CONFERENCE RECOMMENDATIONS - The Josiah …

1 CONFERENCE . RECOMMENDATIONS . June 15 18, 2016 | Atlanta, GA. registered Nurses: Partners in Transforming Primary Care RECOMMENDATIONS from the Macy Foundation CONFERENCE on Preparing registered Nurses for Enhanced Roles in Primary Care Primary care in the United States is in urgent teams. Teams can increase access to care; improve need of transformation. The current organization the quality of care for chronic conditions; and and capacity of our primary care enterprise are reduce burnout among primary care practitioners, insufficient to meet the healthcare needs of the including physicians, physician assistants, and public.

2 The 2010 Affordable Care Act (ACA), nurse practitioners. But this team-focused culture which emphasizes the importance of primary care, shift is nascent and, without enough appropriately has enabled millions more people to seek care at trained healthcare professionals, primary care a time when more than half of Americans have could falter under the increased demand. at least one chronic condition and many have multiple illnesses and complex healthcare needs Who can help alleviate the pressures on primary trends that will continue as the population ages. care? A tremendous, available resource is the However, resources currently allocated to primary million registered nurses (RNs) who comprise care are inadequate.

3 Strengthening the core of the largest licensed health profession in the nation. primary care service delivery is key to achieving RNs are the ideal team members to help expand the Triple Aim: improved patient care experiences, primary care capacity, yet they have been woefully better population health outcomes, and lower underutilized in primary care settings. Practices healthcare costs. that have deployed registered nurses in enhanced roles have shown improved health outcomes, These mounting pressures from external forces are reduced costs, and enhanced patient satisfaction.

4 Shifting primary care toward new practice models staffed by high-functioning, interprofessional Josiah Macy Jr. Foundation | 44 East 64th Street, New York, NY 10065 | 1. registered nurses, appropriately prepared and perhaps most importantly, many RNs are working to the full scope of their licensure, can not exposed consistently to the full range successfully implement and sustain patient- of primary care content in the classroom or centered services for the aging and increasingly through instructional clinical experiences, complex primary care population. They can which overwhelmingly focus on inpatient and increase access to care for all patients, and acute care.

5 As a result, RNs may lack skills also assist in the management of patients and competencies essential to functioning with chronic diseases such as diabetes, effectively in primary care. hypertension, chronic obstructive pulmonary disease, and substance abuse and mental The significance of these issues and their health conditions who require more services. relevance to the mission of the Josiah Macy They also can help improve transitional care, Jr. Foundation prompted the Foundation to as patients move between hospitals, other focus its annual CONFERENCE on the topic of care facilities, and home.

6 Further, they can Preparing registered Nurses for Enhanced Roles help improve patient engagement, quality in Primary Care. The CONFERENCE represented scores, and team collaboration using health the intersection of three themes of importance assessments, patient education, motivational to the Foundation in its efforts to help reform interviewing, medication reconciliation, care health professions education: improving planning, and more. This can occur through primary care, preparing nurses for leadership RNs following a panel of patients as well as roles, and linking education reform and through nurse-led individual and group visits.

7 Healthcare delivery transformation. While the large RN workforce has the potential The CONFERENCE generated actionable to help meet the 21st century demands facing RECOMMENDATIONS around the potential for primary care, a number of barriers must be RNs to help meet the urgent needs of primary overcome. First, many RNs currently working care. Participants at the two-and-a-half-day in primary care spend much of their time working CONFERENCE held June 15 18, 2016. on patient triage, sorting out who needs to in Atlanta, Georgia included more than 40. be seen immediately and who can wait.

8 This leaders in primary care, representing academic is an important function, but primary care nursing and medicine, healthcare delivery practices need to balance RNs' time between organizations, professional nursing associations, traditional triage and the emerging chronic care healthcare philanthropy, and more. Nursing management, care coordination, and preventive students also were at the table. care. Second, some state laws limit utilizing RNs to the full extent of their education and The forward momentum in primary care training. Even when state law supports full means we are moving in the right direction, practice authority, healthcare organizations toward higher value care that is focused on sometimes restrict RNs from practicing to the improving the health of the public, said Macy full extent of their licensure.

9 Foundation President George Thibault, MD. But we have a long way to go. We simply Third, much of the work that RNs and can't meet the primary care needs of the nation other primary care team members currently unless registered nurses are part of the solution, perform is not directly reimbursable under and we must prepare them appropriately and the traditional fee-for-service payment model, then use them for this role.. meaning that new payment models are needed to facilitate the growth of primary care teams that include RNs. Finally, and 2. Context for the CONFERENCE The Institute of Medicine's Future of Nursing1.

10 Report, released in 2011, echoed these themes: Nursing has its roots in primary health care. [W]hile changes in the healthcare system Florence Nightingale, widely recognized as the will have profound effects on all providers, 19th century founder of modern nursing, said: this will be undoubtedly true for nurses. Money would be better spent in maintaining Traditional nursing competencies, such as health in communities rather than building care management and coordination, patient hospitals to cure. By the early 20th century, education, public health intervention, and registered nurses were serving as autonomous transitional care, are likely to dominate in a primary care providers, particularly in urban reformed healthcare system as it inevitably centers and rural communities where the needs moves toward an emphasis on prevention and were greatest.