Nursing Economic$
The CAPACITY Professional
Development Model for Community-
Based Primary Care Nurses: Needs
Assessment and Curriculum Planning
Laura P. Kimble
Quyen Phan
JoAnna L. Hillman
The complexity of nursing
practice within community-
based primary care requires a
robust approach to professional
development to assure the
community-based primary care
workforce is fully prepared to
deliver high-quality, cost-effective
care. The implementation of a
needs assessment around full
scope of license practice among
community-based primary care
registered nurses in a single
institution within an academic-
clinical partnership is described.
110
Jeannine Blackman
Celia Shore
P roviding quality
community-based primary
care is challenging
because of the complexity of
health promotion and chronic
care needs across the lifespan
within the community, social
determinants of health, and lack
of resources devoted to the
primary healthcare system
(Bodenheimer & Mason, 2017).
There are also shortages of
primary care providers, including
physicians and advanced practice
providers such as nurse
practitioners and physician
assistants (Bodenheimer &
Mason, 2017). Consequently,
there is growing recognition that
full scope of license practice
among registered nurses (RNs) in
community-based primary care
settings can help mitigate
provider shortages and enhance
person-centered outcomes
(Bauer & Bodenheimer, 2017;
Flinter et al., 2017), particularly
when they practice at the full
scope of their education and
training. Full scope of license
May/June 2020 | Volume 38 Number 3
Natelege Swainson
Chimora Ngozi Amobi
practice in community-based
primary care involves nursing
activities requiring knowledge
and skill around care
coordination, providing care
using protocols, and managing
panels of patients to improve
health outcomes such as hospital
readmissions (American
Academy of Ambulatory Care
Nursing [AAACN], 2017a). Having
the requisite knowledge, skills,
and attitudes to provide full
scope of license practice in
community-based primary care
will require appropriate
education and training (Flinter et
al., 2017).
The Community-Academic
Partnership for Primary Care
Nursing Transformation
(CAPACITY) project involves an
academic-clinical partnership
between a school of nursing; an
academic center for evaluation,
training, and professional
development; and a Federally
Qualified Health Center (FQHC)
serving vulnerable populations
in a large urban area. A primary

objective of the CAPACITY
project is to use professional
development to promote full
scope of license practice among
RNs within the FQHC.
In this article, a needs
assessment of FQHC RNs
around full scope of license
practice is described. Needs
assessment data and key
sources from the literature were
used to develop a setting-
specific professional
development model. The
CAPACITY Professional
Development Model was used
to guide educational offerings to
support full scope of license
practice for RNs in community-
based primary care.
Background
The changes in healthcare
financing brought about with
the Affordable Care Act, the
aging U.S. population, and the
mass retirement of physicians,
nurses, and other clinicians
(who themselves are among the
aging population), have resulted
in severe shortages of access to
primary care across the country,
primarily impacting rural and
underserved communities
(Bodenheimer & Mason, 2017).
One approach to improve
access is to test new models of
primary care; for example,
moving from solo or small
private, fee-for-service models to
larger Accountable Care
Organizations and hospital- or
health system-owned practices.
In the traditional fee-for-service
model of primary care delivery,
practices only received income
for physician services or
procedures because there was
Nursing Economic$
no reimbursement tied to
coordinating care, providing
health education, or providing
close monitoring of high-risk
patients with chronic diseases.
Consequently, these nursing
activities often were not offered,
provided inadequately, or
provided by physicians and
other staff. As trends in
reimbursement are moving
toward capitated and shared
risk/shared savings models, and
billing codes for chronic disease
management are added to fee
structures, the value added by
professional nurses working in
full-scope roles is being
demonstrated throughout the
country (Bodenheimer & Mason,
2017).
To be successful, these new
models of primary care require
all members of the healthcare
team, especially RNs, to practice
to the full scope of their license
and education (AAACN 2017a;
Bodenheimer & Bauer, 2017;
Bodenheimer & Mason, 2017;
Fraher et al., 2015). Nurses
compose the largest number of
healthcare clinicians, with
approximately 3 million RNs
working nationwide (Fraher et
al., 2015), and the ranks of
professional nurses have
increased substantially, with the
number of nurses entering the
workforce more than doubling
between 2002-2010 (Auerbach
et al., 2013). However, only
about 10% of nurses currently
work in ambulatory care, and
much of their time is spent
solely on triaging phone calls
and emails and performing
office functions that are within
the scope of practice of less
highly educated staff
May/June 2020 | Volume 38 Number 3
(Bodenheimer & Bauer, 2017).
Ambulatory care nurses may
have little opportunity to engage
in full scope of license practice
activities or obtain professional
development to support
expanded roles. In addition,
most new graduates, as well as
seasoned nurses who have been
working in other settings such
as acute care, lack the
appropriate education and
training to move into RN roles
requiring skills such as care
coordination and chronic
disease management (Flinter et
al., 2017).
Professional Development
Needs for RNs Currently
Practicing in Community-
Based Primary Care
Competency in nursing
involves ensuring “nurses have
the knowledge, skills, and
abilities expected and required
for their practice settings”
(Anema & McCoy, 2010, p. 190).
Multiple competencies related to
RNs practicing in community-
based primary care have been
identified, but to date, they have
not been formally delineated.
These competencies likely will
evolve along with new models
of primary care. Nurses who
have spent their time handling
low-level telephone triage or
administering limited treatments
and vaccinations need
professional development
related to competencies, such as
care coordination, chronic
disease management of large
patient panels, effective and
efficient use of standing and
delegated orders, integrating
behavioral health into primary
111

