True Convenience

Kim,

I just hope that you realize that Minute Clinic is not the end all and be all of primary care, and there are more companies out there that truly are receptive to the nurse practitioner's needs.  I don't work for Minute Clinic, and I am not going to say who I work for as public mudslinging about different companies is not professional.

This is the happiest I have been in an NP job in a long time.  Is my company perfect?  No, but when you find the perfect job, let me know.  I take the time to educate.  I take the time to refer patients to excellent primary care providers in my community.  I take the time to make a difference, however small, in someone's life.  

FOR EXAMPLE,  I had a woman present to me with bronchitis, who has a history of asthma and allergies, that had been "controlling" her asthma with OTC Bronkaid, taking 8-10 pills a day!  She heard about my clinic, researched prices, and was more than willing to see me since she didn't have to pay an arm and a leg.  Did I mention that she makes about $17000 a year and can't qualify for Medicaid in Wisconsin because she has no dependent children?  WI Medicaid NEVER covers childless adults 18-64, leaving an entire section of the population hung out to dry.  In a few visits, I managed to get her mostly off the Bronkaid, prescribed her Albuterol, tapered oral prednisone, and cetirizine (for allergies), and referred her to the free local asthma management clinic.  Tell me that this isn't making a difference and is cookbook medicine.

I am also frustrated at the lagging numbers of patients in my clinic, but instead of b****ing about it, I am standing up and trying to do something about it.  People won't use the clinic if they don't know it's there.  We have a whole population that can't afford insurance, have incredibly high deductibles, and come to retail clinics because they can't afford to go anywhere else.  Hmmmm, feed your family or get your house foreclosed on due to outstanding medical bills?  What would you do?  I, too, am getting involved through my PROFESSIONAL NURSING AND NP ORGANIZATIONS in health care reform.  I personally visit my legislators in the state capitol, and I keep regular email contact with my federal legislators about the issues I hold dear.  We all want improved health care coverage for all, but if all we do is waste our energy b****ing at each other, nothing is going to get done.

The golden rule is applicable here.  Respect me, and I will respect you.

I must say I agree with sharon Ledbetter on this thread. If she feels she is making a difference and is happy with her role, good for her.

One point she made that is really spot on, NP's need to organize! Our profession is so fragmented we can't get anything done to promote ourselves. We can't even agree on a uniformed title or credential for heaven sakes! The other day I received a fax at my office on one of my patients from another providers office. The fax had all the providers at that office listed on the bottom of the fax. There where four NP's at that office and they used 4 different credentials; FNP-BC, ACNP, NP-C, ARNP-BC.

Plus some of them had BSN and MSN behind their names, which is not appropriate. It was like a confussing mess of letters piled behind their names. NO patient or other healthcare provider would have any idea what all those letters mean. Why is it so difficult to get nurse practitioner to use just  the simple "NP" credential?? If we did, more people would start to understand who we are and a lot less confusion would result.

Ther is very little uniformity in nurse practitioner education and training. Our profession badly needs to be reformed. I  personally doubt it will ever happen. There are too many little pockets of speciality care that won't give up their power to work for the greater good of our profession. Look at PA education programs and then look at ours, what a difference!

William Beatty, MSN, MS, BSN, BS, AA, ARNP, CRNP, NP-C, ATC.......ooops! I ment-- William Beatty, NP

