Financial models used to embed registered nurses in primary health care settings in the United States: A scoping review.
Document Type
Article
Publication Date
9-2025
Identifier
DOI: 10.1016/j.outlook.2025.102533
Abstract
BACKGROUND: Registered nurses (RNs) are increasingly recognized as key contributors to team-based primary care. However, funding limitations and restrictive reimbursement policies hinder their integration.
PURPOSE: This scoping review aimed to identify and categorize funding models used to support RN roles in U.S. primary care and evaluate associated cost and clinical outcomes.
METHODS: Guided by PRISMA-ScR, we searched PubMed, CINAHL, and Ovid Medline for publications in the past 15 years. After screening, 23 studies were included and synthesized.
DISCUSSION: Funding models varied and included direct nurse billing, salaried positions, and value-based team payments. Several studies reported reduced emergency department visits, hospitalizations, or Medicare spending due to RN-led care. Others noted limited cost recovery, high infrastructure needs, and billing challenges.
CONCLUSION: Embedding RNs into primary care requires policy changes to expand reimbursement, practice investments in RN training and role optimization, and further research using standardized metrics to assess cost-effectiveness and integration impact.
Journal Title
Nursing outlook
Volume
73
Issue
5
First Page
102533
Last Page
102533
PubMed ID
40829367
Keywords
Registered nurse, Primary health care, Cost, Care delivery
Recommended Citation
Norful AA, Muir KJ, Cramer E, Jung HJ, Nikpour J. Financial models used to embed registered nurses in primary health care settings in the United States: A scoping review. Nursing Outlook. 2025;73(5):102533. doi:10.1016/j.outlook.2025.102533
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