care, and functioning as full
members of interprofessional
teams. Well-implemented team-
based care is especially
challenging as it requires
changes in culture of care
within an organization, clinician-
to-clinician and clinician-to-
patient interactions, and shared
understanding of mutual roles
and responsibilities
(Schottenfeld et al., 2016).
AAACN offers web-based
courses in care coordination and
transition management and
ambulatory care nursing;
however, the cost of these
courses may not be supported
by RNs’ employers. Additionally,
the culture of care within each
organization likely has unique
needs to be addressed among
RN staff. Consequently,
professional development
programs are enhanced by
setting specific needs
assessment data and a robust
conceptual foundation on which
to scaffold knowledge, skills,
and attitudes over time. This
was the approach used to form
an academic-clinical partnership
between Emory University’s
School of Nursing and the
Centers for Training and
Technical Assistance and Mercy
Care Atlanta to support
community-based primary care
practice among Mercy Care RNs,
conduct the needs assessment,
and create the professional
development model.
Description of CAPACITY
Academic-Clinical
Partnership
The CAPACITY project
involves a partnership among
112
Nursing Economic$
Emory University’s Nell
Hodgson Woodruff School of
Nursing (NHWSN), Rollins
School of Public Health Centers
for Training and Technical
Assistance, and the FQHC,
Mercy Care, Atlanta. Founded in
1905, NHWSN currently has
approximately 1,000 students
across baccalaureate, master’s,
doctor of nursing practice, and
doctor of philosophy in nursing
programs. The school has 160
full and part-time faculty,
assisted by clinical instructors
who provide supervision of
students in 500 clinical sites. In
addition to traditional clinical
experiences, students also have
service-learning opportunities
locally, regionally, nationally,
and internationally. Pre-licensure
nursing students are required to
complete two 3 credit hour
courses relevant to community-
based primary care focused on
population health and
ambulatory nursing.
Emory Centers for Training
and Technical Assistance
(Centers) within Emory
University’s Rollins School of
Public Health strengthens the
public health workforce and
builds capacity within the public
health field by providing
training and technical assistance
to public health professionals
and organizations nationwide to
help them design, implement,
and evaluate programs,
practices, and policies. Emory
Centers recently expanded by
formalizing a Center for
Planning, Evaluation, and
Quality Improvement and a
Center for Organizational and
Professional Development. Their
services span across all public
May/June 2020 | Volume 38 Number 3
health issues, risk factors, and
professional competencies. The
Emory Centers have over 17
years of experience using public
health approaches and
disseminating evidence-based
practices through training and
technical assistance. It has
provided capacity-building
services to community, state,
and national-level public health
partners in all 50 states, District
of Columbia, and U.S. territories,
and also has extensive
experience managing and
implementing large federally
funded projects.
Mercy Care, the practice
partner for the CAPACITY
project, is one of the largest
federally qualified health centers
in the Atlanta, Georgia region,
and a Health Services and
Services Administration-
designated Health Care for the
Homeless provider. Since 1985,
the organization has played a
significant role in addressing
community-based primary care
gaps within the community.
Mercy Care has a network of 11
clinics and two mobile vans
providing primary care services
to the medically underserved in
two large counties as well as to
those who fall within service
and access gaps (those who are
either uninsured or
underinsured and, therefore, are
without access to primary care).
In 2017, the organization
provided services to over 13,000
patients, 70% of whom were
homeless, and 79% uninsured.
The organization implements an
Integrated Behavioral Health
(IBH) program offering onsite
behavioral health services in all
clinics. The IBH program

