December 16, 2020

by Wendy Bowles, Margaret Graham and Portia Zaire

The COVID-19 pandemic has exposed both the importance of and deficiencies in our healthcare system, including our primary care infrastructure. And beyond a shadow of a doubt, it has spotlighted the need for registered nurses to play a larger role in serving patients in primary care settings.

Primary care is defined by the Department of Health and Human Services (2019) as the provision of integrated, accessible health services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients and practicing in the context of family and community (HRSA, 2019). The primary care workforce is responsible for providing primary, secondary and tertiary prevention and the management of chronic disease. Approximately one-half of all Americans have at least one chronic disease and 25% of Americans have two or more chronic diseases. Ninety percent of healthcare dollars are spent on the management of chronic disease (APHA, 2020).

RNs now assume three emerging primary care functions: (1) managing the care of patients with chronic disease by facilitating behavior change and adjusting medications; (2) leading complex care management teams to help improve care and reduce cost for patients with multiple diagnoses; and (3) coordinating care between primary care homes and other providers (Bodenheimer and Bauer, 2017).

New data published by the Association of American Medical Colleges (AAMC) shows the U.S. could see an estimated shortage of between 21,400 and 55,200 primary care physicians by 2033. Nurse educators have recognized and met the need for more primary care professionals by expanding graduate nursing education, and the development of advanced nurse practice programs has proliferated. However, nursing education at the undergraduate level has not kept pace.

RNs comprise the largest healthcare profession in the United States. A redesign of nursing education and clinical experiences will propel how a transformed healthcare system meets the changing needs of our population. Undergraduate RN education should focus on the RN practicing at top of their scope. Indeed, all members of the healthcare team must practice at top of scope in order to satisfy healthcare needs and fill care gaps in our diverse communities. This includes RNs, who can help coordinate patient care that addresses complex care management and preventive measures for optimal levels of health. The new design will also enable RNs in primary care to help meet unmet demand in the management of chronic disease, behavioral health care and the overwhelming impact of the opioid epidemic.

Law and regulation for RN practice need to be evaluated in each state to ensure the RN is practicing at the top of their scope. Regulatory prohibitions of RNs using “patient diagnoses,” sometimes referred to as “medical diagnoses,” must be changed in Ohio and other states to maximize the RN’s participation on the healthcare team. In addition, the joint regulatory statement by the Ohio Boards of Pharmacy, Medicine and Nursing regarding the Use of Protocols to Initiate or Adjust Medications must be amended to allow RNs to work closely with the healthcare team in the management of patients with chronic disease. This will dramatically increase the number of educated professionals who can support patients with chronic disease and enhance access to care.

Well-prepared primary care RNs, working at the top of their scope, are able to:

  • assume an enhanced role in the delivery of high quality care,
  • use protocols to help manage chronic disease,
  • use health coaching and other wellness strategies to assist in behavior change,
  • expand community partnerships,
  • provide evidenced based care across the life span to enhance patient safety,
  • reduce adverse events,
  • impact and improve patient satisfaction,
  • support and promote optimal health status,
  • track admissions and readmissions, and
  • manage costs within and among continually expanding complex populations.

RNs are the best prepared to facilitate functioning of the interprofessional teams and coordinate care with patients (American Academy of Ambulatory Care Nursing, 2016). It is anticipated that the demand for primary care RNs in Ohio will grow due to changes in models of healthcare delivery, increased insurance coverage for care provided by RNs and the increased primary care needs of the aging population.

Faculty from The Ohio State University College of Nursing are helping meet the increasing need for primary care clinicians, with grant funding from the Health Resources and Services Administration (HRSA).  Through this funding mechanism, the faculty have designed three separate programs that equip the RN to practice as part of the interprofessional care team with shared responsibility and accountability for the health of populations: the RN in Primary Care Certificate, the Primary Care Academic Certificate for enrolled undergraduate students and the RN in Primary Care Residency.

The College of Nursing is the only academic institution in the region to offer this unique educational experience. The faculty have seen a great response and willingness of community RNs to strengthen their knowledge, skills and abilities. New and experienced RNs who have completed the certificate and residency programs have increased their confidence, expanded their capacity to be change facilitators in their organizations, acquired skills to use evidence-based practice and have validated and empowered the role of the RN in the primary care setting. This education, coupled with partnership from clinical agencies in the community, promises to accelerate what must be done to prepare RNs to transform health and improve lives for patients in primary care, now more than ever!

