The Role of Nurse Practitioners in Retail Clinics, Essay Example

Abstract

The emergence of retail clinics over the past decade has presented new opportunities for patients to obtain preventative care and treatment in a unique setting. These facilities often employ the expertise of nurse practitioners in order to minimize the burden placed on physicians and subsequently provide these knowledge-based experts with increased opportunities to advance their careers. Retail clinics are a popular model due to their cost effectiveness and their ability to satisfy a specific niche of patients, while also promoting high quality care and treatment. It is important to identify the appropriate knowledge and skill sets that are required to address the challenges that exist in recruiting nurse practitioners to fill these roles, particularly their level of comfort and knowledge of clinic care in the retail environment. Retail clinics and nurse practitioners must continue to demonstrate their value and contributions to local communities, using preventative care, and treatment as a viable service model. At the same time, the role of nurse practitioners must be continuously evaluated to ensure that their skills are used effectively for a positive purpose. For nurse practitioners, retail clinics may be beneficial, but their participation in managing these clinics remains a challenge. Therefore, retail clinics must be evaluated in order to determine their effectiveness, as well as the primary role of nurse practitioners in this process. The role of nurse practitioners in retail clinics introduces many important questions regarding their value and knowledge within these environments.

The Role of Nurse Practitioners in Retail Clinics

In the modern era, Nurse Practitioners (NPs) are key contributors to healthcare practice in many ways. They provide expert advanced knowledge and guidance in many areas and practice settings, such as direct patient care, diagnosis, treatment, research, and administrative duties. It is essential that NPs continue to explore the alternatives that are available to expand the scope of their practice and to recognize where they might provide value within healthcare settings. These factors demonstrate the importance of critical areas in which NPs offer their knowledge and expertise. One emerging area of consideration in which NPs have an increased presence is retail, whereby new clinics have been established within stores as a means of providing consumers with healthcare services without the need to go through a doctor’s office or traditional healthcare clinic. These opportunities provide a basis for exploring the different perspectives associated with the role of NPs in retail clinics and whether or not this is an appropriate use of their knowledge, expertise, time, and resources.

Quality of care and guidance within the retail clinic environment is also a primary concern, as this environment may not utilize NPs effectively. There are opposing views regarding the role of NPs in retail clinics; therefore, these perspectives should be addressed as a means of developing new insight regarding whether or not NPs belong in these environments. It is necessary to evaluate these conditions and if NPs with extensive knowledge and expertise are utilized properly under these conditions. The following discussion will address the role of nurse practitioners in retail clinics, including the pros and cons of this role, whether or not it benefits these professionals, and whether or not patients are provided with the best possible quality of care within the retail environment. Existing research regarding this topic will also be explored in an effort to provide a comprehensive understanding of retail clinics and the significance of nurse practitioners as key contributors to care and treatment in the retail clinic environment.

Retail Clinics: Purpose and Function

Throughout the United States, there has been an increased presence of retail clinics in many metropolitan and suburban areas. These clinics represent an emerging trend in healthcare practice that focuses on the retail environment due to their presence, visibility, and availability in many communities, in addition to limited access to traditional healthcare environments for many residents (Cassel, 2012). The value of these clinics continues to be explored in conjunction with the type of care and treatment that is provided in standard clinical settings, such as doctor’s offices (Cassel, 2012). It is expected that retail environments will offer unique benefits that traditional clinics cannot provide, such as access to pharmacies and other retail products within the same location. One reason behind the increase in retail clinics is the limited number of primary care physicians that are available for a large number of patients, thereby increasing the necessity for other alternatives that enable patients to see healthcare professionals quickly and without significant delays (Cassel, 2012).

Many primary care physicians do not provide the type of scheduling that enables patients to be seen same day, particularly when they experience an event that requires prompt evaluation (Cassel, 2012). The problem in question may not be serious enough to require a visit to the emergency department, and under these circumstances, patients may have no choice but to visit a retail clinic to be seen promptly (Cassel, 2012). These factors play a role in enabling patients to be seen quickly so that if additional care is required, it will be determined by a healthcare professional within the retail environment (Cassel, 2012).

