title: Association between registered nurse staffing and management outcomes of patients with type 2 diabetes within primary care: a cross-sectional linkage study.
abstract: BACKGROUND
  As the organization of primary care continues to evolve toward more interdisciplinary team structures, demonstrating effectiveness of care delivery is becoming important, particularly for nonphysician providers. Nurses are the most common nonphysician provider within primary care. The purpose of this study was to examine the relation between primary care delivery models that incorporate registered nurses and clinical outcomes of patients with type 2 diabetes.
  
  
  METHODS
  Patient data from the Canadian Primary Care Sentinel Surveillance Network were matched with survey data from 15 Family Health Team practices in southeastern Ontario. Included patients were adults with type 2 diabetes mellitus who had at least 1 primary care encounter at a Family Health Team practice that completed the organizational survey between Apr. 1, 2013, and Mar. 31, 2014. The clinical outcomes explored included hemoglobin A1c, fasting plasma glucose, blood pressure, low-density lipoprotein cholesterol and urine albumin:creatinine ratio.
  
  
  RESULTS
  Of the 15 practices, 13 (86.7%) had at least 1 registered nurse. The presence of 1 or more registered nurses in the practice was associated with increased odds of patients' having their hemoglobin A1c, fasting plasma glucose, blood pressure and low-density lipoprotein cholesterol values meet recommended targets. Practices with the lowest ratios of patients with diabetes to registered nurse had a significantly greater proportion of patients with hemoglobin A1c and fasting plasma glucose values on target than did practices with the highest ratios of patients to registered nurse (p < 0.01 and p = 0.03, respectively).
  
  
  CONCLUSIONS
  The findings suggest that registered nurse staffing within primary care practice teams contributes to better diabetic care, as measured by diabetes management indicators. This study sets the groundwork for further exploration of nursing and organizational contributions to patient care in the primary care setting.
authors.affiliation: School of Nursing (Lukewich), Memorial University of Newfoundland, St. John's, Nfld.; School of Nursing (Edge, VanDenKerkhof, Tranmer), Department of Anesthesiology and Perioperative Medicine (VanDenKerkhof), School of Medicine, and Department of Public Health Sciences (Tranmer), Faculty of Health Sciences, Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
authors.forename: Julia
authors.initials: J
authors.lastname: Lukewich
authors.affiliation: School of Nursing (Lukewich), Memorial University of Newfoundland, St. John's, Nfld.; School of Nursing (Edge, VanDenKerkhof, Tranmer), Department of Anesthesiology and Perioperative Medicine (VanDenKerkhof), School of Medicine, and Department of Public Health Sciences (Tranmer), Faculty of Health Sciences, Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
authors.forename: Dana S
authors.initials: DS
authors.lastname: Edge
authors.affiliation: School of Nursing (Lukewich), Memorial University of Newfoundland, St. John's, Nfld.; School of Nursing (Edge, VanDenKerkhof, Tranmer), Department of Anesthesiology and Perioperative Medicine (VanDenKerkhof), School of Medicine, and Department of Public Health Sciences (Tranmer), Faculty of Health Sciences, Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: VanDenKerkhof
authors.affiliation: School of Nursing (Lukewich), Memorial University of Newfoundland, St. John's, Nfld.; School of Nursing (Edge, VanDenKerkhof, Tranmer), Department of Anesthesiology and Perioperative Medicine (VanDenKerkhof), School of Medicine, and Department of Public Health Sciences (Tranmer), Faculty of Health Sciences, Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
authors.forename: Tyler
authors.initials: T
authors.lastname: Williamson
authors.affiliation: School of Nursing (Lukewich), Memorial University of Newfoundland, St. John's, Nfld.; School of Nursing (Edge, VanDenKerkhof, Tranmer), Department of Anesthesiology and Perioperative Medicine (VanDenKerkhof), School of Medicine, and Department of Public Health Sciences (Tranmer), Faculty of Health Sciences, Queen's University, Kingston, Ont.; Department of Community Health Sciences (Williamson), Cumming School of Medicine, University of Calgary, Calgary, Alta.
authors.forename: Joan
authors.initials: J
authors.lastname: Tranmer