News and Commentary RNs and the Future of Primary Care: One Student’s Reflections

Andrew Harmon is a BSN student at Jefferson College of Nursing in Philadelphia, PA.

The Setting
So there I was, standing in the middle of a tropical orchid garden, surrounded on all sides by vibrant glass sculptures rising out of the lush vegetation, when I look down to see none other than former president Jimmy Carter reaching out to me for a handshake. No, this was not a hallucination brought on by the heat of an Atlanta summer, though it certainly felt that way at times. This was just another dinner courtesy of the Josiah Macy Jr. Foundation. Had it not been for the surreal 24 hours that preceded it, I would have been certain that it was a dream. But this was no dream. I was living the life of a conferee at the Foundation’s 2016 conference: Preparing Registered Nurses for Enhanced Roles in Primary Care in Atlanta, Georgia. There, I found myself surrounded by the country’s foremost experts in economics, finance, policy, health care, and nursing as they attempted the improbable: fixing primary care in America in two and a half days.

The Challenge
To understand the scope of this challenge it’s important to know just what we’re up against. As it stands, we are at the convergence of some particularly ominous trends in the health of our nation. Simply put, there is a rapidly growing gap between the supply of and the demand for primary care. On the supply side, a plateau in the number of physicians entering primary care and an increase in the rate of retirement means that by 2020, the number of retiring practitioners could overtake the number entering the field. On the demand side, the rapid growth of the elderly demographic, increased coverage provided for by the ACA, and the diabetes and obesity epidemics are rapidly overtaking available resources. If we are to meet these challenges, we need to seriously reconsider the way we deliver primary care.

The Transformation
This is where the registered nurse comes in. As it stands, nurses in primary care settings tend to spend most of their time triaging patients, answering EMR inbox messages, and performing office functions such as injections, wound care, and patient education. Though these tasks are instrumental to the functioning of primary care practices, they represent an underutilization of the nurse’s skills and education. Forward-thinking practices across the country are beginning to utilize nurses in expanded roles with exciting results. In these practices, nurses lead complex care management teams to improve care and reduce the costs of high-utilizing, multi-diagnosis patients.

This transformation, however, is not without obstacles. Everything from the education of nurses to reimbursement for their services is in need of tweaking if RN’s are to catalyze the evolution of primary care. Through two and a half days of breakout groups and plenary sessions, conferees wrestled with these obstacles and ultimately formulated a list of recommendations that will guide educators, policy makers, practice owners, and everyone in between in leveraging the expanded role of the RN to provide more effective and efficient health care.

RNS Primary Care

The Future
As the conference drew to a close I began to reflect on the experience and all that we had accomplished. Though actionability was a consistent emphasis throughout the conference, I still had trouble visualizing exactly how these recommendations would propagate through the healthcare system.

In January, I had the good luck and privilege to see that transformation in action. Independence Blue Cross, in partnership with the American Academy of Nursing, hosted an event with an equally star-studded and diverse cast of nurses, physicians, community leaders, and others with a passion for primary care. This was the first in a series of conversations on how to bring the insights gained from the conference into the practical sphere.

Through a series of panel discussions, I began to see where the rubber meets the road. As audience members offered comments and asked questions, it was clear that the recommendations were already having an impact. Everyone from insurance executives to ER physicians provided unique perspectives on how these recommendations could be put to work in their respective practice settings. Having seen the impact this conversation had on those in attendance, I know that the insights gained at the conference will be amplified as they spread throughout healthcare system. I am extremely grateful to have been a part of this process and look forward to seeing how the transformative power of these ideas continues to manifest to the benefits of patients, providers, and the healthcare system at large.

Bodenheimer, T. & Bauer, L. (2015). The future of primary care: enhancing the RN role. Commissioned paper.

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