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Real Life in Retail Health

Retail Nurse Practitioner: Good for the Profession?

Published July 3, 2008 11:40 AM by Jayne Targgart
Hello, and welcome to my blog. I work as a nurse practitioner in a retail clinic. My thoughts today are concerning the professional image of nurse practitioners.

Nurse Practitioners are striving to be recognized as health care providers. The retail clinic environment does provide the visibility to the community. Most clients come to the window and say "I need to see a doctor." When I inform them that we are a nurse practitioner-run clinic and they would see me, the nurse practitioner, they say, "Oh, okay whatever, I just need to be seen."

So I ask, is this the image we want, just anyone is okay?

This is my chance to make a lasting impression on this client. This is where nurse practitioners can show their stuff. Fifteen minutes is what you have to get the client in and out. In that 15 minuets you have to make the client feel that you know exactly what you are doing, make them comfortable, be pleasant, examine, diagnose, and write a plan of care all the while listening to them and educating every step of the way.

I always start by introducing myself, and then ask what symptoms are the most troubling. I then do a complete exam according to their complaints. Listen to all lung fields, use egophany if needed (which they have never seen before), if congested or wheezing then try a deep breath and expel it by coughing then see if it clears at all, apical for at least 1 min., (which bothers them because they think something is wrong, no one ever listens that long) look in both ears, palpate sinuses, palpate cervical nodes, examine nares, for color and patency, (that is usually a surprise to them), palpate the abdomen if its a UTI that I'm suspecting (they look a little startled most times, they usually just pee in a cup and no exam is done). Now you have their attention and hopefully their confidence.

I believe that some of the clients have already self diagnosed themselves and know they want an antibiotic. Our society is acutely aware of their needs and firmly believes that they are accurate judges of their health care needs. This is where retail health care collides with medical knowledge. The client sees the retail clinic as a place they pay for a service that they want and expect a certain product i.e., antibiotic. The nurse practitioner is responsible to treat according to evidenced based practice and not client desires. The client (customer) will not be satisfied with the service if they do not get what they "paid" for, regardless if they really need it or not. There are days when I just want to sit at my window and hand out scripts,,, because so many clients "just need an antibiotic," even thought they became ill less than 48 hours previously. The clients firmly believe that all coughs, colds, body aches, sore throats must be treated with antibiotic. Which includes the flu and most all of the clients I see know that the flu is a virus, but they don't want it to "turn into pneumonia or bronchitis" so they need an antibiotic.

This is where the art of teaching truly comes out in a nurse practitioner role.

To educate clients in a retail setting is difficult for several reasons. Firstly you have no history with this person. Can you make a client trust you in 15 min enough for them to discard their own beliefs? Do you have the ability to instill in a stranger that you are competent and knowledgeable when it comes to their health? Then what happens when they disagree. Is the customer always right? Do you forego medical knowledge just to satisfy the customer?

If retail health clinics are to propel the image of the nurse practitioner as a qualified, educated, competent health care provider, then they must also follow evidenced based practice and not customer desire, knowing that the customer may not be satisfied and may not return. In retail word of mouth is your best friend and your worst enemy, so treading carefully over clients beliefs can be difficult and at times impossible.

The battle is to change a culture of illness avoidance ("I can't be sick," "I can't keep the kids home from school because I have to work, so they can't be sick," "I don't' want to wait for it to get worse.").

The weapon is education. The client is the student. The nurse practitioner is the "expert," and unfortunately indiscriminate use of antibiotics by other health care professionals is your competition.

Luckily I work at a clinic that has very specific protocols that we follow and as long as you follow the guidelines no one can fault you and your boss will stand for you if need be. Even though the protocols limit my practice parameters I believe in the retail setting they are a necessary evil. Protocols also aides in overhead cost containment. Then if I really want to treat outside of protocol I have to notify my collaborating physician and discuss it. We can always come up with a solution.

I firmly believe that retail health clinics can thrive and are a valuable asset to health care. The use of limited protocols makes retail clinics a complement to the areas urgent cares, ER's and PMD offices. They should not be seen as competition because the client usually starts with the doctor's office and is unable for whatever reason to be seen. The next option is the urgent care or ER which is very costly for a minor illness, and usually very time consuming.

Today's society wants quality care that is convenient to their schedule and is not cost-prohibitive.

Nurse practitioner-run, retail clinics is one answer to society's need for quality convenient health care.

