Primary Care Certificate Program:
Primary Care Nurses
Spencer Revels and Judy Neubrander
The healthcare climate in the United States is currently in a state of transformation, and
as a result the roles of many healthcare workers are in flux. One approach to strengthening this
new healthcare system is to evaluate and improve the function of valued healthcare providers
such as primary care nurses (PCN). Nurses working in the primary care sector already play a
vital role in providing quality care to patients in the United States. A new model of healthcare
has been emerging in the U.S, which has spurred new amendments to the Affordable Care Act
and the Patient Protection Act. These new healthcare mandates called for an expansion in access
to healthcare and to provide a more patient centered medical home, thus increasing the demand
for primary care providers. This shift in the healthcare delivery model should be reflected in the
academic curriculum preparing nurses for the primary care sector. Other countries such as
Australia and Canada have been in the process of creating primary care certificate courses in
order to prepare their nurses to be more successful on the job (Oandasan et al., 2010). There is
an inherent responsibility of nurse educators in the U.S. to anticipate and prepare for this change
in the healthcare delivery system. Therefore, it has been imperative to examine the current role
of the PCN as well as explore new functions that will aid in delivering efficient and quality care
under this new model.
Current research in primary health care has called for a change in the academic
curriculum for nursing education (Berg & Dickow, 2014, Baxley & Cunningham, 2014,
Drummond, Abbott, Williamson, & Somji, 2012, Oandasan et al., 2010). Primarily, the type of
care in which the PCN delivers has been vastly different from the care delivery of one in an acute
setting (Oandasan et al., 2010). When examining care delivery of the family practice nurse,
Oandasan et al.’s (2010) stated that these nurses “played an important role in gathering
information from the patients to develop a holistic understanding, which included lifestyle,
familial, and socioeconomic circumstances” (p. e379). PCN’s have been treating patients in an
individualized and unique manner, therefore their education should also reflect that specificity.
In addition, Drummond et al.’s (2012) study and others encouraged nursing educators to
reevaluate the curriculum for nurses going into primary care because in their careers, nurses have
been fulfilling roles in which they have not explicitly been trained for (Berg & Dickow, 2014).
Nurses have been working in these roles not only because it was defined to be in their scope of
practice, but also because these roles were a crucial need within the primary care office. One
such role was communicating and coordinating with other professionals to meet patient needs
(Haas, Swan, & Haynes, 2013). Nurses in the primary care sector have been undoubtedly
working within an interdisciplinary team comprised of doctors, additional nurses, office staff,
practice managers, and other professionals. Current research has indicated that although it is
common practice for the PCN to work within a team, nurses have not been explicitly trained for
interdisciplinary teamwork (Baxley & Cunningham, 2014, Drummond et al., 2012). Drummond
et al.’s (2012) completed a study on inter-professionalism in primary care facilities within
Canadian family medicine clinics; the researchers asserted that nurses need to be better educated
on interdisciplinary teamwork because few nurses are prepared to work in these teams when they
arrive on the job. Although working optimally within a team comes with experience, explicitly
training nurses on teamwork skills could better prepare them for the primary care environment.
Specifically, further educating nurses on the roles within their own scope of practice as well as
the responsibilities and limitations of other professionals within the team could aid the
interdisciplinary team to function more productively and efficiently to maximize quality patient
care (Banner, MacLeod, & Johnston, 2010, Baxley & Cunningham, 2014). The hallmark
function of the PCN has been coordination of patient care, yet the success of that job depends
primarily on communication within an interdisciplinary team. Therefore, it is imperative that
nurses be trained for interdisciplinary teamwork.
Nurses have had a steadfast history of being a vital member of primary care office by
fulfilling roles from patient advocacy to providing efficiency within the office (Haas et al.,
2013). A primary role of the PCN has been care coordination or case management, which
involves facilitating communication between the doctor, other providers, the patient, and the
patient’s family (Haas et al., 2013, Yang & Meiners, 2014). Many studies have shown that PCN
in the role of care coordinator is the most patient centered model (Haas et al., 2013). Yang and
Meiners (2014) stated that nurses are best equipped at care coordination because they take
initiative in patient care, while also knowing their patient’s personal and medical needs; PCN
have met these needs by sharing information with not only efficiency, but also accuracy due to
their advanced medical training. Similarly, a study by Oandasan et al. (2010) in Canada, showed
that successful PCN had a relationship centered approach to care delivery, in which good patient
care was founded upon a trusting nurse-patient relationship that was established over time. A
study conducted by Haas et al. (2013) also confirmed that “coaching and counseling of patients
and families” was an important role of the PCN in care coordination because it built long term
relationships with the patients as well as their families (p.46).
