I work in a new area for nursing: Nurse Practitioner in a Convenient Care Clinic providing minor care in a retail setting. That is, I diagnose and treat sore throats in a grocery store. My practice involves sore throats, ear aches, URI, Influenza, Dermatitis, and UTIs for adult women. I am a Family Nurse Practitioner and we do episodic care for anyone one year and older. My oldest patient, thus far, was a one hundred-year-old lady who received her flu shot in my clinic.
Working in a retail clinic requires a lot more than the ability to diagnose and treat minor ailments. To be good at this position, one needs to be able to triage simple, routine care from more serious conditions that require a higher level of care and greater follow-up. If you don’t want to miss heart failure from bronchitis, you need to be aware that things may not be as clear cut as they look. At the same time, the famous saying, “look for horses before zebras”, is the general rule.
Working in a Retail Clinic requires possessing strong people skills. You have to be able to sometimes smile when you may not feel like it. Most nurses have these skills; however working in the center of the real world can sometimes be brutal. Every nurse has experienced the patient who comes to see you knowing exactly what their diagnosis is, and that they need some specific drug (one they saw on TV last night, maybe?) that will cure everything. There are a lot of folks who come in with a 24 hour cold and know that only an antibiotic, the specific one their sister-in-law just finished taking, is what they must have for treatment.
In Retail Health Care, it is not uncommon to find yourself face to face with a patient who sees you as a go between to satisfy their needs, not a professional with standards of care and evidence based medicine guidelines. That is where your skills as listener, nurse, educator, and sometimes a highly skilled manipulator, come in to play. Like other providers, if what the patient wants will meet their needs, I can bend and give a requested drug. If the patient requests a sledge hammer like Levoquin, when a less potent drug is more effective, I have to set limits. But this is, I think, part of the art of nursing, and Retail Health Care requires that art! A practitioner must be both educator and diplomat. We also serve as Receptionist, Nurse’s Aide, Data Entry person, Coder, Money Collector and Insurance expert. Add to that Marketing Representative and Janitor, and you get a glimpse of my glamorous life.
I do make good pay and while my hours are long, I get more days off. The field is new and evolving. Our scope of practice is limited in that as nurse practitioners, we are able to provide more care than the setting permits. But as we evolve, I can see more preventive education happening, and hopefully my role can devolve back to having less hats and more time as clinician. I work for a company, and like other nurse practitioner employees, there are glitches in the companies’ awareness of the nurses’ role. Hopefully, since NPs, as well as PA’s, are the main providers, this will give us, the employees, a greater input into the growth of this area of health care.
Whatever the outcome, it is exciting being a part of something new and, I believe, helpful to the US health care system. I see Retail Care as an adaptation to a system that has put the convenience of our patients secondary to the convenience of the health care providers. I see it as a way to provide safe, evidence-based care, that is cost-conscious in a system where cost is out of control. Most of all, I like the goals for my practice. And until something comes along and takes the business out of Health Care, I like the business and I’m in.