One of the key considerations regarding retail clinics is their ability to coordinate care in regards to chronic illness, which is increasingly common in many individuals and families (Cassel, 2012). This is particularly useful when a patient is under the watchful eye of a primary care physician or specialist, but experiences an event that has exacerbated the condition in question and requires immediate evaluation (Cassel, 2012). The retail environment may be quite useful under these conditions, as it provides patients with relief until they are able to visit their primary care physicians (Cassel, 2012). This type of support in the interim is likely to be particularly useful because it enables patients to experience a sense of relief that they have been evaluated by a healthcare professional (Cassel, 2012).

As of 2012, there were over 1,400 retail clinics in operation in the United States, which is a dramatic increase over a period of several years (Cassel, 2012). Current models are located in retail pharmacies and big-box stores with high traffic, where nurse practitioners and/or physician assistants serve as key experts in providing basic and limited healthcare services that adhere to standard guidelines (Cassel, 2012). However, questions have been raised regarding the quality of care that these clinics provide, as well as the cost of performing these services (Cassel, 2012). Most importantly, patient satisfaction appears to be high, and some organizations are also accredited by the Joint Commission due to their excellent follow-up services and chart reviews (Cassel, 2012). These factors support the development of new perspectives regarding patient care, including the coordination of care between the primary provider in the retail clinic and the pharmacist, who are located in the same retail area (Cassel, 2012). In particular, patients with chronic illnesses are likely to benefit from these services because patients have access to a healthcare professional and a pharmacist to guide them in addressing treatment alternatives, symptoms, and possible side effects (Cassel, 2012).

Communication in the Retail Clinic

One of the key issues to consider with retail clinics is their level of communication with primary care providers, which may not always occur in the desired manner (Cassel, 2012). This may present complications for patients when information is not properly translated in a timely fashion (Cassel, 2012). In response to this concern, retail pharmacies have made efforts to improve their communication with physicians in order to coordinate care in an effective manner that will produce the desired outcomes, with some using electronic records as a means of communication (Cassel, 2012). Therefore, advanced technological capabilities must be identified and implemented at retail clinics so that they are viable sources of care, treatment, and information for patients on a regular basis; however, this is an expensive proposition that must be considered (Cassel, 2012).

Retail clinics pose a unique challenge for the healthcare community in that they are not yet a proven commodity on a widespread basis, which poses a potential risk for some organizations to operate these clinics with economic favorability (Tu and Boukus, 2013). The lack of clear focus and understanding of the purpose of retail clinics in some communities limits their growth potential due to lack of awareness, knowledge, or general confusion regarding their value (Tu and Boukus, 2013). Furthermore, many of these clinics are not available in the areas with the greatest level of need, such as low income or disparaged communities, and instead, are located in middle class or affluent communities (Tu and Boukus, 2013). These factors further demonstrate a lack of understanding regarding these clinics and their potential value in communities, particularly those with the greatest amount of need (Tu and Boukus, 2013).

Retail clinics often attract younger persons and families, as these individuals are likely to be more open to a different type of patient care experience (Tu and Boukus, 2013).  These efforts will support the development of new strategies to attract a more diverse patient population across a larger number of locations (Tu and Boukus, 2013). Evidence also suggests that some population groups are likely to participate in preventative services in greater numbers, which many retail clinics offer (Tu and Boukus, 2013). These factors create an opportunity for alternative marketing that will increase the visibility of retail clinics and the opportunity to make these clinics more affordable to attract larger numbers of patients across different population groups, as the retail environment may serve as a single location for a variety of services (Tu and Boukus, 2013).

