On The Quick
RNs Taking on Primary Care Responsibilities
While we all know that the demand for primary care is already outstripping the supply, there are still some significant obstacles to using RNs to fill that gap. A new study from the UCSF Center for Excellence in Primary Care and the California HealthCare Foundation looks at the strategies some health systems have developed to overcome those obstacles and allow RNs to play a greater role in primary care.
TRAINING RNs FOR OUTPATIENT SETTINGS
The study, published in August, presents a series of case studies of how 11 different U.S. health centers and health systems (and one in Sweden) have integrated RNs into the primary care role. The U.S. organizations profiled say that one of the biggest obstacles to using RNs in primary care is that current RN training programs are too focused on the inpatient hospital or home care roles. That leaves many nurses ill-prepared for outpatient settings, which may require RNs to make their own decisions in a much broader range of situations.
“Nursing schools need to adapt and teach ambulatory care nursing skills,” one nursing leader told the study’s authors.
In the meantime, some of the health centers and health systems profiled have established their own primary care training programs for RNs. Those programs, taught by experienced nurses or nurse practitioners, provide four to five weeks of training in tasks like conducting a physical examination. At some health centers, that’s followed by additional time with a preceptor or mentor to ensure that each nurse has mastered all the required competencies.
THE REIMBURSEMENT GAP
Another major obstacle to using RNs in primary care is the cost-reimbursement gap. Even if a payer provides some reimbursement for services provided by a registered nurse (which many insurers still don’t), the rates are much lower than for physicians or even nurse practitioners. While physicians or NPs cost more, they also bring in more revenue, which can make them a better financial value than RNs.
The health systems profiled have responded by using their RNs to enhance the capabilities of their M.D. and NP providers, allowing those providers to use their time more efficiently and potentially see more patients per shift. While using an RN as a primary care provider might not make financial sense, enabling three doctors or NPs to do the work of four definitely does.
Read more about these innovative strategies — including different approaches to nurses’ triage responsibilities.
This article is from workingnurse.com.