Innovative models in place in several states redefine nursing roles in primary care to extend access, improve care and contain costs, according to a policy brief in the Charting Nursings Future series by the Robert Wood Johnson Foundation.
The models in Minnesota, Nebraska, Pennsylvania, Vermont, Washington, D.C., and Veterans Administration hospitals nationwide emphasize the care coordination at which nurses excel, employ interprofessional teams that share responsibility for health outcomes and exploit information technology to enhance patient communication, track care and improve clinical decision-making.
Some also change the way care is paid for and allow nurses, physicians and others to practice to the full extent of their knowledge and skills.
• In Minnesota, the nonprofit healthcare organization HealthPartners empowers primary care nurses to serve their patients. As part of an overall collaborative approach, nurse practitioners diagnose and treat common conditions in person and via the Internet.
Meanwhile, RNs and licensed practical nurses collaborate with other professionals to anticipate patient needs, treat some acute conditions with standard protocols, and ensure patients have the supports in place to implement care plans successfully.
The approach has helped HealthPartners provide a standard of care that exceeds state averages as measured by specific quality measures, at a cost 10% lower than the state average.
• The “Prescription for Pennsylvania,” a series of reforms launched in 2007 in response to concerns about the cost and quality of care for patients with chronic conditions, included relief from state restrictions on NPs, allowing them to practice to the full extent of their training.
That shift, in turn, led to dozens of NP-staffed convenient care clinics opening around the state. Pennsylvania also began to offer financial incentives to primary care practices to implement the widely respected Wagner Chronic Care Model, relying on nurses to provide care management.
• Vermonts Blueprint for Health program deploys nurse care coordinators statewide in clinics and private practices, where they collaborate with social workers, behavioral health counselors and others to transform the delivery of primary care. Nurses often serve as team leaders, and they and other members of the teams meet with patients to make sure they receive the preventive and coordinated care they need.
The state also changed its nurse practice act to mitigate physician shortages by allowing experienced APRNs to engage in solo practice.
• At Veterans Administration hospitals, where the equivalent of 8,500 full-time nurses are on duty, nurses provide continuous, coordinated primary care to the nations veterans, playing multiple roles as part of Patient-Aligned Care Teams. Each PACT includes a primary care provider (an NP, physician or physician assistant), a nurse care manager (an RN), a clinical associate (an LPN or nursing assistant) and a clerical associate.
Each veteran has a PACT RN responsible for coordinating care over the long term, in person or via telehealth technology. This continuity of care over an extended period of time serves to create strong bonds between nurses, patients and their families, according to the VA.
To download the full brief, “Implementing the IOM Future of Nursing Report — Part III: How Nurses Are Solving Some of Primary Cares Most Pressing Challenges,” visit: www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2012/08/issue-18–implementing-the-iom-future-of-nursing-reportpart-iii.html.
Past editions of the Charting Nursings Future series are available at www.rwjf.org/humancapital/product.jsp?id=38074. The next issue of the series will explore barriers to the growth of the primary care sectors capacity, including reimbursement mechanisms and regulatory, policy and financial barriers that make practicing to the full extent of their education and training difficult for nurses.