Certainly do appreciate your comments but I am still very strong on the opinion that retail health is convenience for the hypochondriac in most cases and these people will not go to the ER and pay high fees to satiate their addiction.  The retail health clinic in a drugstore and supermarket is the perfect place.  Cheap, no appointment necessary ,and no one will really turn them away.   I do not want my fellow NP's to buy into this gimmick and try to sell it to the public as a true convenience.  Maybe the convenience lies with us, that we have a non stressful job, doing much of nothing, but we are not serving the community, not one bit.  In the end, retail health will phase out because it is driving up cost for unecessary visits.  I could deal with it better, if it was always fee for service and no insurance accepted, because they I would tell myslef, it was like going to the shrink.  OK,  YOU want to have someone look at a concern, then pay for it!  Now, for the NP's that are choosing for a career, they have to rethink this.  If you are 50+ years old and you want to remain actiive, but not stressed or over worked, I guess you might find a place for yourself.  But this is only after you have been a bonafide NP practicing for years and understanding your role. NEW GRADS should be prohibited!  I am getting involoved with health care reform under OBAMA, and I will keep in mind all the wonderful pro-active skills that NP's have and can utilize to bring health care into this new century!  WE have the potential as a unique group of providers to really change the direction of health in this country, but we can not be tantalized and used by a drugstore chain of business men/women who are really running the show.  If not your license, they would not have a bonus check.  PLEASE REMEMBER WHAT WE BRING TO THE TABLE HERE------------------they bring nothing, but their checkbooks, but we could revolutionize health care and we do not need them.  RETAIL HEALTH IS NOT THE ANSWER MY FELLOW Colleague!  My typing is not a reflection of my spelling

Jodi, quite the contrary regarding my desire to support my profession.  I am very concerned about our profession and how we integrate into health care delivery.  I am not sure how you think you are promoting support to our profession  buying into this concept of REtail health that has nothing to do with who we are and the impact we should have on health care delivery.  You do not do any preventative care, because you are working at the same retail health market that I know.  And you know that the EMR and clinical guidelines have taken away your approach to clinical judgement, differentials, and diagnosis with treatment.  IN fact, you can only prescribe what your clinical guideline book says!  Did you work so hard to get a degree to allow a guideline  book to become your bible or as you call your recipe book. You are being dishonest not to fess up to that reality.  What are you accomplishing in Retail Health---- seriously.

Think about  what you are destroying in terms of a health care industry that is falling apart due to greed, excessive costs, and unecessary visits, care.  We should be teaching the public how to use health care and not abuse health care. YOur retail clinic wants you to do unecessary strep cultures (DNA probes) on patients who test negative to Strep in a quick rapid strep.  The patient in the first place probably did not nee the strep test, and now you are sending out a second culture to sustantiate the first!  This is abuse of  insurance and  the system.  Eventually, retail health will cause rates to go up due to unecessary health care visits!   That is what retail health fosters.  Cleaning out of ears---------------another dimension-----------if you need your ears professionaly cleaned out, you need to go to an ENT/ ENT NP rather than the retail clinic that uses a water pik to clean out your ear.  Need I say more!  Retail health makes you feel what?  In control?  Do you like the isolation of sitting alone all day?  Do you like that you can sit all day?  What is it that you think you are providing here and what are you doing for NP's who are losing clinical skills in a retail clinic setting.  And yes, Minute Clinic, who you work for, hires new graduates.  Anything that crawls will be hired!  What does that say !

I am glad my blog got you all excited.  First of all, I have many years of experience in a primary care setting and the company I work for currently providing retail health is attentive to our needs as providers.  Secondly, the EMR I use is not a cook book, I document just like any practitioner would using and EMR and it makes my visits smooth and quick.  I agree that using new grads in retail health makes me nervous also, I think 2-3 years of experience should be mandatory.

I am sorry you are all hesitant to support your own profession as we expand into new roles....  No I don't see MD's wanting to work in this setting and that is fine because yes I worked hard for all my degrees and yes I want to make a difference and yes I do think retail health is doing this.  

Well.

Hope ya'll feel better now.

I work in a retail clinic. I am an excellent clinician. I still can't spell but I do have two master's degrees and 40 years of experience as a nurse.

I  agree. We are being, at times , used. However,I don't think we need to throw the baby out with the bathwater. Working in a hospital, a medical office or anywhere you are not an independent practitioner, you are being used ( and independent practitioners get used in more ways than I want). And you are selling health care. All health care is a business, even the non-profits need money to be there. And, you are right, it should not be that way. Now, keep hope alive and work to change our health care system but "get a life".

