LITERATURE REVIEW: NURSE AS PRIMARY CARE PROVIDER
Nofriweldi1, Helvia Masfirda2
Master Program of Nursing, Faculty of Nursing, Andalas University
Street of Limau Manis, District of Pauh, West Sumatra 25163, Indonesia
ABSTRACT
Primary services are the backbone of health
services. Primary health care providers at
the primary health care level. As a nurse
undergoing a function as a nurse becomes
embedded in the primary care team. There is
wide variability in nursing roles and
responsibilities throughout the organization.
Policy makers asked to take a closer look at
how best to use registered nurses in the
primary care team. Lack of knowledge about
the effective primary care nurse's role and
the challenges of responsibility the ability of
policy makers to develop recommendations
to effectively deploy registered nurses in
Indonesia. Primary care is needed to ensure
efficient, evidence-based, and quality health
care
Method:
Search research articles in multiple
databases using specific keywords in the
2013-2015 period. Search results obtained 5
journals and 12 references that discuss about
Register Nursing as primary care provider
Results and Discussion:
Literature review indicates Criteria include:
1) Registered Nurses who practice in the
interprofessional team; 2) Description of the
role and responsibilities of registered
nursing; 3) Arrangement of primary care. All
studies are eligible undergo quality
assessment by using Integrative Quality
Criteria for Design tools Review Multiple
Study management, patient education,
treatment management, and can often shift
between clinical and administrative
responsibilities. There are a limited number
of registered nurses participating in primary
care policy making and research.
1
Conclusion:
Integrating registered nurses into primary
care has the potential to improve patient
access to primary care providers because
registered nurses can equip multiple service
providers Workload: they update recipes,
handle patient inquiries, and provide patient
education. Clear protocols of practice and
nursing should be written by registered
nurses to ensure safety, and effective nursing
care.
Keywords:
Register Nursing,Care Provider, Primary
Care, models, review
INTRODUCTION
Globally, demand for primary care
services is increasing as the population ages
and many patients live longer with many
chronic diseases. Patients require ongoing
primary care services, such as monitoring
their condition, and following up (World
Health Organisation, 2009)Nursing services
need efforts to improve the quality of
hospital services through efforts to improve
the quality of nursing services, and nurse
professionalism in providing and managing
nursing care activities to patients. The duties
of nurses in providing nursing care include
reviewing the needs of the patient, planning
nursing actions, implementing action plans,
evaluating the results of nursing care,
documenting nursing care, participating in
counseling (Ali, 2002).
In addition to rising demands for
health care services, many countries face a
severe shortage of health care providers. The
World Health Organization estimates that
4.3 million doctors, midwives, nurses and
support workers are needed to meet the
health care needs of patients worldwide
(World Health Organisation, 2009).The
United States (US) alone requires additional
52,000 primary care physicians by 2025 to
meet the demand for primary care
services(Petterson, 2012). In Spain, nearly
70% of all health care is given in primary
care but there are twice as many specialist
doctors as primary care physicians.The
increasing demand for primary care services
has prompted national policy makers, such
as in the United Kingdom, to allocate
substantial funds to ensure adequate primary
care delivery by 2020(Schilling, 2015).
Recommendations from access to
care, and improve the quality of patient care,
emphasize the importance of team-based
care delivery models In such models,
physicians from various disciplines,
including physicians, nurses, pharmacists,
social workers and others, collaborate to
provide care to patients. In recent years,
investigators have investigated the
composition and performance of primary
interprofessional care, particularly
interprofessional teams comprising doctors,
nurse practitioners, physician assistants, and
pharmacists, to examine the delivery of their
patient care (Dey et al., 2011, Lenander et
al. 2014, Proia et al., 2014).
Today registered nurses (RNs) are
increasingly embedded in the
interprofessional primary care team (Ladden
et al., 2013). Policy makers and health care
administrators are looking for evidence to
better understand RN's roles and
responsibilities in primary care.
Comprehensive Understanding RN
capabilities and their impact on patient care
will help develop effective care models
utilizing RN qualifications to improve
primary care capacity (Keleher et al., 2009).
For example, policy organizations, such as
the American Academy of Nursing, partner
with the Josiah Macy Foundation, call for
2
effective integration of RN in primary care
(Josiah Macy Foundation, 2016). The
purpose of this literature is to synthesize
international evidence on the roles and
responsibilities of the primary RN to make
recommendations to maximize RN
contribution in the team-based prima care
model.
MATERIALS AND METHODS
This study is a kind of literature
review secondary research which means the
analysis of the form of criticism (build /
drop) of research that has been done on a
part of a particular science (Taylor, 2013)
Sample inclusion criteria in this study The
following criteria are applied during the
literature search. Inclusion criteria 1. Studies
that include the use of registered nurses who
practice in interprofessional teams. 2.
Studies that provide an overview of the roles
and responsibilities of nursing.3. Studies
conducted at primary care sites.
Exclusion criteria: 1. Description of the
nursing role is specific only to advanced
nursing care, such as nurse practitioners 2.
Special role description for other medical
disciplines, such as physician or physician
doctor's assistant. 3. Research is performed
only in acute care. 4. This study examined
ambulatory settings in addition to primary
care, such as specialist offices.
In this study, researchers analyzed
about nurse as primary care provider . Data
taken from Canada, Australia, United States
and Spain journals relevant to this Research
topic, were conducted using some databases
such as GOOGLE, PROQUEST,
ELSEVIER, with time limitations as of
January 2010 through April 2017. The full-
text articles are reviewed to select the
research journals that match the sample
inclusion criteria.
Analysis of this research results
journal using critical appraisal method.
Critical appraisal is a systematic process to
test the validity, results, and relevance of a
scientific proof (research result) before
being used to make a decision (Abdullah,
M., Firmansyah, 2013). Critical aspects
include: publication year, country (research
location), research design, population,
sampling, used instrument, research results /
findings, and conclusions.

