Meet Lori Phinney, a nurse practitioner providing care to patients at a retail-based clinic in Boston. Here’s what she has to say about nursing in retail.
MP3 Audio Podcast
Retail Clinic Nurse Interview Segment:
Jamie Davis: Lori, welcome to Nursing Notes Live. It’s great to have you on the show.
Lori Phinney: Thank you, Jamie. It’s great to be here.
Jamie: So I always start off by asking the nurses on the show what were their reasons for becoming a nurse? What was your motivation for being a nurse?
Lori: I actually have a sort of non-traditional way that I got there. I went to University of Vermont in 1998 as a college freshman convinced that I was going to be an orthodontist. And my pass to dental school is going to start with a bachelor’s degree in Biomedical Technology and then I was going to move forward from there. And I got into the classes in Biomedical Tech and I made it through the first semester. And then the second semester kind of started to hit and the math was really intense and math has never been my really, really strong point. So I sort of re-evaluated. At that point, I knew I wanted to be in healthcare and I really knew I was up against three more years at least of intensifying math. And I probably was not going to be able to hang in there. So I had a long talk with my mom and she said, “You know, all three of us are nurses,” all three of her sisters and four girls are nurses and nurse practitioners and, “Why don’t you think about that? That’s something you’re familiar with.” And I kind of wondered why I had never thought about that. I walked right down to the nursing office. Looked at the curriculum. Saw some math, some stitch and sticks and said, “Okay, I think I can hang in there with this.” And I changed my major right there that day and here we are. I literarily can’t believe having my career in nursing over the last 12 or 13 years that I didn’t always want to be a nurse as a little girl. It’s definitely my calling.
Jamie: It’s funny you say that because math has never been my strong suit either and I kind of did the same thing. I originally started in journalism and then went to a second career in healthcare and became a nurse. Looking at statistics and some of the pre-calc and things that I had to do, that was about the limit of what I think I wanted to do in math.
Lori: Me too. This is perfect. [Laughter]
Jamie: It is. So tell us a little bit about your progression from getting your BSN and then moving on to becoming an Advanced Practice Nurse.
Lori: So I got my BSN in 2002. I finished that up. And I had a short stint where I worked as a brand new grad near my Charlestown home in Gardner, Massachusetts at a small community hospital. I got an amazing start there. And then I kind of sort of to get the bugs that a lot of my friends are moving to the city and we were getting apartments together and I was spending a lot of weekend time in Boston and I wanted to be a little bit closer to my friends and doing that kind of single thing in the city. So I got an apartment with one of my girlfriends from college, moved to Boston and got a job at St. Elizabeth in Brighton right on the outskirts of Boston on a Med-Surg floor and we had a four-bed Cardio-Thoracic unit. So I really got about a year there as I worked as an RN and that’s where I really got most of my assessment skills and made some great friends and, actually, [I’ll be] in one of these girls’ wedding from this floor on October 26. So coming right up. We stayed really close over the years. We just have a great group girls there but I always kind of knew that I wanted something more, where I had a little bit more autonomy for myself and a little bit more decision-making ability. So I always knew in the back of my mind, I’ll be going on to get a Master’s degree in Nursing and becoming a family NP. I even knew that specifically that’s what I wanted to do. I started working on that in 2004 and finished that up in 2007. And shortly, thereafter, left the Med-Surg floor and started my career as an NP.
Jamie: What was the big difference, the big shift for you to move from a Med-Surg nurse in a hospital setting to a family practice nurse practitioner?
Lori: It was a huge shift and I actually – my first job as a nurse practitioner was a hospitalist. So it wasn’t that big of shift. I was still in that environment. I was just tasked with a lot more intense decision-making and I kind of again knew I wanted to get some more of family-practice feel, be more of an ambulatory setting where you are seeing the acute patients are coming. You’re dealing with the problem and then you’re sending them right back out into the world. So I almost stayed in the hospitalist position for about a year and then moved on to a kind of a more of a family practice situation.
Jamie: Now you’re working in a clinic setting, where you are working in I guess in a Minute Clinic and attached to a pharmacy, correct?
Lori: Yes. It’s CVS Pharmacy.
Jamie: What’s that like? That’s a little bit different even than a traditional family practice setting?
Lori: Yes, this is really different. We actually just expanded our services in October, the beginning of October to include Sports Physicals for kids. So that’s a little bit more like a wellness type of a situation but the bulk of what we do here is healthy people with acute problems who are short on time and they’re able to walk right in here, have to step through evaluation, get some evaluation and drops for conjunctivitis, have a cough to listen to. We see some rashes. We do a lot of poison ivy. But generally the population is healthy, happy. They walk right in. They sign in. We do the visit with these patients and we send them right back off conveniently into their life. So it’s really nice and it’s really helpful to people that we’re here.
Jamie: And certainly a great fit with the changing face of our healthcare system here in the United States.
Jamie: So how does that work? Are people going to be using a clinic yours as a family practice home or is this really for that acute situation where they just need to get looked at right away?
Lori: Well, right now, it’s really more the acute situation where they’re looked at right away and we do send a conversation of what was done and a copy of the record to that patient’s primary care doctor. We don’t want to take the place of the medical home. We still want them to have their primary care doctor for their yearly physicals, for co-morbid things that are going on and things that need deeper evaluation and more referral strength behind them. But what we are moving forward is being able to work in conjunction with the medical home. If a primary care doctor takes the patient’s blood pressure that’s high on the first reading, eventually, what we’re moving towards is that primary care doctor will then be able to say, “You can go to the Minute Clinic for your second reading” and then when I do the second reading and find that it’s still high, I’m going to be able to converse either through medical records via the computer or via phone or text of whatever the technologies that we developed with the primary care doctor and alert them that I’m going to start that patient on the first step of their hypertensive treatment because I got the second reading. And we’ll work in conjunction that way for a lot of different services.