addresses each individual’s
physical and behavioral health
concerns simultaneously while
also giving the individual the
tools and resources needed to
develop stability and self-
sufficiency. In 2017, there were
over 57,000 clinic visits, 12,000
mental health visits, 9,500 dental
visits, and approximately 1,000
vision visits. About 6,000 visits
were completed for case
management services.
Mercy Care has
approximately 211 full-time and
part-time employees working at
its administrative headquarters
and its clinic sites throughout
the community. The health
provider staff at Mercy Care are
predominantly physicians, nurse
practitioners, physician
assistants, psychologists and
behavioral counselors, and
medical assistants. At the time of
the needs assessment in Fall
2018, 11 RNs were employed by
Mercy Care. Overall, Mercy
Care’s staff composition is
representative of the agency’s
target population, with more
than 80% of the staff
representing various minority
groups. Under the direction of a
master’s-prepared clinical nurse
manager, RNs at Mercy Care are
responsible for coordinating the
transition from hospital to
community-based care for
patients discharged from
selected hospitals who will be
receiving their follow-up care
with Mercy Care. Also, RNs
schedule individuals for nurse-
only visits to support self-
management of medications and
assist with treatment plans
between visits with physicians.
The RNs work from the patient’s
Nursing Economic$
care plan, providing health
education, monitoring selected
health indicators such as blood
pressure or glucose levels and
adjusting medication regimens
accordingly. For the most part,
these adjustments fall within
standing orders, but when
needed, the RNs consult with
physicians and nurse
practitioners should they
encounter unexpected issues.
The CAPACITY Project
Leadership Team (PLT) was
formed to support the work of
the partnership. It included the
NHWSN-based CAPACITY
project director, evaluators from
Emory Centers, partnership
liaison from NHWSN, partnership
liaison from Mercy Care, project
instructional designer, and
project training specialist.
Needs Assessment
Methodology
Following a determination
process required by the
Institutional Review Board in
which this project was not
deemed research, a needs
assessment was conducted using
a mixed-methods and phased
approach to identify areas of
interest and importance for
practicing to the full scope of a
nursing license. To assure full
participation and buy-in from
the RNs regarding the needs
assessment, an initial on-site
meeting was held at the FQHC.
During this meeting, RNs were
oriented to the CAPACITY
project and gathered initial
information on their working
environment. Data sources
included team-developed pre
and post-assessment surveys
May/June 2020 | Volume 38 Number 3
asking RNs about their
definition of, level of
understanding, and confidence
in practicing to the full scope of
their license. The data from
these surveys were used to
inform the design of the needs
assessment. RNs were told
during the meeting that a needs
assessment would be conducted
and that all 11 RNs within Mercy
Care would have the
opportunity to participate via
link to an online survey sent to
their work email address.
Next, a literature review was
conducted to inform the needs
assessment design. The PLT
reviewed preliminary drafts of
the survey questions for the
needs assessment. The team’s
evaluators revised and finalized
the survey questions. The final
version was deployed to the
RNs through Qualtrics, an online
survey platform. Qualtrics
permitted creation of a visually
appealing survey, response rate
monitoring, and survey data
download for cleaning and
analysis.
For the needs assessment, a
modified version of the Patient
Centered Medical Home
Assessment (PCMH-A) was
developed (Safety Net Medical
Home Initiative, 2014) to assess
RNs’ perceptions of their
practice in the areas of engaged
leadership, quality improvement
strategy, empanelment,
continuous and team-based
healing relationships, organized
evidence-based care, patient-
centered interactions, enhanced
access, and care coordination.
The PCMH-A was developed by
the MacColl Center for Health
Care Innovation at the Group
113