In addition to the previously stated nursing roles, a study by Haas et al. (2013) further
defined patient-centered roles of PCN that they recommend as core competencies and associated
activities for care coordination. The researchers included previously mentioned roles such as
“education and engagement of patient and family,” “cross setting communication and transition”
from one facility to another, “teamwork and collaboration”, “patient centered care planning,” and
patient advocacy for preventative care (Haas et al., 2013, p.46). An additional dimension was
the PCN’s role in support for self-management of a patient’s chronic disease management, which
involved providing educational materials and medication sheets. Another competency presented
was the overall nursing process, which included assessment, planning, implementation and
intervention, and evaluation, as a result of procedures such as asking open ended questions to the
patients to assess their knowledge of their illness. The researchers also cited “decision support
and information systems” as related to population health management as a strong role of the
PCN in care coordination (Haas et al., 2013, p.46).
Most importantly, research suggested that higher levels of care coordination leads to
better healthcare outcomes, therefore, PCN’s being the optimal care coordinators could improve
healthcare outcomes overall and ultimately reduce healthcare cost (Berg & Dickow, 2014,
DiCicco-Bloom et al., 2007, Yang & Meiners, 2014). However, as one study underlined, “care
coordination involves skills that are…not traditionally emphasized in most advanced-practice
nurse training” (Yang & Meiners, 2014, p.98). Furthermore, the Nurse Role Exploration
Project: The Affordable Care Act and New Nursing Roles out of California, stated that
alterations to nursing education is key to implementing new nursing roles in the primary care
sector such as care coordination (Berg & Dickow, 2014). Clearly, there has been a demand for
nursing education to embrace care coordination into the PCN’s curriculum.
California’s Institute for Nursing and Health Care (CINHC) has sought to create a new
model for primary health care in anticipation of the transformation of our health care system.
Through this, Berg and Dickow (2014) defined five new nursing roles that met the changing
health care climate in California. One role already discussed was care coordination, however,
they further identified this role to extend to supervising team members and advising entire
communities as a means to population health management. Another role defined a PCN as a
faculty team member, which called for PCN to “take the lead in creating interdisciplinary teach
teams” to educate others on interdisciplinary approaches to care (Berg & Dickow, 2014, p.10).
Also, Berg and Dickow (2014) added the role of informatics specialist, advising nurses to
design software and interpret data. They called for PCN to be nurse and family cooperative
facilitators, to encourage the use of tele-health application for “connecting people where they
live and work to understand and adjust elements that will result in healthier, more successful
outcomes;” in this role, they identified the PCN as taking responsibility for early intervention
and prevention (Berg & Dickow, 2014, p.11). Finally, the CINHC distinguished PCN’s as
primary care providers. According to the authors, PCN’s have met the criteria of a primary care
provider because they have been proven valuable in the community; they delivered support to
individuals and families for prevention of illness and helped them maintain overall wellness as
well as assisted management of chronic illness. In essence, PCN could fill the role of primary
care provider in order to increase access to health care in areas without immediate access (Berg
& Dickow, 2014).
Looking at roles of PCN in today’s health care system, it was clear that PCN’s are not
only necessary, but valued in the primary health care sector. PCN are currently providing care
coordination, case management, patient advocacy, as well as holistic and patient centered care.
The anticipated PCN will take on larger roles such as interdisciplinary team leader, primary care
provider, and informatics specialists; the care coordination position will grow to providing
community education and planning for preventative care, individual support and planning for
chronic illness management, and population health management. As suggested by current
research and new health care legislation, it appears that the PCN will become an even more
essential in the health care model. To aid in this metamorphosis, it imperative that nursing
educators thoughtfully prepare nurses by providing them with a relevant and innovative
curriculum specific to primary care.
References
Banner, D., MacLeod, M. L. P., & Johnston, S. (2010). Role transition in rural and remote
primary health care nursing: A scoping literature review. Canadian Journal of Nursing
Research, 42(4), 40-57.
Baxley, E. G., & Cunningham, P. R. (2014). Meeting North Carolina’s health care needs
through interprofessional education and practice. North Carolina Medical Journal, 75(1),
65-67.
Berg, J. G., & Dickow, M. (2014). Nurse role exploration project: The affordable care act and
new nursing roles. Nurse Leader, 12(5), 40-44. doi:10.1016/j.mnl.2014.07.001
Drummond, N., Abbott, K., Williamson, T., & Somji, B. (2012). Interprofessional primary care
in academic family medicine clinics: Implications for education and training. Canadian
Family Physician, 58, e450-e458.
DiCicco-Bloom, B., Frederickson, K., O’Malley, D., Shaw, E., Crosson, J. C., & Looney, J. A.
(2007). Developing a model of social capital: Relationships in primary care. Advances in
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