The concept of retail clinics, while gradually increasing in visibility, has also become increasingly relevant to managed care and insurance providers as part of their coverage (Lewis, 2013). It is less expensive to support a retail clinic compared to costs associated with a visit to an emergency room (Lewis, 2013). Furthermore, many retail clinics see patients who might not have a primary care physician; therefore, they will not disrupt their current care with these visits (Lewis, 2013).  These efforts are considerable and support a continued effort to reduce the cost burden for insurers and for consumers through the expanded utilization of retail clinics (Lewis, 2013).

With the implementation of the Affordable Care Act, it is very likely former uninsured consumers may visit retail clinics because they do not have primary care physicians (Lewis, 2013). These factors are critical because they support the growth of the retail clinic enterprise throughout the healthcare industry (Lewis, 2013). Retail clinics are attractive for the following reasons:

“Major retail clinics are in growth mode again, buoyed by patient preference as well as the healthcare reform law that will unleash millions of newly insured members into the market. To capture more of these consumers, retail clinics are expanding services to include preventive care, physicals and weight management” (Lewis, 2013).

These factors demonstrate the growing importance of retail clinics in the patient’s home environment. , as well as highlight the opportunities for expanded presence in communities where they might not currently exist, thereby fulfilling a much-needed void in some communities (Lewis, 2013).

For nurse practitioners, changes continue to their scope of practice which in turn impact their ability to focus on advanced opportunities in new settings (Martin, 2014). Under these conditions, it is possible an organization will pay greater attention to the work nurse practitioners perform, and use these professionals as employees in new practice environments, such as retail clinics (Martin, 2014). For nurses, these opportunities provide numerous benefits in the form of an active leadership role within a retail clinic to demonstrate knowledge and expertise in healthcare practice (Martin, 2014). Another benefit for retail clinics is the lower cost payout to nurse practitioners versus physicians, who are much more expensive to recruit and retain for these positions (Martin, 2014). It is evident that retail clinics employing nurse practitioners may experience greater benefits and more accessibility for patients rather than relying on physicians to fill these roles (Martin, 2014). In these roles, nurses act as promoters of change, whereby they represent a new dimension of healthcare practice that is designed to enhance patient care quality (Martin, 2014). It is important to identify the resources that are required to ensure that nurse practitioners are given an opportunity to promote change within this setting (Martin, 2014).

Retail clinics represent an opportunity to improve the visibility and scope of primary care in many communities (Kaissi, 2012). It is known that “Several demand and supply-side factors have contributed to an impending shortage of 46,000 primary care physicians (PCPs) by 2025. As more baby boomers are turning 65, obesity rates are soaring, and chronic diseases rates are spiraling out of control, less and less medical students are choosing primary care as a specialty of study for financial and other considerations” (Kaissi, 2012, p. 1). Therefore, the shortage of primary care physicians represents an opportunity to use nurse practitioners as a viable resource to provide expert knowledge and preventative care in a different type of environment that does not require the expertise of a primary care physician (Kaissi, 2012). From this perspective, it is necessary to evaluate the conditions under which nurse practitioners fill a void in healthcare environments, such as retail clinics (Kaissi, 2012). These opportunities support the development of new perspectives to facilitate favorable outcomes for patients in a variety of community-based settings (Kaissi, 2012). Retail clinics, however, are not favorably observed by many physicians due to their perceptions regarding the quality of care that is provided in these clinics (Kaissi, 2012). This demonstrates the importance of educating physicians and the general public regarding the use of retail clinics as a feasible alternative when primary care settings are not a feasible option (Kaissi, 2012).

Effectiveness of Retail Clinic Model

In order to determine the effectiveness of the retail clinic model, it is necessary to evaluate the costs associated with this process and whether or not it is a cost effective alternative for healthcare practice (Sussman et.al, 2013). The potential exists within these environments to achieve cost savings and greater compliance with the required guidance set forth by the nurse practitioner (Sussman et.al, 2013). It is believed that the costs of retail clinics are significantly lower, in some areas between 40 and 80 percent lower than the costs of services that are offered in a physician’s office (Sussman et.al, 2013). However, if this model catches on, it is likely that additional benefits will be identified that support primary care practice methods as a whole (Sussman et.al, 2013).