Health Research Institute and
Qualis Health (Safety Net
Medical Home Initiative, 2014).
The PCMH-A was used for the
assessment because it offered a
concise way of assessing the
activities the RNs described in
the first survey, such as
culture/climate aspects of their
organization, interprofessional
team dynamics, service to
patients, etc. Furthermore, the
assessment has been used and
validated in over 65 primary
care sites. The PCMH-A consists
of 36 questions divided into
eight domains. An example of a
question in the patient-centered
interactions domain is provided
in Figure 1. For ease of
deployment in the online survey
platform, the original 12-point
response scale format on the
survey was revised. Each
question was scored from 1 to
4, with 1 representing the
lowest level of function and 4
representing the highest level of
function. Also assessed were
RNs’ needs related to
organizational and
environmental context, “soft
skills” such as communication
and conflict management, and
learning needs associated with
serving as a preceptor to pre-
licensure nursing students.
Following the online survey,
the CAPACITY evaluators
completed an in-person session
with Mercy Care RNs to validate
the major areas of professional
development needs identified
through the online survey.
During this session, RNs
responded to the following
discussion questions: (a) Do you
agree with the finding that this
area is a need? (b) If no, why? If
114
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Figure 1.
Example Question from CAPACITY RN Needs Assessment Survey
1. Patient-Centered Interactions
This refers to encouraging patients to expand their role in decision-making,
health-related behavior change, and self-management.
Please select the option that best describes your experience at your care site.
Assessing patient and family values and preferences
…is not done.
…is done, but not used in planning and organizing care.
…is done and providers incorporate it in planning and organizing care on
an ad hoc basis.
…is systematically done and incorporated in planning and organizing care.
I don’t know/Unsure, please
specify________________________________________________
Involving patients in decision-making and care
…is not a priority.
…is accomplished by provision of patient education materials or referrals
to classes.
…is supported and documented by practice teams.
…is systematically supported by practice teams trained in decision-
making techniques.
I don’t know/Unsure, please specify
________________________________________________
yes, in what areas are you most Needs Assessment Analysis
in need of training? and (c)
What barriers might you face in Findings were analyzed and
making improvements in this represented with descriptive
area after training (environment, statistics and charts/tables
population served, resources, generated through Qualtrics and
staffing)? The in-person Microsoft Excel. Open-ended
discussions complemented the questions were analyzed
online survey by revealing through thematic analysis
additional areas of need not utilizing NVivo 11 software.
captured by the survey and by
achieving buy-in from the RNs Results of the Needs
on the findings of the needs Assessment
assessment and subsequent
direction of the professional All of the 11 Mercy Care
development curriculum. RNs participated in the needs
assessment (100% response
May/June 2020 | Volume 38 Number 3