The three authors lead the RN in Primary Care program at The Ohio State University College of Nursing. Wendy Bowles, PhD, APRN-CNP, CNE, is assistant professor of clinical nursing and assistant dean for baccalaureate programs. Margaret Graham, PhD, APRN-CNP, FAANP, FNAP, FAAN, is associate professor and vice dean. Portia Zaire, MSNEd, BSN, RN-CCCTM, is nurse case manager.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) Nurse, Education, Practice, Quality and Retention Grant UK1HP31699 entitled Registered Nurses in Primary Care as part of an award totaling $2,763,494. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.

August 25, 2020

COLUMBUS, OH — The Ohio State University College of Nursing set a college record for external funding received for research by its faculty from a range of national organizations that strive to improve healthcare.

Throughout fiscal year 2020, 135 total funding proposals were submitted to the National Institutes of Health (NIH), American Cancer Society, Human Resources and Services Administration (HRSA) and other external funding groups. Eighty-seven grants were awarded, totaling nearly $13 million in research funding.

“Our faculty researchers have demonstrated leadership and excellence in pursuing science that improves lives, and we’re making an impact,” said Mary Beth Happ, PhD, RN, FGSA, FAAN, associate dean for research and innovation at the College of Nursing. “From work to reduce health disparities in our communities to better quality of life in older adults and improving care for children in the NICU, our faculty research is working to build a healthier world.”

Among the awards received, Heather Tubbs Cooley, PhD, RN, FAAN, Janna Stephens, PhD, RN, Candy Rinehart, DNP, FNP, ADM-BC, FAANP, and Lorraine Mion, PhD, RN, FAAN, received multi-year grants worth more than $1 million to conduct their research:

  • Tubbs Cooley received a $2.8 million R01 grant from the National Institute of Child Health and Human Development (NIH/NICHD) for her study on NICU nursing care enhancement. Tubbs Cooley and her team hope to gain a better understanding of NICU nurse workloads in order to provide the best quality of care and safety for their patients.
     
  • Stephens received a four-year, $1.6 million R01 grant from the National Institute of Nursing Research (NIH/NINR) for her study entitled “Reducing Cardiovascular Risk Factors in Black Young Adults.” This study will focus on developing strategies to assist African American community college students in improving their health habits to reduce the risk of cardiovascular disease later on in life.
     
  • Rinehart, CEO of the nurse-practitioner-led Total Health and Wellness center, received $650,000 in grant support funds from HRSA. This funding helps support the Total Health and Wellness center’s primary care services to underserved populations. The center also was awarded “Federally-Qualified Health Center” status and is one of only 77 health centers in the country to receive this status.
     
  • Mion, Vanderbilt University colleague, Nilanjan Sarkar, PhD and their team, received a five-year, $3.13 million grant provided by the National Institute on Aging (NIH/NIA) to develop socially-assistive robots in extended care facilities to encourage interaction among older adults, especially those with dementia.
July 16, 2019
College of Nursing launches new programs to educate RNs for primary care settings

The Ohio State University College of Nursing hosted an event for current and future registered nurses (RNs) on Thursday to promote new programs aimed at preparing RNs for enhanced roles in primary care settings.

The college is leading the charge in the movement to expand opportunities for current and future RNs to receive the education they need for these roles. The Registered Nurses in Primary Care Certificate for current working nurses (offered 100% online) – along with a companion residency program to build confidence in the new skills RNs are learning – and the Primary Care Academic Certificate for BSN and RN-to-BSN students at Ohio State were developed to enhance the role of the registered nurse in several areas, including:

  • Episodic and preventative care
  • Triage
  • Chronic disease management – including mental health and substance use disorders
  • Hospital transition management
  • Health coaching
  • Quality improvement
  • Leadership

“We spend $3.3 trillion on healthcare in the United States, more than any other developed country. The majority of that (90%) goes to treat chronic and mental health conditions,” said Margaret Graham, PhD, APRN-CNP, FAANP, FAAN, vice dean and associate professor in the College of Nursing. “Sixty percent of our population has one chronic disease; 40% has two or more.

