Anyone out there follow this group?
William Morris
ss...@bellsouth.net
issues. Our first issue is about nurse practioners and jobs at
convenient care clinics:
This letter is to shed some insight to new or soon to be new Advanced
Practice Nurses about a fast growing trend in today's healthcare
arena: retail health clinics. The purpose of this letter is to
summarize both the positive and negative aspects of working in a
retail clinic, so that nurse practitioners can be better informed.
Minute Clinics were founded in May 2000 by Robert Krieger in
Minnesota. They are walk-in healthcare centers usually located in
retail stores such as Target or CVS. They are staffed by Advanced
Practice Nurses and Physician's Assistants, with physician back-up,
that can diagnose and treat common illnesses such as bladder
infections, colds, and strep throat. They also give vaccinations and
perform screening tests for conditions such as diabetes, pregnancy,
and hypercholesterolemia. The idea is not to eliminate the PCP, but
to compliment the PCP.
Retail health clinics have many advantages for patients: convenience,
with excellent quality of care at a lower cost. But what are the
benefits for NPs? In retail clinics, there will be increased
visibility of the role they play and the holistic, quality care they
provide. What better way to advocate the important role of an NP?
If more autonomy or a more independent practice interests you, retail
clinics may be an obvious choice. At most retail clinics standardized
protocols and guidelines assist nurse practitioners, physician
assistants (PA) and physicians (MD or DO) in clinical decision making.
Scope of practice and regulatory status for retail clinics varies by
state, clinic company, and retail location. However, to date,
standards of care have yet to be developed and it has not been
determined as to whether the physician has to physically be on the
premises or within a certain radius. The AANP has developed standards
on NP practice in retail clinics, stating that these measures must be
met to maintain, not limit, the high level of quality care that NPs
can provide. They encourage NPs to be involved in the development of
policies and practice guidelines, and all aspects of forming and
running these clinics.
While the retail clinics boast multiple advantages, their recent
popularity raises several concerns. First, many patients may use these
clinics for symptom relief rather than seeking a more complete model
of healthcare. Even though the goal is to compliment the care received
by the primary care provider, these clinics may inadvertently
eliminate it. The nurse practitioners and physician's assistants that
staff these clinics must realize their client's temptation and counsel
patients to maintain regular, consistent communication with their
primary care provider. Some of these patients may present with a
common complaint, but have a "laundry list" of medications for
multiple co-morbidities. This challenge to patient safety and
continuity of care necessitates the use of protocols for primary
provider communication.
The second concern is that the public will gain a restricted
perception of the nurse practitioner's scope of practice.
Unfortunately, many Americans still do not understand what a nurse
practitioner is. The limited spectrum of conditions managed by retail
clinic nurse practitioners may lead the public to believe that this is
all we can handle. What sets nurse practitioners apart from other
healthcare providers is our holistic care which encompasses health
promotion, disease prevention and education in addition to treatment.
We are concerned that the fast-paced convenience of these retail
clinics will not be an environment conducive to holistic practice.
Lastly, there is a concern that new nurse practitioners may develop a
mindset that they are seeing minor conditions such as colds, flu,
sprains, or rashes and fail to see the bigger picture or disease
state. This problem, along with the ambiguity of the collaborative
physician role, lack of experience and possible lack physician
guidance could put the new nurse practitioner in a difficult
situation. Until history and exam skills are honed and diagnostic and
therapeutic decisions are refined, the new nurse practitioner should
have ample support of the collaborative physician and ample
opportunities to see new clinical conditions. Therefore, we think that
new nurse practitioners should not be candidates for employment in
these retail clinics. Currently, some require two years of experience
and others only minimal experience.
Although Retail Clinics are gaining popularity and emerging quickly,
other issues such as insurance, liability, and third-party
reimbursement remain unresolved.
The AANP's standards on NP practice in retail clinics:
http://www.aanp.org/NR/rdonlyres/enb465lstzries6k5kqdudsgt6rgfjhaee7pxslwnodfarbhkxgeu554ct5xsandhkeoajusbbqhom/Retailbasedclinicpaper1006.pdf
Thanks for reading our post.
Team B. Nursing Roles. UNC-Chapel Hill