Table 1.
Selected Demographic Characteristics of Registered Nurses
(n=11)
Characteristics
Gender
Female
Male
Race
Black/African American
White/Caucasian
Highest Education Obtained in Nursing
Associate degree in nursing
Bachelor’s degree in nursing
Master’s degree in nursing
Length of Time Practicing as RN
1 year or less
More than 1 year, but less than 2 years
At least 2 years, but less than 5 years
At least 5 years, but less than 10 years
10 years or more
rate). Selected demographic
characteristics of the RNs are
summarized in Table 1. All were
female and the majority
reported their race as
Black/African American. Most
RNs held a bachelor’s degree in
nursing (45%), followed by a
master’s degree in nursing
(36%), and associate degree in
nursing (18%). The majority had
been practicing as an RN for
more than 10 years (55%).
Evaluation data from the first
meeting with RNs indicated they
had an advanced understanding
of what it means to practice to
the full scope of their license.
The majority felt confident in
their knowledge of full scope of
license practice (62%) and their
ability to apply full scope of
license practice in their work
(75%).
Nursing Economic$
n %
11 100
0 0
6 55
5 45
2 18
5 45
4 36
0 0
0 0
3 27
2 18
6 55
RNs identified nursing
activities they considered to be
full scope of license practice:
using standing orders,
scheduling nurse visits, refilling
medication, flip visits
(telemedicine handoffs),
psychiatric assessments,
innovative solutions to address
patient needs, handoffs to
different sites without the need
for a physician visit, review of
discharge paperwork, making
initial patient assessments and
presenting the case to providers,
assisting patients in finding
resources, and communicating
with other disciplines such as
pharmacy. Overall, they
perceived themselves as
autonomous and able to make
good decisions for patients.
Nurses identified barriers to full
scope of practice as logistical
May/June 2020 | Volume 38 Number 3
limitations (e.g., availability of
providers, scheduling), lack of
certification and resources to
provide optimal wound care,
need for diabetes educator
certification, navigating differing
access for insured versus
uninsured patients, and the
need to continue with duties
that fell below their scope of
practice. The availability of
physicians and other providers
related to scheduling patient
visits was also a barrier, and
nurses reiterated their support of
the objective to provide them
with professional development.
Online Needs Assessment
PCMH-A Survey Results with
RN Validation
Mean scores for each
question of the PCMH-A and
aggregated mean scores by
domain were calculated.
Questions with mean scores less
than 3.70 were discussed among
the evaluator and the
information analyst to determine
gaps in knowledge, skills, and
attitudes, and professional
development approaches
required to move the RNs and
the organization to the higher
level of function.
Of the eight PCMH-A
domains, quality improvement
strategy (M=3.52; SD=0.39) and
care coordination (M=3.39;
SD=0.34) were the highest
scoring domains, and
empanelment (M=2.73; SD=0.32)
was the lowest scoring domain.
Along with empanelment, other
domains identified for
improvement were continuous
and team-based healing
relationships (M=3.12; SD=0.53),
organized, evidence-based care
115

(M=3.13; SD=0.33), and
enhanced access (M=3.13;
SD=0.28). During the in-person
discussion, the participating RNs
agreed with the identified higher
and lower scoring domains. In
discussing the lower score
around continuous and team-
based healing relationships, RNs
thought the organization’s clinics
were not optimally structured to
support this domain. For
example, it was challenging for
the team to do rounding.
Additionally, RNs expressed that
members of the healthcare team
needed to understand each
other’s scope of practice better
and support them to implement
that to full scope, and also trust
each discipline’s abilities to
provide quality patient care.
Concerning the lower
domain score for empanelment,
RNs expressed that acquiring
additional certification and
providers’ understanding of RN
ability and scope of license
could help improve the
adoption of empanelment at the
organization. Another barrier to
empanelment was that RNs did
not have a process to schedule
patients for subsequent visits
before they left the initial RN
visit. For the domain, organized,
evidence-based care, RNs
expressed a need for additional
certification such as wound
care; diabetes education; access
to nursing journal databases
such as Ovid, Medline, and
CINAHL; learning how to do a
systematic literature review and
data analysis; and discerning
credible sources. RNs also
thought there was a need for
role clarification and quality of
care teams to disseminate and
116
Nursing Economic$
enforce best practices
throughout the organization.
To obtain information about
patient care content areas for
professional development, RNs
reported they encountered
hypertension (64%), diabetes
mellitus (55%), and behavioral
health disorders (36%) most
often in the organization. When
asked about topic areas they
would like to gain more
knowledge and skill, most
participants identified substance
abuse (55%), behavioral health
(45%), diabetes/prediabetes
(45%), dermatology (45%), and
wound care (36%). Since
diabetes and behavioral health
disorders also were identified as
frequently encountered
disorders, these topic areas were
considered priorities for
curriculum development and
training. In reviewing roles and
task assignments within the
organization, the majority
agreed they currently practiced
to the full scope of their license
(55%) and that tasks were
assigned according to the
appropriate skill level of the
staff person (64%). Most
participants agreed they perform
screenings, provide chronic
disease management education,
provide medication adherence
counseling, and provide disease
prevention counseling during
their interactions with patients.
Concerning soft skills, RNs
reported highest levels of
confidence in the areas of
demonstrating resourcefulness,
functioning autonomously,
working with others, instilling
trust, taking initiative, and
showing resilience. Lower
confidence was expressed in the
May/June 2020 | Volume 38 Number 3
areas of managing ambiguity,
managing conflict, and
managing complexity. RNs
reported that communicating
effectively (73%), working with
others (64%), demonstrating
resourcefulness (64%), taking
initiative (55%), and making
effective decisions (55%) were
most important in performing
their daily work as an RN.
The online survey included
questions about areas RNs
needed to improve in soft skills.
They reported needing training
around managing complexity
(64%), managing conflict (55%),
communicating effectively
(55%), and leading/guiding
others (45%). Because
communicating effectively was
identified as the most critical
area for performing their work
as an RN, this skill was an
important focus for training and
development.
Finally, RNs were asked
about areas of knowledge
deficit related to precepting pre-
licensure nursing students
completing clinical experiences
in their organization. Most
identified expectations of the
preceptor role, learning
theories/teaching techniques,
and identifying learning
opportunities for the student as
the highest areas of knowledge
deficit. The RNs reported the
lowest knowledge deficit around
adapting teaching to
accommodate the learner and
giving feedback.
Prioritizing Professional
Development Needs
Perspectives
The evaluator facilitated a