“While there has been an increase in nurse practitioners, we really don’t have enough providers in Ohio to meet the demand,” Graham continued. “Across the country, only about 10% of RNs are currently working in primary care.”

Simple Google searches show dozens of job openings across central Ohio for nurses interested in working in primary care settings. Healthcare organizations large and small are searching for nurses prepared to practice at the top of their license to provide patients with quality care in community-based settings.

The demonstrated need is clear. Several recent media stories highlight the critical need for well-qualified and well-prepared nurses. The 2019 Health Value Dashboard from the Health Policy Institute of Ohio ranked the state 46th on health value, a composite measure of Ohio’s performance on population health outcomes and healthcare spending. Causes for this low ranking include issues with access to care and insufficient spending on prevention. At the same time, demand for primary care RNs in Ohio is expected to grow substantially because of changes in healthcare delivery models, increased insurance coverage and an aging population. RNs represent the largest healthcare workforce in the country, with 222,200 in the state of Ohio alone.

Registered nurses attending the “Enhanced and Innovative Role of the RN in Primary Care” event had many reasons to consider a shift to primary care, from work-life balance to seeking new opportunities.

“Maybe this is another door, an avenue for something different,” said one RN.

Others already engaged in the program are using their new knowledge and skills to make an impact in the primary care setting.

“Through the certificate program, I have been able to educate my team on healthcare bias,” said current student Melynda Iles. “We allow the patient to be at the center of their care. We listen to them, meet them where they are and refer them in the right direction.”

“I wanted to learn something new,” said Kieonna Stewart, care coordinator for Primary One Health. “The residency program was an eye-opener and gave me a chance to bounce ideas off other students. I also have more confidence in myself and feel that I have a voice as an RN.” 

The Registered Nurses in Primary Care certificate program – which aims to enroll and educate at least 100 current RNs in Ohio over four years based on grant funding from the federal Health Resources and Services Administration (HRSA) – will help build foundational support for primary care intervention and proactive approaches to create a healthier population in Ohio. This is the College of Nursing’s first HRSA grant dedicated to RN education. Tuition assistance is available through the grant to enroll in the RN in Primary Care certificate program.

June 12, 2019

Cindy Anderson, PhD, RN, APRN-CNP, ANEF, FAHA, FNAP, FAAN, associate dean for academic affairs and educational innovation at The Ohio State University College of Nursing, announced that the Nursing Faculty Loan Program (NFLP) application process for the 2019-20 academic year is now open.

The NFLP, funded by a grant from the Health Resources & Services Administration (HRSA) arm of the U.S. Department of Health and Human Services, provides funding to eligible doctoral students who are interested in becoming an educator after finishing their terminal degree. The program was created to address the growing shortage of nursing faculty across the country. In exchange for full-time, post-graduation employment as nurse faculty, this program authorizes cancelation of up to 85 percent of loans for a period of four years after graduation. Students who complete additional coursework through the college’s nurse educator certificate while enrolled in their doctoral program will receive distinct consideration.

You can find more details about the program, eligibility and a link to the application on the “Loans” page of the Ohio State University College of Nursing website. The deadline for applications and supporting materials is July 15, 2019.

July 09, 2018

Two grants proposed by the College of Nursing have been awarded by the Health Resources & Services Administration (HRSA), an agency of the United States Department of Health and Human Services.

A $1.39 million, two-year grant titled, Practice Partnership for APN Education,” will help to support an innovative academic partnership between The Ohio State University College of Nursing and the Ohio Association of Community Health Centers (OACHC) and Federally Qualified Health Centers (FQHCs) across the state. The program offers the College of Nursing advanced-practice nursing faculty the opportunity to work with primary-care preceptors across the state in FQHCs to help prepare primary-care, advanced-practice nursing students in the family, pediatric, adult gerontology, women’s health and midwifery programs to facilitate graduates’ employment in rural and underserved areas.  

