<p><strong>PURPOSE: </strong>Pediatric primary care redesign includes changes to clinical teams and clinical workflows. This study described the perspectives of pediatric clinicians on their experience with redesign.</p>

<p><strong>DESIGN AND METHODS: </strong>This qualitative study explored clinician perspectives on a newborn care redesign pilot at a pediatric primary care site. Newborn Hallway (NBH), implemented in 2019, clustered morning newborn visits with a single physician, increased RN staffing, and provided newborn-specific training for RNs. NBH also revised visit documentation templates to promote communication between RNs and physicians and shared completion of history taking and education. We conducted semi-structured qualitative interviews with clinicians. The interview guide was developed using the Consolidated Framework for Implementation Research. Interviews were recorded and transcribed, and coded using an integrated approach.</p>

<p><strong>RESULTS: </strong>We interviewed 17 staff (8 physicians, 8 RNs, 1 nurse practitioner) from 3/2020 to 1/2021. Clinicians reported that NBH implementation was facilitated by widespread agreement on baseline challenges to newborn care, and interest in optimizing roles for RNs. Clinicians believed NBH facilitated teamwork, which mitigated unpredictability in newborn needs and arrival times, and improved staff satisfaction. Perceived barriers to NBH included staffing constraints and ambivalence about whether sharing tasks with RNs would negatively influence patient relationships and continuity.</p>

<p><strong>CONCLUSIONS: </strong>Pediatric primary care redesign focused on sharing tasks between RNs and physicians can promote teamwork and address unpredictability in clinical settings.</p>

<p><strong>PRACTICE IMPLICATIONS: </strong>Resolving questions about how redesign influences patient continuity and trust, and clarifying optimal staffing may help facilitate adoption of clinical team and workflow innovations.</p>

<p><strong>PURPOSE: </strong>Registered nurses (RN) participate in delivery of routine pediatric preventive care. This pilot study characterized variation in RN roles and overlap with other team roles.</p>

<p><strong>METHODS: </strong>We conducted a pilot cross-sectional survey of RNs from an urban/suburban pediatric primary care network. RNs described tasks during preventive visits and other staff completing similar tasks. Health system data characterized office staffing, volume, and patient population. We assessed whether role overlap and time on key tasks was associated with office characteristics or staffing ratios.</p>

<p><strong>RESULTS: </strong>Twenty-three offices reported a mean ratio of RNs to physicians and nurse practitioners of 0.99 (range 0.62-1.33). Of tasks RNs completed during preventive care, health education overlapped most with physician/nurse practitioner roles (17 sites with overlap) and rooming patients overlapped most with medical assistant roles (20 sites with overlap). Across sites, RNs spent 9% of time on health education and 26% on rooming. Offices with more role overlap between RNs and physicians/nurse practitioners had higher RN to physician/nurse practitioner ratios (1.13 versus 0.86, t-test p-value 0.002). There was no association between role overlap and other office characteristics, or between RN time on key tasks and staffing ratios.</p>

<p><strong>CONCLUSIONS: </strong>RN staffing ratios varied twofold across offices. RNs spent more time on tasks that overlapped with medical assistant roles than tasks that overlapped with physician/nurse practitioner roles.</p>

<p><strong>PRACTICE IMPLICATIONS: </strong>Opportunities exist to optimize RN pediatric primary care roles, for example by delegating certain tasks. Optimization may reduce costs, while improving quality, patient experience, and staff satisfaction.</p>