title: Does the "office nurse" level of training matter in the family medicine office?
abstract: BACKGROUND
  The "office nurse" or clinical associate (registered nurse [RN], licensed practical nurse[LPN], or medical assistant [MA]) is a key member of the family medicine care team, but little is known about the influence of their level of training on team performance.
  
  
  METHODS
  The performance of the clinical dyad (clinician and associate) was studied in relation to the level of training of the nurse. The dyad's performance was measured by the performance indicators of diabetes scores, patient satisfaction, and productivity.
  
  
  RESULTS
  Dyads with a RN scored higher in meeting all 5 of the diabetes quality indicators (27.8%) than those with a LPN (19.3%) or an MA (14.7%). For patient satisfaction, the RN dyads also scored higher than the other dyad groups (positive responses: RN, 96.8%; LPN, 95.5%; MA, 94.6%). Productivity was the same in all groups. Better diabetes performance was seen in those practices with fewer competing demands: nonrural versus rural (22.2% vs 15.1%, respectively), and those not doing obstetrics versus those doing obstetrics (20.3% vs 15.1%, respectively), and for physicians versus associate providers (18.8% vs 15.1%, respectively). Higher patient satisfaction was observed in those dyads who were nonrural verus rural (96.6 vs 94.1%), among those doing obstetrics (96.0% vs 94.9%), and in physicians verus associate providers (95.7% vs 93.2%). The number of years working with the same clinician was twice as high for RNs (6.63) and LPNs (6.57) than for MAs (3.29).
  
  
  CONCLUSIONS
  A higher level of education of the clinical associate seems to confer skills that enhance the care team's management of chronic illness such as diabetes. This could potentially decrease the practice burden on other team members while facilitating the team's objectives in meeting quality indicators.
authors.affiliation: Franciscan Skemp Healthcare, Mayo Clinic Health System, La Crosse, WI, USA. hust.jean@mayo.edu
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Erickson
authors.forename: Richard A
authors.initials: RA
authors.lastname: Erickson
authors.forename: Paul V
authors.initials: PV
authors.lastname: Targonski
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Cox
authors.forename: James R
authors.initials: JR
authors.lastname: Deming
authors.forename: James W
authors.initials: JW
authors.lastname: Mold
mesh_terms: D003920:Diabetes Mellitus / Q000451:nursing; D004506:Education, Nursing; D004522:Educational Status; D004526:Efficiency; D004650:Employee Performance Appraisal; D005194:Family Practice / Q000458:organization & administration*; D019538:Health Care Surveys; D006801:Humans; D007400:Interprofessional Relations; D015146:Midwestern United States; D009726:Nurses / Q000458:organization & administration*; D015399:Nursing Research; D010348:Patient Care Team / Q000458:organization & administration*; D017060:Patient Satisfaction; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires