Retail Nurse Practitioner: Good for the Profession?
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