3
RESULTS
Critical analysis of the 5 research journals / articles sampled in the literature review is set
forth in table 1.

Table 1 Critical analysis

Article 1 2 3 4 5
No.
Title Canada To Australia To Spain To United Australia To
determine the report an analyze RN States examine
roles of RNs analysis of the contributions To capture roles and
working health to meeting nurses' responsibiliti
in primary care promotion/ primary health perception of es of
settings in prevention care objectives patient practice
Ontario and work reported aligned care nurses in the
the extent to by teams' effect area of health
which chronic RNs on their and
disease nursing development
management practice and and in
strategies have role identity advising
been as they parents
implemented transitioned to about child
team-based health issues
model of care
Researche Lukewich et Keleher & Planas Stewart et al., Walsh et al.,
rs al., Parker, Campmany et
al.,
Year of 2014 2013 2015 2015 2015
Publicatio
n
Research Canada Australia Spain United Australia
location States

Research Cross Cross Cross Qualitative Cross

design Sectional Sectional Sectional Sectional

Population RNs (218) RNs (54) Primary Health RN (12) RNs (159)
& NP (73) Care LPN (6)
Sampling RPN (16) Teams (350)
Health Care
Professionals
(16,000)
Instrument Survey Survey National Semi- National
Questionnaire General Mandatory structured Online
Practices Electronic interviews Survey
 Reporting VA Health General
Primary Health Care medical/pract
Care Practices System ice
(PACT) Community
based;
specialists;
Pediatric;
Maternity
Conclusio There is the The health Nursing has a Healthcare Results
n potential to promotion relevant role in managers identify
optimize and practices of the implementing disparities
standardize the primary care achievement of PCMH should with relation
nursing role nurses were a significant consider its to attendance
within primary most number of inherent at, and
care and commonly in health cultural and funding of,
improve the the objectives in practice child health-
implementatio downstream PHC services. transformation related
n of chronic realm of This s professional
disease disease contribution development
management prevention and should be activities
strategies. health recognized as across
education but it has geographical
nurses aspired important regions of
to take on roles consequences Australia.
in more in terms of Strategies are
upstream work service needed to
of partnerships payment and improve
and public health equality of
collaboration. access to
Nurses' ongoing
opportunities child health
are and
undoubtedly development
constrained by education,
both the and limit the
general impact of
practice setting geographical
and their isolation on
educational professional
preparation. development
DISCUSSION
This review synthesizes existing international evidence regarding the roles and
responsibilities of RN in primary care in four countries: Spain, USA, Australia and Canada All
research is available in English and all studies meet the standard quality for eligibility in this
review. The findings suggest that in team infrastructure, RNs mostly hold clinical nursing care
responsibilities such as treatment administration, wound care management, assisted procedures,
screening, risk assessment, and patient education. In Spain alone, one-third of primary primary
care goals are affected by RN primary care responsibilities (Planas-Campmany et al., 2016). It
highlights the potential of RN in meeting primary care goals. It is clear that RN plays an
important role in the chronic disease of diabetes and hypertensive management, and has an
important role in controlling and monitoring risk factors, and assessing the effects of treatment
and treatment (Planas-Campmany, C., Quinto, L., Icart-Isern, M.T., Calvo, E.M., Ordi, 2016).
This is achieved by addressing patient concerns over the phone, which prevents
unnecessary patient visits or major care provider warnings for complications requiring more
attention. RN also often shifts between clinical and administrative tasks. This multitasking can
benefit the organization because RN can be reduced The main service provider's workload is by
taking care of additional clinical care, administrative tasks, dealing with complaints, managing
equipment and equipment, and supervising the transfer of laboratory specimens. However, if the
majority of RN responsibilities are included in nursing duties, there is a misuse of their clinical