 A second four-year grant for $2.76 million, titled Preparing the RN Workforce to Practice in Primary Care to the Full Scope of Their License,” will help to support an innovative academic partnership between The Ohio State University College of Nursing, PrimaryOne Health, the Community Health & Wellness Partners of Logan County, Total Health and Wellness Center and other FQHCs in Ohio to recruit and  educate pre-nursing students and current registered nurses to practice to the full scope of their license in community-based primary care. This academic partnership will strengthen the College of Nursing faculty’s ability to increase the distribution of primary-care nurses in rural and underserved areas by adding additional clinical placements over the four-year funding period.

Margaret Graham, PhD, APRN-CNP, FAANP, FNAP, FAAN, vice dean and associate professor in the College of Nursing is project director for each grant. Graham was assisted in the writing of the second grant by Wendy Bowles, PhD, RN, APRN-CNP; Cindy Anderson, PhD, RN, APRN-CNP, ANEF, FAHA, FNAP, FAAN; and Awais Ali, BA. Melissa Pavolino, BS, and Fran Eppich, MBA, provided support for preparation of each grant.

September 11, 2012

The Ohio State University College of Nursing has received a $1.5 million grant from The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, to implement an interprofessional physical and mental health primary-care center in a Near East Side neighborhood of Columbus, Ohio.

 

The grant allows for full-time operation of a planned Ohio State College of Nursing Total Health & Wellness Center, a primary-care clinic set to open in autumn 2012. The clinic will offer an innovative nurse practitioner-led interprofessional collaborative practice (IPCP) that integrates mental health and primary-care services from medical, pharmacy and social work team members for high-risk populations in inner-city Columbus.

 

“This grant will support us to not only fund some personnel for our clinic, but also to support interprofessional collaborative practice/education and some terrific evidence-based programs to enhance health and wellness for the east Columbus community, which are so greatly needed,” said Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN, dean of The Ohio State University College of Nursing, university chief wellness officer and associate vice president for health promotion.

 

The center will incorporate evidence-based intervention programs, including Million Hearts education and screening and cognitive-behavioral skills building for depression and anxiety, to improve health outcomes of the underserved in the Near East Side neighborhood. Introduced in September 2011 by the Department of Health and Human Services (HHS), the Million Hearts initiative is a public-private sector effort connecting programs and policies aimed at preventing one million heart attacks and strokes in the next five years.  

 

The first objective of the project is to develop a healthcare delivery team to achieve the core competencies for IPCP as outlined by the national Interprofessional Education Collaborative Expert Panel. The second is to implement and sustain an IPCP model that incorporates Million Hearts, an NP-led TeamCare model, the US Preventive Services Task Force recommendations for depression screening and Creating Opportunities for Personal Empowerment (COPE), an evidence-based program for overweight teens and adolescents who are depressed and anxious.

 

“This integrated model of care has outstanding potential for positive impact because a targeted focus on improving the health and wellness of individuals with chronic conditions will hopefully improve adherence to treatment, improve outcomes and lower healthcare costs,” said Margaret Graham, PhD, RN, FNP, PNP, project director and associate dean for advanced practice & clinical partnerships at the College of Nursing.

 

Kristie Flamm, MSN, FNP-BC, ACNP-BC, formerly an emergency room nurse practitioner at Ohio State’s Wexner Medical Center, has been named director of the Total Health & Wellness Center. The center will be staffed by family nurse practitioners serving as primary care providers in collaboration with physicians and a psychiatric mental health nurse practitioner. Other members of the team will include registered nurses, mental health counselors, pharmacists, dietitians and social workers.

 

HRSA is the primary federal agency for improving access to healthcare services for people who are uninsured, isolated or medically vulnerable.

 

For more information, please contact Kathryn L. Kelley, chief advancement officer at 614-688-1062 or kelley.81@osu.edu.

 

About The Ohio State University College of Nursing

 

The Ohio State University College of Nursing is the world’s preeminent college known for transforming health and transforming lives through innovative academic programs and research that improves outcomes and evidence-based clinical practice. We exist to revolutionize healthcare and promote the highest levels of wellness in diverse individuals and communities throughout the nation and globe. The College of Nursing is part of the largest health science campus in the nation that is comprised of seven health sciences colleges, including dentistry, medicine, nursing, pharmacy, optometry, public health and veterinary medicine. Please visit us at www.nursing.osu.edu.