PHILADELPHIA - The number of in-store health clinics staffed by nurse practitioners has grown dramatically in the last year. Many major supermarket chains are at least experimenting with the concept, CVS has been expanding the clinics in many markets, and Wal-Mart Stores recently announced plans to install 50 clinics in its stores as part of a broader program aimed at making health care more accessible to employees and customers. Tine Hansen-Turton is the chief executive officer of the National Nursing Centers Consortium here, which represents 120 nurse-managed clinics. She tells SN what the clinics can bring to the shopping experience, speaks to differing state regulations, answers criticisms of some doctors who have said patient safety may be compromised by these in-store services, and talks of the future for these health clinics.
SN: What is the potential for nurse-staffed health clinics in supermarkets?
HANSEN-TURTON: They are cost-effective and provide high-quality care; they are readily available to the consumer, and patient satisfaction is high. The nurse-practitioner-staffed and -run clinics are here to stay. They provide excellent, efficient care while bringing in additional shoppers and potential revenue to the supermarkets. Imagine a supermarket with a full pharmacy adjacent to a nurse-managed clinic. A shopper can go into the clinic for a diagnosis, purchase her medicine at the pharmacy, and then pick up items from the market that he or she may have had no intention of buying before the clinic visit.
SN: Why is their number growing?
HANSEN-TURTON: Nurse-managed health centers have a proven record of providing high-quality, cost-efficient health care services to everyone. When looking at the future of these nurse-practitioner-run clinics, it is important to put them in the context of the overall U.S. health care industry. The U.S. spends more money on health care than any other country, yet 20% of our population does not have access to adequate health care services, and many consumers do not have an ongoing relationship with their primary care providers or physicians. For many people, the emergency room is still considered the place to go for health care when you cannot get an appointment with your primary care provider because the office is closed or the doctor is unavailable. That's why the in-store health clinics are so attractive. At the in-store clinics, patients are seen right away on the consumer's schedule so that most working parents won't have to lose a day of work waiting for a doctor to return a telephone call, or by waiting endless hours in a hospital emergency room.
SN: Some doctors have criticized such clinics. How would you respond?
HANSEN-TURTON: Some physicians view nurse-run clinics as competitors. But states have come a long way in terms of adopting laws that authorize certified registered nurse practitioners to prescribe and provide primary care. Most certified registered nurse practitioners work in collaboration with physicians, just as primary care physicians work in collaboration with specialists. With a six-year decline in U.S. medical school applications from 47,000 in 1996 to 33,501 in 2002, the future of family physicians is unclear. By 2010, the United States will experience a shortage of 50,000 physicians, rising to 200,000 physicians by 2020. Regardless of attempts to attract medical students into primary care, the decline in family physicians cannot be ignored, and thus supports the growing number of certified registered nurse practitioners in primary care and in-store retail areas.
A relatively new focus on health promotion and prevention has emerged due to vast health disparities in the U.S., and it has sparked debates about primary care workforce needs and the roles of various types of health care professionals. Nursing has been at the forefront of the debate, positioning the nurse practitioners as health professionals who have comprehensive skills in primary care, health promotion and disease prevention.
SN: How do the state regulations on nurse practitioners differ?
HANSEN-TURTON: States vary as to how they define scope of practice for certified nurse practitioners. In some states, the scope is enacted by the state legislature, whereas in other states, boards of nursing have the authority to define the scope of practice. While certified registered nurse practitioners' permitted scope of practice and independence from physician involvement vary somewhat from state to state, in general, nurse practitioners are both capable and legally authorized to provide primary care to patients who are comparable to that of a primary care physician.
In 43 states, certified registered nurse practitioners now practice independently or in remote collaboration with physicians, whereas only seven states require physician supervision. As primary care providers, nurse practitioners can manage 80% of adult and 90% of pediatric primary care currently delivered by physicians.
SN: Most of these are now run by smaller types of companies. Do you see larger health-related firms getting involved?
HANSEN-TURTON: The new companies that are starting the in-store clinics are all run by entrepreneurs and leaders who, like most of us, are tired of a broken health care system. They see these clinics as a way to bring quality health care access to people where they live and when they need it. Hospitals at some point may also get into the business of nurse-managed health care clinics. For now, however, it took the private and non-health care sector to see that nurse-run health clinics are a wonderful way to expand access of care to everyone.