discussion of the needs
assessment results to prioritize
professional development
offerings. Although
empanelment was identified as
the lowest scored PCMH-A area
by the RNs, indicating an
opportunity for professional
development, they rated this
domain as a very low priority
(9%). The highest priority
domains from the RNs’
perspective were patient-
centered interactions (73%),
care coordination (64%), and
organized, evidence-based care
(45%). Because organized,
evidence-based care was a lower
scoring domain in the PCMH-A
assessment, this domain was
identified by the CAPACITY
team as a focus for initial
curriculum development and
training.
Strategies for Creating the
Professional Development
Model
From the needs assessment
data, the CAPACITY professional
development model was
supported by and cross-
referenced with primary source
documents for community-based
primary care including the
Community/Public Health
Competencies from the Quad
Council (Swider et al., 2013), the
AAACN Role of the Nurse in
Ambulatory Care (2017b),
current literature around the
enhanced role of the RN in
primary care, and the
Interprofessional Learning
Continuum Model (Institute of
Medicine [IOM], 2015). The
Quad Council competency set
was included because it
Nursing Economic$
delineates the competencies for
public health nurses, many of
whom practice to the full scope
of the RN license and some
practicing in an expanded role.
The role and scope of
ambulatory care nursing from
the AAACN was vital as it
emphasizes care coordination
and transition management,
which are key components of
practice within the organization.
The current literature related to
community-based primary care
practice supported efforts to
enhance full scope of license
practice while delineating the
challenges in creating practice
changes within organizations.
The team was encouraged
by the attitudes of the RNs
whose desire to optimize their
knowledge and skills was
fundamentally based on wanting
to provide the best nursing care
possible to the most vulnerable.
When examining the
Interprofessional Education
Collaborative (IPEC) Core
Competency domains, they
resonated with the team’s goals.
Organizations need the
expertise of all members of the
care team (RNs, advanced
practice nurses, physicians, front
desk personnel, behavioral
health specialists, and medical
assistants) to provide the best
care to patients. Patient care is
innately an interprofessional
enterprise. Consequently, the
team considered the IPEC
competency domains of
values/ethics for interprofessional
practice, roles and
responsibilities for collaborative
practice, interprofessional
communication practices, and
interprofessional teamwork and
May/June 2020 | Volume 38 Number 3
team-based practice when
creating the model (IOM, 2015).
Results of the survey were
discussed. Team meetings were
held to assure learning needs
were addressed and the model
would remain relevant as the
RNs progressed in their learning.
Flexibility to respond to
emerging healthcare trends and
organizational changes was a
key feature for the model.
Finally, because another
objective of the grant was to
provide professional
development to RNs working in
community-based primary care
in the state, a consideration was
how professional development
offerings to the clinical partner
could be scaled up for broader
dissemination. For example,
how might a face-to-face
offering be converted into a
professional development
module that could be delivered
using online approaches?
CAPACITY Professional
Development Model
Description
The CAPACITY model and
associated curriculum contain
domains, competencies,
courses/modules, and learning
objectives. Given the multiple
definitions of these terms in the
literature, initial work involved
defining these components of
the curriculum for the model for
the CAPACITY project (see
Figure 2).
The major domains and
their associated competencies
within the model are
summarized in Figure 3: Focus
on Self (Professional
Development), Focus on Care
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 Nursing Economic$