Jayne Targgart, NP


Just started as College Nurse, although been an NP for 10 years. RN for 23 years.  I need protocols the College will be contracting with a physician for urgent type of visits for students and faculty. Please help I don't want to order a book and go through all of that entails. Thanks sally

Sally, NP September 19, 2008 5:42 PM

Hello,%0d%0a%0d%0aI have to agree with Sharon regarding the impedence that strict guidelines are to using my clinical judgement.  I often feel like a trained monkey could do my job it is so restrictive.  Unfortunately this is but one of the many problems I have with my retail health position.  I feel that my professionalism is compromised working for a drugstore.  The company I work for was originally it's own entity but then was bought by a large retail/pharmacy corporation.   I really think this matters when considering public perception.  Their influence over clinic operations is slowly increasing.   I am waiting for the day that they tell me that the store manager has some supervisory role over me (at which point I am definitely out of here).  %0d%0a%0d%0aI originally believed that retail healthcare would be good for the profession because it would get the average citizen familiar with the NP role.  Now I'm not so sure that seeing NP's in such a restrictive environment is so good for us.  Having to "call the doctor" because you want to prescribe something that is not on The List can't inspire confidence in patient's that we are capable of independent practice.  %0d%0a%0d%0aI think retail healthcare is a very good concept but the reality of it, at least at my company, just doesn't work for me.   %0d%0a%0d%0aOne positive note on retail healthcare is the salaries.  I do believe that the competition has raised NP salaries in the area.

Jane Smith August 28, 2008 1:46 PM

I too work in a retail health clinic, with strict protocols.  I've been there almost a year and struggle with the protocols.  Many NPs employed there silently break the protocols, for things as simple as giving amoxicillin to adults vs pen vk.  I don't like adhering to such strict protocols and do feel more like an RN in this role than an NP in many instances.  I will be looking to go to a place that respects the practice, educations, and expertise of NPs.

The positive:  Retail health clinics do offer a wonderful service to the public.  Patients are constantly thanking me for being there.  I think the clinics are elevating the profession of NPs and the salary.

Mary, retail health - NP July 23, 2008 11:58 PM
overland park KS

I recently started working in a retail clinic and it is wonderful. It fills a void in healthcare that exists for the working parent who can't see their provider during "normal" visiting hours. We also have the opportunity to "catch" those that fall through the cracks mainly the men 18 to 35 years that haven't seen a healthcare provider in since childhood and college students. It also allows us, as NP's, to educate the public on not only illnesses, but also on what the NP role is and what it means to them. And as a working  mother of a 9 year old and 4 month old, the clinic is very helpful to me. Being able to take my child in be seen and then get back home in most cases under an hour is phenomenal. It is convenient as well as less expensive then an unneeded trip tp ER/Urgent care.

Georgetta Serdynski, FNP July 21, 2008 10:49 AM
Milwaukee WI


I agree with you in the regards that it limits our profession.  I must state that not all retail clinics operate  in the same way as ours does.  There is variety in every facet of life.  Our clinic is trying to become a "brand"  What you recieve in one clinic you must also be able to recieve  at the other.  Since we do not perform any chronic disease management, have very limited diagnosis that we treat,  and we can not follow up or have repeat exams, the protocols make sense.  It is easier for multiple players (NP's) to work at all the sites.  We also have a Collaborating MD who must over see 5% of our work and with that in mind I am sure that plays a part of the limits to our practice.  

Our managment is also trying not to be in direct competition with the family doctors which again plays a part in the protocols being set into place.  

For NPs to be truly independent we need to be able to dx, plan and treat without the requirements of collaborating physicians.  Until such a time we will always have to follow what ever guidelines our employers/collaborating physicians set before us.

When chosing a practice to work in these  thoughts must be considered.

As  Nurse Practitioners we can still send the message of competance to our clients with our ability to educate and  with  our skilled examinations.  

Jayne Targgart

Jayne Targgart July 17, 2008 3:48 PM

Janet,%0d%0a I agree with your discription of what we providers at Retail clinics do, however, I disagree with having to discuss changes in following a written protocol with an MD when your clinical judgement says to provide different care. It feels demeaning to me and to my knowledge. The clinic I work for has not yet gone to that extreme. If it does I think I will be out of here. Health care is more than providing a protocol. If it were not, why not give everyone the book and let them call it in themselves. They already diagnose themselves, why not develop their own plan of care? An overstatement  as it might be hard to look in your own ears.:) Why do you feel a protocol is "Necessary"? Is it for protection against law suits?? That is the only reason I can think  of and that doesn't seem to be a help. If someone is going to sue, just saying I followed the protocol doesn't seem enough of a defense. Judgement has to be there no matter what and if our judgement as an NP is not valued, why practice?%0d%0aIn this new area of Retail Clinics, owned and operated by companies, I believe we need to be vigilent and if necessary outspoken to prevent NP's going the way of RN's in hospitals. I would hate to see our role  taken over and demeaned. And I really hope that our professional organizations are going to be there  for us?%0d%0a

Sharon Ledbetter July 12, 2008 4:48 PM

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