On an individual basis, it appears that retail clinics provide quality care at a lower cost, which represents a means of treating a larger number of patients using fewer dollars per capita (Sussman et.al, 2013). This opens up an opportunity to develop a strategy that encompasses a successful approach to primary care that otherwise would not be provided to a given patient population (Sussman et.al, 2013). Therefore, it is likely that a number of population groups that do not currently receive adequate primary and/or preventative care could be supported by these clinics over time (Sussman et.al, 2013).

The concept of a healthcare clinic in a retail location may mystify some experts and consumers, who find it difficult to walk into a retail location and witness a clinic setting. However, this continues to be an increasingly popular means of obtaining preventative and primary care for patients because it is convenient and affordable (Brissette, 2010). However, many members of the medical community do not support these clinics for the following reasons: “Clinics are generally staffed by mid-level practitioners, such as nurse practitioners and physician assistants, rather than by medical doctors.  They are licensed to diagnose, treat, and prescribe medications for common medical conditions, as well as administer preventive care.  They are not, on the other hand, trained to sort through the complex web of medical symptoms that some people may possess” (Brissette, 2010). Under these conditions, therefore, medical professionals may be skeptical of these resources and their potential benefits for patients (Brissette, 2010).

Other challenges for retail clinics include the following:

• limited diagnostic capabilities within the retail environment
• treating symptoms related to chronic illness without a comprehensive understanding of its history
• the lack of a “medical home,” whereby care is provided routinely through a primary care physician
• limited standards of care that govern retail clinics
• conflicts of interest regarding the availability of pharmacies in the same location to increase revenue generation
• medical care and treatment that is not consistent and is fragmented across different areas
• a substitution for care that would otherwise be provided in a traditional medical office
• excessive use of these facilities, even when they are perhaps not necessary (Brissette, 2010).

Each of these factors must be considered in an examination of retail clinics as primary sources of medical care for some patients with access to these services (Brissette, 2010).

Some experts argue that the use of retail clinics in the modern healthcare environments poses a challenge to the traditions set forth by primary care physicians, while also lacking the knowledge and experience to successfully operate a retail environment in an effective manner (Hermanson et.al, 2013). To be specific, retail clinics should be managed by professionals with healthcare and retail experience, which is sometimes difficult to achieve due to lack of experience in both areas (Hermanson et.al, 2013). In the beginning stages of a retail clinic endeavor, it is likely that leaders will possess the enthusiasm and support that is necessary to commence operations effectively; however, staffing issues may pose a serious problem for some clinics, along with limited capital for advertising and marketing efforts (Hermanson et.al, 2013).

From this perspective, it may be argued that retail clinics are not suitable endeavors for some healthcare professionals, particularly if they lack sufficient experience and an understanding of the retail model (Hermanson et.al, 2013). Furthermore, there may be a lack of cohesion in the communication efforts made by the clinic with respect to primary healthcare providers in the transmission of health information regarding clinic services (Hermanson et.al, 2013). These conditions reflect a lack of cohesion in the business operations conducted by some retail clinics, as well as a lack of understanding of the retail clinic model (Hermanson et.al, 2013).

These efforts demonstrate that some retail clinic providers are not equipped with the tools and resources that are necessary to accommodate the needs of patients within community-based settings (Hermanson et.al, 2013). Organizations in this capacity must develop strategies that will be effective in accommodating patients, but that also possess the type of experience that is necessary to achieve the desired patient outcomes (Hermanson et.al, 2013). Therefore, those without retail knowledge may not be able to be successful in the retail clinic environment, due to the significant business-related expertise that is required to operate a clinic of this nature in a successful manner (Hermanson et.al, 2013).

