Effectiveness of registered nurses on system outcomes in primary care: a systematic review

Abstract

Background Internationally, policy-makers and health administrators are seeking evidence to inform further integration and optimal utilization of registered nurses (RNs) within primary care teams. Although existing literature provides some information regarding RN contributions, further evidence on the impact of RNs towards quality and cost of care is necessary to demonstrate the contribution of this role on health system outcomes. In this study we synthesize international evidence on the effectiveness of RNs on care delivery and system-level outcomes in primary care. Methods A systematic review was conducted in accordance with Joanna Briggs Institute methodology. Searches were conducted in CINAHL, MEDLINE Complete, PsycINFO, and Embase for published literature and ProQuest Dissertations and Theses and MedNar for unpublished literature between 2019 and 2022 using relevant subject headings and keywords. Additional literature was identified through Google Scholar, websites, and reference lists of included articles. Studies were included if they measured effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN within the context of an independent or interdependent role) and reported outcomes of these interventions. Included studies were published in English; no date or location restrictions were applied. Risk of bias was assessed using the Integrated Quality Criteria for Review of Multiple Study Designs tool. Due to the heterogeneity of included studies, a narrative synthesis was undertaken. Results Seventeen articles were eligible for inclusion, with 11 examining system outcomes (e.g., cost, workload) and 15 reporting on outcomes related to care delivery (e.g., illness management, quality of smoking cessation support). The studies suggest that RN-led care may have an impact on outcomes, specifically in relation to the provision of medication management, patient triage, chronic disease management, sexual health, routine preventative care, health promotion/education, and self-management interventions (e.g. smoking cessation support). Conclusions The findings suggest that primary care RNs impact the delivery of quality primary care, and that RN-led care may complement and potentially enhance primary care delivered by other primary care providers. Ongoing evaluation in this area is important to further refine nursing scope of practice policy, determine the impact of RN-led care on outcomes, and inform improvements to primary care infrastructure and systems management to meet care needs. Protocol registration ID PROSPERO: International prospective register of systematic reviews. 2018. ID=CRD42018090767.

An examination of primary health care nursing service evaluation using the Donabedian model: A systematic review

“…Many of the studies in this review limited their PHC service evaluation to the outcome section of the Donabedian ( 2005 ) model. This focus, to the exclusion of structures and processes, appears common in PHC service evaluation literature (see Lukewich et al, 2022 ; Simou et al, 2015 ). Studies that consider patient health outcomes but not service structure and processes ignore the holistic nature of services and the association between these factors and service outcomes.…”

Nurses’ work in relation to patient health outcomes: an observational study comparing models of primary care

“…A recent systematic review identi ed 23 studies reporting quantitative outcomes from nurse-led interventions in primary care. Improvements were reported for weight loss, pelvic oor muscle strength and endurance, blood pressure and glycaemic control, exercise self-e cacy, social activity, improved diet and physical activity levels, and reduced tobacco use [23]. An earlier Cochrane systematic review of 18 randomised trials of primary health care services found that care delivered by nurses, compared to doctors, could generate better outcomes for a broad range of patient conditions.…”

Nursing contributions to virtual models of care in primary care: a scoping review protocol

“…18 To date, nurses have contributed considerable knowledge and skills to the effectiveness of team-based care in primary care settings. 19 Similarly, their skills and knowledge can be leveraged in the virtual delivery of services.…”

“…Strides have been made in Canada to strengthen the integration of nurses in primary care and clarify their roles and functions in team-based care by developing national competencies for RNs in primary care17 and expanding their scope of practice (eg, increased prescribing authority for NPs) 18. To date, nurses have contributed considerable knowledge and skills to the effectiveness of team-based care in primary care settings 19. Similarly, their skills and knowledge can be leveraged in the virtual delivery of services.…”