We’re taking a look at the nurses working in retail and urgent care clinics around the country. These locations are changing the face of healthcare and how it’s managed. Hear what Dodi Iannaco, a nurse practitioner at Virtua Express Urgent Care in New Jersey, and Angela Patterson, Chief Nurse Practitioner Officer at CVS Minute Clinic have to say about urgent care.
MP3 Audio Podcast
Nursing Panel Discussion:
Jamie Davis: Angela and Dodi, welcome to Nursing Notes Live. It’s great to have you here with us today. So I guess I’ll start with you first, Angela, why don’t you share with us your reason for becoming a nurse and something about your education and career path to where you are today?
Angela Patterson: Sure. So ever since I was a young girl, I wanted to do something that was about working with people and helping and caring for people. From my youngest years, I thought about teaching and then nursing. And through high school I had a guidance counselor who encouraged me towards the nursing piece because I like math and science and I very much was drawn to the social services. So I went to college and got my bachelor’s degree and became an RN. And through work and interactions with another mentor, became aware of nurse practitioner practice and that just really resonated with me. So I was an RN for – and I practiced as an RN just for a couple of years before I was able to get in to graduate school and became a nurse practitioner and that was about 25 years ago. In terms of career path, when I first became a nurse and then a nurse practitioner, I always thought my interest would be around women’s health. And I do that for a number of years. One of the great things about nursing is that there are so many opportunities to get involved and do different things and just because of opportunities being in front of me and my willingness to try new things and just try and get some things on, I started taking care of pediatric patients. I did some international travel on medical mission trips. I taught. Eventually found that my love was really primary care and taking care of families and community-based settings and that piece in particular really stuck for me. But I’ve had a varied history of experiences and really thankful that nursing really put that in front of me.
Jamie: Thanks. How about you, Dodi?
Dodi Ianacco: I think why I wanted to become a nurse, my mom is a nurse. And I have a great-grandma that was a nurse too. So I think I just really wanted to know how to help people. My mom was the person that the neighbors would call and say, “Hey, what do you think about this? So and so got hurt, can you look at it?” That kind of thing. She always really enjoyed that. And she was the one like stopping to pull over at a car accident to help. Things like that. So I think that I wanted to help people and I think that I wanted to know how to take care of my friends, my family members. I wanted to be that knowledgeable first like my mom. And then career path, would you like me to talk about?
Dodi: Okay. So I actually started out as a licensed practical nurse. Because, I don’t know, I just got to do that first. It was a sort of a one-year program at the time. I thought at the time that that was kind of what I was going to do. I got a job and really like it. And then probably within about six months, I realized that I was almost doing what the RNs were doing at the long-term care facility where I was working. So I want to be an RN. Then I kind of got on the education track and slowly went for my BSN, my MSN, became a nurse practitioner, and I finished the doctorate about three years ago. I did long-term care for a little while. I did Med-Surg for a long time. Then I became a family nurse practitioner, did family practice, the convenient care. And then I did actually education as well and have come to I guess kind of find my niche right now in urgent care.
Jamie: And we’re talking this month on Nursing Notes Live about acute care and urgent care. And I almost feel like we should give them both their due because while there are some similarities to an acute care clinic setting like you might see in a Minute Clinic at CVS or some place and an urgent care center, there are some key differences there as well. Dodi, what would you describe as a nursing experience in an urgent care setting where it’s not really emergency but it’s also not primary care?
Dodi: Right. It’s a good mix. We see minor injuries and illnesses basically. So we see patients for all the things that you would see in a retail health or convenient care setting – so the colds, the flu, the cough, the fevers. We actually see adults and babies, six months and up here. We always have a physician on site which is nice for the nurse practitioners. And then we see kind of a fun part that mixes it up a little bit. We’ll see injuries including fractures and lacerations and abscesses and minor skin conditions, things like that. So it’s a good mix and it really does. It develop your skills. You get to read your own x-rays. The radiologist is reading them as well but you can read your own x-rays. For our staff here, they get to kind of develop all those areas as well.
Jamie: Angela, you’re associated with CVS and Minute Clinic, is that correct?
Angela: That’s correct.
Jamie: That retail type of setting, that retail clinic setting is changing the way we provide care for people or with the way people seek care I guess I should say in communities around the country right now.
