morlock, Pronovost, & Breckenridge-Sproat, 2011). As community healthcare in rural settings continues to grow, as evidenced by the 17% increase between 1990 and 2009, the need for bachelor’s-prepared nurses who possess skills in coordinating care and are ready to practice in primary care settings to meet population health needs will continue to grow (American Hospital Association, 2011).

The supply of healthcare providers in primary care is declining in relation to the growing population. The percentage of physicians in practice declined from 41% in 1998 to 18% in 2014 (Bauer & Bodenheimer, 2017). Conversely, registered nurses are the largest health occupation population at over 3.1 million and the profession is expected to grow to four million by 2025 (United States Department of Health & Human Services, 2017). Registered nurses practicing to the full scope of their license can assist in meeting the unmet healthcare needs of the millions of people in the United States with chronic disease and public health issues (Bauer & Bodenheimer, 2017; Smolowitz et al., 2015). Opportunities for registered nurses to practice to the full scope of their license include, but are not limited to, independent registered nurse visits using standing orders for acute or chronic conditions; medication management; leading complex care management teams to help improve care and reduce the cost of care for patients with multiple diagnoses; and coordination of care between hospital, primary care, and home settings (Bodenheimer & Bauer, 2016; Flinter et al., 2017).

These factors impacting primary care have implications for nursing education and provide an opportunity for collaboration between academic institutions and clinical practice partners. Barton (2017) asserts that partnerships with healthcare systems to explore potential opportunities is pivotal in enhancing the focus of clinical learning on primary care. Expanding nursing curriculum to include primary care competencies and strategies for how the registered nurse can practice to the full scope of his/her license may also benefit the future nursing workforce. Strong collaborations between academic institutions and clinical practice facilities may aid in the improvement of the current healthcare delivery system, enhancement of the primary care nursing workforce readiness for practice, recruitment of future registered nurses in primary care, and the opportunity to train future registered nurses to practice to the full scope of their license.

Purpose: The purpose of this project, entitled “Impacting Models of Practice and Clinical Training for Registered Nurses and Students (IMPACT-RNS)”, was to collaborate with rural primary care practice partners to provide a clinical experience in primary care for undergraduate baccalaureate nursing students. The clinical experience was designed to provide students with a 150-hour longitudinal clinical experience in the primary care setting, exposing them to registered nurses who practice to the full scope of their license. The process for planning the implementation of the clinical experience will be discussed.

Method: Thirteen rural and/or underserved practice partners expressed an interest to partner with an academic institution for the clinical experience. The practice partners committed to providing a registered nurse preceptor for up to two students each semester.

Results: Each clinical partner identified registered nurse preceptors who would be willing to work with individual students. Recruitment materials were developed by the academic institution including a brochure and video promoting the benefits of participating in a clinical experience in a primary care setting. Faculty members at the academic institution developed a student application form and formal process for students to follow if they wanted to be considered for placement in the primary care clinical experience.

Conclusion: Collaboration between academic-practice partners to develop a clinical experience for undergraduate nursing students allowed exposure to the role of registered nurses practicing to the full scope of their license in rural primary care settings. The clinical experience may aid in recruiting registered nurses to work within the primary care setting, which may enhance patient care, improve patient safety, and improve patient outcomes in rural and/or underserved primary care settings locally and potentially across the globe. By sharing the process for planning the clinical experience, other interested academic institutions may replicate similar opportunities within their facilities.