1. Stewart, Kenda R. PhD
  2. Stewart, Greg L. PhD
  3. Lampman, Michelle MA
  4. Wakefield, Bonnie PhD, RN
  5. Rosenthal, Gary MD
  6. Solimeo, Samantha L. PhD, MPH


OBJECTIVE: The experiences of RNs and licensed practical nurses (LPNs) implementing a patient-centered medical home (PCMH) in the Department of Veterans Affairs (VA) primary care clinics were examined to understand model implications for nursing practice and professional identity.


BACKGROUND: National implementation of the PCMH model, called patient-aligned care teams (PACTs) in VA, emphasizes areas of nursing expertise, yet little is known about the effect of medical homes on the day-to-day work of nurses.


METHODS: As part of a formative evaluation to identify barriers and facilitators to PACT implementation, we interviewed 18 nurses implementing PACT.


RESULTS: Challenges to nurse's organizational and professional roles were experienced differently by RNs and LPNs in the following areas: (1) diversified modes of care and expanded clinical duties, (2) division of labor among PACT nurses, and (3) interprofessional status in the team.


CONCLUSIONS: Healthcare managers implementing PCMH should consider its inherent cultural and practice transformations.