It is also expected that when healthcare professionals working in retail clinics collaborate with those of other organizations, there may be conflicts or challenges regarding these associations, due in large part to lack of cohesion of care and limited or nonexistent physician influence on clinic operations (Burkle, 2011). Nonetheless, local and state laws may govern these relationships and provide a basis for improving these relationships to facilitate greater quality of care (Burkle, 2011). However, the retail clinic model is popular and viable for a number of reasons, including the following:

“Retail clinic profit models rely on nonphysician practitioners, predominantly nurse practitioners, who receive lower salaries and lower third-party reimbursement to provide more affordable care than might be delivered in an emergency department or urgent care clinic. Physician organizations have fought for increased regulations impacting scope of practice and physician oversight of services.  Future profession-driven practice regulations and standards may influence the role that physicians undertake when accepting a supervisory or collaborative role” (Burkle, 2011).

This perspective is relevant because it provides a basis for the exploration of new concepts to address patient care within the retail clinic environment, as well as a means of gaining physician involvement on some level so that nurse practitioners working in these clinics have access to physician expertise and guidance as necessary (Burkle, 2011). These factors are significant because the retail clinic concept remains new and often unexplored in some communities, which poses a possible risk to the integrity of these clinics until they are proven effective over time (Burkle, 2011). The level of regulation and oversight that is provided by states often governs the retail clinic model because it considers the relevance of physician involvement and the limitations of nurse practitioners within these settings (Burkle, 2011).

Retail clinics often fill a much-needed void within the healthcare system, particularly when there is a lack of focus or availability of primary care services for many children and adults (To, 2013). This is an important perspective because it provides insight regarding the need for additional oversight in the area of retail clinics and their impact on patient care outcomes, particularly in communities where primary care services are limited (To, 2013). One of the primary focus areas for retail clinics is acute illnesses including urinary tract infections and sore throats, as well as vaccination services and screenings for some conditions, such as high cholesterol and blood pressure (To, 2013).

Since healthcare is often motivated by the consumer marketplace, it is more important than ever to support these needs through the retail clinic concept (To, 2013). In recent years, the majority of illnesses for which patients sought treatment in the retail clinic environment included sinusitis, upper respiratory infection, pharyngitis, urinary tract infection, and otitis media, amongst others (To, 2013). For many patients, the retail clinic environment offers an ideal platform to obtain care in a manner that promotes consistency in quality of care and treatment, given that the conditions seen by nurse practitioners are routine in nature and are not typically serious (To, 2013).

It is important to identify the resources that are available to address these concerns and to take the steps that are necessary to produce high quality patient care and satisfaction by properly diagnosing and treating a minor condition (To, 2013). The patient care model set forth by retail clinics also requires care providers to be effective communicators when interacting with the local population regarding their ability to provide high quality care and treatment. This approach will provide reassurance to the populations that visiting a retail clinic is the correct choice (To, 2013).

From a cost efficiency perspective, retail clinics offer a viable model, as they support the development of new perspectives to accommodate patient care needs and to reflect upon the challenges of offering knowledge and expertise that is appropriate for the clinic environment (Andrews, 2012). There are considerable issues related to the models set forth in the retail clinic environment, and in particular, the cost of these services to insurance companies and for patients (Andrews, 2012). Many patients are satisfied with the care that they receive in the retail clinic, as well as the cost of these services, even if they do not have some form of health insurance or their plan does not cover retail clinic costs (Andrews, 2012). Under these circumstances, it is likely organizations which operate as retail clinics will be provided with feedback that will motivate them to expand their presence within communities and provide care that is as effective as the care provided in a traditional retail environment (Andrews, 2012).

It is also expected that these environments will support the development of new perspectives to encourage high quality patient care on a continuous basis (Andrews, 2012). The role of nurse practitioners in these settings is critical, as they provide a level of care and expertise that patients must be able to trust (Andrews, 2012). In one study, it was determined that the cost of services at a retail clinic was an average of $110, which was much lower than a primary care office visit at $156, an urgent care visit at $166 and an emergency department visit at $570 (Andrews, 2012). Each of these alternatives may be cost prohibitive, particularly for the uninsured or underinsured; therefore, the retail clinic may serve as the most viable alternative (Andrews, 2012). From this perspective, it is necessary to legitimize retail clinics for their favorable patient satisfaction rates and their ability to appease patients who otherwise would not be able to afford care and in turn, may drain the resources of the current healthcare system in different ways that could pose a problem for other patients who also require care and treatment (Andrews, 2012).

