The Advanced Practice The Advanced Practice Nurse Managed Clinic: Nurse Managed Clinic: Nurses Responding to ChangeNurses Responding to Change

Rosemary Goodyear Ed.D, APRN-BC, Rosemary Goodyear Ed.D, APRN-BC, FAANPFAANP

APN Managed Clinics:APN Managed Clinics: Nurses Responding to ChangeNurses Responding to Change

Identify the professional requirements Identify the professional requirements for operating an APN managed clinicfor operating an APN managed clinic

List the social, cultural and legal List the social, cultural and legal implications of establishing an APNMCimplications of establishing an APNMC

Discuss the potential of this method of Discuss the potential of this method of providing health care within the providing health care within the nation’s current health care systemnation’s current health care system

APN Managed ClinicsAPN Managed ClinicsFoundational elements of a APN Foundational elements of a APN

Managed clinicManaged clinic::Mission/Purpose/PhilosophyMission/Purpose/PhilosophyLeadership and ManagementLeadership and ManagementFiscal supportFiscal supportProfessional standards and/or Professional standards and/or

regulationsregulationsProfessionals prepared as APNsProfessionals prepared as APNsConsumer/patient marketingConsumer/patient marketing

APN Managed ClinicsAPN Managed Clinics

Mission-Mission-Purpose- Purpose- Philosophy-Philosophy-

APN Managed ClinicsAPN Managed Clinics

LeadershipLeadership

ManagementManagement

APN Managed ClinicsAPN Managed Clinics

Fiscal SupportFiscal Support

APN Managed ClinicsAPN Managed Clinics

Professional Professional StandardsStandards

RegulationsRegulations

APN Managed ClinicsAPN Managed Clinics

APN PreparationAPN Preparation

APN Managed ClinicsAPN Managed Clinics

Consumer/Patient Consumer/Patient MarketingMarketing

APN Managed Clinics APN Managed Clinics

History of nurses managing health care History of nurses managing health care independently and interdependentlyindependently and interdependently::

In home during child birth and plaguesIn home during child birth and plagues In wars caring for the soldiers In wars caring for the soldiers In public/community health during In public/community health during

epidemicsepidemics

APN Managed ClinicsAPN Managed Clinics

Professional RequirementsProfessional Requirements

EducationEducationKnowledge workerKnowledge workerQualified workforceQualified workforce

APN Managed ClinicsAPN Managed Clinics

EducationEducation

Moved from hospitals to universities --Moved from hospitals to universities --beyond post-basicbeyond post-basic

Scientific advances created knowledge Scientific advances created knowledge gapsgaps

Expanded role requires life long Expanded role requires life long learninglearning

APN Managed ClinicsAPN Managed Clinics

Nurses became “knowledge Nurses became “knowledge workers”*workers”*

Harnessing the power of theoretical and Harnessing the power of theoretical and analytical knowledgeanalytical knowledge

Technology enhanced business and Technology enhanced business and networkingnetworking

Health care consumer is poorly servedHealth care consumer is poorly servedWorkforce is redesignedWorkforce is redesigned

*White, K. & Begun, J. 1998, Nursing entrepreneurship in an era of *White, K. & Begun, J. 1998, Nursing entrepreneurship in an era of chaos and complexity, Nrs. Admin. Q. 22, (2); 40-47.chaos and complexity, Nrs. Admin. Q. 22, (2); 40-47.

APN Managed ClinicsAPN Managed Clinics

Qualified workforceQualified workforceQualified students for enrollmentQualified students for enrollmentQualified faculty and approved curriculumQualified faculty and approved curriculumHealth care system open for APNsHealth care system open for APNsAPN role legitimizedAPN role legitimizedFiscal support for education Fiscal support for education Patient acceptance of APN role Patient acceptance of APN role

APN Managed ClinicsAPN Managed Clinics

Social, Cultural & Legal Social, Cultural & Legal ContextsContexts Social implicationsSocial implications

Women’s role in societyWomen’s role in societyTrends of health in nationTrends of health in nationDirection of health policyDirection of health policy

APN Managed ClinicsAPN Managed Clinics

Cultural influencesCultural influences

Perceived role of nursePerceived role of nurseEmployee versus independent providerEmployee versus independent providerRisk taking and assertivenessRisk taking and assertiveness

APN Managed ClinicsAPN Managed Clinics

Legal context Legal context Legitimate role and CredibilityLegitimate role and Credibility

Scope of practice and titleScope of practice and titleProfessional and/or Regulatory Professional and/or Regulatory

competencecompetence

APN Managed ClinicsAPN Managed Clinics

““If you have the foresight, If you have the foresight, you’re blessed, but if you you’re blessed, but if you have insight, you’re a have insight, you’re a thousand times blessedthousand times blessed.”.”