Jamie: Really just a great place for a nurse to have an autonomous practice where you are. It must be incredibly gratifying.
Lori: It’s fantastic. It’s my own little room. I’m actually sitting in here right now. I’m on my lunch break talking to you guys and I got my own clinic here. I run it the way that I like it to be run. I can organize things the way I like or disorganize things the way I like. It’s really my own little space, my own little office. And if I need the support of a collaborating doctor, they’re a phone call away. I can call my other practitioners who I work with in other clinics and we can collaborate and run things by each other via phone. But really I’m here by myself and I love it. It’s perfect.
Jamie: So what if someone was looking to say, “I’m ready to move on in my practice as a nurse and move in to a setting where I’m a nurse practitioner and looking at this type of autonomous practice.” What kind of skills do they need to develop?
Lori: I think you need to develop – what’s really important is a keen assessment skill. It guides us through everything. It’s what you need if you’re a registered nurse and you walk into that patient’s room and you know something is not quite right but you don’t know exactly what it is. We all know exactly what I’m talking about here and you just can shout out, “I need help!” Everyone kind of rushes in and help you out. And it’s fun because it does still translate to this type of a situation. You know I’m here by myself. I still get my sixth sense going once in a while or a patient comes in and they sit down and they have a cough, let’s say. I just kind of know in my heart of heart that this patient can be evaluated by me and I can make sure that they possibly get to the next safest place but that thing, the higher level of care, and I need to figure out immediately how to get them there. So it translates right back in. So your assessment skills that you learn as a brand new grad nurse, they follow you all the way through and they become more fine-tuned and a little bit more sophisticated maybe but that feeling of nursing, when you know you need some help, stays with you forever.
Jamie: So what’s in the future for this type of nursing? What do you see down the road as this continues to develop and expand into different settings for this types of nurse practitioner-run clinics?
Lori: This is an example that I just use about the medical home and the blood pressure is one thing. Massachusetts has a fairly limited scope of practice compared to other states with Minute Clinic. We are expanding and we are including more things slowly. But in a lot of other states, they’re going full-blown with these wellness services and they’re doing amazingly well. They offer weight loss clinics where the patients can come in, get some advice, get weighed in, and talk with the nurse practitioner about that type of a thing. They do smoking cessation. They do, of course, the blood pressure monitoring. We do a 90-day medication refill if someone needs a medication refill and it’s within our guidelines for something that we can refill for a patient. We’re able to make that happen. The physicals are going to be a huge addition for Massachusetts where we’re able to evaluate children and they can sign off for their sporting event or for back to school and also the DOT physical. So we’re able to do drivers for trucking companies and people who work in the transportation industry who need a really specified physical with an eye exam and a hearing exam and some drug testing involved and things like that. So we’re able to really make an imprint on all different types of wellness and illness and everything along.
Jamie: Fantastic. What’s one of the most rewarding things that’s happened in the course of you’re doing this type of nursing?
Lori: I had a man come in to the clinic two Thanksgivings ago who had a bad cough and some shortness of breath. He was a young in the 40s with two young children at home and he said, “I had a bad cold like this all week and last night it was really, really bad. I took my daughter’s nebulizer at home last night and I’m still really looking for some air here. I can’t get enough.” And immediately my radar went up that we need to get this man some help. So I talked him into taking an ambulance ride over to the local hospital after I assessed him and got a good picture of what I thought might have been happening which I thought was a really bad pneumonia and he had four pulmonary emboli and he had von Willebrand’s and all kinds of family history factors and that he had never had any idea about – and all kinds of things have happened because he was present here at the clinic that day at that time and my assessment skills were on point that day to get him to the safest place because it really could have been fatal if he had come out at home for another hour, who knows? So I’ve been able to develop a really nice relationship with him. We’ve become friends. We’re on each other’s Christmas card lists. And he comes in and sees me often and we have really become good friends and that is amazing to me. When I think about that, I’m just so excited every time I think about his story.
Jamie: Well, it just shows that you do get an opportunity to develop a relationship with these patients even though they are coming in maybe once in a blue moon but you still have an opportunity to develop some sort of rapport with them.
Jamie: So what’s the final thought you’d like to offer to nurses that are looking at the changing environment of nursing practice and how many different opportunities that are opening up out there?
Lori: I think it’s maybe just not to be afraid to try a bunch of things. Eventually, the right thing will find you. And that’s really been my story. I took the hospitalist job. I took an orthopedic nurse practitioner job. And neither one of those really felt quite right. And then I came across this job that I’m currently in with Minute Clinic and I just feel so passionate about their mission and I really want to do everything that we say we strive to do and do it with the best ability that I can and it’s because I just really felt strongly about the message that we’re trying to send, how we’re keeping people on their path to better health and helping them find that path if they’ve waylaid a little bit. It’s really important. So you really have to feel in your heart that what you’re doing is right for you and not to be afraid to try a few things and if you don’t get there with the first, it is okay, it’ll find you eventually. The other thing I would suggest to people who are maybe looking for a change or wondering where to go is really find a mentor. Someone who they look up to. That they want to emulate. And really have a monthly meeting with them or pick their brain for their nursing career story and see how you can get on a path like that person and to keep in touch because the relationships are really important.
Make sure you check out the entire October, 2013 issue of Nursing Notes, where we look at urgent care and retail clinics around the nation. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month bringing you a panel discussion on nursing in retail or urgent care clinics with Dodi Iannaco a nurse practitioner at Virtua Express Urgent Care in New Jersey, and Angela Patterson, Chief Nurse Practitioner Officer at CVS Minute Clinic. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes.
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