Expanding the BSN Role: The Integration of Nurse Visits Into Undergraduate Nursing Curriculum

Background: According to the literature, there is a gap in current undergraduate nursing education in that traditional curriculum focuses on acute care skills while public health and primary care skills are taught as adjunctive. However, in 2011 the Institute of Medicine (IOM) published the Future of Nursing which states that as healthcare moves to a preventative care model, nurses need a comprehensive foundation in public and community health nursing. As such, educational curriculum's in nursing must be expanded to include content focused on assisting the individual, family, and community to achieve the highest level of functioning (AACN, 2013). Furthermore, the development of a competent future public health nursing workforce is strongly influenced by the educational experiences of nursing students and the responsibility for providing realistic, high quality public health nursing education. In order to support the educational needs of our future nursing workforce in both public health settings and community-based primary care, there is a need for additional skills and competencies to include: population health, coordinating with interprofessional teams, recognizing and responding to epidemiological patterns, and understanding care as value-based across the lifespan. Efforts to bridge this gap in undergraduate curriculum requires innovative strategies that will prepare our future nursing workforce in the care of complex patient populations.

Purpose: To provide longitudinal clinical training experiences for BSN students in community-based primary care settings that provide the BSN student with the opportunity to develop primary care skills relating to populations with chronic disease management. The aim of this presentation is to discuss the integration of nurse visits into our undergraduate clinical experiences to better prepare our nursing graduates for roles in community-based primary care.

Methods: Undergraduate nursing students are placed in nurse-managed clinics that provide care to vulnerable populations who are resource scarce and have limited access to healthcare services. In this expanded nursing role, the student nurse employs public health concepts and primary care skills as they initiate and lead nurse visits in patients needing chronic disease management. The expectation is that the student nurse provides patient education, medication reconciliation, medication adherence counseling, and behavior change/goal setting. The student nurse does not initiate or intensify medications but works closely with the interprofessional team to ensure treatment to target goals are identified and being met. The student nurse also works with patients who have positive social determinants of health screenings and refers them to appropriate community resources. During their community-health clinical, the student nurse takes full ownership of their panel of patients with mentorship from clinical faculty.

Conclusion: Nurse visits are in the early stage of integration in our undergraduate community-based clinical experience. A Plan, Do, Check, Act quality improvement cycle is in place to facilitate a meaningful exchange of information and to identify any barriers our undergraduate student nurses encounter. Further outcome evaluation will examine the impact of nurse visits on target to treatment goals in our patients needing chronic disease management. Overarching outcomes for this expanded nursing role are that our graduating nurses will be better prepared and armed with knowledge and skills to care for those in community-based primary care settings.