title: Role of the registered nurse in primary health care: meeting health care needs in the 21st century.
abstract: There is widespread interest in the redesign of primary health care practice models to increase access to quality health care. Registered nurses (RNs) are well positioned to assume direct care and leadership roles based on their understanding of patient, family, and system priorities. This project identified 16 exemplar primary health care practices that used RNs to the full extent of their scope of practice in team-based care. Interviews were conducted with practice representatives. RN activities were performed within three general contexts: episodic and preventive care, chronic disease management, and practice operations. RNs performed nine general functions in these contexts including telephone triage, assessment and documentation of health status, chronic illness case management, hospital transition management, delegated care for episodic illness, health coaching, medication reconciliation, staff supervision, and quality improvement leadership. These functions improved quality and efficiency and decreased cost. Implications for policy, practice, and RN education are considered.
authors.affiliation: Columbia University School of Nursing, New York, NY. Electronic address: js928@columbia.edu.
authors.forename: Janice
authors.initials: J
authors.lastname: Smolowitz
authors.affiliation: Jefferson Interprofessional Education Center, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Speakman
authors.affiliation: Department of Maternal Child and Family Nursing, Seattle University, Seattle, WA.
authors.forename: Danuta
authors.initials: D
authors.lastname: Wojnar
authors.affiliation: Centers for Medicare and Medicaid Services, Baltimore, MD.
authors.forename: Ellen-Marie
authors.initials: EM
authors.lastname: Whelan
authors.affiliation: Saint Catherine University, Saint Paul, MN.
authors.forename: Suzan
authors.initials: S
authors.lastname: Ulrich
authors.affiliation: Adult Inpatient and Integrative Oncology, Dana Faber Cancer Institute and Brigham and Women's Hospital, Boston, MA.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Hayes
authors.affiliation: Boston Children's Hospital, Boston MA.
authors.forename: Laura
authors.initials: L
authors.lastname: Wood
mesh_terms: D002908:Chronic Disease; D019468:Disease Management; D006301:Health Services Needs and Demand / Q000639:trends; D006801:Humans; D024802:Nurse's Role; D011216:Practice Management, Medical / Q000458:organization & administration; D057184:Practice Patterns, Nurses' / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D014481:United States
keywords: Primary care; Primary health care; Registered nurse