Retail-based Clinics: An Opportunity to Increase Public Awareness of NPs or Add to the Confusion?

Article Outline

• Support for NPs in Retail-based Clinics
• Rationale Against NPs in Retail-based Clinics
• Copyright

Cindy Parsons, DNP, ARNP, BC, is an assistant professor of nursing at the University of Tampa and maintains a part-time private practice. She earned her DNP at Rush University in 2006. She is board certified as a family psychiatric nurse practitioner and as a child and adolescent psychiatric clinical specialist. She has worked in a variety of roles in psychiatric nursing: direct care provider, clinical nurse specialist, nursing management, and NP. She has presented at numerous state and national conferences and has published in nursing journals and texts at both the generalist and advanced practice level.

Roger Green, DNP, FNP, FAANP, is director of the DNP program at Rocky Mountain University of Health Professions in Provo, UT. He is a board-certified family nurse practitioner and has more than 7 years of experience in primary care. He is an active member of local, state, and national nursing and nurse practitioner organizations and has presented numerous lectures on various topics in advanced practice. As an academician and active clinician, he advocates for NPs on the national level and works to improve the scope of practice for NPs.

One of the goals of Healthy People 2010 is to increase the ability of American families to obtain health care. Our current system is fraught with problems such as difficulty getting an appointment, limited hours of service, high out-of-pocket costs, complex health insurance rules, and a decrease in persons covered by insurance. Retail-based clinics (RBCs), strategically located in pharmacies, groceries, or discount stores, offer a solution to this crisis. RBCs currently number close to 200 nationwide and are estimated to total several thousand by the end of 2007. The rapid expansion of RBCs speaks clearly to consumer needs: access to timely, cost-effective, and high-quality health care.

Nurse practitioners (NPs), based on their education and training, are highly skilled clinicians capable of delivering quality episodic care and are an appropriate choice of provider for this model. Do RBCs provide the profession with an opportunity to increase public knowledge about the role and scope of practice of NPs, or do they add to the confusion by their inherent limitations on NP practice?

What do you think? Are RBCs an opportunity to increase public awareness of NPs or do they add to the confusion? To comment on this matter, email section editor Jacqueline Rhoads at JRhoads@lsuhsc.edu.

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Support for NPs in Retail-based Clinics 

Cindy Parsons

Our current health care system purports to be built on a foundation of primary care; however, one needs to only look to the economics and infrastructure of it to determine that it is heavily weighted toward acute care. Problems with access to quality primary care abound and include geographic and time constraints, limitations based on insurance, or an inability to afford care.

RBCs provide an alternative point for consumer access to health care. These clinics offer nursing a tremendous opportunity to demonstrate the full spectrum of advanced nursing practice and affect the current health care delivery system. NPs often are employed in the role of primary health care provider for RBCs because they provide an excellent fit in this delivery system, with its focus on episodic care. NPs have advanced clinical training grounded in nursing, with its emphasis on disease prevention and health promotion, and complemented with training in medical diagnosis and treatment.

RBCs allow NPs to become the first-line contact for consumers. NPs can use these visits to employ their full range of clinical skills. They can provide treatment for consumers with acute and chronic illnesses, evaluate other health risks, offer education on lifestyle modification, increase consumer awareness about health promotion and disease prevention, link them to appropriate after-care services, and coordinate care with primary care providers. An added benefit is that by providing a needed service, after-hours care, they can generate goodwill by alleviating the burden of overflowing emergency rooms.

Through increased public exposure and greater use of NP services, we have a unique opportunity to capitalize on a mass public relations campaign with little expense. We must remain diligent and work through our professional organizations to ensure that NPs are allowed to practice to the full extent of their scope.

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Rationale Against NPs in Retail-based Clinics 

Roger Green

Public perception and awareness of the NP role is still limited throughout the United States. The media rarely feature NPs as experts in primary care and pharmaceutical companies still advertise, “Ask your doctor to prescribe x.” NPs remain a well-kept secret, although clients receiving care from NPs consistently report high levels of satisfaction.

RBCs in theory may be a golden opportunity for NPs to promote the role, but, in reality, they may prove detrimental to the profession. NPs need to be wary of public perceptions about the actual conditions NPs are permitted to manage. Concern abounds about the limited services provided in RBCs. Although the services rendered are convenient, they consist of episodic care and management of minor illnesses. Many RBCs have a business model with the NP as the sole staff person responsible for handling patient intake, performing a limited physical examination, and diagnosing and treating the illness. NPs give their own injections, perform their own diagnostics, and collect payment for services or process insurance claims. This business model limits the NPs scope of practice and may yield an unintended outcome of public perception that NPs are able to care only for limited and specific conditions, those advertised for in the RBCs. State by state variances in practice also contribute to increased confusion for consumers. NPs will need to work hard to counter the message of limited role and scope of practice. The public will need to be educated that our role is not limited to basic primary care and that NPs work in a multiple array of clinical environments.

Although the retail movement offers a window of opportunity to increase NP visibility, we must work hard to ensure the public has an accurate perception of our unique role, capabilities, and diverse areas of clinical expertise.