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Principles and Important Considerations

To achieve increased patient volume and enhanced health outcomes, the registered nurse (RN) must work to the full scope of nursing practice [PDF, 77.6 KB] in a primary care setting such as a family practice or walk-in clinic. This means that the RN works with the physician to provide complete care to all patients in the practice, rather than just being assigned tasks such as immunization or taking vitals. The following principles may be helpful in establishing an efficient physician-RN team.

  1. Non-selective patient scheduling: To provide early intervention, early disease detection and comprehensive health screening, the RN should be involved with as many patients as possible, not just those with diseases. For example, the RN may see a 42-year-old man with knee pain and, after assessing the problem, will take the opportunity to check the family history, complete a global risk assessment, and ensure screening and immunizations are current. This can be an excellent time to also address lifestyle issues such as nutrition, exercise and smoking.

  2. Complex and time-intensive care: For the collaborative practice to be as effective as possible, the RN should provide care to the most time-intensive cases, such as those patients with complex health needs and well women, well baby and geriatric visits. This allows the physician to focus on more episodic cases (which usually require less time) and join the RN to complete any additional medical assessment, to review the plan of care and issue prescriptions. Most of these tasks will require less physician time, which allows the physician to see more patients each hour.

  3. Nursing roleOptimizing the role of the RN to ensure he or she can provide as much independent care as possible is essential to meet the goals of enhanced access and outcomes. This may be accomplished by putting medical directives in place, ensuring that all team members are clear on expectations and approaches to patient care (see team discussion guide), and participating in continuing education opportunities as a team. This can also mean providing more services to patients in their homes such as 24-hour blood-pressure monitoring, ABI assessment, insulin starts, etc.

  4. Non-nursing tasks:. It is important that office work be delegated as necessary to administrative and support staff. Tasks such as filing, scheduling appointments, answering phones, stocking rooms, ordering supplies, sending specimens, sterilizing equipment and cleaning can be delegated. If workload or lack of support staff make delegation problematic, it could be worthwhile to hire additional help – even if it is just part-time – to optimize the RN’s time to provide care. Making best use of the RN’s skills will increase access and enhance outcomes, therefore increasing revenue.

  5. Technology: A physician-RN team will be better able to populate electronic medical records and migrate health information, providing better access to information and therefore more efficient care. Utilizing such technology to its maximum potential not only improves efficiency, but also provides more information and better tracking to enhance patient care. Adding equipment such as a printer/scanner to the office can lead to great time savings in the long term.

  6. SpaceThe physician’s and RN’s examination spaces should be in close proximity to each other. This will facilitate communication and help boost efficiency.

  7. Communication: Good communication will help ensure effective patient flow. For example, a way to communicate that the RN is finished with a patient and is ready to be joined by the physician can boost efficiency. A computer prompt, phone call, or door left ajar could be employed for this purpose. As another example, joint visits, whereby the RN summarizes the patient’s health problems when the physician joins them in the examination room, provides an important confirmation that information has been heard correctly. Joint visits also have the benefit of including the patient as part of the health-care team. By contrast, if the RN is reduced to a triage function, the physician often spends the same amount of time with a patient, who winds up repeating his or her health problems.