In the United States, clinical placements can be challenging to identify, particularly because rotations generally focus on acute settings, and because partnerships with primary care settings are typically not well established. The minimal focus on this nursing role in academic curriculum previously highlights why primary care clinical competencies are not well defined. With the growing workforce demand for primary care nurses, particularly roles in complex care management, nursing students need to have additional education and experience with frontline nurses in these settings to truly understand the care continuum and the full array of job opportunities available to them upon graduation.
A DEU was developed at the Community Health Center, Inc. (CHCI) to provide senior year baccalaureate nursing students experience in an interprofessional collaborative practice environment with frontline primary care nurses that support complex care management work for the provider panels they support. This was one facet of the implementation of a complex care management program across 12 clinical sites of CHCI. CHCI is a statewide agency providing care to individuals with low socioeconomic status, including many that are uninsured and underinsured. It has 14 integrated patient-centered primary care sites, delivering medical, behavioral health and dental services along with other ancillary care services such as those delivered by registered dieticians, podiatrists or chiropractors to name a few. CHCI delivers care in over 200 total service delivery sites, when school based clinics and health care for the homeless sites are included in the total count.
Through the DEU, nursing students learn how to deliver care to patients in the primary care setting. At the CHCI, students receive support and mentorship from clinical instructors and clinical faculty coordinators who prepare them for the rigor of caring for patients in the primary care setting. The clinical instructors are nurse care managers who have experience delivering care to patients in the primary care setting. In pre-clinical conference, students receive brief didactic to support their understanding of the role of the primary care nurse and to ensure they truly understand the shift in critical thinking needed for this setting. As the students learn about primary care competencies in their academic programming in the classroom, they are reinforced with real examples in pre-clinical conference and then concurrently practice them during their rotation time at the primary care site.
Students also experience innovative healthcare practices such as team huddles, integrated care meetings, and population management. They are trained on how to use dashboards, scorecards and other data sources to inform their practice throughout the day. They also participate in innovative training delivered to CHCI’s nurses such as Project ECHO©: Complex Care Management, which is a telehealth model that creates a knowledge network for nurses. It includes both didactic and case-based learning, where frontline nurses and student nurses can present complex cases and get feedback and support from a multi-disciplinary team of experts on next steps in their care planning.
Students were part of focus groups during the first two years of DEU implementation to provide direct feedback that informed performance improvement between year one and year two. They contributed changes to the length and content of the DEU, as well as to further confirm the potential benefit. This ongoing quality improvement will ensure an optimized student experience, and hopefully will improve nursing preparation, and possibly increase the number of new nurses that choose primary care as their chosen career. One student shared during the focus group: I like how they kind of changed my view about where nursing can go…it’s not just, you see a patient and that’s it and you move on. You can stay with that patient and follow-up with them and make sure that everything in their life is not affecting their health.
The DEU is vital in training the next generation of nurses to understand the critical role of the primary care nurse. As students build this understanding, they also learn what it means to work on an interprofessional collaborative practice team. Simultaneously, they have the opportunity to build their leadership and collaboration skills to better care for complex patients once they enter the nursing workforce, no matter which part of the care continuum.
See more of: Evidence-Based Practice Sessions: Oral Paper & Posters