APN Managed ClinicsAPN Managed ClinicsFoundational elements of a APN Foundational elements of a APN

Managed clinicManaged clinic::Mission/Purpose/PhilosophyMission/Purpose/PhilosophyLeadership and ManagementLeadership and ManagementFiscal supportFiscal supportProfessional standards and/or Professional standards and/or

regulationsregulationsProfessionals prepared as APNsProfessionals prepared as APNsConsumer/patient marketingConsumer/patient marketing

APN Managed ClinicsAPN Managed Clinics

Methods for implementing APN Methods for implementing APN Managed ClinicsManaged Clinics

Business approaches:Business approaches:Entrepreneur or IntrapreneursEntrepreneur or IntrapreneursCollaborative practiceCollaborative practiceCorporationsCorporations

APN Managed ClinicsAPN Managed Clinics

Entrepreneur or IntrapreneursEntrepreneur or Intrapreneurs

Starting a business focused on Starting a business focused on health care, alone or with a partnerhealth care, alone or with a partner

Starting a business within an existing Starting a business within an existing health care facility such as a hospitalhealth care facility such as a hospital

APN Managed ClinicsAPN Managed Clinics

Collaborative practiceCollaborative practice

Working alongside or in partnership Working alongside or in partnership with another professional in the with another professional in the business of health carebusiness of health care

APN Managed ClinicsAPN Managed Clinics

CorporationsCorporations

Independently contract to Independently contract to establish a health service within establish a health service within and existing non-health related and existing non-health related corporationcorporation

APN Managed ClinicsAPN Managed Clinics

Infrastructure for Implementation Infrastructure for Implementation of N-MC.of N-MC.Know the trends influencing health Know the trends influencing health

carecareIdentify consumer’s unmet health Identify consumer’s unmet health

needsneedsFollow the scientific advancesFollow the scientific advancesOversight of fiscal viabilityOversight of fiscal viabilityMonitor health policy changesMonitor health policy changes

APN Managed ClinicsAPN Managed Clinics

Infrastructure for implementationInfrastructure for implementation

Know the trends influencing health Know the trends influencing health carecareDemographic shift of populationDemographic shift of populationBurden of illness shiftBurden of illness shiftProvider ratio disparitiesProvider ratio disparitiesPandemicsPandemics

APN Managed ClinicsAPN Managed Clinics

Infrastructure for implementationInfrastructure for implementationConsumer’s unmet health needsConsumer’s unmet health needs

Individual patientIndividual patientHigh Risk populationsHigh Risk populationsTarget groupsTarget groupsCommunityCommunity

APN Managed ClinicsAPN Managed Clinics

Infrastructure for implementationInfrastructure for implementationScientific DiscoveriesScientific Discoveries

New procedures and medicationsNew procedures and medicationsCurrent researchCurrent researchOpportunities for focal providersOpportunities for focal providersCaseload managementCaseload management

APN Managed ClinicsAPN Managed Clinics

Infrastructure for implementationInfrastructure for implementationFiscal viabilityFiscal viability

Securing and assuring funds for Securing and assuring funds for operation and advancement of clinicsoperation and advancement of clinics

Research the outcomes of health care Research the outcomes of health care Cost-effectiveness of APNsCost-effectiveness of APNsBudget and accountingBudget and accounting

APN Managed ClinicsAPN Managed Clinics

Infrastructure for implementationInfrastructure for implementationMonitor health policy changesMonitor health policy changes

Involvement in policy process Involvement in policy process Monitor trends in governmental Monitor trends in governmental

resource allocationresource allocationPolicy implications for nursing practicePolicy implications for nursing practicePolicy changes that affect patient carePolicy changes that affect patient care

APN Managed ClinicsAPN Managed Clinics

The future of APN Managed Clinics The future of APN Managed Clinics depends on all these factors and the depends on all these factors and the individual commitment to bring about individual commitment to bring about change. Barriers exist, but they can be change. Barriers exist, but they can be overcome through leadership, overcome through leadership, knowledge and collaboration. Success knowledge and collaboration. Success relates to the efforts and energies of all relates to the efforts and energies of all nurses in your community/nation nurses in your community/nation working together to make change.working together to make change.

APN Managed ClinicsAPN Managed Clinics

Thank youThank you

Rosemary Goodyear Ed.D, APRN-BC, Rosemary Goodyear Ed.D, APRN-BC, FAANPFAANP

rtgoodyear@roadrunner.comrtgoodyear@roadrunner.com