Implications of the Patient-Centered Medical Home for Nursing Practice.
OBJECTIVE
The experiences of RNs and licensed practical nurses (LPNs) implementing a patient-centered medical home (PCMH) in the Department of Veterans Affairs (VA) primary care clinics were examined to understand model implications for nursing practice and professional identity.


BACKGROUND
National implementation of the PCMH model, called patient-aligned care teams (PACTs) in VA, emphasizes areas of nursing expertise, yet little is known about the effect of medical homes on the day-to-day work of nurses.


METHODS
As part of a formative evaluation to identify barriers and facilitators to PACT implementation, we interviewed 18 nurses implementing PACT.


RESULTS
Challenges to nurse's organizational and professional roles were experienced differently by RNs and LPNs in the following areas: (1) diversified modes of care and expanded clinical duties, (2) division of labor among PACT nurses, and (3) interprofessional status in the team.


CONCLUSIONS
Healthcare managers implementing PCMH should consider its inherent cultural and practice transformations.
Author Affiliations: Qualitative Analyst (Dr K. R. Stewart), Associate Director of Operations (Ms Lampman), Codirector (Dr Wakefield), Core Investigator (Dr G. L. Stewart), Director (Dr Rosenthal), Investigator (Dr Solimeo), US Department of Veterans Affairs, VISN 23 Patient Aligned Care Team Demonstration Lab; Research Health Science Specialists (Ms Lampman and Drs K. R. Stewart, Solimeo, Rosenthal, and Wakefield), US Department of Veterans Affairs, Center for Comprehensive Access & Delivery Research and Evaluation; and Qualitative Analyst (Dr K. R. Stewart), US Department of Veterans Affairs, Veteran Rural Health Resource Center Central Region, Iowa City VA Health Care System; Professor (Dr G. L. Stewart), Tippie College of Business, University of Iowa; and Interim Chair and Department Executive Officer (Dr Rosenthal), Assistant Professor (Dr Solimeo), College of Medicine, Division of General Internal Medicine, University of Iowa Carver, Iowa City.
Kenda R
KR
Stewart
Greg L
GL
Stewart
Michelle
M
Lampman
Bonnie
B
Wakefield
Gary
G
Rosenthal
Samantha L
SL
Solimeo
D006801:Humans; D007407:Interviews as Topic; D015146:Midwestern United States; D009735:Nursing Homes; D018802:Patient-Centered Care; D057184:Practice Patterns, Nurses'; D011320:Primary Health Care / Q000458:organization & administration; D016730:Program Development; D014481:United States; D014493:United States Department of Veterans Affairs