Title: The Nurse Practitioner and Primary Care Nurse: Differentiating the Roles in Primary Care
1The Nurse Practitioner and Primary Care Nurse
Differentiating the Roles in Primary Care
- Katie de Leon-Demare RN (EP), MN, FNP
- Rebecca Neto RN, BN
- River Avenue Community Health Centre, WRHA
2River Avenue Community Health Centre
3What is a Nurse Practitioner ?
- RN with advanced education
- (Master of Nursing - NP Stream)
- additional licensure RN (EP)
- Canadian NP Examination
- American Nurses Credentialing Centre Exam
- authority to treat, prescribe refer
- Extended Practice Regulations
- Shadow Billing using MB Tariff Codes
4The Nurse Practitioner Diversity of Practice
Settings
- Primary care
- Ambulatory care
- Acute care
- Neonatal ICU
- Pediatric ICU
- Emergency
- Chronic care
- Home care
- Long-term care
- Personal Care Homes
5Research on the NP role in Primary Health Care
6Research on the NP role in Primary Health Care
- Conclusions
- 1. Patient outcomes were equivalent. (Brown SA
Grimes DE Nurs Res 1995 Mundinger et al. JAMA
2000 Spitzer WO et al. NEJM1974) - 2. NPs can provide a major increase in total
quantity of clinical service, without a reduction
in quality.at a net cost that is still less than
that of conventional approaches. ( Spitzer WO et
al. NEJM 1974290251-256)
7The Strong Model of Advanced Practice
Direct comprehensive care
Support of systems
Collaboration
Scholarship
Patient
Publication and professional leadership
Education
Empowerment
Research
Novice
Expert
8A typical day in the clinic
- Chronic disease diagnosis management
- Transitional care to long-term care
- Case management
- Preceptorship of NP students
- Periodic health examinations
- Health promotion health counseling
- Diagnosis treatment of minor episodic
illnesses - Prenatal care
9Collaborative Practice Model
- Primary Care Nurse
- Nurse Practitioner
- Physicians
- Shared Care Counselor
- Shared Care Psychiatrist
- Community MH Worker
- Public Health Nurses
- Dietitian
10 The Nurse Practitioner in Home Care
- Goals of Nurse Practitioner in Home Care
- Improve access to primary care services for home
bound clients - Promote continuity of care between hospital, the
primary care provider and the home - Reduce hospital readmission
- Provide additional health resource for home care
staff, clients/families
11Research Geriatric Nurse Practitioners in Home
Care
- Outcomes
- Decreased hospital nursing home admission
- Decreased outpatient visits
- Disability and nursing home admission delayed in
treatment groups - Higher caregiver satisfaction
- Less readmissions (37 control vs 20
intervention) - Hospital stay days (4 days control vs 1.5
intervention)
- Zimmer (1985)
- N 167 homebound, disabled, unable to access
outpatient clinic - Stuck (1995) Alessi (1997)
- Cho (1998) Bula (1999)
- Naylor (1999)
- N 363 adults
- 30 without social support
-
12The Nurse Practitioner in Home Care
- Improved and timely access to primary care
services - Timely response to acute exacerbation and
episodic illnesses - Continuity of care between acute care and home
care
13The Nurse Practitioner in Home Care
- Timely and appropriate referral to health
services - House calls and on-going primary care for the
frail elderly - Family and patient education and support
14Collaborative Practice Team in Home Care
- Nurse Practitioner
- Physicians/Specialist
- Case Coordinators
- Visiting nurses
- Occupational/ Physiotherapist
- Clinical Nurse Specialist
- Nutritionist
- Primary care nurse
15Outreach Satellite Wellness Clinic
- Fred Tipping Place
- Winnipeg Housing Authority
- 200 Apartments for 55
- Wellness Wednesdays
16Research Publication
- Utilization of research and evidence in practice
- Research on NP practice and outcomes
- Presentations publications
17Do you need an nurse practitioner in your primary
care team ?
- What are the needs of the population and
community served by the clinic? Are there gaps in
services? - Is there a match between these needs and the
skill set of the NP? - Are support systems in place?
18Tips to successful integration of a nurse
practitioner to your team
- Informed health team members clients
- Supportive work environment
- space, scheduling
- time for non-clinical aspects of role
- continuing competency
- Enabling policies
- Minimizing liability issues
- Managing role overlaps
19What is a Primary Care Nurse?
- Baccalaureate in Nursing
- Education/certification in primary care clinical
areas (diabetes asthma) - Community experience
20Role of the Primary Care Nurse
- Health promotion education
- Case management within primary care team
- Clinical care within scope of practice of nursing
- Chronic disease management
21The Primary Care NurseA typical day in the
clinic
- Telephone triage
- Management of incoming lab reports
- Nursing appointments
- Initial assessment of minor episodic illnesses
- Nursing procedures
- Clinic support management
- Intake appointments
- Special projects
22Conclusion
- Maximize the potential contributions of both
nursing roles - Appropriate use of human resources
- Improving timely access to care
- Promote client satisfaction