Patient Care Staffing Patterns and Roles in Community-Based Family Practices

Journal of Family Practice, Oct, 2001 by Virginia Aita, Diane M. Dodendorf, Jason A. Lebsack, Alfred F. Tallia, Benjamin F. Crabtree

KEY POINTS FOR CLINICIANS

* Family practices employ a wide range of nursing
and non-nursing staff, but the responsibilities
given to patient care staff are often not tied to
professional training.

* Collaborative care models that are recommended
for enhancing quality of care require physicians
and administrators to hire staff trained to
meet clinical goals and not just economic goals.

* Nursing and other support staff can assume
greater leadership responsibilities when encouraged
by physicians and administrators.

* OBJECTIVE Our study describes patient care staff patterns and roles in community-based family practices.

* STUDY DESIGN We used a multimethod comparative case study design that included detailed descriptive field notes of the office environment of 18 family practices and of 1637 clinical encounters, as well as in-depth interviews of practice staff and physicians.

* POPULATION We included physicians and staff in 18 community-based Nebraska family practices.

* RESULTS Practices are staffed with a range of clinical personnel, including registered nurses, licensed practical nurses, certified medical assistants, radiology technicians, and trained and untrained medical assistants. Each of these has specific educational preparation that potentially qualifies them for different patient care roles; however, staff roles were determined primarily by local needs and physician expectations rather than by education, training, or licensure. The overall majority of practices used non-nursing personnel as the predominate patient care staff. Patient care staff-to-clinician ratios ranged from a low of 0.5 to a high of 3.3.

* CONCLUSIONS Staff members often fulfill roles independent of mining. Staff leadership is potentially important for designing effective collaborative care models; however, we found leadership only occurred with the approval of clinic authorities. These practical issues are rarely addressed in normative recommendations about system change and intervention. Our findings indicate that there are considerable opportunities for better use of the nursing and other patient care staff in the delivery of clinical services. Developing a collaborative practice model should include formalizing expectations of staff to reflect training and experience, and explicitly configuring staff to meet the needs, values, and goals of a practice.

* KEYWORDS Family practice; practice management, medical; nursing staff; office nursing; organization and administration; physicians' practice patterns, (J Fam Pract 2001; 50:889)

Submitted, revised, August 13, 2001. From the departments of Preventive and Societal Medicine (V.A.) and Family Medicine (D.M.D.), University of Nebraska Medical Center, Omaha; the University of Nebraska, Omaha (J.A.L.); the Department of Family Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick (A.F.T, B.F.C.); the Cancer Institute of New Jersey, New Brunswick (B.F.C.); and the Center for Research in Family Practice and Primary Care, Cleveland (B.F.C.). Reprint requests should be addressed to Virginia Aita, RN, PhD, Department of Preventive and Societal Medicine, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075. E-mail: vaita@unmc.edu.

This section presents extended, structured abstracts from articles that appear in full on The Journal of Family Practice's Web site (http://www.jfponline.com). Articles published online meet the same high standards for peer review as those published in print, and are indexed on MEDLINE. We encourage you to visit our Web site to take advantage of the many enhanced features of our electronic version.