HomeMy Nurse InfluencersWhat you may not know about primary care nursing practice

What you may not know about primary care nursing practice

Author(s): By Kae Livsey, PhD, MPH, RN

Nursing is a great career option. There are so many places that nurses can practice. My career has taken me from the perioperative environment at a Level I trauma center to being the only RN on staff at a free clinic managing the clinic and providing care management services.

Like many new nurses, I was enthralled by the high pace of the OR and the adrenaline rush.  However, later in my career, I learned that I could engage in higher levels of nursing practice and make tangible impacts on the lives of others in the community setting. As a nurse care manager for individuals with multiple chronic diseases and no insurance, I was able to experience what independent RN practice is – like what we are taught in school!

There are a lot of misconceptions about primary care nursing practice – so I wanted to share some thoughts about what I have learned about primary care nursing:

RNs can enjoy independent practice

As reimbursement of primary care services moves to more of a value-based model (based on outcomes, not just volume of patients seen), primary care nursing offers incredible opportunities for RNs to practice independently at their fully licensed scope by engaging in care coordination and care management to improve outcomes of patients and populations.

While most practice settings are still learning what this could look like, we need to seize these changes in healthcare to articulate and create roles that recognize the independent practice of nursing by the licensed registered nurse more clearly. Nurses also need better role models to understand more fully what this looks like.

Primary care nursing is challenging – not boring!

We conducted focus groups of RNs practicing in primary care from across the US who reported a wide range of roles that they fulfill in primary care practice settings. These range from clinic practice management roles, overseeing quality and performance improvement, providing care coordination and care management, engaging in co-visits with medical providers, and conducting independent nurse clinic visits.

Triage is another high-level nursing practice that requires the skill set of a registered nurse in primary care. If you like variety – consider primary care nursing!

The RNs we interviewed also lamented that there is a great deal of confusion among nurses about what primary care nursing practice is all about. Some noted that their colleagues asked, “Why would you want to do that now? Save that for your retirement job!” and indicated that there was a sense that primary care nursing was not really very challenging. This could not be further from the truth! When you see a patient in the inpatient setting, they often have been evaluated and have received a medical diagnosis: when someone calls on the phone for triage support or shows up at the clinic door, it takes acute nursing assessment and clinical reasoning skills to figure out what might be going on with that patient. Primary care also is fast paced and requires lots of teamwork. Think about it: if we had more RNs in primary care helping coordinate care and help patients understand their disease processes, engage in self-care management, and navigate our complex healthcare system, then we could reduce the burden on our nursing colleagues in the acute care environment having to deal with acute manifestations of chronic diseases!

Primary care nursing lets you develop relationships with your clients!

I have been working for the past few years to develop a post-BSN residency fellowship in primary care with support from a federal grant and an awesome project team. In addition to a robust didactic curriculum and simulations, this program provides an immersive 6-month primary care practicum experience for both new graduate nurses (residents) and experienced nurses (fellows).

Most schools of nursing do not expose learners to primary care experiences, which needs to change.  When we have asked our experienced nurses who join the program why they are interested in primary care, a common refrain is that they want to be able to engage in long term relationships with the people they serve.  This is possible in primary care, especially with the new emphasis on quality outcomes and care management to support regular clinic visits.

We still have a long way to go to get where we need to be for RNs to be fully integrated appropriately on the team. This will require lots of education, advocacy, and policy change. I am all in – anyone want to join me?

Kae Livsey has more than a decade of experience creating and developing applied community-based learning experiences for undergraduate BSN students, with particular emphasis on use of community-based service learning experiences, simulation and working with underserved populations. 

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