Angela: It’s certainly adding additional options for access to care during those times when you’re not able to get an appointment with your primary care provider for sure. Just as an overview of how convenient care clinics or retail health clinics fit in community-based healthcare and support the patient-centered medical home is that they are access points in support of affordable, accessible and convenient healthcare in our community. The clinics are staffed by most commonly board-certified family nurse practitioners or physician assistants. They’re open seven days a week. No appointment is required. They’re in that work with most insurance plans. In terms of what care they offer to patients, retail clinics treat a limited set of common illnesses such as sore throats or bladder infections. In addition, they also administer vaccinations, provide monitoring services for common chronic conditions like diabetes and high blood pressure. The clinicians there perform health screenings and offer prevention and wellness services such as smoking cessation and weight management services.
Jamie: Wow, I was aware of some of that but not all of the additional – like the chronic illness services that are provided. That seems like it’s really filling a gap in care in our communities.
Angela: Well, definitely it fills the gap. Given the fact that half of the patients we see are seen during evening hours and on the weekends. Thanksgiving Day and some holidays like Easter are some of our busiest days of the year in terms of providing service visits. I think that in terms of our role in community-based care, we really see ourselves as being complementary and collaborative to the patient-centered medical home. So we work very hard at CVS Minute Clinic to partner in a collaborative way with local primary care providers and healthcare organizations to support the care of patients and offer additional access points other than an expensive emergency room alternative. In support of healthcare reform which is really about extending affordable care, that’s accessible and convenient and high quality to patients.
Jamie: Dodi, what are your thoughts about this new model or newer model of having more access to various types of care whether it’s an acute care or urgent care center, a clinic setting like you’ve seen in a retail clinic. There certainly are a lot of things going on that are giving patients those better opportunities.
Dodi: Right. I think with the Affordable Care Act, with different things that are changing in the United States, it’s just like Angela said, it is better access points for patients. So these are after-hours options for your doctor’s office and they’re really meant to lessen the burden on the EDs. We don’t want people that aren’t acutely ill going to the emergency room, kind of wasting healthcare dollars and stuff when they can be seen potentially in a retail clinic setting or an urgent care. The urgent cares are actually open 365 days a year. So we’re here a lot. We have a lot of providers to cover our hours because we’re just here every single day. If patients will say, “Wow, you’re here on Christmas?” We’re like, “Yes, what if you need us? If you cut your finger slicing onions on Christmas. We’re here to repair that for you.” So I think it’s an interesting time in healthcare and I think it’s a really interesting field.
Angela: I like to add on Dodi’s comments and I totally support what Dodi has presented. Actually, that’s what we ride on. I also think in terms of the Affordable Care Act over the coming months and even now millions of Americans who clinically did not have the opportunity to have healthcare insurance able to secure health insurance coverage and are entering the healthcare delivery system. And it’s important that we think about how best to deliver affordable quality, convenient care to these newly-insured Americans especially given the fact that we have a shortage of primary care providers in our country. It is expected that that shortage is going to continue over the next 5, 10, 15 years. Without innovation and care delivery and new models of care coming into the healthcare delivery system like convenient care clinics, like CVS Minute Clinic, folks’ only option would be the emergency room which is the most expensive alternative to receiving care and for a subset of patients that is the most appropriate care. But for a very large majority of folks who deal with common illnesses like sore throat or ear infections or who need care and support for managing common chronic diseases like diabetes and high cholesterol and high blood pressure, emergency room is not the best place. And as we think about how to increase our provider workforce across the country to care for people in the community, which is really what most patients want, options like retail clinics are supporting the tenets of healthcare reform which is community-based care that’s affordable, convenient and high quality. So I think it’s a great development and a great advancement in our healthcare delivery system.
Jamie: And as both of you are evidence of that nurse practitioner is going to be a key part of that changing environment for healthcare in so many places and really has become quite a successful model for providing those primary care, those family care services whether it’s in a setting like yours, Dodi, or something like the Minute Clinic with Angela. Dodi, what kind of interaction do you all have from the urgent care side of things with a family practice, the person’s primary care home?
