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Nurses prepare to take on larger role in primary care delivery

nurse advising a patient about her medications
This fall, SDSU nursing students will receive expanded instruction about rural nursing, the role of the registered nurse in primary care and the opioid epidemic through IMPACT-RNS, a U.S. Health Resources and Service Administration-funded project that seeks to address the shortage of health-care professionals in rural and underserved areas.

Nurse-researchers at South Dakota State University are helping rural clinics more fully utilize registered nurses in primary care and have expanded the nursing curriculum to better prepare students to deliver that care.

“We want to see what we can do locally to help facilities re-envision what the future of primary care could look like with RNs practicing to the full extent of their licensure,” Associate Nursing Professor Heidi Mennenga said. She leads the research team working on Impacting Models of Practice and Clinical Training for Registered Nurses and Students, known as IMPACT-RNS.

The four-year U.S. Health Resources and Service Administration-funded project seeks to address the shortage of health-care professionals in rural and underserved areas by preparing nursing students and practicing RNs to function in expanded roles in a primary care setting. In addition, the students and RNs will learn their role in dealing with opioid epidemic, including patient assessment, intervention and treatment.

Primary care is typically the first contact patients experiencing symptoms have with a health-care provider, usually a doctor, physician assistant or nurse practitioner. This care can involve diagnosis and treatment, patient education and/or counseling and chronic disease management.

“The trend has been away from using RNs in primary care as a means of saving money,” Mennenga said. However, the literature supports better patient outcomes and reduced health-care costs when RNs are more fully utilized. “This is part of a national conversation that has been going on for the last three years,” she pointed out.

nursing taking patients blood pressure
Registered nurses can use standing orders to treat patients in a primary care setting.

Re-envisioning primary care

The research team is working with 13 clinical partners in South Dakota and Minnesota, connecting with administrators and key people to explain what they are trying to do. Site leaders for the project are Assistant Deans of Nursing Leann Horsley and Linda Burdette, Director of Academic Nursing Education Programs Christina Plemmons and Assistant Professor of Nursing Alham Abuatiq.

“We have done needs assessments with our clinical partners to determine how they are now using RNs in primary care and where they’d like to be,” Mennenga said. “We are asking facilities to identify short-term and long-term goals. For instance, do they may want to use RNs to manage acute care visits? For example, when a patient comes in with symptoms of an ear infection, RNs could use standing orders to manage that case independently.”

This summer the team will work with the clinics individually by providing more education, develop standing orders or meeting with key people to describe how roles would change.

Training nursing students

This fall, SDSU nursing students will receive expanded instruction about rural nursing, the role of the RN in primary care and the opioid epidemic. In addition to developing the curriculum, the research team is rolling out simulations specifically related to primary care and opioid addiction.

Furthermore, the first cohort of five senior nursing students will begin their two-semester primary care clinical experiences this fall. “This is the first longitudinal experience where students are in a clinical setting for more than a semester and the first dedicated primary care experience,” Mennenga said. The SDSU team developed a brochure and a video to promote the primary care clinical to seniors in the Brookings and Aberdeen nursing programs.

Each student will spend 150 hours working one-one-one with an RN preceptor. One student will be placed at each of the first-year clinical sites—Flandreau, Milbank, Sisseton and Canby and Luverne, Minnesota.

“With this small number of students, we will have good communication to see how the experience is going and (work with the clinics and preceptors) to fine-tune it,” Mennenga said. The researchers will add four clinical sites to the program each of the next two years to offer the primary care experience to more students.

“The facilities hope this will be an additional recruitment tool,” she added. The team will track how many of the clinical students go on to work in a rural location.

Training practicing nurses

As part of the project, the research team is developing four continuing education modules related to rural nursing, the RN role in primary care and the opioid epidemic.

“We are working on finalizing drafts of each module and will then send them out for review,” Mennenga said. She anticipates the modules will be available to SDSU faculty members and the RN preceptors at the clinical sites this fall. The long-term goal is to have these professional development modules available online.

“Using year one for capacity building was a wise decision. It takes a lot of devoted time to get faculty up to speed on the project and how it will impact the curriculum and to work individually with our first five clinical practice partners,” Mennenga said. “We have accomplished what we set out to do and are well positioned as we move into year two.”