When nurse practitioners are the primary operators of retail clinics, it should be noted that they provide an exceptional level of cost savings for these facilities, particularly when they are able to practice on an independent basis in states where these actions are permitted (United Healthcare, 2014). From a costing perspective,

“Researchers have estimated that up to 27% of emergency-related visits could have been handled appropriately at retail clinics and urgent care centers, offering cost savings of $4.4 billion per year. The research did not show any decrease in effectiveness of treatment, as measured through excess ER visits or hospitalizations following use of the retail clinic – meaning cost savings can be realized without lowering the quality of care” (United Healthcare, 2014).

These factors support the continued growth and development of retail clinics throughout the United States, as they provide an exceptional level of care and treatment in a simplified format that does not pose a significant burden for healthcare organizations and for the system as a whole (United Healthcare, 2014).

These factors also contribute to a greater level of efficiency within a retail clinic environment, a faster turnaround time from one patient to the next, and an opportunity for nurse practitioners to perform as knowledge and treatment experts to improve the health of visiting patients (United Healthcare, 2014). These circumstances require a level of attention and detail that must engage the healthcare system in order to attract new supporters so that the retail clinic model is realized for its true value to the healthcare community (United Healthcare, 2014). These circumstances also reflect a means of supporting the development of new perspectives to encourage the development of new strategies that will enable physicians and other healthcare experts to support the retail clinic model, This will also encourage nurse practitioners to assume a leadership role in these environments on a continuous basis so that patient needs, that otherwise might be unmet, are met within these facilities (United Healthcare, 2014).

In a research study conducted by Rohrer, Garrison, and Angstman (2012), a comparison  was conducted by evaluating the care and treatment provided by a nurse practitioner working in a retail clinic versus the care provided in a traditional primary care office, using otitis media as an example. The study explored the return visit rate for patients visiting both types of care facilities to determine which had the higher frequency of return visits (Rohrer et.al, 2012). With this framework, it was determined that the services provided in retail clinics led to a much lower return rate than patients who were treated in traditional primary care offices (Rohrer et.al, 2012). These factors are critical because they support the continued growth and development of the retail environment as a viable method of receiving high quality patient care and treatment for a variety of acute conditions, which include otitis media (Rohrer et.al, 2012).

The contributions of nurse practitioners in the retail clinic environment are essential to the growth of these practice settings and their ability to secure greater standards of care (Rohrer et.al, 2012). Future studies must examine other types of acute illnesses because the potential exists to identify the effectiveness of retail clinics in the prevention of future visits to these clinics. It is important to identify the resources that are required to conduct studies of this nature and to recognize the contributions of nurse practitioners in filling these roles in retail clinics. They possess the knowledge and expertise that is required to ensure that patient care outcomes are achieved in a timely manner that will facilitate positive results for this patient population.

The Emergency Nurses Association has established its own position in regards to nurse practitioners and their role in retail clinics in order to demonstrate the viability of these clinics and their impact on patient care outcomes (Emergency Nurses Association, 2012). In this context, advanced practice nurses, including nurse practitioners, are experts in their field and possess the knowledge and experience that is required to operate in a retail clinic environment (ENA, 2012). In addition, the Emergency Nurses Association recognizes the importance of nurse practitioners in achieving established standards of care and treatment, along with a means of educating patients regarding their care on a regular basis (ENA, 2012).