Most of my patients have minor illnesses. That is what we do"minor illness", if they don't they get shipped out PDQ. I am good at triage. This year I am responsible for preventing two people from diabetic coma and a stroke or heart attack by recognizing what was going on and getting them to an ER.And yes, some are not as sick as they want to be. So do I label them and treat them with contempt? I hope not. What I try to do is educate them and listen to them. And I am thankful they can come to me and not clog up emergency rooms or busy practices. sometimes I get tired of colds and hangnails, but a lot of these people need  to connect and be listened to. And the insurance companies save money cause an ER is way more expensive.

I don't have guidelines forced on me. And I would not work in a place that does not trust me to treat my patient without a cook book.

Both of you are right that many companies treat their NPs like cogs in a wheel. And that is our fault. If we worked together as nurses and enforced ANA standards for NPs in the Retail Clinic, they  wouuld not be able to do this. Unfortunately, nurses have never stood up too much for their profession in general and NP's are not much better. Since F. Nightingale we have been dumped on. Any one wnat to help organize us, I am game.

And last, Retail Clinics use new graduates. Shame. The practice I worked in when I graduated did too. And I am sure I got as much support there as a new graduate does in a Retail Clinic.

A big law suit. Well, maybe so, Never saw one of those in a doctor's office or hospital, did you?

I do get to sit around  a lot, especially when my cllinic was new. Those were the days. Now, sometimes I have 3 or 4 people waiting on me. I have to learn how to train people to walk-in at 30 minute intervals.

What really gets me, about what ya'll said was the part about conflict of interest. I don't like it when doctos question my ethics and I sure as, well sure don't like it when another nurse does. Maybe there is some projection going on here??Maybe where you were you had to use the pharmacy in your store. did they have a gun pointed at your head? You sure don't work for my company. I give the patient a script( if they need one) and where they get their meds is their business, not mine. And by the way, the next time you get a pen or go to a lunch, or get CEUs from a  pharm rep don't forget, that is a conflict of interest.

Another last, I do go out in the store and help people find OTCs. Sometimes to save them money, if they can't afford me. ( do not tell my boss), sometimes to show a patient where the mucinex is. I do educate peole about OTCs. How many kids died from uneducated use of OTCs  last year? How many people got ripped off or got elevated bp from OTCs  last year?

So, ms. Kim and Ms Marie, thanks for your opinions and  I hope you find a place that fits you better than a Retail Clinic.  But it is too bad you could not see some of the problems facing Retail NPs and help work for solutions rather than get off on dissing me. Is dissing the way you spell it. Like I said , I can not spell.

PS. Let us know when you find the perfect place to practice.

I am employed by a retail health clinic who came into our region like big guns and hired all the available FNP's and paid a trendy rate, nothing special, but trendy in today's market.  The retail/drugstore chain recently closed down  stores in the market and let go of 50% of its staff, with absolutely no notice.  They fired people as quickly as they hired them because the are not doing as well as they anticipated, so, they are unable to justify the amount of staff.  The move was unprofessional, at best,  and certainly demonstrated how very little the retail business respects their professional staff.  They treated the FNP's like they treat their high school shelf stockers.  Very sad!  But the realilty is that the retail business might need to  re-think in terms of how much the community really needs his kind of health care, outside of flu shots, during a seasonal time. The other reality is that we as Board Certified NP's have to rethink how willing we are to let business, a drug store chain or supermarket, dictate our practice and function.  

