Utilization of registered nurses in primary care teams: A systematic review

Abstract

Background Registered nurses are increasingly becoming embedded in primary care teams yet there is a wide variability in nursing roles and responsibilities across organizations. Policy makers are calling for a closer look at how to best utilize registered nurses in primary care teams. Lack of knowledge about effective primary care nursing roles and responsibilities challenges policy makers' abilities to develop recommendations to effectively deploy registered nurses in primary care needed to assure efficient, evidence-based, and quality health care. Objective To synthesize international evidence about primary care RN roles and responsibilities to make recommendations for maximizing the contributions of RNs in team-based primary care models. Design Systematic Review Data Sources The Meta-Analysis and Systematic Reviews of Observational Studies framework guided the conduct of this review. Five electronic databases (OVID Medline, CINAHL, EMBASE, PubMed and Cochrane Library) were searched using MeSH terms: primary care, roles, and responsibilities. The term "nurs*" was truncated to identify all literature relevant to nursing. Review Methods The initial search yielded 2,243. Abstracts and titles were screened for relevance and seventy-one full text reviews were completed by two researchers. Inclusion criteria included: 1) Registered nurses practicing in interprofessional teams; 2) Description of registered nursing roles and responsibilities; 3) Primary care setting. All eligible studies underwent quality appraisal using the Integrative Quality Criteria for Review of Multiple Study Designs tool. Results Eighteen studies met eligibility across six countries: Australia, United States, Spain, Canada, New Zealand, and South Africa. Registered nurses play a large role in chronic disease management, patient education, medication management, and often can shift between clinical and administrative responsibilities. There are a limited number of registered nurses that participate in primary care policy making and research. Conclusion Integrating registered nurses into primary care has the potential to increase patient access to a primary care provider because registered nurses can supplement some of the provider workload: they renew prescriptions, address patient questions, and provide patient education. Clear practice protocols and nursing policy should be written by registered nurses to ensure safe, and effective nursing care. The use of a medical assistant or nurse’s aide to perform non-nursing tasks allows registered nurses to take on more complex patient care. Future research should expand on emerging payment models for nurse-specific tasks.

How do nurse managers describe clinical nurses' work arrangements? A qualitative study

“…Lily, a paediatric oncology nurse manager with 36 years of registered nurse experience, put it succinctly, ‘Having travellers go in while you're trying to look for permanent employees [is a strategy that] helps your permanent staff’. Participants' definition mirrored the increasing prevalence of team‐based care observed in international healthcare systems (Norful, Martsolf, de Jacq, & Poghosyan, ). The similar ways that the participants categorized their nurses in terms of teams created a permanent‐temporary distinction by referencing to their units' staff nurses, nurses' tenure and anticipated tenure on their units.…”

Exploring the utility of the Nursing Role Effectiveness Model in evaluating nursing contributions in primary health care: A scoping review

“…A comprehensive review of the literature and consultation with experts would therefore need to be performed to determine which variables identified in the NREM are the most relevant to nursing outcome evaluation in primary health care before the NREM could be used in this setting (Haggerty, ; Hogg, Rowan, Russell, Geneau, & Muldoon, ). Recently, a systematic review conducted by Norful et al () synthesized international literature related to the roles/processes of primary care RNs and made recommendations for optimizing their contributions in primary health care teams. This review included 18 studies from six countries.…”

“…This review included 18 studies from six countries. Fundamental roles/processes of the RN in primary care identified were assessment, monitoring and follow‐up of patients with chronic diseases (Norful et al, ). Similarly, a systematic review synthesizing outcome measures and the effectiveness of this important and growing role in primary health care teams is needed and currently being conducted by the present research team (Lukewich et al, ).…”

“…For example, reduced adverse events are significantly associated with a higher number of hours of care delivered by RNs (Dubois, D'Amour, Tchouaket, et al, 2013;Kane, Shamliyan, Mueller, Duval, & Wilt, 2007;Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002). Nurses have continuously shown their ability to meet many objectives of primary health care (Norful et al, 2017). They have responsibilities in primary health care, including patient engagement, leading teams to improve care of patients, coordinating care and promoting population health (Bodenheimer & Mason, 2016).…”

Primary Care Providers’ Perspectives on Errors of Omission

“…This suggestion is supported by evidence that standing orders for RNs and other primary care team members help to reduce omission of preventative care, such as vaccinations and screenings. [45][46][47] These suggestions are important for policy makers seeking ways to better use RNs in primary care. 48 Furthermore, 1 key element of an effective PCMH is the construction of high-functioning teams; thus, practice managers should promote effective teamwork and optimal communication.…”