Nurse practitioners must support patient safety at all times and reflect upon the needs of patients through their activities that will support and enhance quality of patient care under specific conditions (ENA, 2012). Furthermore, when additional care and treatment is required at a higher level, these professionals provide much-needed guidance and support in facilitating advanced care alternatives through referrals and/or communication with the primary care physician (ENA, 2012). This will encourage physicians to remain open to collaborations with nurse practitioners under different conditions that will likely have a positive impact on patient care outcomes (ENA, 2012).

Nurse practitioners are trained to provide expert care and treatment to patients who otherwise might not have access to these services in a more traditional healthcare environment (ENA, 2012). Therefore, it is expected that nurse practitioners are able to bridge some of the gaps in care that currently exist and are required to evaluate all patients who visit the retail clinic in a timely and efficient manner (ENA, 2012). This is best achieved through a combination of resources that will support and enhance the care and treatment that are observed in the clinic environment, as well as the level of patient satisfaction that is reported after these visits have occurred (ENA, 2012). In addition, nurse practitioners must provide their patients in retail clinics with a higher level of commitment in order to establish trust and a greater understanding of their needs as patients so that quality of care and treatment is optimized under a variety of different conditions (ENA, 2012).

Nurse practitioners who are employed in retail clinics must develop strategies that will support and enhance the quality of care that they provide to their patients. It is important for these professionals to be recognized for their level of skill and their contribution to the healthcare system, but to also be recognized for their level of independence and their ability to work without the guidance of a physician. For these reasons, the American Nurses Association (ANA) supports the integration of nurse practitioners into retail clinics because they provide expert knowledge and technique to patients who visit these clinics (American Nurses Association, 2014).

Most importantly, the ANA supports nurse practitioners in these roles with the following statement:

“Peer-reviewed studies continue to add evidence confirming that NPs offer high quality care in the primary care setting. In addition to their education and expertise in diagnosis and treatment, NPs’ proficiency in providing health education and prevention services makes them skilled managers and service providers in retail-based clinics. Retail-based clinics provide an additional innovative entry point for patients to access affordable, high-quality health care, thus helping to address some of the system’s more pressing problems” (ANA, 2014).

This level of support suggests that nurse practitioners possess the knowledge, education, training, and resources that are necessary to support their growth and development as professionals within the retail clinic environment, and they also demonstrate their ability to be successful in garnering the respect and attention of the healthcare community in these roles, where they often provide expert knowledge and guidance to patients who otherwise would not have access to any type of healthcare services due to scheduling or lack of affordability (ANA, 2014). With this framework in mind, it is important to recognize the valuable contributions of nurse practitioners and to demonstrate their ability to be successful in these roles on a continuous basis (ANA, 2014).

SummaryIn today’s complex and competitive healthcare environment, many alternatives are available to provide high quality care and treatment to patients in need of services. These opportunities include the development of new strategies to address primary care in non-traditional settings, particularly since many communities lack these facilities and a sufficient number of physicians to support population health. Therefore, the retail clinic environment has emerged over the past decade to fill this void and to provide an opportunity for patients to visit their local retail establishment to obtain care and treatment for a variety of acute conditions. In addition, they are able to obtain vaccinations and screenings that may lead to the diagnosis of possible chronic conditions. These clinics operate using the knowledge and expertise of nurse practitioners, who typically serve as primary staff and provide many patients with care and treatment that, is timely and more cost effective than visiting a physician or the emergency department. Therefore, it is necessary to examine these clinics and to determine whether or not this model is viable over the long term.

Perhaps one of the most significant issues to consider is that physician oversight in some states may be limited, and with lack of oversight, the patient level of comfort in a retail clinic environment may be minimized. In other cases, however, nurse practitioners have full oversight and authority to provide advanced diagnostic services that support the growth of these clinics and their viability in the future. It is necessary to establish a greater understanding of the retail clinic model, the services that are provided, and the role of nurse practitioners in order to accomplish the desired objectives. This will support high quality patient care and treatment for many acute conditions that might not require treatment by a primary care physician or a visit to the emergency department, but require some degree of attention within the retail clinic environment.

