With physician staffing shortages and a lack of appointment openings across traditional primary care settings, patients are faced with inaccessibility to care. As a result, patients are looking beyond the traditional primary care office and instead looking to non-traditional care sites. As Andy Jassy, Amazon’s CEO, appropriately said in February 2023, “If you fast forward 10 years from now, people are not going to believe how primary care was administered.” Today, primary care is moving closer to the patient, bringing us toward a future where it will be easier to access healthcare when and where it’s needed.
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A recent survey found that Americans are increasingly open to receiving care from professionals other than their primary care physician, including in places such as clinics in retail pharmacies, department stores or grocery stores. Further, more than three-quarters of Americans said they would trust a pharmacist, physician associate (PA), nurse practitioner (NP), or nurse to manage minor illnesses. However, a key question remains – who will staff these settings and be responsible for the direct care patients receive?
Nurses bring the consistency needed in any setting
It’s no secret that stressors associated with the Covid-19 pandemic have influenced many nurses to leave the acute care bedside and the profession altogether. The National Council of State Boards of Nursing recently found that 100,000 registered nurses left the workforce since 2020 and 600,000 more plan to leave by 2027 due to stress, burnout or retirement.
The reality is that nurses want to take care of their patients, but they want to do so in an environment where they can deliver safe, quality care. New settings for primary care may be an answer, offering nurses a welcome change of scenery while allowing them to continue operating in a patient-facing role. Having more options outside of acute care may also help increase nursing school enrollment and improve retention in the long run.
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This presents an opportunity for nurses to act as the “glue” that can hold these emerging, non-traditional, primary care sites together. As nursing remains the most trusted profession and NPs have long been accepted as primary care providers, nurses and NPs are uniquely qualified to guide patients through care interactions and bring the consistency associated with primary care to new places. In a traditional acute care environment, patients spend a significant amount of time with the nurses on staff. This existing patient-nurse relationship will translate well into new primary care settings, as nurses are well-equipped to engage directly with patients to understand their needs and ensure they can obtain the necessary treatments and interventions to optimize wellness and disease prevention.
Overcoming staffing challenges
Of course, pulling nurses from one setting into another could present challenges for an already strained healthcare system. Many of the nurses expected to leave the profession by 2027 have many years of experience and are an incredibly valuable resource in the workforce, especially for novice nurses who look to them for guidance. New primary care sites could offer positives such as being more consistently staffed, which might keep many of those experienced nurses working for longer. However, these new sites must be aware of existing staffing challenges in acute care settings to avoid contributing to the crisis.
Due to the ongoing nurse shortage and because hospitals are regularly staffed far below 100% bed capacity, nurses in acute care settings may be scrambling to deliver care on any given day, particularly if there is a sudden surge in patients. While minimum staffing ratio bills currently in review across the country are a logical step to help ensure safe care for patients, we also need to consider the competency of the nurses at the bedside and how we can ensure all nurses are properly trained to deliver the care they’re asked to provide.
Promoting safe staffing can go a long way in reducing burnout and improving patient outcomes, not just in acute care settings but in primary care and beyond.
Working collaboratively together
It’s important to remember new primary care sites won’t be staffed by one discipline alone, they will require a team. As mentioned above, Americans are increasingly open to pharmacists participating in their care. While this isn’t yet commonplace, pharmacists were given the emergency authority to prescribe Paxlovid to increase access to this treatment during the Covid-19 pandemic. This makes for an environment ripe with opportunity for collaboration between pharmacists, nurses, and NPs – divvying up responsibilities based on the unique skillsets of each profession.
For example, in a primary care clinic, nurses could act as the first resource for patients, immediately assessing them and determining who needs to see the NP provider first. With established patient trust, nurses and NPs can work with patients to make sure they receive the treatment they need and can obtain and afford their medications, while also educating patients to help keep them well. In a retail clinic, pharmacists could talk patients through potential drug-drug interactions while nurses help offer points of connection throughout their care encounter. Managed correctly, we’re looking toward a future of more accessible care for all, backed by the strengths of nurses, pharmacists and other health professionals.
Overall, nurses are poised to play a leading role in staffing these non-traditional settings for primary care. As new care sites emerge, the industry must take advantage of this opportunity to bring more nurses back into the fold, give patients the touchpoints with nurses that they need and staff these settings collaboratively and in a way that doesn’t worsen today’s nursing shortage.
Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, is a practicing nurse practitioner in critical care for Penn Medicine, Chester County Hospital and adjunct faculty for Drexel University in Philadelphia, PA and Neumann University in Aston, PA. Anne has over 39 years of experience in nursing and 25 years of experience as a nurse practitioner. She currently serves as Chief Nurse of Health Learning, Research & Practice, Wolters Kluwer.
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