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RN Role Reimagined: How Empowering Registered Nurses Can Improve Primary Care

Thomas Bodenheimer, Laurie Bauer, J. Nwando Olayiwola, and Sara Syer of the Center for Excellence in Primary Care at UCSF

Facing a shortage of primary care physicians and a large increase in patients needing care, safety-net clinics are realizing the full potential of using the nursing workforce to deliver better care.

With growing demands on primary care and a shortage of primary care clinicians, safety-net clinics are asking, What is the role of the registered nurse (RN) in primary care?

This report describes how 11 community health centers and county health systems in California, as well as two health centers outside California, are using the following strategies to expand the RN role in primary care:

  • Provide RNs with additional training in primary care skills, so they can make more clinical decisions
  • Empower RNs to make more clinical decisions, using standardized procedures
  • Reduce the triage burden on RNs to free up time for other responsibilities
  • Include RNs on care teams, allowing them to focus on their team's patients
  • Implement RN-led new-patient visits to increase patient access to care
  • Offer patients co-visits in which RNs conduct most of the visit, with providers joining in at the end
  • Deploy RNs as "tactical nurses"
  • Provide patients with RN-led chronic care management visits
  • Employ RNs' skills to care-manage patients with complex health care needs
  • Train some RNs to take responsibility for specialized functions
  • Schedule RNs to perform different roles on different days
  • Preserve the traditional RN role and focus on training medical assistants (MAs) and licensed vocational nurses (LVNs) to take on new responsibilities

The full report is available under Document Downloads.

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