One Small Group of Family NPs
& One Large Retail Clinic Corporation
by Meg Helgert RN, FNP
I’ll start at the beginning. When I began on my path in nursing, I felt the main purpose was
to help people and deliver quality care with intelligence and compassion. (Oh, yes, my
mother also once told me “go into nursing, you’ll always have a job.” This is true, to
some extent, and I do still thank her for those words of encouragement.)
However, throughout my career, I’ve seen health care become disjointed, parceled out to
big corporations, and impossible for average people to comprehend -- much less afford. I’
ve seen nursing lose ground by not being “invited to the table” to offer input in many,
many instances. I’ve watched nursing become a financial bargaining point for
corporations (including hospitals and clinics) to negotiate for better bottom lines. I’ve
worried as people left the nursing profession for more lucrative careers. And I’ve been
privileged to be part of the development of Advanced Practice as a way to make things
better -- but then have seen Advanced Practice become a corporate bottom-line issue as
well.
Forming Our Network
Two-and-one-half years ago I began working for a company that came to Portland,
Oregon, to open retail clinics. They hired about thirty Family Nurse Practitioners to work
in these retail clinics. Following an intensive orientation, we set out to make this situation
work for the company and for ourselves. However, over the next six to eight months,
several clinic sites closed, people quit to find more secure and lucrative employment, and
within the year the company closed all the clinics and left the Portland area, leaving many
without jobs.
Our Concerns
During this time, a group of eight of us began to come together to deal with some serious
questions regarding our practice within this corporate entity
* Was our employment contract fair, reasonable, and in the best interest of
providing good health care?
* Was the EMR (electronic medical record) system in place at the time reliable and
safe? How could we fix aspects that were not?
* What was our "prescriptive authority” through a company based out of state?
* What were the effects of having a distant medical director reviewing records and
over-seeing the practice of family nurse practitioners, despite the state laws
providing for a robust, independent scope of practice and equally robust prescriptive
privileges?
As one can see, there were obstacles to overcome. The positions were very isolating for
us, so we formed our own network, which led to social events outside of work where we
could communicate and begin to provide support for one another. Twelve hours alone in
a small cubicle without another person to talk with seemed particularly difficult, so we
connected with other colleagues via phone and email to provide relief from this isolation,
which was not seen as an issue from a financial, "bottom line" perspective. Ironically,
higher-paid physician colleagues working in similar settings do not work alone, and
ancillary staff is hired to offset long hours, paperwork and billing tasks, personal safety
issues, and cleaning the clinic at the end of the day (!!) In our setting, we did it all, alone.
(Talk about being cost-effective.)
Our Accomplishments
I look back over what this small group accomplished with pride!
* We hired an east coast attorney (Carolyn Buppert: (http://www.buppert.com) to
assist us in re-writing the employment contract.
* We helped re-design the EMR so it was more “provider-friendly,” more effective, and
safer for patient care. We did this because it needed doing -- but the result was also
a far better system for company efficiency.
* We filled in for one another on holidays and weekends, to help cover all the gaps in
the schedule. We developed strong ties, and we were in constant communication
with one another through it all, even the dismal outcome.
Our Impact
And so, for me the question is: Did the eight of us do the right thing? My answer is a
resounding “yes."
Retail health clinics now flourish across the country -- , perhaps in part because of what
we have done? Hopefully, retail clinic owners have learned some things about what
nurse practitioners can accomplish, and about developing a healthy workplace culture.
In addition to influencing the landscape of retail clinics, what we did as a small group
helped to develop skills that can be applied in many settings: skills regarding what a
written employment contract should provide; how to question an authority out of state
when it conflicts with our state laws; how to develop policies that differ from those set
down by corporate, non-medical owners, and so on.
Possibly our most important lesson was this: How to support one another through all of
the difficult transitions and maintain our professionalism. Out of this “adventure”
numerous articles have been written (see link below to the Medscape article), a local
Portland business newspaper reporter followed this story closely (see link to article
below) and is still following developments in this trend in healthcare.
I believe we can invest in our careers. We can take great pride in our profession. We
can help to grow as we work together to understand the changing world around us. To
help people and to deliver quality care, with intelligence and compassion -- those were
the goals in my heart and mind long ago. And my colleagues along this path have
seemed to feel the same way. I hope this story contributes to our work together.
Meg Helgert RN, FNP
Family Nurse Practitioner
Portland Oregon
Meg is currently employed in Family Practice, and provides locum tenens to a small rural
clinic in Oregon. She received her NP certification from Good Samaritan Hospital &
Medical Center (Portland Oregon), Dec 1980. She received her Bachelor’s Degree in
Social Science from Portland State University in 1995. She is also currently an Associate
member of AFCE (Association of Certified Fraud Investigators). To contact Meg:
http://www.medscape.com/viewprogram/5982
Working in a Retail Clinic: What Nurse practitioners Need to Ask
Tracy Klein RN, MS, WHCNP, FNP (from Topics in Advanced Practice Nursing
(Medscape)
Sept 20 2006
http://www.bizjournals.com/portland/stories/2006/09/25/story5.html
Robin Moody
Portland Business Journal
Sept 22 2006