Promoting Full Scope of License Practice for Community-Based Primary Care RN: Capacity Professional Development Model

Objective: Providing quality healthcare to patients who are homeless, low income, and/or uninsured in community-based settings is challenging. Chronic illness is common and often coupled with behavioral health issues. Nurses are an integral part of interprofessional teams in community-based primary care. Promoting full scope of license practice among registered nurses (RN) in these settings is an important strategy to achieve optimal patient outcomes. The Community-Academic Partnership for Primary Care Transformation (CAPACITY) project, funded by the Health Resources & Services Administration involves an academic-clinical partnership between the School of Nursing, Emory University and Mercy Care, a Federally Qualified Health Center serving vulnerable populations in Atlanta, Georgia. In this presentation, we describe our efforts to assess Mercy Care RN’s professional development needs. We describe the CAPACITY model to guide professional development efforts related to full scope of RN license practice informed by the needs assessment along with key sources from the literature.

Approach: We used a modified version of the Patient Centered Medical Home Assessment (PCMH-A) to assess nurses’ perceptions of their practice in the areas of engaged leadership, quality improvement strategy, empanelment, continuous and team-based healing relationships, organized evidence-based care, patient-centered interactions, enhanced access, and care coordination. We also assessed perceived deficits in content knowledge and soft skills as well as environmental norms related to full scope of license practice.

Evaluation Data: Overall, Mercy Care RN’s were strong across all areas related to the PCMH. Greatest strengths were in areas of quality improvement strategy, care coordination, and engaged leadership. Areas nurses identified for growth were in empanelment, continuous and team-based healing relationships, and organized evidence-based care. Nurses desired more content related to substance abuse, behavioral health, diabetes, dermatology, and wound care. Nurses recognized within environmental norms that task shifting to a more appropriate skill level would be desirable. With soft skills, RNs functioned autonomously, demonstrated resourcefulness, and showed resilience, but desired growth related to managing complexity, communicating effectively, and managing conflict. Using these data, we developed our CAPACITY professional development model, informed by the Entry Level Competencies Quad Council, the AAACN: Role and Scope, current literature around the enhanced role of the RN in primary care, and Interprofessional Learning Continuum Model.

Strategies for Addressing Professional Development Needs: The CAPACITY model and associated curriculum includes domains, competencies, courses/modules, and learning objectives. The four domains of the model are: Focus on Self (Professional Development), Focus on Care Team (Working with Teams), Focus on Patients (Enhancing Care Delivery), and Focus on Solutions (Reducing Barriers to Care). Competencies within the domains are well delineated and professional development courses and modules will be incrementally provided over the 4 year project period. Formative and summative evaluation will be used to demonstrate how tailored professional development helps move RNs clinical practice on the continuum towards full scope of license practice.