Dodi: We send our printed notes from our EMR to every patient’s primary care provider after their visit and we collect that information to make sure that they’re getting the information. We actually have, because I’m part of a hospital system, all of our community providers that are part of our health system have the same EMR as us so we can see their notes and they can see our notes. It’s really nice. When we first change to the system, it was a big difference for all the providers here because they were used to a different EMR but if somebody goes to one of our family providers, I can see their allergies, their medications, their history and it just allows me as a provider to more quickly review that information.
Jamie: That type of integrated system hopefully will at some point – and we all probably wish for this – at some point, we’ll have that type of integrated electronic health record available for all patients regardless of system.
Angela: I think that’s a very important point. I think one of the ways that we, at Minute Clinic, are striving to achieve that is through integration with medical records, with the healthcare organizations until we have clinical affiliations and we are formally clinically affiliated with over 30 major healthcare organizations across the country. It’s part of that affiliation, we work within our IT system to integrate so that we can share medical records when appropriate so that when we see a patient whose PCP is part of this healthcare organization, they receive the visit summary and at the same time, even the clinician who is caring for the patient, can view the patient’s problem with the medication to help support quality safe care. So I do believe that collaboration and integration within the community and within healthcare, between healthcare organizations and patient-centered medical home and urgent care centers and retail clinics. It’s really critically important to provide the patient with the highest quality and safest care.
Jamie: As we close out here, I just like to ask both of you – I guess I’ll start with you, Dodi – what advice would you give to a nurse or maybe a nursing student out there who’s saying, “This sounds like a career path for me.” What kind of skills do they need to develop?
Dodi: I still am sort of old school in that I still sort of think that new nurses should get – a staff nurse, RN, should get potentially like a year of Medical-Surgical experience or ED experience, something like that before they kind of venture out into different settings. But the ambulatory setting and the community setting is ideal for nurses and for nurse practitioners as well. I think having like maybe that one year of Med-Surg experience, taking care of all the common conditions that you’re going to see in hospitalized patients, gives you a really good background or a really good base to build on to come into an ambulatory setting such as urgent care.
Jamie: Angela, what about you?
Angela: I would definitely encourage anyone who’s interested in the career in nursing to pursue, I think it is incredibly rewarding and the opportunity to really expand and grow and experience work settings that are diverse and varied is really unlimited. I think that what’s important is to have a mentor look at your resources. We visited a high school that really supports the curriculum to help support future nurses. So if a high school were – if you’re thinking about nursing that would be the place would you go. I think there are more programs and opportunities like that coming up across our country as we try to build a comprehensive workforce to take care of these newly-insured
Americans and moving forward. I do believe that healthcare trends show that there’s going to be a greater shift towards community-based care and community-based ambulatory setting especially as more and more Americans are afflicted with chronic conditions such as diabetes and high cholesterol and high blood pressure. So I think that in general, being in school, being able to do well in math and sciences is certainly important as well social services and I think that going through school many of us got support to those course because they can be challenging. There are study groups and tutors and I think that if you’re really committed and able to work through that, it’s a wonderful career with tremendous opportunities and certainly something that is very much needed in this country as we seek to achieve success with healthcare reform.
Jamie: Yes, I know that there’s a very inspiring story in our other segment this month with our Get-To-Know Nurse, Lori, who talked about her – not necessarily college-bound track in her earlier education and how she worked hard to become the nurse that she is today. It’s just interesting that you say that, you need that help along the way because I think mentoring is so important. In nursing, I think just doubly so because there’s so many great resources out there. Nurses who have years and years of experience, who can just lend so much back to the profession.
Dodi: I absolutely agree. Nursing can be a tough curriculum. Math and science doesn’t come easy but it’s not impossible in have mentors and having many mentors and utilizing all of these resources. It’s really important and you can be successful in taking that path. I think if you are in it and you find that maybe it’s not quite nursing, I think that’s okay. Healthcare reform is going to take the effort to call allied health professionals whether it’s pharmacists, occupational therapists, speech therapists. I think it’s going to take all of us working together and holding hands to support the care of patients in the community to really achieve healthcare reform in the country.
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 where I sit down and chat with our Get to Know Nurse this month, Lori Phinney. Lori is a nurse practitioner providing care to patients at a retail-based clinic in Boston. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes.