AHRQ Views: Blog posts from AHRQ leaders
Today’s Nurses: Poised to Fill Needs in Primary Care
Decades ago, nurses were the main providers of community-based primary care in many pockets of America. This was especially true in rural or inner-city areas, communities that today we might consider medically underserved.
It was Lillian Wald, for example, founder of the Henry Street Settlement in1893 in New York City, who established a new role in which nurses provided primary care in community settings – later termed “public health nursing.” Nurses’ engagement in community and primary care settings waned after World War II, however, with more and more nurses moving from community to hospital-based settings.
But there are good reasons to believe that it’s time for the pendulum to swing back to primary care and community settings once again.
The need persists, of course, for nurses to provide acute care in hospital settings. But today’s traditional health care delivery model overlooks the growing demand for nurses at the front lines of care delivery in primary care settings.
Everything about the way health care is delivered is changing. And the recognition is growing that our Nation’s demand for primary care cannot be met solely by our partner physicians and physician assistants. About 8,000 primary care physicians enter the workforce each year, but the number of primary care physicians who retire each year is projected to reach 8,500 by 2020.
Clearly, these trends represent an important opportunity for nurse practitioners (NPs), registered nurses (RNs), and physician assistants (PAs) - not as replacements for physicians, but as partners in a team-based approach to care delivery.
NPs and PAs, who comprise approximately 30 percent of the primary care workforce, already play a central role in the delivery of a broad range of primary care services, while leading practice improvement efforts focused on quality and safety. The time for RNs to join them is here.
This year, the theme for the American Nurses Association-sponsored National Nurses Week, May 6 to 12, is "Nurses: Inspire, Innovate, Influence." Certainly, as primary care moves to team-based practice models, RNs are inspiring, innovating, and influencing. They are well positioned to take on leading roles and new responsibilities.
As members of the primary care team, RNs can protect and enhance the safety of patients while ensuring the delivery of the highest quality care possible. RNs assume diverse roles in primary care, often serving as care coordinators, health coaches, health educators, and health advocates, especially for patients with complex medical conditions.
Being on the front lines of primary care, RN’s are prepared to develop personal relationships with patients and caregivers. RNs also are poised to lead the development of integrated, person-centric care plans that include patient values and preferences, well as contributing to and leading innovative new models of care.
As the Nation’s lead Federal agency for patient safety, AHRQ is committed to improving safety and quality in ambulatory settings. We can and should prepare for a future in which we help make primary care safer and more efficient. To that end, I highlight below a few AHRQ tools developed to empower nurses and other health professionals to improve safety in primary care settings.
First is TeamSTEPPS®, short for Team Strategies & Tools to Enhance Performance and Patient Safety. TeamSTEPPS is an evidence-based training curriculum developed to improve health care professionals’ communication and teamwork skills. When RNs work well with physicians and other health care professionals, patients benefit.
But working in teams is not always easy. This is why AHRQ, along with the Department of Defense, developed TeamSTEPPS. A version tailored solely for ambulatory settings, TeamSTEPPS for Office-Based Care, is available on AHRQ’s website.
In addition, AHRQ has several resources designed to increase patients’ and families’ participation in ambulatory care. Research shows that when patients are engaged with their health care, measurable improvements in safety and quality often occur.
Among these AHRQ resources is the Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families, a toolkit that supports staff efforts to partner with patients and families to improve quality and safety. It includes a technique called the “Warm Handoff Plus,” which involves patients and families in efforts to ensure safe handoffs of care between providers in ambulatory settings. AHRQ has a similar guide for hospital-based care.
AHRQ is proud to partner with nurses and celebrate National Nurses Week. With AHRQ tools and resources in hand, RNs, the largest health care workforce, can significantly enhance quality and safety. If we get this right, and we must, everyone—physicians, nurses, PAs and, most importantly, patients—will benefit.
Dr. Ricciardi is the Director of the Division of Practice Improvement and AHRQ's Senior Nursing Advisor