As health care continues its shift from a volume to a value focus, new payment models emphasize the need for expanded primary care access, effective population health management, improved patient engagement, and interdisciplinary care team collaboration. This transformation presents a compelling argument to optimize the scope of practice and expand the contribution of registered nurses in primary care.
Progressive healthcare organizations are embracing opportunities presented by value-based care with creative strategies. For example, one California health system, with the help of experienced nurse leadership, redefined the structure of a patient’s primary care team, dynamically identifying the care team member needed for any given visit. For example, a patient may need to see only the nurse and nurse assistant for one scheduled visit but on another visit needs to be examined by the physician and provided training by the nurse.
Additionally, the patient pathway from appointment preparation to next appointment rescheduling was streamlined to shorten wait time by starting intake procedures from the moment the patient enters the office. Further, the critical handoff between the physician and the nurse is expedited by the needs-based stratification of patients, each associated with evidenced-based care protocol. This expands the role of nurse, allowing them to assume greater responsibility for patient care.
The positive health outcomes are significant: improved diabetes management, increased breast and colon cancer screening, higher staff experience scores, and greater patient retention.
To be successful in such value-based initiatives, healthcare organizations must ensure nurses are working at the top of their license. Progressive providers have increased patient access by conducting new nurse-only patient visits during which registered nurses document patient histories, order lab and other diagnostic tests, and determine patient acuity.
By implementing newly defined standardized procedures, clinics are increasing the registered nurse’s scope of clinical decision making including medication refills and anticoagulant and chronic care management. Nurses also are conducting physical examinations, providing triage, and subsequently presenting patient cases to practitioners—activities that significantly improve overall workflow and efficiency. Moreover, evidence shows nurse-led chronic, complex, and transitional care management results in decreased hospital days and emergency department (ED) admissions.
Key to these nurse leadership initiatives is the elimination of activities that do not directly contribute to the health and well-being of patients. The incorporation of innovative technology can assist in this effort. For example, advanced communication technology can help nurses communicate efficiently with other members of the care team including those off-site, such as home health nurses and healthcare professionals at specialized hospitals, skilled nursing facilities, and wound care clinics. Real-time video conferencing can allow nurses to conduct virtual visits with patients, increasing a practice’s capacity to see new patients and making it possible for other members of the care team (including the patient’s family) to collaborate on the plan of care.
By expanding the role and leadership of registered nurses and implementing improved processes facilitated by innovative technology in primary care, provider organizations can transform healthcare delivery, achieving improved efficiency and better outcomes at lower costs.
Michelle McCleerey, PhD, MA, MEd, MBA, RN, is vice president of PerfectServe, Knoxville, Tenn.