Leadership Challenges Defining the Role of the RN in Primary Care Rosemarie Polemi, MSN, RN Debbie Zuege, MS, RN
Leaders in Action!
Leadership Influencing others’ actions to achieve the most desirable outcomes possible
Why is having the RN be the designated leader of the ambulatory healthcare team so important? Reality: PC availability and access is a challenge There is a shortage of PC physicians * Ambulatory patients have become more complex with diverse needs Technology provides many avenues for care Achieving the Quadruple Aim (patient experience (quality & satisfaction), population health, cost, staff work life) *Association of American Medical Colleges. (2018). The Complexities of Physician Supply and Demand: Projections from 2016-2030 (Final Report). Washington D.C.: HIS Markit LTD.
Why Should an RN be the ”Leader” of the Primary Care (PC) health care team? Triaging and setting priorities Leading the healthcare team – coach, mentor, direct Utilizing RN skills to leverage the RN as a provider Coordinating care and navigating systems
Microcosmic Pilot Literature review Observation of model in practice (LaClinica, Denver) Conducted 6 month pilot with 2 PC physicians in medical office setting (selected MDs and RN) Developed standard work for each member of the health care team Defined RN/MD collaborative visit Identified metrics to measure and evaluate Collected baseline data for metrics
Outcomes Nearly a quarter of provider visits done via RN/MD collaborative visit 2 to 3 visits were done independently by RN Provider time with patient per visit decreased by half Increased physician same day appointment capacity Patient engagement in care and satisfaction increased Physician, RN, LPN, MA “ teamlet ” job satisfaction increased
Learnings/Conclusions RN as leader of healthcare “ teamlet ”: More effectively utilized each team members skills and increased their job satisfaction Reduced the physician’s time per patient, thereby increasing capacity to see more patients and focus on more complex patients Provide more continuity for patients and engage with patient as lifelong coach Developing standard work for each role reduces redundancy and increases team efficiency Improved team relationships improves overall patient relationship and satisfaction
Challenges Develop metrics to ensure quality of care for patient is not affected (e.g. visit with RN not adequate and results in a 2nd visit for patient to see physician) Ensure that long term evaluation demonstrates an increase in savings to offset the cost of RN
Questions ???
Break Out Exercise What issue/problem/project might you use the “nursing process” to address?
Leadership and Learning “Leadership and learning are indispensable to each other.” . Kennedy, 35 th President of the United States) ( John F “We now accept the fact that learning is a lifelong process of keeping abreast of change. And the most pressing task is to teach people how to learn.” (Peter Drucker, American management consultant, educator, author)
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