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Increased access to health insurance and health care, increased complexity of patients in our aging society, and challenges in primary care team staffing are among many current challenges to providing high quality, effective, and satisfying care to all patients. At the same time, the team is expected to attend to the equally important need for prevention, health promotion, and care coordination and management of the population at large. The demand to manage multiple, comorbid complex chronic illnesses are overwhelming the primary care system and causing waits, delays, and a shifts toward receiving primary care in inappropriate settings such as the emergency room (ER). Solutions cannot be limited to producing more physicians, nurse practitioners (NPs), and physician's assistants (PAs) as primary care providers, but rather in looking at all members of the primary care team and ensuring that each member is contributing at their highest level based on education, training, and licensure/certification. One professional, the registered nurse with a Bachelor of Science in Nursing (BSN-RN), has traditionally been underutilized as a core member of the primary care team. Supporting BSN-RN practice as a key member of the primary care interprofessional team is a strategy that will help meet the needs of our patients. BSN-RNs have the knowledge, skills, and abilities to assume critical roles in prevention, health promotion, management of acute and episodic illness, chronic illness management, transition management, and complex care management and coordination, as well as supporting the work of the entire interprofessional team (Josiah Macy, Jr. Foundation, 2016; American Academy of Ambulatory Care Nursing ([AAACN], 201). Transforming the role of the BSN-RN in primary care requires the coordinated responses of policy makers, academic institutions, accrediting bodies, primary health care providers and other primary care team members. In 2015, the Health Resources and Services Administration (HRSA) provided financial support (HRSA-16-066) to nine universities to develop educational models that provide BSN students to gain more clinical experience in community settings (HRSA, 2015). In late 2017, building on those successes, HRSA initiated a new funding initiative (HRSA-18-012) and called for proposals addressing strategies focused on recruiting both current and future nurses to practice careers in primary care, utilizing their full scope of practice as a member of primary care teams (HRSA, 2017). Fundamental learning from these projects demonstrated that BSN-RNs are an essential component for quality care. Therefore, policies which impede primary care organizations from investing in the BSN-RN as a core member of the primary care team must be addressed.

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The National Nurse-led Care Consortium hosts this webinar highlighting the recently formed medical-legal partnership in East Tennessee. This session will focus on developing a Medical Legal Partnership (MLP) practice in a rural setting, where the distance between legal and health partners is up to five hours, and the availability of services for low-income patients is scarce. Using tele-technology to communicate between partners, and elevating the combined health and legal priority of children’s healthcare insurance access and optimization, the East Tennessee MLP has tackled some of the common challenges of rural MLPs, and brought new solutions to rural MLP practice. This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number and title for grant amount (under grant number U30CS09736, a National Training and Technical Assistance Cooperative Agreement (NCA) for $1,350,000, and is 100% financed by this grant). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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The recent study by Argamany et al1 concluded that the incidence and hospital mortality for Clostridium difficile infection (CDI) differed between major regions of the United States and across different seasonal times of the year. However, these conclusions were not supported by the data in their study because the authors based them exclusively on statistical significance without considering the effect size of their findings. The effect sizes of region and season on CDI were very low or near zero, contradicting their conclusion, as subsequently explained.

Excerpt: The recent study by Argamany et al1 concluded that the incidence and hospital mortality for Clostridium difficile infection (CDI) differed between major regions of the United States and across different seasonal times of the year. However, these conclusions were not supported by the data in their study because the authors based them exclusively on statistical significance without considering the effect size of their findings. The effect sizes of region and season on CDI were very low or near zero, contradicting their conclusion, as subsequently explained.

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