Perhaps most relevant to the discussion is the impact that nurse practitioners have on the retail clinic environment and whether or not this impact makes a difference in the quality of care that is provided over the long term. It is expected that nurse practitioners will continue to serve as the primary care providers in retail clinics for the foreseeable future. Therefore, they must be provided with an environment that supports and enhances greater quality of care in a non-traditional healthcare environment. Although many physicians might not approve or support retail clinics for a variety of reasons, they are nonetheless a key factor in the current and future landscape of healthcare practice. Therefore, their contributions must be considered and validated by using the knowledge and expertise that has been generated throughout the brief history of these clinics to date.

From the perspective of the advanced practice nurse, retail clinics provide a number of opportunities to experience career advancement and to demonstrate the importance of this profession as a key driving force within the healthcare industry. However, recognizing the value of this profession in a relatively new climate for healthcare services is somewhat difficult to decipher, as many key experts, including physicians, may not be entirely convinced that these practice methods are legitimate and appropriate environments in which to provide patient care. Therefore, additional education regarding retail clinics and their role in shaping patient care outcomes in a favorable manner represents a means of supporting the growth of retail clinics, particularly in areas where the need is greatest. Under these circumstances, retail clinics fill a much needed void in practice that primary care facilities cannot always meet, given the shortage of primary care physicians and the challenges associated with time management and scheduling, particularly when patient numbers exceed the number of available physicians. Therefore, practice methods must provide greater acknowledgement and support of the objectives sought with the retail clinic model in order to provide greater legitimacy for the actions conducted within these facilities. Nurse practitioners must also be provided with the resources that are necessary to support a high quality and effective care and treatment environment so that patients experience greater comfort in these surroundings. Patient care needs are significant throughout communities; therefore, if retail clinics are able to fill some of these voids that are significant throughout healthcare practice, it is possible that the standing and reputation of nurse practitioners with expert knowledge and understanding of healthcare practices will improve within the healthcare community, along with their level of support within the consumer population on a gradual basis.

Nurse practitioners must continue to play an integral role in establishing new perspectives regarding patient care and treatment for acute illnesses. Furthermore, preventative care and health screenings, such as vaccinations and diabetes testing, are critical in today’s healthcare platform. It is important to identify the resources that nurse practitioners require to provide high quality care to these patients, including preventative alternatives. The prevention of chronic illness and other conditions is critical in today’s society; therefore, nurse practitioners working in the retail clinic environment must examine their available resources and use them wisely in order to provide optimal support and guidance to community members in need of care and treatment across all population groups.

References

American Nurses Association (2014). Additional access to care: supporting nurse practitioners in retail-based health clinics. Retrieved from http://nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/ANAPositionStatements/Position-Statements-Alphabetically/Additional-Access-To-Care-Supporting-Nurse-Practitioners-In-Retail-Based-Health-Clinics.html

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Cassel, C.K. (2012). Retail clinics and drugstore medicine. Journal of the American Medical Association, 307(20), 2151-2152.

Emergency Nurses Association (2012). Nurse practitioners and retail health care clinics. Retrieved from http://www.ena.org/SiteCollectionDocuments/Position%20Statements/NursePractitionersRetailHealthCareClinic.pdf

Hermanson, P.M., Berkshire, S.D., Leaming, L., & Piland, N. (2013). Retail health clinics: sustain or close? A case study. Journal of Management Policy and Practice, 14(6), 37-41.

Kaissi, A. (2012). Can retail clinics save primary care? Primary Health Care: Open Access, 2(3), Retrieved from http://www.omicsgroup.org/journals/2167-1079/2167-1079-2-e104.pdf

Lewis, Jr., M. (2013). Payers warm up to retail clinics. Managed Healthcare Executive, Retrieved from http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/payers-warm-retail-clinics

Martin, M. (2014). Nursing during an era of change: a challenge and opportunity. Journal of Nursing Education and Practice, 4(1),189-199.

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