expertise.
It is important that RN play an active role in the creation and maintenance of nursing
practice policies that define their roles and responsibilities in primary care. We recommend that
when integrating RN into primary care, clear protocols and policies will be written to guide the
RN responsibilities. Policymaking by those unfamiliar with RN skills and training can lead to
underutilization of RNs in primary care. Surprisingly, in this review, RN Australia is the only
nurse who reports on maintaining an active RN policy or doing research in primary care.
Integrating RN into the primary care team does not replace the need for assistant medical
care or administrative staff. When RN is assigned to too many administrative and non-clinical
responsibilities, such as cleaning and setting up exam rooms, or answering phone calls, it
hampers their potential productivity to manage more complex patient care supported by
Education and Training. This task can be completed effectively by the receptionist or assistant
physician thereby enabling RN to devote time to the patient care management that is within their
scope of practice. Practitioners of managers must understand that RNs underutilization, when
they spend 55% of their time on non-maintenance tasks, is the use of inefficient RN advanced
skills and competencies to be used in direct patient care. Use of wise clerical personnel allows
the RN to fully use their clinical skills and work with patients, thereby reducing service provider
strain(Ladden, M.D., Bodenheimer, T., Fishman, N.W., Flinter, M., Hsu, C., Parchman, M.,
Wagner, E.H., 2013).
It is important to illuminate what additional research is needed. First, while the findings
in this review show the contribution of RN to screening, health promotion and management of
individual chronic diseases, their impact on management of multimorbidity remains unclear.
There are no current practice guidelines for managing co-morbidity patients and are often based
on specific recommendations of chronic diseases. As more and more patients are present with
some co-morbidities, patient care management will increase in complexity.
Future research and policy analysis around multimorbidity and practice guidelines is
recommended to determine how to best utilize RN. Second, it is important to note that
integration of RNs into primary care practices is often economically driven. For example, one of
our included studies identified the hesitant practice of being employed by RN due to funding
arrangements(Condon, J., Willis, E., Litt, 2000). However, no current study has explored the cost
or cost effectiveness benefits of adding RN as an additional hierarchical level to the primary care
team. Addressing the specific payment modalities for RN services provided in primary care is
beyond the scope of this paper. The payment model is different from country so it makes it
difficult to formulate a universal recommendation on how to pay Practice for the time RN spent
in patient care. Team-based payment models have emerged but there is variability in health care
costs across primary care settings (eg US medical homes)(Martsolf, G.R., Kandrack, R., Gabbay,
R.A., Friedberg, 2016).

CONCLUSION
The results of literature review on 5 research results journals (Stewart, 2015)(Keleher, H.,
Parker, 2013)(Lukewich, Edge, VanDenKerkhof, & Tranmer, 2014)(Planas-Campmany, C.,
Quinto, L., Icart-Isern, M.T., Calvo, E.M., Ordi, 2016)(Walsh, 2013) related to the importance of
nurse as primary care provider. Delivery of team-based treatments to meet The needs of patients
in primary care, it is important to effectively utilize all primary care existing labor resources,
including RNs, to meet the demands of high quality patient care. This review provides evidence
of current RN roles and responsibilities in primary care settings in six countries. When a clear
protocol of practice and nursing policy is used to guide Practice nursing, pinning RN into the
primary care team has the potential to improve patient access to primary care services and reduce
the workload of the organization. RNs need to be enhanced involvement in policy-making and
research around primary care to promote their effectiveness of utilization. Furthermore,
recommended multimorbidity RNN practice guidelines, as well as payment models, which
include specific RN tasks, are investigated further.

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