The  blog on True Convenience, I am not in agreement with the blogger who initiated the posting.  Yes, you can be seen without an appointment, yes you do not have to wait long, but the health care services are limited, and frankly, these services do not require immediate attention in most cases.  I do agree that the majority of the clients being seen in these retail walk in clinics are not necessary visits and the insurance companies will have to pick up a cost, if the patient is billing insurance.  I am not sure that kind of abuse is adding to our health care issues, by driving up costs due to uncessary visits and billing.  The other issue that has to be mentioned, is the level experience of the provider at these retail clinics.  The retail clinic I work at hires new graduates who have had no experience working as a NP.  The bulk of the NP's hired  are not extremely clinically impressive either.  One would not know that unless they were familiar with the individual provider.  It is true that a mandated EMR and guidelines are enforced so the NP has a small window to diagnose, treat, and limit mistakes but,  is that convenience to the unkowing public?  I think a law suit will come about in the near future that will dampen all this excitment about these retail clinics.  You know, convenience should not supercede the health care visit.  The health care visit has to be about excellence and not just a kind smile in a lab coat!  I do not believe the retail health care setting is offering excellence and I can make this statement honestly because I have worked in this setting.  When I took the position, I  thought I was getting into a great new era where NP's could function well as they were trained, but I learned very quickly, it is a questionable business and the NP's hired will not stay long, if they have any level of clinical expertise.  Is that true convenience?  I think as NP's we need to look at the retail business with caution and trepidation because it has the potential of sinking all the privledges that the NP's have earned over the last decade in terms of prescriptive authority, abililty to practice  without a physician on the premise, independence.  We are selling our profession short by allowing business to "use" our licensure and privledge, which I agree with the comment above somewhat.  I am not angry as I feel the first comment renders a bit of anger, but I do agree with the basis of what is being communicated.  Let us not fall prey to business antics, which is what brought this entire retail market into focus and it is a conflict of interest, to be working in a drug store that sells the remedies we are recommending.  It is a conflict to walk over to a pharmacist to find out what to prescribe as another option, it is a conflict to be selling our professional skills by walking around a store, greeting people with discount coupons.  You would not catch physicians doing this or walking around a store giving out coupons to bring in business.  IN some cases, handing out candy and cookies to attract business.  We earned our licensure through hard work and education, and we should not let business and business men direct our destiny, which is what is happening here.   Be aware fellow NP's and do not be attracted to what you consider is a easy going, non stressful job, where you can play on the computer the bulk of your day, and steal a snooze, while no one is watching.  This is not doing our profession any good and it is a ruse that you are being sold, that you are providing necessary health care.  You are helping to line the pockets of your managers, and their managers with their stock options and bonus packages.  You are hired help and they could not function nor have jobs if your license was not so versatile that they could dream up its use, as they have. If you want true convenience, set up a health care delivery system that is not in a drug store, or supermarket, and deliver care that includes teaching, prevention, care for chronic diseases, such as hypertension and DM, etc.  Deliver this care on your terms and not with an EMR that will dictate your actions, because you are trained to make these decision independently.  Your license and board certifications gave you that authority.  The MBA business man is not sharing  his/her bonus with you, are they.  You have taken what you have worked so hard for and turned it over to a group of people that could not do what you can do and yet, they tell you how to function.  Do you think any of our colleagues, the physicians, physiotherapists, medical technicians would allow themselves to be used in a similar setting.  In the end, look, how they dismissed your fellow colleagues the minute the bottom line, affecting their bonus got interrupted.  So, the true convenience really rests on our backs and we should not permit them to use us and convince us how convenient it all is.  Be true to yourselves when you buy into the glamour of "retail" and know that it is not about health care , it is about the buck!

You are deluding yourself with what retail health is really providing and more importantly, what it is not providing.  This is a scam that was thought about by businessmen who figured out how to use the license of a NP.  Business men convinced MD's to take over insurance and look at the results of that.  MD's have lost control over how to treat patients and insurance -big business regulates patient care.  Here come the NP's, what can we make off them and let them feel useful!%0d%0a%0d%0aCome on people. Are you all drinking the same cool-aid.  What is retail health other than a business that sits in a store that sells OTC and prescriptions.  The NP follows a EMR and does not have to use any clinical judgement because the EMR does it for them, be it right or wrong.%0d%0a%0d%0aYou are hired guns being paid a fwe extra dollars per hour and you have to clock in like a factory worker, work 12-13 hours and sit alone all day waiting to snare into your lair.%0d%0a%0d%0aLets talk about your patient population,which consists mostly of hypnchondriacs who have insurance and only have to pay you $10.00 to have 30 strep throats done every month because these patients are frightened about STREP.  90% negative of course!    REALLY%0d%0a%0d%0aWhat the NP is doing and does not realize this is  helping to corrupt a health care system that is already in the toilet. Now these hypochondriacs have a place to go everytime they need to fill their own insecurities and they dio not need an appointment.  AS a matter of fact, if you don