Figure 2.
Curriculum Plan Structure for Registered Nurses

Domains Competencies Courses/modules learning objectives

Groups of Skills and behaviors Relevant learning Expected curriculum

competencies that required for success that offerings that increase goals that reflect what
form a cohesive can be observed knowledge and facilitate knowledge, skills,
theme behavior change attitudes learners should
be able to exhibit upon
course completion

Figure 3.
CAPACITY Curriculum Model for Registered Nurses with Competencies within Each Domain

FoCus on selF FoCus on CaRe team FoCus on PatIents FoCus on solutIons

Continuing Professional
Working with teams enhancing Care Delivery Reducing Barriers to Care
Development

• Current Knowledge and • Continuous, Team-Based • Organized, Evidence- • Care Coordination

Skills Relationships Based Care • Effective Protocol
• Practice to Full Scope of • Interprofessional • Patient-Centered
License Communication Interactions
• Contributes to Nursing
Profession

1. Maintain competence in 1.
one’s own profession
appropriate to scope of
practice.
2. Incorporate public health
and nursing science in the
delivery of care to
individuals, families, and
groups. 2.
3. Foster a climate of mutual
respect and shared values.
4. Contribute to nursing
profession through
teaching, mentoring, and
role modeling.
Apply relationship-building
values and the principles
of team dynamics to
perform effectively in
different team roles to
plan, deliver, and evaluate
patient/population-
centered care.
Communicate with
professionals in health and
care teams in a responsive
and responsible manner
that supports a team
approach to the promotion
and maintenance of health
and the prevention and
treatment of disease.
1. Promote care that is based
on scientific evidence and
planned and delivered so
the team optimizes the
health of their entire panel
of patients.
2. Encourage patients to
expand their role in
decision-making, health-
related behavior change,
and self-management.
3. Demonstrate culturally
appropriate public health
nursing practice with
individuals, families,
groups, and community
members.
1. Use the knowledge of
one’s own role and those
of other professions to
appropriately assess and
address the healthcare
needs of patients and to
promote and advance the
health of populations.
2. Provide reliable and
barrier-free access to the
care patients need, when
they need it, in ways that
are patient-centered and
efficient.

Team (Working with Teams),
Focus on Patients (Enhancing
Care Delivery), and Focus on
Solutions (Reducing Barriers to
Care). The domain Focus on Self
reflected areas of professional
development the RNs identified
as knowledge gaps as they
provided daily care. There was
recognition commitment to
ongoing learning was essential
to being an effective RN in
community-based primary care,
and the RN was consistently
building on current knowledge
and skills. Competencies within
this domain included increasing
self-awareness, maintaining
competence appropriate to
one’s scope of license, and
incorporating public health and
nursing science during care
delivery. Specific knowledge
and skills areas to target for
professional development in this
domain included understanding
individual style and how that
influences nursing practice,
leading and guiding others,
wound care, behavioral health,

