Collaborating With Rural Practice Partners to Address the Need for Registered Nurses in Primary Care

Background: Primary care in the United States (U.S.) is changing. There is a growing shortage of healthcare providers and increased prevalence of chronic disease (Association of American Medical Colleges [AAMC], 2018; Bauer & Bodenheimer, 2017; Flinter, Hsu, Cromp, Ladden, & Wagner, 2017). Additionally, even though registered nurses (RNs) have been shown to be effective chronic disease care managers, RNs are underutilized in the primary care setting (Bodenheimer & Bauer, 2016). Furthermore, when RNs are employed in primary care, seldomly are they practicing to the full scope of their license (Bauer & Bodenheimer, 2017; Flinter et al., 2017). Full scope of practice may include independent RN 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 settings, and home (Bodenheimer & Bauer, 2016; Flinter et al., 2017). The demand for primary care is on the rise and the number of primary care providers is declining. By 2020, the estimated shortage for primary care physicians is between 14,800 to 49,300, which will negatively impact primary care (AAMC, 2018). Primary care practices need to redesign their delivery models to fully utilize the skills and expertise of RNs (Josiah Macy Jr. Foundation, 2016). Employing RNs in primary care who are practicing to the full scope of their license may assist in meeting the unmet healthcare needs of the millions of people in the U.S with chronic disease and public health issues (Bauer & Bodenheimer; Smolowitz et al., 2015).

Purpose: The purpose of the project was to collaborate with rural primary care practice partners to address the need for RNs in primary care. Academic partners developed and distributed a needs assessment focused on the use of RNs in primary care and their ability to practice to the full scope of their license.

Method: Thirteen practice partners expressed an interest to partner with an academic institution to explore the use of RNs in primary care. A needs assessment was developed by academic partners and sent to nurse leaders at 13 rural primary care facilities via an online survey in December 2018. The needs assessment included questions that asked about the current use of RNs in primary care, examples of current responsibilities of RNs in primary care, the desire to use RNs in primary care (if not currently utilized), the level of knowledge and confidence of RNs practicing to the full scope of their license, and educational needs required by the facility in order to achieve future goals of RNs in primary care.

Results: Results from the needs assessment are currently being analyzed and will be available for report at the Sigma Biennial in October 2019. Overall responses from the healthcare facilities will be presented as well as the plan for addressing the facility needs that result from the assessment.

Conclusion: The use of a needs assessment may enhance the academic-practice partnership between the rural primary care facilities and the academic institution. The academic institution will use the results from the needs assessment, in collaboration with the rural practice partners, to develop innovative strategies to fully utilize RNs in primary care settings. Collaborating on strategies for utilizing RNs to the full scope of practice may enhance care and improve patient outcomes in rural and/or underserved primary care settings locally and potentially across the globe.