Since last summer, when the American Academy of Nursing and the Josiah Macy Foundation collaborated to design a conference on the role of nurses in primary care, there has been a lot of buzz about preparing RNs for an optimal role (Berkowitz, 2016). The Josiah Macy Foundation (n.d.) published six recommendations from the conference. Nurse faculty and nursing education leaders are mentioned prominently in four.
In preparation for the conference, Wojnar and Whelan's (2016) report of a survey about primary care curricula was distributed to participants. Its findings, from 1,409 schools of nursing, include facilitators and barriers to the inclusion of primary care content in curricula. As might be expected, leaders and forward thinking faculty were cited as significant facilitators. Barriers included several items: lack of faculty support, challenges in obtaining appropriate role models, fear of inadequate skill attainment in primary care, and clinical placements. Many associate degree programs, because they often cannot obtain acute care placements, reported using outpatient and primary care settings over time, although often as "shadowing" versus "active learning" experiences. I recommend this article as you consider your program.
In the context of the conference findings, recommendation V is particularly powerful: "Academia and healthcare organizations should partner to support and prepare nursing faculty to educate pre-licensure and RN-to-BSN students in primary care knowledge, skills, and perspectives." A fundamental characteristic within nursing academia, however, is lack of first-hand knowledge of the fully operationalized role of the RN in primary care. As the world of nursing has become increasingly specialized, faculty expertise typically lies within an advanced practice area. Or, if related to primary care, the faculty members are APNs, not primary care RNs. Yes, there is a gap in faculty expertise.
Recommendations from the conference acknowledge that resources for faculty development must include partnerships with providers. Such partnerships are fundamental to offering robust, effective nursing education. And although many academic-practice partnerships are with health care systems oriented toward the provision of acute care services, ties to community services, primary care practices, and clinics also exist and need our focus.
One difficulty, however, is the scarcity of role models in these settings to coach and prepare the vast numbers of faculty who need this education. If faculty cannot teach the optimum practice of the RN in primary care, optimum execution of the role will be haphazard and fragmented.
As the world of nursing has become increasingly specialized, faculty expertise typically lies within an advanced practice area. Or, if related to primary care, the faculty members are APNs, not primary care RNs. Yes, there is a gap in faculty expertise.
What can we do? I think we need to begin by answering the question: What's in it for the practice? As happened when nursing first began its development and implementation of advanced practice roles, it is likely that many health care partners will be skeptical. So tap the literature. Make the case for RNs who provide care coordination, prevention, and health promotion. Become immersed in the practice setting, both learning and defining the optimal role of the RN.
Another benefit of faculty immersion is to look beyond the RN role. For example, the roles of vocational nurses are likely to change, and these staff members need orientation to the RN's work and its impact on their efforts. Faculty can also create the environment for the deployment of students who can further advance outcomes and provide real-life experiences for the entire team.
Subsidizing the presence of faculty costs both salary expenses and time for providers. Faculty should not be expected to volunteer their time. Rather, their experience should be intentional, deliberate, and structured to yield the primary care practice the patient outcomes desired and facilitate students' future learning. Moreover, faculty who have the immersion experience can describe and define the learning outcomes available for students, thus transitioning the goal of the fully implemented RN role in primary care into curricular content and outcomes.
It is by such leadership that faculty will transform this critical aspect of care service delivery, making the culture of primary care one that provides the full scope of services of the RN as an integral part of the health care team. Nurse faculty are key to the successful transformation of the primary care setting.
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