118 May/June 2020 | Volume 38 Number 3


prediabetes/diabetes
management, and dermatology.
The domain Focus on Care
Team emphasized continuous
team-based relationships and
interprofessional
communication. Within this
domain, professional
development addressed the
importance of applying
relationship-building values and
the principles of team dynamics
to plan, deliver, and evaluate
care within the primary care
setting. Responsive and
responsible communication was
the second competency
identified within this domain.
The strong cultural norm of
diversity and respect within the
organization provided excellent
groundwork for professional
development within this
domain. The team identified
several professional
development offerings relevant
for this domain including “soft
skills” training in the areas of
work with others,
communicating effectively,
managing conflict, and building
relationships.
The domain Focus on
Patients addressed the need for
coordinated, evidence-based
care and patient-centered
interactions. Competencies
within this domain were around
providing evidence-based care
that is planned and delivered to
optimize patient and population
outcomes. A second
competency within this domain
was to enhance RN-patient
interactions to expand patients’
roles in decision-making, health
behavior change, and self-
management. The final
competency in this domain
Nursing Economic$
relates to demonstrating
culturally appropriate public
health nursing practice. The RNs
acknowledged the population
they served had limited
economic resources and other
challenges associated with the
social determinants of health.
However, they still valued
supporting the autonomy of
their patients to make decisions
about their health.
The final domain within the
model is Focus on Solutions.
This domain includes vital
aspects of full scope of license
practice, such as care
coordination and effective use
of protocols. Competencies
within this domain involve using
knowledge about the RN role as
well as the roles of other
professions to meet the needs of
others, providing reliable and
barrier-free access to the care
patients need in ways that are
patient-centered and efficient.
Although RNs were providing
care coordination and using
protocols, they desired to refine
their skills in these areas,
including formal training
provided by AAACN.
Professional Development
Planning
Once the model was
established, in a series of
meetings among the CAPACITY
PLT and CAPACITY academic
faculty, professional
development needs were
mapped with professional
development programs and
assets already available within
the organization. CAPACITY
faculty subject matter experts
and other team members with
May/June 2020 | Volume 38 Number 3
expertise to create and deliver
professional development
programs within each domain
were identified. In collaboration
with the CAPACITY RN
partnership liaison within the
organization, RN professional
development days were
provided quarterly. The first few
professional development
opportunities were provided in-
person to establish rapport, with
the option of conducting
professional development online
if the RNs preferred.
Professional development
programs that readily could be
converted to enduring programs
were identified to use with
other RN groups such as nurses
within the state. Additional
strategies to build rapport with
the partnership RNs included
communicating with a monthly
newsletter about offerings and
expectations to put learning into
action and synthesize
experiences with checkpoints/
group coaching calls.
In prioritizing topics for
years 1 and 2 of the project, the
following areas were targeted:
care coordination, wound care,
evidence-based care, behavioral
health in primary care
(substance abuse, mental health
basics), and community
resilience model training (a
model to help individuals cope
with adverse childhood events
and trauma). Soft skills training
topics include the Myers Briggs
Type indicator as it relates to
efficient functioning of teams,
understanding strengths, leading
with strengths, emotional
intelligence, and conflict
resolution. Finally, in response
to emerging professional
119

development needs related to
changes within the organization,
a face-to-face program on
workflow process management
will be offered.
Formative evaluation of the
professional development
program is ongoing. In the final
2 years of the project, the
impact of CAPACITY Model on
the clinical practice of Mercy
Care RNs, their ability to work
within interprofessional teams,
and the health outcomes of their
patients will be evaluated.
Conclusion
CAPACITY is a 4-year
project funded by the Health
Resources and Services
Administration to enhance full
scope of license practice among
RNs practicing in community-
based primary care. A needs
assessment of RNs within the
academic-clinical partnership
informed the development of a
site-specific professional
development plan. The
complexity of nursing practice
within community-based
primary care requires a robust
approach to professional
development to assure the
community-based primary care
workforce is fully prepared to
deliver high-quality, cost-
effective care. $
Laura P. Kimble, PhD, RN, FNP-C, FAAN
Clinical Professor
Assistant Dean of Clinical Advancement
Nell Hodgson Woodruff School of Nursing
Emory University
Atlanta, GA
120
Nursing Economic$
Quyen Phan, DNP, RN, FNP-BC, APRN
Assistant Clinical Professor
Nell Hodgson Woodruff School of Nursing
Emory University
Atlanta, GA
JoAnna L. Hillman, MPH
Director of Research and Evaluation
Emory Centers for Training and Technical
Assistance
Emory University
Atlanta, GA
Jeannine Blackman, MSN, RN
Clinical Nurse Manager
Mercy Care
Atlanta, GA
Celia Shore, MDV
Associate Director of People and Programs
Emory Centers for Training and Technical
Assistance
Emory University
Atlanta, GA
Natelege Swainson, MPH
Manager
Learning Networks and Evaluation
Emory Centers for Training and Technical
Assistance
Emory University
Atlanta, GA
Chimora Ngozi Amobi, MD, MPH
Public Health Program Associate
Emory Centers for Training and Technical
Assistance
Emory University
Atlanta, GA
Acknowledgment: The work described in
this manuscript was supported by the Health
Services and Services Administration (HRSA)
of the U.S. Department of Health and Human
Services (HHS) as part of an award totaling
$2,724,632 with no funding from non-
governmental resources. 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.
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