Expanding the Role of Registered Nurses in Primary Care: A Business Case Analysis.

Primary care is evolving in response to payment reform, changes in the primary care workforce, and development of new models of work emphasizing team care. The role of registered nurses in these new models is being reexamined and reimagined, with increased registered nurse engagement in chart review prior to visits, histories and physicals, preliminary patient assessment, patient education and coaching in ordered care, delivery of care under standardized orders and protocols, transition planning, and care coordination. The business case for employing registered nurses in these new roles has not been fully addressed. This article examines the business case and financial issues in this expansion of practice. Under both fee-for-service and value-based, capitated, or shared saving models of reimbursement, there are strategies for increasing the number of registered nurses in primary care practices, and expanding the engagement of registered nurses that can increase net revenues for primary care practices, even when the costs of the additional staffing are taken into account.